Desai Arti D, Popalisky Jean, Simon Tamara D, Mangione-Smith Rita M
Department of Pediatrics, University of Washington, Seattle, Washington; and Seattle Children's Research Institute, Seattle, Washington
Seattle Children's Research Institute, Seattle, Washington.
Hosp Pediatr. 2015 Apr;5(4):219-31. doi: 10.1542/hpeds.2014-0097.
The quality of care transitions is of growing concern because of a high incidence of postdischarge adverse events, poor communication with patients, and inadequate information transfer between providers. The objective of this study was to conduct a targeted literature review of studies examining the effectiveness of family-centered transition processes from hospital- and emergency department (ED)-to-home for improving patient health outcomes and health care utilization.
We conducted an electronic search (2001-2012) of PubMed, CINAHL, Cochrane, PsycInfo, Embase, and Web of Science databases. Included were experimental studies of hospital and ED-to-home transition interventions in pediatric and adult populations meeting the following inclusion criteria: studies evaluating hospital or ED-to-home transition interventions, study interventions involving patients/families, studies measuring outcomes≤30 days after discharge, and US studies. Transition processes, principal outcome measures (patient health outcomes and health care utilization), and assessment time-frames were extracted for each study.
The search yielded 3458 articles, and 16 clinical trials met final inclusion criteria. Four studies evaluated pediatric ED-to-home transitions and indicated family-tailored discharge education was associated with better patient health outcomes. Remaining trials evaluating adult hospital-to-home transitions indicated a transition needs assessment or provision of an individualized transition record was associated with better patient health outcomes and reductions in health care utilization. The effectiveness of postdischarge telephone follow-up and/or home visits on health care utilization showed mixed results.
Patient-tailored discharge education is associated with improved patient health outcomes in pediatric ED patients. Effective transition processes identified in the adult literature may inform future quality improvement research regarding pediatric hospital-to-home transitions.
由于出院后不良事件发生率高、与患者沟通不畅以及医疗服务提供者之间信息传递不充分，护理转接质量日益受到关注。本研究的目的是对有关以家庭为中心的从医院和急诊科到家庭的转接过程对改善患者健康结局和医疗服务利用有效性的研究进行有针对性的文献综述。
我们对PubMed、CINAHL、Cochrane、PsycInfo、Embase和Web of Science数据库进行了电子检索（2001 - 2012年）。纳入的是符合以下纳入标准的儿科和成人人群中关于医院和急诊科到家庭转接干预的实验性研究：评估医院或急诊科到家庭转接干预的研究、涉及患者/家庭的研究干预、出院后≤30天测量结局的研究以及美国的研究。提取每项研究的转接过程、主要结局指标（患者健康结局和医疗服务利用）以及评估时间框架。
检索共获得3458篇文章，16项临床试验符合最终纳入标准。四项研究评估了儿科从急诊科到家庭的转接，表明针对家庭的出院教育与更好的患者健康结局相关。其余评估成人从医院到家庭转接的试验表明，转接需求评估或提供个性化转接记录与更好的患者健康结局及医疗服务利用减少相关。出院后电话随访和/或家访对医疗服务利用的有效性结果不一。
针对患者的出院教育与改善儿科急诊科患者的健康结局相关。成人文献中确定的有效转接过程可能为未来关于儿科从医院到家庭转接的质量改进研究提供参考。
