Synthesis of evidence
The selected articles were graded and synthesized for the review. Akosah and colleagues, found that the implementtation of a disease management program that included individualized education and early physician follow-up resulted in a 77% risk reduction for 30-day readmissions and a significantly (p ≤ .05) lower rate of readmissions for initial diagnosis after 90 days and one year after discharge of initial diagnosis. Naylor et al. , reported 49% fewer readmissions (p ≤.05) and decreased costs after implementation of an advance practice nurse (APN) protocol in randomized control ” study to examine the effectiveness of advance practice nurse-centered discharge planning, education, and home follow-up interventions for 363 elders at risk for hospital readmission. The APN intervention proved to decrease overall costs for the intervention group in comparison to the control group by $668.00 ($215,378 vs. $214,710) respectively, however, this did not reach statistical significance (p = .70). The results of this study are not generalizable due to the nature of the educational program. The approach of the education program posed a threat to validity because the protocol was customized, therefore not being executed in the same manner for all participants compromising the fidelity of the patient intervention.