Department of Medicine, Brigham and Women's Hospital, United States of America.
Department of Medicine, Brigham and Women's Hospital, United States of America; Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, United States of America.
Cardiovasc Revasc Med. 2021 Oct;31:78-82. doi: 10.1016/j.carrev.2020.12.015. Epub 2020 Dec 13.
The passage of the Hospital Readmissions Reduction Program (HRRP) has been associated with been associated with decreased risk-standardized readmission rates for heart failure (HF) patients. However, some quantitative analyses have shown association between HRRP and increased mortality for hospitalized HF patients. Qualitative information on what hospital programs were actually implemented can help us understand if this trend is a causal effect of the law or an unrelated trend.
To perform a systematic literature review to synthesize evidence on what clinical programs American hospitals implemented in response to HRRP.
Following PRISMA guidelines, we conducted a systematic review in April 2020 that included a search of PubMed, the Cochrane Library and Cumulative Index to Nursing and Allied Literature (CINAHL) for studies related to hospital strategies to reduce HF readmissions.
Of 20 included articles, 8 were qualitative (survey and interviews), 3 were systematic reviews, 5 were single site quality improvement (QI) initiatives, 2 were plans for ongoing randomized control trials (RCTs), one was a plan for a future RCT and one was an observational analysis. We found that interventions hospitals undertook in response to HRRP to reduce HF readmissions fell into four categories: inpatient care, discharge, transitional care and data collection/administration. The majority of interventions were related to transitional care, most commonly scheduling follow up appointments within 7-14 days of discharge, performing post-discharge phone calls and partnering with community physicians.
We did not find any published evidence of practices that could mechanistically be linked to harm to HF patients enacted by hospitals in response to HRRP. For example, no programs encouraged emergency department providers to discharge patients from emergency departments. We found QI initiatives, improved discharge planning and increased post-discharge follow up.
医院再入院率降低计划（HRRP）的通过与心力衰竭（HF）患者的风险标准化再入院率降低有关。然而，一些定量分析表明 HRRP 与住院 HF 患者的死亡率增加之间存在关联。关于医院实际实施了哪些项目的定性信息可以帮助我们了解这一趋势是该法律的因果效应还是无关趋势。
进行系统文献综述，综合美国医院为响应 HRRP 而实施的临床方案的证据。
根据 PRISMA 指南，我们于 2020 年 4 月进行了一项系统综述，该综述包括对 PubMed、Cochrane 图书馆和 Cumulative Index to Nursing and Allied Literature（CINAHL）的搜索，以查找与医院减少 HF 再入院策略相关的研究。
在 20 篇纳入的文章中，8 篇为定性研究（调查和访谈），3 篇为系统评价，5 篇为单站点质量改进（QI）计划，2 篇为正在进行的随机对照试验（RCT）计划，1 篇为未来 RCT 的计划，1 篇为观察性分析。我们发现，医院为响应 HRRP 而采取的减少 HF 再入院的干预措施可分为四类：住院治疗、出院、过渡性护理和数据收集/管理。大多数干预措施与过渡性护理有关，最常见的是在出院后 7-14 天内安排随访预约、进行出院后电话随访以及与社区医生合作。
我们没有发现任何关于医院为响应 HRRP 而采取的可能对 HF 患者造成伤害的做法的证据。例如，没有任何计划鼓励急诊科医生将患者从急诊科出院。我们发现了 QI 计划、改善出院计划和增加出院后随访。
