Transitional Care Interventions From Hospital to Community to Reduce Health Care Use and Improve Patient Outcomes

被引:29
作者
Tyler, Natasha [1 ,2 ,9 ]
Hodkinson, Alexander [1 ,2 ]
Planner, Claire [2 ]
Angelakis, Ioannis [1 ,3 ]
Keyworth, Christopher [4 ]
Hall, Alex [5 ]
Jones, Paul Pascall [6 ]
Wright, Oliver George [6 ]
Keers, Richard [2 ,7 ,8 ]
Blakeman, Tom [1 ,2 ]
Panagioti, Maria [1 ,2 ]
机构
[1] Univ Manchester, Manchester Acad Hlth Sci Ctr, NIHR Sch Primary Care Res,Fac Biol Med & Hlth, Div Populat Hlth Hlth Serv Res & Primary Care,Sch, Manchester, Lancs, England
[2] Univ Manchester, Natl Inst Hlth & Care Res, Greater Manchester Patient Safety Translat Res Ctr, Div Populat Hlth Hlth Serv Res & Primary Care, Manchester, Lancs, England
[3] Univ Liverpool, Inst Populat Hlth, Dept Primary Care & Mental Hlth, Liverpool, England
[4] Univ Leeds, Dept Expt Pathol, Leeds, England
[5] Univ Manchester, Div Nursing Midwifery & Social Work, Manchester, England
[6] Univ Manchester, Manchester, Lancs, England
[7] Pennine Care NHS Fdn Trust, Pharm Dept, Ashton Under Lyne, Surrey, England
[8] Univ Manchester, Ctr Pharmacoepidemiol & Drug Safety, Sch Hlth Sci, Div Pharm & Optometry, Manchester, England
[9] Univ Manchester, Manchester Acad Hlth Sci Ctr, NIHR Sch Primary Care Res, Oxford Rd, Manchester M13 9PL, England
关键词
RANDOMIZED-CONTROLLED-TRIAL; CONGESTIVE-HEART-FAILURE; HIGH-RISK PATIENTS; QUALITY-OF-LIFE; 30-DAY READMISSIONS; FOLLOW-UP; PHARMACIST INTERVENTION; ELDERLY-PATIENTS; OLDER-ADULTS; DECREASE REHOSPITALIZATION;
D O I
10.1001/jamanetworkopen.2023.44825
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Importance Discharge from the hospital to the community has been associated with serious patient risks and excess service costs.Objective To evaluate the comparative effectiveness associated with transitional care interventions with different complexity levels at improving health care utilization and patient outcomes in the transition from the hospital to the community.Data Sources CENTRAL, Embase, MEDLINE, and PsycINFO were searched from inception until August 2022.Study Selection Randomized clinical trials evaluating transitional care interventions from hospitals to the community were identified.Data Extraction and Synthesis At least 2 reviewers were involved in all data screening and extraction. Random-effects network meta-analyses and meta-regressions were applied. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed.Main Outcomes and Measures The primary outcomes were readmission at 30, 90, and 180 days after discharge. Secondary outcomes included emergency department visits, mortality, quality of life, patient satisfaction, medication adherence, length of stay, primary care and outpatient visits, and intervention uptake.Results Overall, 126 trials with 97 408 participants were included, 86 (68%) of which were of low risk of bias. Low-complexity interventions were associated with the most efficacy for reducing hospital readmissions at 30 days (odds ratio [OR], 0.78; 95% CI, 0.66 to 0.92) and 180 days (OR, 0.45; 95% CI, 0.30 to 0.66) and emergency department visits (OR, 0.68; 95% CI, 0.48 to 0.96). Medium-complexity interventions were associated with the most efficacy at reducing hospital readmissions at 90 days (OR, 0.64; 95% CI, 0.45 to 0.92), reducing adverse events (OR, 0.42; 95% CI, 0.24 to 0.75), and improving medication adherence (standardized mean difference [SMD], 0.49; 95% CI, 0.30 to 0.67) but were associated with less efficacy than low-complexity interventions for reducing readmissions at 30 and 180 days. High-complexity interventions were most effective for reducing length of hospital stay (SMD, -0.20; 95% CI, -0.38 to -0.03) and increasing patient satisfaction (SMD, 0.52; 95% CI, 0.22 to 0.82) but were least effective for reducing readmissions at all time periods. None of the interventions were associated with improved uptake, quality of life (general, mental, or physical), or primary care and outpatient visits.Conclusions and Relevance These findings suggest that low- and medium-complexity transitional care interventions were associated with reducing health care utilization for patients transitioning from hospitals to the community. Comprehensive and consistent outcome measures are needed to capture the patient benefits of transitional care interventions.
