Interventions to improve access to health and social care after discharge from hospital: a systematic review

OBJECTIVES: To determine the effectiveness and costs of interventions intended to improve access to health and social care for older patients following discharge from acute hospitals. METHOD: Systematic literature review, following NHS Centre for Reviews and Dissemination guidelines, of randomised controlled trials evaluating needs assessment methods and patient discharge co-ordinator roles. These services targeted patients aged 60 years and over and varied depending on whether or not they selected frail patients (e.g. those at risk of needing nursing home care). Outcomes assessed included: referrals to or use of health and social care (15 studies); mortality (13 studies); patients' functional health status and disability (13 studies); and patient perceptions of health (five studies), quality of life (three studies), cognitive functioning and psychological well-being (ten studies), social support (two studies) and the adequacy of services (four studies). RESULTS: Fifteen randomised controlled trials (23 papers), mainly from the USA, were identified. The interventions provided and patient groups targeted by these services were heterogeneous. There was, however, some evidence that services combining needs assessment, discharge planning and a method for facilitating the implementation of these plans were more effective than services that do not include the latter action. CONCLUSIONS: The assessment of need may be insufficient in itself for the adequate provision of post-discharge care. Needs assessment should be combined with a service that facilitates the implementation of care plans.