Hospital Competition and Unplanned Readmission: Evidence from a Systematic Review

Abstract Background Unplanned readmission may result in consequences for both the individual and society. The transition of patients from hospital to postdischarge settings often represents a discontinuity of care and is considered crucial in the prevention of avoidable readmissions. In older patients, physical decline and malnutrition are considered risk factors for readmission. The purpose of the study was to determine the effects of nutritional and physical exercise interventions alone or in combination after hospital admission on the risk of hospital readmission among older people. Methods A systematic review and meta-analysis of randomized controlled studies was conducted. The search involved seven databases (Medline, AMED, the Cochrane Library, CINAHL, Embase (Ovid), Food Science Source and Web of Science) and was conducted in November 2018. An update of this search was performed in March 2020. Studies involving older adults (65 years and above) investigating the effect of nutritional and/or physical exercise interventions on hospital readmission were included. Results A total of 11 randomized controlled studies (five nutritional, five physical exercise and one combined intervention) were included and assessed for quality using the updated Cochrane Risk of Bias Tool. Nutritional interventions resulted in a significant reduction in readmissions (RR 0.84; 95% CI 0.70–1.00, p = 0.049), while physical exercise interventions did not reduce readmissions (RR 1.05; 95% CI 0.84–1.31, p-value = 0.662). Conclusions This meta-analysis suggests that nutrition support aiming to optimize energy intake according to patients’ needs may reduce the risk of being readmitted to the hospital for people aged 65 years or older.

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Systematic Review: Predictors of Successful Transition to Community-Based Care for Adults With Chronic Care Needs

Care Management Journals ◽

10.1891/1521-0987.9.4.154 ◽

2008 ◽

Vol 9 (4) ◽

pp. 154-165 ◽

Cited By ~ 18

Author(s):

Lolita Jacob ◽

Eileen Blechman Poletick

Keyword(s):

Systematic Review ◽

Hospital Readmissions ◽

Patient Characteristics ◽

Emergency Department Visits ◽

Unplanned Readmission ◽

Care Needs ◽

Community Based ◽

Mixed Support ◽

Qualitative Systematic Review ◽

Difficult Transition

Difficult transition from acute hospital back to the community can be challenging. Problems encountered during this process can lead to unplanned readmission and emergency department visits. It is important for care managers to be able to identify patients susceptible to difficult transition and to understand strategies to reduce risk of unplanned hospital readmission. This qualitative systematic review of 10 studies of discharge interventions and patient characteristics finds little evidence that enhanced discharge support is related to improved physical status at home, but there is mixed support for its role in preventing or delaying hospital readmissions in certain discharge diagnoses, specifically heart failure and stroke. Additionally, those with adequate social support and confidence in their self-care ability tend to experience fewer readmissions than do those living alone and those who perceive themselves as not ready to return home.

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Systematic review and meta-analysis on the effect of hospital competition on quality of care: Implications for senior care

Archives of Gerontology and Geriatrics ◽

10.1016/j.archger.2019.05.001 ◽

2019 ◽

Vol 83 ◽

pp. 263-270 ◽

Cited By ~ 1

Author(s):

Vivien Chia-Ying Shen ◽

William J. Ward ◽

Liang-Kung Chen

Keyword(s):

Systematic Review ◽

Quality Of Care ◽

Meta Analysis ◽

Hospital Competition

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Risk scores identifying elderly inpatients at risk of 30-day unplanned readmission and accident and emergency department visit: a systematic review

BMJ Open ◽

10.1136/bmjopen-2018-028302 ◽

2019 ◽

Vol 9 (7) ◽

pp. e028302 ◽

Cited By ~ 4

Author(s):

Camille Schwab ◽

Patrick Hindlet ◽

Brigitte Sabatier ◽

Christine Fernandez ◽

Virginie Korb-Savoldelli

Keyword(s):

