• Gijs Hesselink, Lisette Schoonhoven, Paul Barach, Anouk Spijker, Petra Gademan, Cor Kalkman, Janine Liefers, Myrra Vernooij-Dassen, and Hub Wollersheim.
• Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. g.hesselink@iq.umcn.nl
• Ann. Intern. Med. 2012 Sep 18;157(6):417-28.

BackgroundEvidence shows that suboptimum handovers at hospital discharge lead to increased rehospitalizations and decreased quality of health care.PurposeTo systematically review interventions that aim to improve patient discharge from hospital to primary care.Data SourcesPubMed, CINAHL, PsycInfo, the Cochrane Library, and EMBASE were searched for studies published between January 1990 and March 2011.Study SelectionRandomized, controlled trials of interventions that aimed to improve handovers between hospital and primary care providers at hospital discharge.Data ExtractionTwo reviewers independently abstracted data on study objectives, setting and design, intervention characteristics, and outcomes. Studies were categorized according to methodological quality, sample size, intervention characteristics, outcome, statistical significance, and direction of effects.Data SynthesisOf the 36 included studies, 25 (69.4%) had statistically significant effects in favor of the intervention group and 34 (94.4%) described multicomponent interventions. Effective interventions included medication reconciliation; electronic tools to facilitate quick, clear, and structured summary generation; discharge planning; shared involvement in follow-up by hospital and community care providers; use of electronic discharge notifications; and Web-based access to discharge information for general practitioners. Statistically significant effects were mostly found in reducing hospital use (for example, rehospitalizations), improvement of continuity of care (for example, accurate discharge information), and improvement of patient status after discharge (for example, satisfaction).LimitationsHeterogeneity of the interventions and study characteristics made meta-analysis impossible. Most studies had diffuse aims and poor descriptions of the specific intervention components.ConclusionMany interventions have positive effects on patient care. However, given the complexity of interventions and outcome measures, the literature does not permit firm conclusions about which interventions have these effects.Primary Funding SourceThe European Union, the Framework Programme of the European Commission.

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