Post-discharge care of older people may be improved by combining needs assessment with implementation of care recommendations
- Pateman, Brian MA, MPhil, RN, DNT
BACKGROUND
Many schemes exist to assess the post-discharge requirements of older people hospitalised for acute episodes. The effectiveness of these assessment schemes in improving post-discharge outcomes is unknown.
OBJECTIVE
To evaluate the effectiveness and cost of organisational institutions that influence access to health and social care for older people after discharge from hospital.
METHOD
Systematic review.
SEARCH STRATEGY
CINAHL, EMBASE, MEDLINE, BIDs Social Science Index, National Institute of Social Work Caredata, PsychLit and Social Abstracts; search date 2000. Hand searches of reference lists and experts in advisory group interviewed.
INCLUSION/EXCLUSION CRITERIA
Randomised controlled trials comparing interventions influencing older people's access to post-discharge health and social care with routine care in the USA. Studies had to assess at least one of the following post-discharge outcomes: use of services, mortality, participant perception of health, quality of life, social support, cognitive functioning and well being, adequacy of services, participant functional health and disability.
INTERVENTIONS
Geriatric consultation teams (GCTs), providing assessment of needs and referral; inpatient geriatric evaluation and management (GEMs), providing assessment and in some cases post-discharge management or monitoring; outpatient GEMs following up assessment with post-discharge care; and discharge planning co-ordinators providing assessment and co-ordinated post-discharge care.
OUTCOMES
Use of services, mortality, participant perception of health, quality of life, social support, cognitive functioning and well being, adequacy of services, participant functional health and disability.
MAIN RESULTS
Fifteen RCTs met inclusion criteria (three RCTs on GCTs, four RCTs on GEMs, three RCTs on outpatient GEMs and five RCTs on discharge planning co-ordinators). Five of fifteen RCTs showed conclusive evidence of some improvement in participant's access to post-discharge health and social care. One GCT study showed some improvement at 6 months; two inpatient GEM studies showed some improvement at 1 year, and two outpatient GEM studies showed improvement at 1 year. Studies of discharge planning coordinators were of particularly poor quality, and follow-up was short (8 to 26 weeks). Variability in the groups targeted by the services limited the generalise-ability of study findings.
AUTHORS' CONCLUSIONS
Services studied were heterogeneous in remit and target population. There was some evidence that services combining assessment of older peoples' need for post-discharge health and social care with a system for implementing the recommendations were more effective than services that provided assessment alone.