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Main Authors: ALAA RIZQ, RAYYA KAHLED ALSUGHAYYR, IBRAHIM ALI ALGHAMDI, SAMI MOTHKER ALMUTAIRI, ALMAHA BIN HULAYYIL, ABDULRAHMAN IBRAHIM M ALMUHAIMEED, SAMI NAZAL ALMUTAIRI, ABDULAZIZ AHMED ALMUTAIRI, MATER SALEM ALMODAIBERI, BADER MAJED ALOTAIBI
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Published: Zenodo 2026
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Online Access:https://doi.org/10.5281/zenodo.19075453
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author ALAA RIZQ
RAYYA KAHLED ALSUGHAYYR
IBRAHIM ALI ALGHAMDI
SAMI MOTHKER ALMUTAIRI
ALMAHA BIN HULAYYIL
ABDULRAHMAN IBRAHIM M ALMUHAIMEED
SAMI NAZAL ALMUTAIRI
ABDULAZIZ AHMED ALMUTAIRI
MATER SALEM ALMODAIBERI
BADER MAJED ALOTAIBI
author_facet ALAA RIZQ
RAYYA KAHLED ALSUGHAYYR
IBRAHIM ALI ALGHAMDI
SAMI MOTHKER ALMUTAIRI
ALMAHA BIN HULAYYIL
ABDULRAHMAN IBRAHIM M ALMUHAIMEED
SAMI NAZAL ALMUTAIRI
ABDULAZIZ AHMED ALMUTAIRI
MATER SALEM ALMODAIBERI
BADER MAJED ALOTAIBI
contents <p><strong><span>ABSTRACT</span></strong></p> <p><span>Hospital discharge is a vulnerable period, especially for adults with multimorbidity, limited social support, poverty, housing instability, or difficulty navigating follow-up care. This systematic review examined hospital-based social work interventions improvement of discharge planning and reduce hospital readmission in adult patients. A structured search of PubMed and PubMed Central was performed, and original adult studies with hospital-based transition interventions containing social work, psychosocial, case-management, navigation, or interprofessional discharge-planning elements were reviewed. Ten original studies were included in the results synthesis. The included studies showed clinically important findings. Interventions with strong post-discharge follow-up, psychosocial assessment, home contact, and linkage to community or primary care often improved follow-up processes and in several studies reduced readmission or later inpatient utilization. not all programs were effective, and some showed neutral results, especially when intervention intensity was low or implementation was difficult. Direct social work-led studies were limited, but broader transition models with clear social work or psychosocial components suggested that addressing social barriers is relevant to safer discharge. Hospital-based social work and socially oriented transitional care appear promising for improving discharge planning, but the effect on readmission is inconsistent in settings and populations. More trials focused specifically on social work-led models are still needed. </span></p> <p><strong><span>KEYWORDS</span></strong><span><br>Social work; discharge planning; hospital readmission; transitional care; care coordination</span></p>
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spellingShingle HOSPITAL-BASED SOCIAL WORK INTERVENTIONS AND THEIR IMPACT ON DISCHARGE PLANNING AND HOSPITAL READMISSION: A SYSTEMATIC REVIEW
ALAA RIZQ
RAYYA KAHLED ALSUGHAYYR
IBRAHIM ALI ALGHAMDI
SAMI MOTHKER ALMUTAIRI
ALMAHA BIN HULAYYIL
ABDULRAHMAN IBRAHIM M ALMUHAIMEED
SAMI NAZAL ALMUTAIRI
ABDULAZIZ AHMED ALMUTAIRI
MATER SALEM ALMODAIBERI
BADER MAJED ALOTAIBI
Social work
discharge planning
hospital readmission
transitional care
care coordination
<p><strong><span>ABSTRACT</span></strong></p> <p><span>Hospital discharge is a vulnerable period, especially for adults with multimorbidity, limited social support, poverty, housing instability, or difficulty navigating follow-up care. This systematic review examined hospital-based social work interventions improvement of discharge planning and reduce hospital readmission in adult patients. A structured search of PubMed and PubMed Central was performed, and original adult studies with hospital-based transition interventions containing social work, psychosocial, case-management, navigation, or interprofessional discharge-planning elements were reviewed. Ten original studies were included in the results synthesis. The included studies showed clinically important findings. Interventions with strong post-discharge follow-up, psychosocial assessment, home contact, and linkage to community or primary care often improved follow-up processes and in several studies reduced readmission or later inpatient utilization. not all programs were effective, and some showed neutral results, especially when intervention intensity was low or implementation was difficult. Direct social work-led studies were limited, but broader transition models with clear social work or psychosocial components suggested that addressing social barriers is relevant to safer discharge. Hospital-based social work and socially oriented transitional care appear promising for improving discharge planning, but the effect on readmission is inconsistent in settings and populations. More trials focused specifically on social work-led models are still needed. </span></p> <p><strong><span>KEYWORDS</span></strong><span><br>Social work; discharge planning; hospital readmission; transitional care; care coordination</span></p>
title HOSPITAL-BASED SOCIAL WORK INTERVENTIONS AND THEIR IMPACT ON DISCHARGE PLANNING AND HOSPITAL READMISSION: A SYSTEMATIC REVIEW
topic Social work
discharge planning
hospital readmission
transitional care
care coordination
url https://doi.org/10.5281/zenodo.19075453