Parkes J, Shepperd S
Division of Primary Care and Population Health Sciences, Imperial College School of Medicine, Norfolk Place, London, UK, W2 1PG.
Cochrane Database Syst Rev. 2000(4):CD000313. doi: 10.1002/14651858.CD000313.
Discharge planning is the development of an individualised discharge plan for the patient prior to leaving hospital for home, with the aim of containing costs and improving patient outcomes. It has been suggested that discharge planning can reduce unplanned readmission to hospital.
To assess the effects of discharge planning for patients moving from hospital to home.
We searched the Cochrane Effective Practice and Organisation of Care Group specialised register, the Cochrane Controlled Trials Register, MEDLINE (1966 to 1996), EMBASE (1980 to 1996), Sigle (1980 to 1996), Bioethics (1985 to 1996), Health Plan (all available years), PsycLit (1974 to 1996), Cinahl (1982 to 1996), EconLit (1969 to 1996), Social Science Citation Index (1992 to 1996), and reference lists of articles.
Randomised trials and controlled trials comparing discharge planning with routine discharge for hospital patients. The outcomes were mortality, clinical complications, hospital length of stay, readmissions, discharge destination, general and disease specific health status, functional status, psychological well-being, patient satisfaction, carer satisfaction, carer burden, cost to the health service, patient and family, general practice, and community services.
Two reviewers independently extracted data and assessed study quality.
Eight studies were included involving 4837 patients. Four studies recruited patients with a medical condition; four recruited patients with a mix of medical and surgical conditions, and one of these recruited medical and surgical patients as separate groups. There was a small reduction in hospital length of stay for elderly medical patients allocated to discharge planning (weighted mean difference -1.01, 95% CI -2.06 to 0.05). The effects of discharge planning on readmission rates were mixed. No statistically significant differences were detected for patient health outcomes. Patients with medical conditions allocated to discharge planning reported increased satisfaction compared with those receiving routine discharge. No statistically significant differences were reported for overall health care costs, although one study reported a significant reduction in readmission costs for medical patients allocated to discharge planning.
REVIEWER'S CONCLUSIONS: The studies showed mixed results, which may reflect the different study populations and the different ways the intervention was implemented. There is some evidence that discharge planning may lead to reduced hospital length of stay, and in some cases reduced readmission to hospital. There is also some evidence that discharge planning increased patient satisfaction. There was no evidence that discharge planning reduced health care costs; however few studies conducted a formal economic analysis.
出院计划是在患者出院回家前为其制定个性化的出院计划，目的是控制成本并改善患者预后。有人提出出院计划可减少计划外的再次入院情况。
评估出院计划对从医院转至家中的患者的影响。
我们检索了Cochrane有效实践与护理组织小组专业注册库、Cochrane对照试验注册库、MEDLINE（1966年至1996年）、EMBASE（1980年至1996年）、Sigle（1980年至1996年）、生物伦理学数据库（1985年至1996年）、健康计划数据库（所有可获取年份）、心理学文摘数据库（1974年至1996年）、护理学与健康照护数据库（1982年至1996年）、经济学文献数据库（1969年至1996年）、社会科学引文索引（1992年至1996年）以及文章的参考文献列表。
比较出院计划与医院患者常规出院的随机试验和对照试验。结局指标包括死亡率、临床并发症、住院时间、再次入院情况、出院去向、一般健康状况和疾病特异性健康状况、功能状态、心理健康、患者满意度、护理者满意度、护理者负担、卫生服务成本、患者及家庭成本、全科医疗成本和社区服务成本。
两名综述作者独立提取数据并评估研究质量。
纳入八项研究，涉及4837名患者。四项研究招募患有内科疾病的患者；四项研究招募患有内科和外科疾病的混合患者，其中一项研究将内科和外科患者作为单独分组进行招募。分配到出院计划组的老年内科患者住院时间略有缩短（加权平均差 -1.01，95%可信区间 -2.06至0.05）。出院计划对再次入院率的影响不一。在患者健康结局方面未检测到统计学显著差异。与接受常规出院的患者相比，分配到出院计划组的患有内科疾病的患者报告满意度有所提高。尽管有一项研究报告分配到出院计划组的内科患者再次入院成本显著降低，但在总体卫生保健成本方面未报告统计学显著差异。
这些研究结果不一，这可能反映了不同的研究人群以及干预措施实施方式的差异。有一些证据表明出院计划可能会缩短住院时间，在某些情况下还可减少再次入院情况。也有一些证据表明出院计划提高了患者满意度。没有证据表明出院计划降低了卫生保健成本；然而很少有研究进行正式的经济学分析。
