Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong.
Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Rm 509, Prince of Wales Hospital, Shatin, Hong Kong.
Perspect Public Health. 2022 Sep;142(5):263-277. doi: 10.1177/1757913920985258. Epub 2021 Mar 15.
An overview of systematic reviews (SRs) and network meta-analysis (NMA) was conducted to synthesize evidence of comparative effectiveness of different peri-discharge complex interventions for reducing 30-day hospital readmissions among heart failure (HF) patients.
We searched five databases for SRs from their inception to August 2019 and conducted additional search for randomized controlled trials (RCTs) published between 2003 and 2020. We used random-effect pairwise meta-analysis with pooled risk ratios (RRs) and 95% confidence intervals (CIs) to quantify the effect of complex interventions, and NMA to evaluate comparative effectiveness among complex interventions. Primary outcome was 30-day all-cause hospital readmissions, while secondary outcomes were 30-day HF-related hospital readmissions, 30-day mortality, and 30-day emergency department visits.
From 20 SRs and additional RCT search, 21 eligible RCTs ( = 5362) assessing eight different peri-discharge complex interventions were included. Pairwise meta-analysis showed no significant difference between peri-discharge complex interventions and controls on all outcomes, except that peri-discharge complex interventions were significantly more effective than controls in reducing 30-day mortality (pooled RR = 0.68, 95% CI: 0.49-0.95, 5 RCTs). NMA indicated that for reducing 30-day all-cause hospital readmissions, supportive-educative intervention had the highest probability to be the best intervention, followed by disease management; while for reducing 30-day HF-related hospital readmissions, disease management is likely to be the best intervention.
Our results suggest that disease management has the best potential to reduce 30-day all-cause and HF-related hospital readmissions. Benefits of the interventions may vary across health system contexts. Evidence-based complex interventions require local adaptation prior to implementation.
对系统评价（SRs）和网络荟萃分析（NMA）进行综述，以综合评估不同出院后综合干预措施在降低心力衰竭（HF）患者 30 天内再入院率方面的比较效果。
我们从建库开始到 2019 年 8 月，在五个数据库中搜索 SRs，并对 2003 年至 2020 年期间发表的随机对照试验（RCTs）进行了额外搜索。我们使用随机效应成对荟萃分析，合并风险比（RR）和 95%置信区间（CI）来量化复杂干预措施的效果，并使用 NMA 来评估复杂干预措施之间的比较效果。主要结局为 30 天全因住院再入院率，次要结局为 30 天 HF 相关住院再入院率、30 天死亡率和 30 天急诊就诊率。
从 20 项 SR 和额外的 RCT 搜索中，纳入了 21 项符合条件的 RCT（n=5362），评估了 8 种不同的出院后综合干预措施。成对荟萃分析显示，除了出院后综合干预措施在降低 30 天死亡率方面显著优于对照组（合并 RR=0.68，95%CI：0.49-0.95，5 项 RCT）外，出院后综合干预措施与对照组在所有结局上均无显著差异。NMA 表明，在降低 30 天全因住院再入院率方面，支持性教育干预最有可能成为最佳干预措施，其次是疾病管理；而在降低 30 天 HF 相关住院再入院率方面，疾病管理可能是最佳干预措施。
我们的结果表明，疾病管理最有可能降低 30 天全因和 HF 相关住院再入院率。干预措施的益处可能因卫生系统背景而异。需要在实施前对基于证据的复杂干预措施进行本土化调整。
