Caseworker-assigned discharge plans to prevent hospital readmission for acute exacerbations in children with chronic respiratory illness

Abstract

Background: Chronic respiratory conditions are major causes of mortality and morbidity. Children with chronic health conditions have i ncreased morbidity associated with their physical, emotional, and gen eral well-being. Acute respiratory exacerbations (AREs) are com mon in children with chronic respiratory disease, often requirin g admission to hospital. Reducing the frequency of AREs and recu rrent hospitalisations is therefore an important goal in the indi vidual and public health management of chronic respiratory i llnesses in children. Discharge planning is used to decide what a person nee ds for transition from one level of care to another and is usual ly considered in the context of discharge from hospital to the home . Discharge planning from hospital for ongoing management of an illness has historically been referral to a general practitio ner or allied health professional or self management by the i ndividual and their family with limited communication between the hospital and pa tient once discharged. Effective discharge planning can decrease the risk of recurrent AREs requiring medical care. An individual cas eworker-assigned discharge plan may further decrease exacerba tions. Objectives: To evaluate the efficacy of individual caseworker-assigned disch arge plans, as compared to non-caseworker-assigned plans, in pr eventing hospitalisation for AREs in children with chronic lung diseas es such as asthma and bronchiectasis. Search methods We searched the Cochrane Airways Group Specialised Register of Trials, the Cochrane Central Register of Controlled Trials (C EN- TRAL), MEDLINE, Embase, trials registries, and reference lis ts of articles. The latest searches were undertaken in Novembe r 2017. Selection criteria: All randomised controlled trials comparing individual casewo rker-assigned discharge planning compared to traditional dis charge- planning approaches (including self management), and their eff ectiveness in reducing the subsequent need for emergency care fo r AREs (hospital admissions, emergency department visits, and /or unscheduled general practitioner visits) in children hosp italised with an acute exacerbation of chronic respiratory disease. We exclud ed studies that included children with cystic fibrosis.