Ont Health Technol Assess Ser. 2017 May 25;17(8):1-37. eCollection 2017.
Transitions in care can increase patients' vulnerability to adverse events. In particular, patients admitted for heart failure or chronic obstructive pulmonary disorder (COPD) have high rates of readmission and return emergency department visits. Heart failure patients have the highest 30-day readmission rates in Canada, and COPD patients comprise the highest volume of readmissions. Combined, these two conditions account for the largest number of emergency department returns. Prompt follow-up of discharged patients has been linked with reduced rates of readmission, emergency department use, and death. This systematic review evaluated the clinical effectiveness of early follow-up, within either 7 days or 30 days after hospital discharge, compared with usual care or a different time to follow-up, in reducing readmissions, emergency department visits, and mortality in patients with heart failure or COPD.
We performed a literature search to identify studies published in English up to May 25, 2016, on early follow-up after discharge from hospital in patients with heart failure or COPD. A single reviewer screened the titles and abstracts and obtained full-text articles for studies meeting the eligibility criteria. The risk of bias in the studies was evaluated according to ROBINS-I and EPOC criteria, and the quality of the body of evidence for each outcome was examined according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria.
From a total of 3,228 unique citations, we identified 10 eligible studies: one randomized controlled trial, two nonrandomized controlled trials, and seven observational studies. Four studies were specifically on 7-day follow-up and 30-day health outcomes. The other six studies were on 30-day follow-up and more variable time to health outcomes. Follow-up was conducted by general and specialist physicians, nurses, and pharmacists in clinics, by telephone, and by home visit. Risk of bias was moderate for most of the studies. Having follow-up within either 7 days or 30 days after hospitalization for heart failure or COPD was associated with lower all-cause readmissions, emergency department visits, and mortality, even after accounting for confounders such as age, sex, socioeconomic status, and disease severity (GRADE: Very low to low). However, the evidence was inconsistent. We did not find a difference in effectiveness between studies using a 7-day versus a 30-day follow-up.
Based on low- and very low-quality evidence, follow-up within 7 days and within 30 days of discharge from hospitalization for heart failure or COPD-compared with usual care or no follow-up-were both associated with a reduced risk of all-cause readmission, emergency department visits, and mortality. Overall, there is a lack of large, methodologically robust studies specifically focusing on the effectiveness of 7-day follow-up after discharge in improving patient outcomes.
护理转接可能会增加患者发生不良事件的风险。特别是，因心力衰竭或慢性阻塞性肺疾病（COPD）入院的患者再入院率和返回急诊科就诊的比例很高。在加拿大，心力衰竭患者的30天再入院率最高，而COPD患者的再入院人数最多。这两种疾病加起来导致了最多的急诊科返回就诊情况。对出院患者进行及时随访与降低再入院率、急诊科使用率和死亡率相关。本系统评价评估了在出院后7天或30天内进行早期随访与常规护理或不同随访时间相比，在降低心力衰竭或COPD患者的再入院率、急诊科就诊率和死亡率方面的临床效果。
我们进行了文献检索，以识别截至2016年5月25日发表的关于心力衰竭或COPD患者出院后早期随访的英文研究。由一名评审员筛选标题和摘要，并获取符合纳入标准的研究的全文。根据ROBINS-I和EPOC标准评估研究中的偏倚风险，并根据推荐分级评估、制定和评价（GRADE）工作组标准检查每个结局的证据质量。
从总共3228篇独特的文献中，我们确定了10项符合条件的研究：1项随机对照试验、2项非随机对照试验和7项观察性研究。4项研究专门针对7天随访和30天健康结局。其他6项研究针对30天随访以及更具变化性的健康结局时间。随访由普通医生、专科医生、护士和药剂师在诊所、通过电话和家访进行。大多数研究的偏倚风险为中等。心力衰竭或COPD患者在住院后7天或30天内进行随访，即使在考虑年龄、性别、社会经济地位和疾病严重程度等混杂因素后，全因再入院率、急诊科就诊率和死亡率也较低（GRADE：极低至低）。然而，证据并不一致。我们没有发现7天随访与30天随访的研究在有效性上存在差异。
基于低质量和极低质量的证据，心力衰竭或COPD患者出院后7天内和30天内进行随访——与常规护理或无随访相比——均与全因再入院、急诊科就诊和死亡风险降低相关。总体而言，缺乏专门关注出院后7天随访在改善患者结局方面有效性的大型、方法学严谨的研究。
