Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Am J Emerg Med. 2020 Dec;38(12):2667-2680. doi: 10.1016/j.ajem.2020.07.043. Epub 2020 Jul 24.
Suboptimal transitions from the emergency department (ED) to outpatient settings can result in poor care continuity, and subsequently higher costs to the healthcare system. We aimed to systematically review care transition interventions (CTIs) for adult patients to understand how effective ED-based CTIs are in reducing return visits to the ED and increasing follow-up visits with primary care physicians.
We searched multiple databases and identified eligible published RCTs of ED-based CTIs affecting outpatient follow-up rates, ED readmission and hospital admission. Two independent authors reviewed titles and abstracts for potential inclusion and selected studies for full review. Study quality was assessed using the Cochrane risk-of-bias tool. ED-based CTIs were classified using a care continuity framework.
Our search generated 28,807 articles; 112 were selected for full-text review. Data were abstracted from 42 articles that met inclusion criteria. Pooling data from 20 studies (n = 8178 patients) found a relative increase in outpatient follow-up with ED-based CTIs compared to routine care (odds ratio 1.79, 95% confidence interval [CI] 1.43, 2.24). However, ED-based CTIs (20 studies, n = 8048 patients) had no significant effect on ED readmissions (odds ratio 1.02, 95% CI 0.87, 1.20]) or hospital admission after ED discharge (13 studies, n = 5742 patients) (odds ratio 0.99, 95% CI 0.86, 1.14) when compared to routine care. Twenty-two studies encompassed CTIs supporting all three functions of care continuity (information, communication and coordination).
ED-based CTIs do not appear to reduce ED revisit or hospital admission after ED discharge but are effective in increasing follow-up.
从急诊科（ED）到门诊环境的过渡不理想可能导致护理连续性差，进而使医疗系统的成本更高。我们旨在系统地回顾护理过渡干预措施（CTI），以了解基于 ED 的 CTI 如何有效降低成年患者返回 ED 的就诊率，并增加与初级保健医生的随访就诊率。
我们搜索了多个数据库，确定了影响门诊随访率、ED 再入院和住院的基于 ED 的 CTI 的已发表 RCT 进行分析。两名独立作者对标题和摘要进行了潜在纳入的审查，并选择了进行全面审查的研究。使用 Cochrane 偏倚风险工具评估研究质量。根据护理连续性框架对基于 ED 的 CTI 进行分类。
我们的搜索生成了 28807 篇文章；112 篇被选为全文审查。从符合纳入标准的 42 篇文章中提取了数据。从 20 项研究（n=8178 名患者）中汇总数据发现，与常规护理相比，基于 ED 的 CTI 可相对增加门诊随访率（优势比 1.79，95%置信区间[CI]1.43，2.24）。然而，与常规护理相比，基于 ED 的 CTI（20 项研究，n=8048 名患者）对 ED 再入院（优势比 1.02，95%CI0.87，1.20）或 ED 出院后住院（13 项研究，n=5742 名患者）（优势比 0.99，95%CI0.86，1.14）没有显著影响。22 项研究包括支持护理连续性的所有三个功能（信息、沟通和协调）的 CTI。
基于 ED 的 CTI 似乎不会降低 ED 复诊率或 ED 出院后的住院率，但可有效增加随访率。
