从医院出院的心衰患者过渡性护理服务的效果比较：系统评价和网络荟萃分析。
Comparative effectiveness of transitional care services in patients discharged from the hospital with heart failure: a systematic review and network meta-analysis.
机构信息
Department of Medicine, McMaster University, and Population Health Research Institute, Hamilton, ON, Canada.
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
出版信息
Eur J Heart Fail. 2017 Nov;19(11):1427-1443. doi: 10.1002/ejhf.765. Epub 2017 Feb 24.
AIMS
To compare the effectiveness of transitional care services in decreasing all-cause death and all-cause readmissions following hospitalization for heart failure (HF).
METHODS AND RESULTS
We searched PubMed, Embase, CINAHL, and Cochrane Clinical Trials Register for randomized controlled trials (RCTs) published in 2000-2015 that tested the efficacy of transitional care services in patients hospitalized for HF, provided ≥1 month of follow-up, and reported all-cause mortality or all-cause readmissions. Our network meta-analysis included 53 RCTs (12 356 patients). Among services that significantly decreased all-cause mortality compared with usual care, nurse home visits were most effective [ranking P-score 0.6794; relative risk (RR) 0.78, 95% confidence intervals (CI) 0.62-0.98], followed by disease management clinics (DMCs) (ranking P-score 0.6368; RR 0.80, 95% CI 0.67-0.97). Among services that significantly decreased all-cause readmission, nurse home visits were most effective [ranking P-score 0.8365; incident rate ratio (IRR) 0.65, 95% CI 0.49-0.86], followed by nurse case management (NCM) (ranking P-score 0.6168; IRR 0.77, 95% CI 0.63-0.95), and DMCs (ranking P-score 0.5691; IRR 0.80, 95% CI 0.66-0.97). There was no significant difference in the comparative effectiveness of services that improved each outcome. Nurse home visits had the greatest pooled cost-savings (3810 USD, 95% CI 3682-3937), followed by NCM (3435 USD, 95% CI 3224-3645), and DMCs (245 USD, 95% CI -70 to 559). Telephone, telemonitoring, pharmacist, and education interventions did not significantly improve clinical outcomes.
CONCLUSION
Nurse home visits and DMCs decrease all-cause mortality after hospitalization for HF. Along with NCM, they also reduce all-cause readmissions, with no significant difference in comparative effectiveness. These services reduce healthcare system costs to varying degrees.
目的
比较心力衰竭（HF）住院患者出院后过渡护理服务在降低全因死亡和全因再入院方面的效果。
方法和结果
我们检索了 2000 年至 2015 年间发表的 PubMed、Embase、CINAHL 和 Cochrane 临床试验注册库中的随机对照试验（RCT），以评估过渡护理服务对 HF 住院患者的疗效，随访时间至少 1 个月，报告全因死亡率或全因再入院率。我们的网络荟萃分析纳入了 53 项 RCT（12356 例患者）。与常规护理相比，以下服务可显著降低全因死亡率：护士家访（排名 P 评分 0.6794；相对风险 RR，0.78；95%置信区间 CI，0.62-0.98），其次是疾病管理诊所（DMC）（排名 P 评分 0.6368；RR，0.80；95%CI，0.67-0.97）。在显著降低全因再入院率的服务中，护士家访效果最佳（排名 P 评分 0.8365；发生率比 IRR，0.65；95%CI，0.49-0.86），其次是护士个案管理（NCM）（排名 P 评分 0.6168；IRR，0.77；95%CI，0.63-0.95）和 DMC（排名 P 评分 0.5691；IRR，0.80；95%CI，0.66-0.97）。改善各结局的服务效果没有显著差异。护士家访具有最大的总体成本节约（3810 美元，95%CI，3682-3937），其次是 NCM（3435 美元，95%CI，3224-3645）和 DMC（245 美元，95%CI，-70 至 559）。电话、远程监测、药剂师和教育干预措施并未显著改善临床结局。
结论
护士家访和 DMC 可降低 HF 住院患者的全因死亡率。与 NCM 一起，它们还可降低全因再入院率，且在疗效上无显著差异。这些服务在不同程度上降低了医疗保健系统成本。
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