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.
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相关论文
共 155 条
[51]   Smart About Meds (SAM): a pilot randomized controlled trial of a mobile application to improve medication adherence following hospital discharge [J].
Habib, Bettina ;
Buckeridge, David ;
Bustillo, Melissa ;
Marquez, Santiago Nicolas ;
Thakur, Manish ;
Thai Tran ;
Weir, Daniala L. ;
Tamblyn, Robyn .
JAMIA OPEN, 2021, 4 (03)
[52]   A Pilot Randomized Control Trial: Testing a Transitional Care Model for Acute Psychiatric Conditions [J].
Hanrahan, Nancy P. ;
Solomon, Phyllis ;
Hurford, Matthew O. .
JOURNAL OF THE AMERICAN PSYCHIATRIC NURSES ASSOCIATION, 2014, 20 (05) :315-327
[53]   Quality of life of individuals with heart failure - A randomized trial of the effectiveness of two models of hospital-to-home transition [J].
Harrison, MB ;
Browne, GB ;
Roberts, J ;
Tugwell, P ;
Gafni, A ;
Graham, ID .
MEDICAL CARE, 2002, 40 (04) :271-282
[54]   Feasibility and impact of a post-discharge geriatric evaluation and management service for patients from residential care: the Residential Care Intervention Program in the Elderly (RECIPE) [J].
Harvey, Penelope ;
Storer, Meg ;
Berlowitz, David John ;
Jackson, Bruce ;
Hutchinson, Anastasia ;
Lim, Wen Kwang .
BMC GERIATRICS, 2014, 14
[55]   Improving care transitions through medication therapy management: A community partnership to reduce readmissions in multiple health-systems [J].
Heaton, Pamela C. ;
Frede, Stacey ;
Kordahi, Andrew ;
Lowery, Lauren ;
Moorhead, Brooke ;
Kirby, Jim ;
Kunze, Natalie ;
Luder, Heidi .
JOURNAL OF THE AMERICAN PHARMACISTS ASSOCIATION, 2019, 59 (03) :319-328
[56]   The impact of a personalised action plan delivered at discharge to patients with COPD on readmissions: a pilot study [J].
Hegelund, Annette ;
Andersen, Ingrid Charlotte ;
Andersen, Marianne N. ;
Bodtger, Uffe .
SCANDINAVIAN JOURNAL OF CARING SCIENCES, 2020, 34 (04) :909-918
[57]   The Post-Discharge Network Coordination Programme: a Randomized Controlled Trial to Evaluate the Efficacy of an Intervention Aimed at Reducing Rehospitalizations and Improving Mental Health [J].
Hengartner, Michael P. ;
Passalacqua, Silvia ;
Heim, Gisela ;
Andreae, Andreas ;
Roessler, Wulf ;
von Wyl, Agnes .
FRONTIERS IN PSYCHIATRY, 2016, 7
[58]   The effects of a transitional care program on discharge readiness, transitional care quality, health services utilization and satisfaction among Chinese kidney transplant recipients: A randomized controlled trial [J].
Hu, Rujun ;
Gu, Bo ;
Tan, Qiling ;
Xiao, KaiZhi ;
Li, Xiaoqin ;
Cao, Xiaoyi ;
Song, Turun ;
Jiang, Xiaolian .
INTERNATIONAL JOURNAL OF NURSING STUDIES, 2020, 110
[59]   The PRISMA Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-analyses of Health Care Interventions: Checklist and Explanations [J].
Hutton, Brian ;
Salanti, Georgia ;
Caldwell, Deborah M. ;
Chaimani, Anna ;
Schmid, Christopher H. ;
Cameron, Chris ;
Ioannidis, John P. A. ;
Straus, Sharon ;
Thorlund, Kristian ;
Jansen, Jeroen P. ;
Mulrow, Cynthia ;
Catala-Lopez, Ferran ;
Gotzsche, Peter C. ;
Dickersin, Kay ;
Boutron, Isabelle ;
Altman, Douglas G. ;
Moher, David .
ANNALS OF INTERNAL MEDICINE, 2015, 162 (11) :777-784
[60]  
Indraratna P., 2022, JMIR MHEALTH UHEALTH, V10