Mabire Cedric, Dwyer Andrew, Garnier Antoine, Pellet Joanie
1University of Applied Sciences and Arts Western Switzerland (HES-SO), School of Health Sciences (HESAV), Lausanne, Vaud, Switzerland 2Bureau d'Echange des Savoirs pour des praTique exemplaires de soins (BEST): a Joanna Briggs Institute Centre of Excellence 3Institute of Higher Education and Research in Healthcare (IUFRS), Lausanne University and CHUV, Vaud, Switzerland 4Lausanne University Hospital - CHUV, Lausanne, Vaud, Switzerland.
JBI Database System Rev Implement Rep. 2016 Sep;14(9):217-260. doi: 10.11124/JBISRIR-2016-003085.
Inadequate discharge planning for the growing elderly population poses significant challenges for health services. Effective discharge planning interventions have been examined in several studies, but little information is available on nursing's role or the specific components of these interventions. Despite the research published on the importance of discharge planning, the impact on patient's health outcomes still needs to be proven in practice.
To determine the best available evidence on the effectiveness of discharge planning interventions involving at least one nurse on health-related outcomes for elderly inpatients discharged home and to assess the relative impact of individual components of discharge planning interventions.
Elderly inpatients aged 65 years or older, discharged from acute care and post-acute care rehabilitation hospitals to home.
The review focused on the six keys components of Naylor's Transitional Care Model: early geriatric assessment, discharge preparation, patient or caregiver's participation, continuity of care, day of discharge assessment and post-discharge follow-up.
This review considered randomized and non-randomized controlled trials, quasi-experimental studies, before and after studies, prospective and retrospective cohort studies, case-control studies and analytical cross-sectional studies.
The outcomes for this review were functional ability, symptoms management, adverse outcomes, unmet needs after discharge, coping with disease, health-related quality of life (QoL), satisfaction with care, readmission rate and healthcare utilization.
A systematic search was undertaken across 13 databases to retrieve published and unpublished studies in English between 2000 and 2015.
Critical appraisal was undertaken by two independent reviewers using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI).
Quantitative data were extracted from included studies independently by the two reviewers using the standardized data extraction tool from JBI-MAStARI.
Due to the wide range of outcome measures, a comprehensive meta-analysis for all studies was not possible. However, meta-analysis was conducted for specific outcome measures, such as readmission, length of stay and QoL.
Thirteen studies met the inclusion criteria and were included in the review. Two out of the 13 studies were pilot studies and one had a pre-post design. Included studies involved a total of 3964 participants with a median age of 77 years. Nurse discharge planning did not significantly reduce hospital readmission rate (odds ratio [OR] = 0.73, 95% confidence intervals [CIs] = 0.53-1.01, P = 0.06). The overall effect score for length of stay was significant (weighted mean difference = 0.29, P < 0.01), suggesting that discharge planning increased the length of hospitalization. The effectiveness of discharge planning did not significantly impact QoL (mental OR = 0.37, P = 0.19 and physical OR = 0.47, P = 0.15).
Findings of this review suggest that nursing discharge planning for elderly inpatients discharged home increases length of stay, yet neither reduces readmission rates nor improves QoL.
针对日益增多的老年人口，出院计划不完善给医疗服务带来了重大挑战。多项研究对有效的出院计划干预措施进行了考察，但关于护理工作的作用或这些干预措施的具体组成部分，现有信息较少。尽管已发表了关于出院计划重要性的研究，但在实践中，其对患者健康结局的影响仍有待证实。
确定关于涉及至少一名护士的出院计划干预措施对居家出院的老年住院患者健康相关结局有效性的最佳现有证据，并评估出院计划干预措施各组成部分的相对影响。
纳入标准 参与者类型：65岁及以上的老年住院患者，从急症护理医院和急性后护理康复医院出院后回家。
本综述聚焦于内勒过渡护理模式的六个关键组成部分：早期老年评估、出院准备、患者或照护者参与、护理连续性、出院日评估和出院后随访。
本综述纳入随机和非随机对照试验、准实验研究、前后对照研究、前瞻性和回顾性队列研究、病例对照研究以及分析性横断面研究。
本综述的结局指标包括功能能力、症状管理、不良结局、出院后未满足的需求、应对疾病的能力、健康相关生活质量（QoL）、护理满意度、再入院率和医疗保健利用率。
在13个数据库中进行了系统检索，以获取2000年至2015年期间发表和未发表的英文研究。
由两名独立评审员使用乔安娜·布里格斯循证卫生保健中心统计学评估与综述工具（JBI-MAStARI）中的标准化批判性评价工具进行批判性评价。
两名评审员使用JBI-MAStARI中的标准化数据提取工具，独立从纳入研究中提取定量数据。
由于结局指标范围广泛，无法对所有研究进行全面的荟萃分析。然而，针对特定结局指标进行了荟萃分析，如再入院率、住院时间和生活质量。
13项研究符合纳入标准并被纳入本综述。13项研究中有2项为试点研究，1项采用前后对照设计。纳入研究共涉及3964名参与者，中位年龄为77岁。护士主导的出院计划并未显著降低医院再入院率（优势比[OR]=0.73，95%置信区间[CI]=0.53 - 1.01，P = 0.06）。住院时间的总体效应得分显著（加权平均差=0.29，P < 0.01），表明出院计划延长了住院时间。出院计划的有效性对生活质量没有显著影响（心理方面OR = 0.37，P = 0.19；身体方面OR = 0.47，P = 0.15）。
本综述结果表明，为居家出院的老年住院患者制定的护理出院计划会延长住院时间，但既不能降低再入院率，也不能改善生活质量。