Systematic Review ◽

At Risk ◽

Emergency Department ◽

Quality Assessment ◽

Data Extraction ◽

Risk Scores ◽

Unplanned Readmission ◽

Accident And Emergency ◽

Elderly Inpatients ◽

Accident And Emergency Department

ObjectivesThe aim of this systematic review was to describe and analyse the performance statistics of validated risk scores identifying elderly inpatients at risk of early unplanned readmission.Data sourcesWe identified potentially eligible studies by searching MEDLINE, EMBASE, COCHRANE and Web of Science. Our search was restricted to original studies, between 1966 and 2018.Eligibility criteriaOriginal studies, which internally or externally validated the clinical scores of hospital readmissions in elderly inpatients.Data extraction and synthesisA data extraction grid based on Strengthening the Reporting of Observational Studies in Epidemiology and Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis statements was developed and completed by two reviewers to collect general data. The same process was used to extract metrological data of the selected scores.Quality assessment of the included studiesAssessment of the quality and risk of bias in individual studies was performed by two reviewers, using the validated Effective Public Health Practice Project quality assessment tool.ParticipantsElderly inpatients discharged to home from hospital or returning home after an accident and emergency department visit.ResultsA total of 12 studies and five different scores were included in the review. The five scores present area under the receiving operating characteristic curve between 0.445 and 0.69. Identification of Senior At Risk (ISAR) and Triage Risk Screening Tool (TRST) scores were the more frequently validated scores with ISAR being more sensitive and TRST more specific.ConclusionsThe TRST and ISAR scores have been extensively studied and validated. The choice of the most suitable score relies on available patient data, patient characteristics and the foreseen clinical care intervention. In order to pair the intervention with the appropriate clinical score, further studies of external validation of clinical scores, identifying elderly patients at risk of early unplanned readmission, are needed.PROSPERO registration numberCRD42017054516.

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The effects of low-ratio n-6/n-3 PUFA on biomarkers of inflammation: a systematic review and meta-analysis

Food & Function ◽

10.1039/d0fo01976c ◽

2021 ◽

Author(s):

Yali Wei ◽

Yan Meng ◽

Na Li ◽

Qian Wang ◽

Liyong Chen

Keyword(s):

Systematic Review ◽

Fatty Acid ◽

Polyunsaturated Fatty Acid ◽

Meta Analysis ◽

Chain Polyunsaturated Fatty Acid ◽

Inflammation Markers ◽

Pufa Supplementation ◽

Long Chain

The purpose of the systematic review and meta-analysis was to determine if low-ratio n-6/n-3 long-chain polyunsaturated fatty acid (PUFA) supplementation affects serum inflammation markers based on current studies.

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Parent Education in Studies With Nonverbal and Minimally Verbal Participants With Autism Spectrum Disorder: A Systematic Review

American Journal of Speech-Language Pathology ◽

10.1044/2019_ajslp-19-00007 ◽

2020 ◽

Vol 29 (2) ◽

pp. 890-902

Author(s):

Lynn Kern Koegel ◽

Katherine M. Bryan ◽

Pumpki Lei Su ◽

Mohini Vaidya ◽

Stephen Camarata

Keyword(s):

Systematic Review ◽

Autism Spectrum Disorder ◽

Parent Education ◽

Autism Spectrum ◽

Verbal Communication ◽

Fidelity Of Implementation ◽

Spectrum Disorder ◽

Education Programs ◽

Minimally Verbal ◽

Parent Education Programs

Purpose The purpose of this systematic review was to identify parent education procedures implemented in intervention studies focused on expressive verbal communication for nonverbal (NV) or minimally verbal (MV) children with autism spectrum disorder (ASD). Parent education has been shown to be an essential component in the habilitation of individuals with ASD. Parents of individuals with ASD who are NV or MV may particularly benefit from parent education in order to provide opportunities for communication and to support their children across the life span. Method ProQuest databases were searched between the years of 1960 and 2018 to identify articles that targeted verbal communication in MV and NV individuals with ASD. A total of 1,231 were evaluated to assess whether parent education was implemented. We found 36 studies that included a parent education component. These were reviewed with regard to (a) the number of participants and participants' ages, (b) the parent education program provided, (c) the format of the parent education, (d) the duration of the parent education, (e) the measurement of parent education, and (f) the parent fidelity of implementation scores. Results The results of this analysis showed that very few studies have included a parent education component, descriptions of the parent education programs are unclear in most studies, and few studies have scored the parents' implementation of the intervention. Conclusions Currently, there is great variability in parent education programs in regard to participant age, hours provided, fidelity of implementation, format of parent education, and type of treatment used. Suggestions are made to provide both a more comprehensive description and consistent measurement of parent education programs.

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Characteristics of the Frequency-Following Response to Speech in Neonates and Potential Applicability in Clinical Practice: A Systematic Review

Journal of Speech Language and Hearing Research ◽

10.1044/2020_jslhr-19-00322 ◽

2020 ◽

Vol 63 (5) ◽

pp. 1618-1635

Author(s):

Céline Richard ◽

Mary Lauren Neel ◽

Arnaud Jeanvoine ◽

Sharon Mc Connell ◽

Alison Gehred ◽

...

