Kamermayer Angela K, Leasure A Renee, Anderson Lisa
Angela K. Kamermayer, DNP, APRN-CNS, NEA-BC, is vice president and chief nursing officer of INTEGRIS Health, Edmond, Oklahoma. A. Renee Leasure, PhD, APRN-CNS, CCRN, is associate professor at Fran and Earl Ziegler College of Nursing, University of Oklahoma Health Science Center. Lisa Anderson, BA, is assistant vice president of Care Management at INTEGRIS Health, Edmond, Oklahoma.
Dimens Crit Care Nurs. 2017 Nov/Dec;36(6):311-316. doi: 10.1097/DCC.0000000000000266.
The Affordable Care Act of 2010 set forth payment models that provided $10 billion to incent the health care system in developing innovative programs that target reform, including transitional care to reduce preventable readmissions. While transitional care programs exist, US hospitals remain challenged, with 1 in 5 readmissions within 30 days.
This systematic review examined the effectiveness of select evidence-based transitions-of-care interventions on reducing 30-day readmission rates, reducing emergency room visits, and reducing mortality rates.
The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines formed the framework for this systematic review. Key study characteristics informed the eligibility criteria and search strategy. Two reviewers independently appraised selected studies using the Critical Appraisal Skills Programme tools. Included studies were summarized and synthesized in order to draw conclusions across studies.
Interventions are aimed at reducing the readmission rate of the adult general medical population. The population of focus in this review includes patients at risk of avoidable readmissions, which includes patients requiring higher levels of care secondary to complications that can contribute to higher mortality after discharge from an acute care setting.
The findings of this review support the use of transitions-of-care interventions such as tailored discharge planning and postdischarge phone calls.
2010年的《平价医疗法案》提出了支付模式，提供100亿美元以激励医疗保健系统开展旨在改革的创新项目，包括过渡性护理以减少可预防的再入院情况。虽然存在过渡性护理项目，但美国医院仍面临挑战，30天内每5例患者中就有1例再次入院。
本系统评价考察了某些循证护理过渡干预措施在降低30天再入院率、减少急诊就诊次数和降低死亡率方面的有效性。
PRISMA（系统评价和Meta分析的首选报告项目）指南构成了本系统评价的框架。关键研究特征为纳入标准和检索策略提供了依据。两名评价者使用关键评价技能计划工具独立评价所选研究。对纳入研究进行总结和综合，以便得出各项研究的结论。
干预措施旨在降低成年普通内科患者的再入院率。本评价关注的人群包括有可避免再入院风险的患者，其中包括因并发症而需要更高护理水平的患者，这些并发症可能导致急性护理出院后死亡率升高。
本评价结果支持使用如个性化出院计划和出院后电话随访等护理过渡干预措施。
