临床干预对医院再入院的影响：已发表的荟萃分析的元综述。
The effect of clinical interventions on hospital readmissions: a meta-review of published meta-analyses.
机构信息
JDC Brookdale Institute, Health Policy Research Program, PO Box 3886, Jerusalem, 91037, Israel.
出版信息
Isr J Health Policy Res. 2013 Jan 23;2(1):1. doi: 10.1186/2045-4015-2-1.
BACKGROUND
The economic impact and ease of measurement of all-cause hospital readmission rates (HRR) have led to the current debate as to whether they are reducible, and whether they should be used as a publicly reported quality indicators of medical care.
OBJECTIVE
To assess the efficacy of broad clinical interventions in preventing HRR of patients with chronic diseases
METHOD
A meta-review of published systematic reviews of randomized controlled trials (RCTs) of clinical interventions that have included HRR among the patients' outcomes of interest.
MAIN FINDINGS
Meta-analyses of RCTs have consistently found that, in the community, disease management programs significantly reduced HRR in patients with heart failure, coronary heart disease and bronchial asthma, but not in patients with stroke and in unselected patients with chronic disorders. Inhospital interventions, such as discharge planning, pharmacological consultations and multidisciplinary care, and community interventions in patients with chronic obstructive pulmonary diseases had an inconsistent effect on HRR. MAIN STUDY LIMITATION: Despite their economic impact and ease of measurement, HRR are not the most important outcome of patient care, and efforts aimed at their reduction may compromise patients' health by reducing also justified re-admissions.
CONCLUSIONS
The efficacy of inhospital interventions in reducing HRR is in need of further study. In patients with heart diseases and bronchial asthma, HRR may be considered as a publicly reported quality indicator of community care, provided that future research confirms that efforts to reduce HRR do not adversely affect other patients' outcomes, such as mortality, functional capacity and quality of life. Future research should also focus on the reasons for the higher efficacy of community interventions in patients with heart diseases and bronchial asthma than in those with other chronic diseases.
背景
全因住院再入院率（HRR）的经济影响和易于衡量性导致了目前的争论，即它们是否可降低，以及是否应将其用作医疗保健质量的公开报告指标。
目的
评估广泛的临床干预措施预防慢性病患者 HRR 的效果。
方法
对已发表的关于临床干预的系统评价进行元综述，这些系统评价将 HRR 作为患者感兴趣的结果之一。
主要发现
对 RCT 的荟萃分析一致发现，在社区中，疾病管理计划可显著降低心力衰竭、冠心病和支气管哮喘患者的 HRR，但不能降低中风患者和患有慢性疾病的未选择患者的 HRR。住院干预，如出院计划、药物咨询和多学科护理，以及慢性阻塞性肺疾病患者的社区干预对 HRR 的影响不一致。
主要研究局限性
尽管 HRR 具有经济影响和易于衡量性，但它们不是患者护理最重要的结果，并且旨在降低 HRR 的努力可能会通过减少合理的再入院来损害患者的健康。
结论
需要进一步研究住院干预降低 HRR 的效果。在心脏病和支气管哮喘患者中，HRR 可被视为社区护理的公开报告质量指标，前提是未来的研究证实，降低 HRR 的努力不会对其他患者的结果（如死亡率、功能能力和生活质量）产生不利影响。未来的研究还应关注社区干预对心脏病和支气管哮喘患者比其他慢性疾病患者更有效的原因。
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