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Meta-Analysis
. 2025 Jul 1;8(7):e2521785.
doi: 10.1001/jamanetworkopen.2025.21785.

Electronic Health Record Interventions to Reduce Risk of Hospital Readmissions: A Systematic Review and Meta-Analysis

Badal S B Pattar  1   2   3 , Abigail Ackroyd  1   2   3 , Emir Sevinc  1 , Taylor Hecker  1 , Keila Turino Miranda  4 , Caitlin McClurg  5 , Kyle Weekes  1   2   3 , Matthew T James  1   2   3   6 , Neesh Pannu  7 , Pietro Ravani  1   2   3   6 , Paul E Ronksley  3   6 , Sofia B Ahmed  7 , Tyrone G Harrison  1   2   3   6
Affiliations
Meta-Analysis

Electronic Health Record Interventions to Reduce Risk of Hospital Readmissions: A Systematic Review and Meta-Analysis

Badal S B Pattar et al. JAMA Netw Open. .

Abstract

Importance: Hospital readmissions are associated with significant health care costs and poor patient outcomes. Despite the rapid adoption of electronic health record (EHR) systems, the use of EHR-based interventions to reduce the risk of hospital readmissions is unknown.

Objective: To systematically review and estimate the association of EHR-based interventions vs controls with preventing 30-day all-cause hospital readmissions as tested in randomized clinical trials (RCTs).

Data sources: Ovid MEDLINE, Ovid Embase, CINAHL, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched from database inception to July 5, 2024, using text words with analogous terms within concept areas of "randomized controlled trial," "hospitalized adults," and "readmissions."

Study selection: RCTs were included if they evaluated the effect of EHR-based interventions on hospital readmissions compared with a control arm without an EHR-embedded component. Studies were excluded if they involved nonhospitalized, pediatric, obstetric, or psychiatric populations or did not report readmission outcomes. Results were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline.

Data extraction and synthesis: Data were extracted independently by 3 reviewers in duplicate. A random-effects model was used to pool data, and the quality of studies was assessed using the Cochrane Risk of Bias tool. Heterogeneity was quantified using the I2 statistic and explored with prespecified subgroup analyses and univariable meta-regression by population demographics, intervention complexity, and publication year.

Main outcomes and measures: The primary outcome was 30-day all-cause hospital readmission, and other readmission outcomes (eg, unplanned readmissions and readmissions at 3, 6, 12, and 24 months) were examined as secondary outcomes.

Results: A total of 116 RCTs involving 204 523 participants (weighted mean [SD] males, 56% [16%]; weighted mean [SD] age, 68 [9] years) were included, with telemonitoring (76 studies [66%]) being the most common EHR-based intervention component followed by case management (45 studies [39%]) and medication reconciliation (33 [28%]). EHR-based interventions were associated with a statistically significant reduction in 30-day all-cause readmissions (OR, 0.83 [95% CI, 0.70-0.99]; I2 = 82%; τ = 0.44 [95% CI, 0.30-0.62]; prediction interval [PI], 0.34-2.06) and 90-day all-cause readmissions (OR, 0.72 [95% CI, 0.54-0.96]; I2 = 78%; τ = 0.34 [95% CI, 0.19-1.00]; PI, 0.33-1.55) compared with control arms.

Conclusions and relevance: In this systematic review and meta-analysis of RCTs, the use of EHR-based interventions was associated with a reduction in 30-day and 90-day hospital readmissions. Future research should examine additional components of EHR interventions to understand and account for remaining gaps in effectiveness.

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Conflict of interest statement

Conflict of Interest Disclosures: Mr Pattar reported being supported by the Canadian Institutes of Health Research Canada Graduate Scholarships Doctoral Award and the Alberta SPOR SUPPORT Unit Graduate Studentship in Patient Oriented Research. Dr Ahmed reported being president of the Organization for the Study of Sex Differences, chair of the Canadian Medical Association Journal Governance Council, chair of the Canadian Institutes of Health Research Institute of Gender and Health advisory board, and University of Alberta Chair in Sex and Gender. Dr Harrison reported receiving grants from the Kidney Foundation of Canada, Alberta Innovates, and the Canadian Institutes for Health Research outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. PRISMA Flow Diagram of Process for Study Inclusion
EHR, electronic health record; RCT, randomized clinical trial.
Figure 2.
Figure 2.. Meta-Analysis Results for Odds Ratios (ORs) of 30-Day All Cause Readmissions Comparing Intervention and Control Arms
Data are for 181 392 study participants. Size of boxes represents study weight.
See this image and copyright information in PMC

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