引用
收藏
页数:21
相关论文
共 155 条
[41]   Transitional care interventions reduce unplanned hospital readmissions in high-risk older adults [J].
Finlayson, Kathleen ;
Chang, Anne M. ;
Courtney, Mary D. ;
Edwards, Helen E. ;
Parker, Anthony W. ;
Hamilton, Kyra ;
Thu Dinh Xuan Pham ;
O'Brien, Jane .
BMC HEALTH SERVICES RESEARCH, 2018, 18
[42]   A randomised trial of pharmacist-led discharge prescribing in an Australian geriatric evaluation and management service [J].
Finn, Shannon ;
D'arcy, Emily ;
Donovan, Peter ;
Kanagarajah, Shanthi ;
Barras, Michael .
INTERNATIONAL JOURNAL OF CLINICAL PHARMACY, 2021, 43 (04) :847-857
[43]   Reducing Hospital Readmissions Through a Skilled Nursing Facility Discharge Intervention: A Pragmatic Trial [J].
Gardner, Rebekah L. ;
Pelland, Kimberly ;
Youssef, Rouba ;
Morphis, Blake ;
Calandra, Kathleen ;
Hollands, Lara ;
Gravenstein, Stefan .
JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION, 2020, 21 (04) :508-512
[44]   A Nurse-Led Bridging Program to Reduce 30-Day Readmissions of Older Patients Discharged From Acute Care Units [J].
Gilbert, Thomas ;
Occelli, Pauline ;
Rabilloud, Muriel ;
Poupon-Bourdy, Stephanie ;
Riche, Benjamin ;
Touzet, Sandrine ;
Bonnefoy, Marc .
JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION, 2021, 22 (06) :1292-+
[45]  
Gillard S, 2022, LANCET PSYCHIAT, V9, P125, DOI 10.1016/S2215-0366(21)00398-9
[46]   A Comprehensive Pharmacist Intervention to Reduce Morbidity in Patients 80 Years or Older A Randomized Controlled Trial [J].
Gillespie, Ulrika ;
Alassaad, Anna ;
Henrohn, Dan ;
Garmo, Hans ;
Hammarlund-Udenaes, Margareta ;
Toss, Henrik ;
Kettis-Lindblad, Asa ;
Melhus, Hakan ;
Morlin, Claes .
ARCHIVES OF INTERNAL MEDICINE, 2009, 169 (09) :894-900
[47]   Support From Hospital to Home for Elders A Randomized Trial [J].
Goldman, L. Elizabeth ;
Sarkar, Urmimala ;
Kessell, Eric ;
Guzman, David ;
Schneidermann, Michelle ;
Pierluissi, Edgar ;
Walter, Barbara ;
Vittinghoff, Eric ;
Critchfield, Jeff ;
Kushel, Margot .
ANNALS OF INTERNAL MEDICINE, 2014, 161 (07) :472-+
[48]   Discharge planning from hospital [J].
Goncalves-Bradley, Daniela C. ;
Lannin, Natasha A. ;
Clemson, Lindy M. ;
Cameron, Ian D. ;
Shepperd, Sasha .
COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2016, (01)
[49]   Effect of a medicines management model on medication-related readmissions in older patients admitted to a medical acute admission unit-A randomized controlled trial [J].
Graabaek, Trine ;
Hedegaard, Ulla ;
Christensen, Mikkel B. ;
Clemmensen, Marianne H. ;
Knudsen, Torben ;
Aagaard, Lise .
JOURNAL OF EVALUATION IN CLINICAL PRACTICE, 2019, 25 (01) :88-96
[50]   An Electronic Health Record-Based Intervention to Increase Follow-Up Office Visits and Decrease Rehospitalization in Older Adults [J].
Gurwitz, Jerry H. ;
Field, Terry S. ;
Ogarek, Jessica ;
Tjia, Jennifer ;
Cutrona, Sarah L. ;
Harrold, Leslie R. ;
Gagne, Shawn J. ;
Preusse, Peggy ;
Donovan, Jennifer L. ;
Kanaan, Abir O. ;
Reed, George ;
Garber, Lawrence .
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 2014, 62 (05) :865-871