Key messages
– Transitional discharge care (an intervention that supports a person move from a stay in hospital to the community) may make little to no difference in admissions to hospital and quality of life, and may improve how well a person functions in day-to-day life and how happy they are with their treatment when they return home, but we are very uncertain about the results.
– The results on costs of running the transitional discharge care program are inconclusive, and the studies provided no information on relapse (a new mental health crisis) or unwanted effects.
– We need more and better studies to investigate how to support people with schizophrenia or schizophrenia-related disorders during the transition from hospital to community.
What is schizophrenia?
Schizophrenia is a persistent and severe mental health condition where people have hallucinations (where they hear, see, smell, taste, or feel things that appear to be real but only exist in their mind) and delusions (a strong belief in something that is untrue), among other debilitating symptoms, leading to poor quality of life. People with schizophrenia-related disorders have symptoms that are similar to those of schizophrenia. The illness varies, with people having different symptoms at different times, often with them requiring admission to hospital for treatment.
What happens when a person with schizophrenia or schizophrenia-related disorders is discharged from hospital?
People with schizophrenia or schizophrenia-related disorders are sometimes admitted to hospital to improve their health, and afterward, they are discharged to their homes or other care facilities. This transition might be difficult and frightening for them and their carers, and they may need help to adapt. There are some interventions to support people with schizophrenia or schizophrenia-related disorders after they leave the hospital, such as case management with an expert guide or continuous care with a nurse.
What is transitional discharge care?
Transitional discharge care is an intervention which provides support to people leaving hospital to cover their medical, practical, and emotional needs. This starts before hospital discharge and continues until people are confident in their homes or care facilities. This may include help with housing; communicating and co-ordinating among healthcare staff, patients, and families; planning meetings; sessions with families; visits to the neighborhood; talking therapy sessions; telephone and face-to-face support; and support groups focusing on recreation, medication, shopping, cooking, and financial responsibilities.
What did we want to find out?
We wanted to know whether transitional discharge care helps people with schizophrenia or schizophrenia-related disorders when leaving the hospital, especially if it reduces the rate of a new mental health crisis (relapse), repeat admissions to hospital, overall functioning in day-to-day life, satisfaction with the care they receive, quality of life, unwanted effects, and costs.
What did we do?
We searched for studies that investigated whether transitional discharge care, compared to no transitional discharge care or usual care, was effective in adults with schizophrenia or schizophrenia-related disorders.
What did we find?
We found 12 studies with 1748 people that compared transitional discharge care to usual care.
Transitional discharge care may make little to no difference to admissions to hospital (4 studies, 462 people). Transitional discharge care may improve functioning (4 studies, 437 people) and may increase people's satisfaction with care (1 study, 76 people), but we are very uncertain about the results. Transitional discharge care may make little to no difference to quality of life (4 studies, 748 people). The results on costs were inconclusive as the study did not fully report the methods (1 study, 124 people).
None of the included studies provided data for relapse or unwanted effects of transitional discharge care.
What are the limitations of the evidence?
All 12 studies had problems with their methods and results were inconsistent. Some studies included people with other mental disorders, so the results might not apply directly to people with schizophrenia or schizophrenia-related disorders. Therefore, we have very low confidence in our findings.
How up to date is this evidence?
The evidence is up to date to December 2022.
There is currently no clear evidence for or against implementing transitional discharge interventions for people with schizophrenia. Transitional discharge interventions may improve patient satisfaction and functionality, but this evidence is also very uncertain. For future research, it is important to improve the quality of the conduct and reporting of these trials, including using validated tools for measuring their outcomes.
Schizophrenia is a chronic mental illness characterized by delusions, hallucinations, and important functional and social disability. Interventions labeled as 'transitional' add to care plans made during the hospital stay in preparation for discharge. They also include interventions developed after discharge to support people with serious mental illness as they make the transition from the hospital to the community. Transitional discharge interventions may anticipate the future needs of the patient after discharge by co-ordinating the different levels of the health system that can effectively guarantee continuity of care in the community. This occurs through the provision of therapeutic relationships which give a safety net throughout the discharge and community reintegration processes to improve the general condition of users, level of functioning, use of health resources, and satisfaction with care.
To assess the effects of transitional discharge interventions for people with schizophrenia.
On 7 December 2022, we searched the Cochrane Schizophrenia Group's Study-Based Register of Trials, which is based on CENTRAL, MEDLINE, Embase, PubMed, CINAHL, ClinicalTrials.gov, ISRCTN, PsycINFO, and WHO ICTRP.
Randomized controlled trials (RCTs) evaluating the effects of transitional discharge interventions in people with schizophrenia and schizophrenia-related disorders. Eligible interventions included three key elements: predischarge planning, co-ordination of care and follow-up, and postdischarge support.
We used standard Cochrane methods. Outcomes of this review included global state (relapse), service use (hospitalization), general functioning, satisfaction with care, adverse effects/events, quality of life, and direct costs. For binary outcomes, we calculated risk ratios (RRs) and their 95% confidence intervals (CIs). For continuous outcomes, we calculated the mean difference (MD) or standardized mean difference (SMD) and their 95% CIs. We used GRADE to assess certainty of evidence.
We found 12 studies with 1748 participants comparing transitional discharge interventions to usual care. All were parallel-group RCTs. No studies assessed global state (relapse) or reported data about adverse events/effects. All studies had a high risk of bias, mainly due to serious concerns about allocation concealment, deviations from intended interventions, measurement of the outcomes, and missing outcome data.
Transitional discharge interventions may make little to no difference in service use (hospitalization) at short- and long-term follow-ups, but the evidence is very uncertain (RR 1.18, 95% CI 0.55 to 2.50; I2 = 54%; 4 studies, 462 participants; very low-certainty evidence). Transitional discharge intervention may increase the levels of functioning after discharge (clinically important change in general functioning) (SMD 0.95, 95% CI −0.06 to 1.97; I² = 95%; 4 studies, 437 participants; very low-certainty evidence) and may increase the proportion of participants who are satisfied with the intervention (clinically important change in satisfaction) (RR 1.96, 95% CI 1.37 to 2.80; 1 study, 76 participants; very low-certainty evidence), but for both outcomes the evidence is very uncertain. Transitional discharge intervention may make little to no difference in quality of life compared to treatment as usual (SMD 0.24, 95% CI −0.30 to 0.78; I² = 90%; 4 studies, 748 participants; very low-certainty evidence), but we are very uncertain. For direct costs, one study with 124 participants did not report full details and thus the results were inconclusive.