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Q In older people admitted to hospital for hip fracture after a fall, does an intensive discharge planning intervention improve physical, functional, and psychosocial outcomes?
randomised controlled trial.
unclear allocation concealment.
blinded (outcome assessor).
Follow up period:
3 months after discharge.
a medical centre in Taiwan, China.
141 patients ⩾65 years of age (mean age 77 y, 69% women) admitted with hip fracture because of a fall. Patients who were seriously ill or cognitively impaired were excluded.
70 patients were allocated to a 3 month individualised intensive discharge planning intervention that was delivered by a nurse and included hospital visits, 1 home visit, telephone availability, and weekly telephone contact to address concerns of patients and caregivers and monitor progress; ongoing assessment of need for treatment and supportive care, and set up of home care and rehabilitation services; education about medication, safety, and use of assistive devices; pictorial brochures on self care and fall prevention; and written summaries of plans, goals, and concerns for patients and caregivers. 71 patients were allocated to usual discharge planning (ie, no written material, home visit, or telephone contact).
length of initial hospital stay, hospital readmission, repeat falls, death, independence in activities of daily living (ADL) (assessed by the Barthel Index), and health related quality of life (QOL) (assessed by the Short Form 36).
Patient follow up:
89% completed the study.
Initial hospital stay was shorter in the intervention group (table). At 3 months, the intervention group had lower rates of hospital readmission and death, and higher scores for ADL independence and overall QOL (table). Groups did not differ for repeat falls (table).
Intensive hospital discharge planning improved physical, functional, and psychosocial outcomes in older people with hip fracture.
Discharge planning is an important aspect of patient centred care. The study by Huang and Liang showed that intensive discharge planning with patient follow up positively affected patient outcomes. The results differ from those of a Cochrane review, which failed to detect a benefit from discharge planning.1 This difference in results may be because of the intensity of the intervention. The control group in the study by Huang and Liang received routine discharge planning, which was defined by what they did not receive: no brochures, written discharge summaries, home visits, or telephone contacts.
The study has 3 key limitations. It was done in a hospital in northern Taiwan, and patients were mainly women with poor or absent literacy skills. Consequently, the findings may not be generalisable to other populations. The use of monetary incentives to reduce participant attrition may have inflated any effects. As well, the discharge planning intervention was delivered by an experienced, masters prepared gerontological nurse. These qualifications are similar to those of an advanced practice nurse in many countries. This comprehensive intervention was so different from routine care that one would expect a positive effect just from the extra attention given to patients.
In an effort to address the high levels of illiteracy in the elderly Taiwanese population, the educational brochure had coloured pictures and few words. This innovative approach would serve all hospitals well, especially those in multicultural settings requiring translation services.
The results of Huang and Liang are relevant to nurses working as discharge planners and home care case managers, and those who work with elderly patients. In the future, perhaps patient centred discharge planning (ie, individualised discharge plans) will be the norm instead of the routine discharge care that currently exists in many hospitals.
For correspondence: Dr T T Huang, Chang Gung University, School of Nursing, Tao-Yuan, Taiwan, Republic of China.
Source of funding: National Science Council, Taiwan.
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