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Patient Outcomes Following Interhospital Care Fragmentation: A Systematic Review

  • Katelin Snow
  • Karla Galaviz
  • Sara TurbowEmail author
Review Article

Abstract

Introduction

Interhospital fragmentation of care occurs when patients are admitted to different, disconnected hospitals. It has been hypothesized that this type of care fragmentation decreases the quality of care received and increases hospital costs and healthcare utilization. This systematic review aims to synthesize the existing literature exploring the association between interhospital fragmentation of care and patient outcomes.

Methods

MEDLINE, the Cochrane Library, EMBASE, and the Science Citation Index were systematically searched for studies published up to April 30, 2018 reporting the association between interhospital fragmentation of care and patient outcomes. We included peer-reviewed observational studies conducted in adults that reported measures of association between interhospital care fragmentation and one or more of the following patient outcomes: mortality, hospital length of stay, cost, and subsequent hospital readmission.

Results

Seventy-nine full texts were reviewed and 22 met inclusion criteria. Nearly all studies defined fragmentation of care as a readmission to a different hospital than the patient was previously discharged from. The strongest association reported was that between a fragmented readmission and in-hospital or short-term mortality (adjusted odds ratio range 0.95–3.62). Over half of the studies reporting length-of-stay showed longer length of stay in fragmented readmissions. All three studies that investigated healthcare utilization suggested an association between fragmented care and odds of subsequent readmission. The study populations and exposures were too heterogenous to perform a meta-analysis.

Discussion

Our review suggests that fragmented hospital readmissions contribute to increased mortality, longer length-of-stay, and increased risk of readmission to the hospital.

KEY WORDS

readmission continuity of care fragmentation of care patient outcomes systematic review 

Notes

Author’s Contribution

No one contributed to the article who is not listed as an author.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

11606_2019_5366_MOESM1_ESM.docx (98 kb)
ESM 1 (DOCX 13 kb)
11606_2019_5366_MOESM2_ESM.docx (98 kb)
ESM 2 (DOCX 14 kb)
11606_2019_5366_MOESM3_ESM.doc (98 kb)
ESM 3 (DOC 63 kb)

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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  1. 1.Department of MedicineEmory University School of MedicineAtlantaUSA
  2. 2.Hubert Department of Global HealthEmory University Rollins School of Public HealthAtlantaUSA
  3. 3.Division of General Medicine and Geriatrics, Department of MedicineEmory University School of MedicineAtlantaUSA

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