Keyword(s):

Systematic Review ◽

Cochrane Library ◽

Neurodevelopmental Outcomes ◽

Frequency Following Response ◽

Ovid Medline ◽

Published Evidence ◽

Mesh Terms ◽

Potential Applicability ◽

Clinical Potential

Purpose We sought to critically analyze and evaluate published evidence regarding feasibility and clinical potential for predicting neurodevelopmental outcomes of the frequency-following responses (FFRs) to speech recordings in neonates (birth to 28 days). Method A systematic search of MeSH terms in the Cumulative Index to Nursing and Allied HealthLiterature, Embase, Google Scholar, Ovid Medline (R) and E-Pub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Web of Science, SCOPUS, COCHRANE Library, and ClinicalTrials.gov was performed. Manual review of all items identified in the search was performed by two independent reviewers. Articles were evaluated based on the level of methodological quality and evidence according to the RTI item bank. Results Seven articles met inclusion criteria. None of the included studies reported neurodevelopmental outcomes past 3 months of age. Quality of the evidence ranged from moderate to high. Protocol variations were frequent. Conclusions Based on this systematic review, the FFR to speech can capture both temporal and spectral acoustic features in neonates. It can accurately be recorded in a fast and easy manner at the infant's bedside. However, at this time, further studies are needed to identify and validate which FFR features could be incorporated as an addition to standard evaluation of infant sound processing evaluation in subcortico-cortical networks. This review identifies the need for further research focused on identifying specific features of the neonatal FFRs, those with predictive value for early childhood outcomes to help guide targeted early speech and hearing interventions.

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Treating Velopharyngeal Inadequacy Using Bilateral Buccal Flap Revision Palatoplasty

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_pers-sig5-2019-0005 ◽

2019 ◽

Vol 4 (5) ◽

pp. 878-892

Author(s):

Joseph A. Napoli ◽

Linda D. Vallino

Keyword(s):

Systematic Review ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

A Priori ◽

Sufficient Evidence ◽

Obstructive Sleep ◽

Before And After ◽

Buccal Flap

Purpose The 2 most commonly used operations to treat velopharyngeal inadequacy (VPI) are superiorly based pharyngeal flap and sphincter pharyngoplasty, both of which may result in hyponasal speech and airway obstruction. The purpose of this article is to (a) describe the bilateral buccal flap revision palatoplasty (BBFRP) as an alternative technique to manage VPI while minimizing these risks and (b) conduct a systematic review of the evidence of BBFRP on speech and other clinical outcomes. A report comparing the speech of a child with hypernasality before and after BBFRP is presented. Method A review of databases was conducted for studies of buccal flaps to treat VPI. Using the principles of a systematic review, the articles were read, and data were abstracted for study characteristics that were developed a priori. With respect to the case report, speech and instrumental data from a child with repaired cleft lip and palate and hypernasal speech were collected and analyzed before and after surgery. Results Eight articles were included in the analysis. The results were positive, and the evidence is in favor of BBFRP in improving velopharyngeal function, while minimizing the risk of hyponasal speech and obstructive sleep apnea. Before surgery, the child's speech was characterized by moderate hypernasality, and after surgery, it was judged to be within normal limits. Conclusion Based on clinical experience and results from the systematic review, there is sufficient evidence that the buccal flap is effective in improving resonance and minimizing obstructive sleep apnea. We recommend BBFRP as another approach in selected patients to manage VPI. Supplemental Material https://doi.org/10.23641/asha.9919352

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Telepractice for Adult Speech-Language Pathology Services: A Systematic Review

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_persp-19-00146 ◽

2020 ◽

Vol 5 (1) ◽

pp. 326-338 ◽

Cited By ~ 9

Author(s):

Kristen Weidner ◽

Joneen Lowman

Keyword(s):

Systematic Review ◽

Primary Progressive Aphasia ◽

Future Research ◽

Service Delivery Model ◽

Speech Language Pathology ◽

Review Of The Literature ◽

Research Designs ◽

Assessment And Treatment ◽

Language Pathology ◽

Screening Assessment

Purpose We conducted a systematic review of the literature regarding adult telepractice services (screening, assessment, and treatment) from approximately 2014 to 2019. Method Thirty-one relevant studies were identified from a literature search, assessed for quality, and reported. Results Included studies illustrated feasibility, efficacy, diagnostic accuracy, and noninferiority of various speech-language pathology services across adult populations, including chronic aphasia, Parkinson's disease, dysphagia, and primary progressive aphasia. Technical aspects of the equipment and software used to deliver services were discussed. Some general themes were noted as areas for future research. Conclusion Overall, results of the review continue to support the use of telepractice as an appropriate service delivery model in speech-language pathology for adults. Strong research designs, including experimental control, across multiple well-described settings are still needed to definitively determine effectiveness of telepractice services.

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