Effects of Transitional Care on Hospital Readmission and Mortality Rate in Subjects With COPD: A Systematic Review and Meta-Analysis

BACKGROUND: Studies on the effect of transitional care on hospital readmissions have reported inconsistent findings, and the effect on mortality has not been reviewed systematically. This systematic review and meta-analysis of randomized controlled trials aims to examine the effect of transitional care interventions on COPD-related readmissions, all-cause hospital readmissions, and all-cause mortality rates in subjects with COPD. METHODS: Electronic databases (CINAHL, Embase, Scopus, MEDLINE, Cochrane, PubMed, Web of Science, Airity, BMJ Respiratory Research Journal, and National Digital Library of Theses and Dissertations) were searched from inception to April 26, 2017. Online searches were conducted using key words and MeSH terms for COPD and transitional care. Entry terms for searching included chronic obstructive pulmonary disease, COPD, COPD transitional care or care transition, continuity of patient care, patient discharge, and patient transfer. The quality of the included trials was assessed using the Cochrane Collaboration tool. RESULTS: 13 randomized controlled trials met the inclusion criteria. Transitional care significantly reduced the risk of COPD-related readmissions (odds ratio = 0.599, 95% CI 0.421-0.852) and all-cause hospital readmissions (odds ratio = 0.720, 95% CI 0.531-0.978), but not that of all-cause mortality (odds ratio = 0.863, 95% CI 0.576-1.294) in subjects with COPD. The effects of transitional care on hospital readmissions were moderated by the duration of interventions, type of care providers, and use of telephone follow-up as an element of the intervention. CONCLUSIONS: There was a significant effect of transitional care on both COPD-related and all-cause hospital readmissions in subjects with COPD. Duration of interventions, type of care providers, and use of telephone follow-up appeared to moderate the beneficial effects of transitional care.