Synthesis of evidence
The selected articles were graded and synthesized for the review. Akosah and colleagues [21], 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 [21]. Naylor et al. [22], reported 49% fewer readmissions (p ≤
.05) and decreased costs after implementation of an advance practice nurse (APN) protocol in a randomized control ”
study to examine the effectiveness of advance practice nurse-centered discharge planning, education, and home follow-up
interventions for 363elders 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.