A systematic review on the effectiveness of continuity of care and its role in patient satisfaction and decreased hospital readmissions in the adult patient receiving home care services.

BACKGROUND: Continuity of care, a concept that in its broadest terms describes patient and provider coordination across time and settings, has evidenced a positive correlation with patient satisfaction and hospital readmission rates. Home health care, where patients receive care from a variety of healthcare practitioners, is one area where these measures are being investigated to determine the effectiveness of continuity of care.

OBJECTIVE: To examine and synthesize the best available evidence related to the effectiveness of continuity of care interventions and their impact on patient satisfaction and all-cause hospital readmissions rates in the adult patient who is receiving home care services.

INCLUSION CRITERIA: Male and female aged 18 years or older receiving home care services, regardless of diagnosis, stage or severity of disease, co-morbidities, or previous treatment received.All types and models of interventions for continuity of care delivered by nurses to patients receiving home care services were considered for inclusion in the review.Patient satisfaction and hospital readmissions.In this review randomised controlled trials were considered for inclusion. In their absence, other research designs, such as non-randomised controlled trials, quasi-experimental studies, and before and after studies were considered for inclusion.

SEARCH STRATEGY: Published and unpublished literature in the English language was sought from the inception of the databases through November 1, 2011.The databases searched included: Academic Search Premier, CINAHL ERIC, Health Reference Center Academic, MEDLINE via PubMed, ProQuest Nursing and Allied Health Source, ProQuest Health Management, Cochrane Central Register of Controlled Trials, EMBASE, Health Source Nursing Academic, PsycINFO and Bio-Med. A search of the grey literature and virtual hand searching of relevant journals was also performed.

METHODOLOGICAL QUALITY: Two reviewers evaluated the included studies for methodological quality using standardised critical appraisal instruments from the Joanna Briggs Institute.

DATA COLLECTION: Data were extracted using standardised data extraction instruments from the Joanna Briggs Institute.

DATA SYNTHESIS: Statistical pooling via meta-analysis was not possible. The results are presented in narrative form.

RESULTS: Two randomised controlled trails and two quasi-experimental studies were included in this review. In one randomised controlled trial, 66% of patients rated their overall satisfaction with care as very good or excellent as compared with 63% of those receiving usual care at 24 months (p=0.31). Another randomised controlled trial reported no statistically significant difference between groups (p value not reported). In one quasi-experimental study there was higher satisfaction rate amongst intervention patients with a mean difference of 16.88 (95%CI[16.32, 17.43] compared with 14.65 (95%CI[13.61, 15.68] in the control group (p=0.001).In one randomised controlled trial there was no statistically significant difference between intervention and control groups in hospital admission rates per 1000 at year two (700 vs. 740; p=0.66). Another randomised controlled trial showed no difference in readmissions at 90 days between groups (36% vs. 35%; no p value reported). In one quasi-experimental study, the mean number of hospital readmissions per patient was higher in the intervention group compared to the control group (0.75; 95% CI[ 0.47, 1.03] vs. 0.66; 95% CI[ 0.40, 0.91]; p=0.599), In another quasi-experimental study, a statistically significant higher number of intervention group patients in the intervention group were discharged and remained at home (34 or 82.9%), compared to the control group (20 or 51.3%) (p<0.05).

CONCLUSIONS: Home care interventions that include nurses and advanced practice nurses with specialised training in the care of the population served as the direct provider along with collaboration with an interdisciplinary team in a high-risk patient populations contributed to reduced hospital readmission rates. The outcomes of the included studies suggest that consistently scheduled home care services promote patient satisfaction.This review concluded that the utilisation of an advanced practice nurse with specialised training in a specific disease process in collaboration with a multidisciplinary team can affect readmission rates and patient satisfaction.Further research is needed that captures a diverse patient population in terms of age and illness and the role that an advanced practice nurse can play.