Patient Outcomes Following Interhospital Care Fragmentation: A Systematic Review
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Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA; 2Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA; 3Division of General Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
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 peerreviewed 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.
Prior Presentation: This study was presented at Emory University School of Medicine’s Resident Research Day and Grady Memorial Hospital’s Resident Research Day. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-019-05366-z) contains supplementary material, which is available to authorized users. Received August 6, 2019 Revised August 14, 2019 Accepted September 12, 2019
J Gen Intern Med DOI: 10.1007/s11606-019-05366-z © Society of General Internal Medicine 2019
INTRODUCTION
Increasing national emphasis has been placed on highvalue, high-quality patient care, with a focus on reducing hospital readmissions, cost, and waste. When patient care is divided among multiple organizations and providers, fragmentation of care occurs. Fragmentation of care
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