Adapting evidence-informed peri-discharge complex interventions in reducing 30-day hospital readmissions for heart failure and COPD

Objective

To select and refine evidence-informed peri-discharge complex interventions(abbrev. Interventions) for reducing 30-day hospital readmissions among Heart Failure(HF) and COPD patients in Hong Kong public healthcare system context using GRADE Evidence to Decision(EtD) framework.

Methods

Two 18-participant panels were recruited to carry out a two-step process for both conditions. In Step 1, participants were invited to prioritize Interventions and suggest important combinations of Interventions. In Step 2, based on the priority lists, participants were invited to conduct a two-round Delphi study for generating consensus-based Interventions for reducing 30-day hospital readmissions. GRADE EtD framework was used to guide the decision-making process, taking into consideration of benefits, harms, values and preferences, equity, acceptability, and feasibility.

Results

Five out of ten Interventions reached positive consensus for HF, while six reached positive consensus for COPD. Case management, discharge planning, patient education, self-management, and telephone follow-up were common components, and were considered as core elements for reducing 30-day hospital readmissions among HF and COPD patients in Hong Kong. Preliminary implementation issues mainly included governance and leadership, financing, health workforce development, service access and readiness, as well as empowerment of patients and caregivers.

Conclusions

This study successfully applied the GRADE EtD framework for starting the adaptation process of complex interventions and established a list of local stakeholders-endorsed Interventions for reducing 30-day hospital readmissions for HF and COPD in Hong Kong. Before implementing and maintaining these endorsed Interventions at scale in local context, further research to improve intervention-context fit as well as piloting and evaluation is necessary.