Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Seven Oaks Hospital Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada.
PLoS One. 2021 Apr 22;16(4):e0249542. doi: 10.1371/journal.pone.0249542. eCollection 2021.
Readmission following hospital discharge is common and is a major financial burden on healthcare systems.
Our objectives were to 1) identify studies describing post-discharge interventions and their efficacy with respect to reducing risk of mortality and rate of hospital readmission; and 2) identify intervention characteristics associated with efficacy.
A systematic review of the literature was performed. We searched MEDLINE, PubMed, Cochrane, EMBASE and CINAHL. Our selection criteria included randomized controlled trials comparing post-discharge interventions with usual care on rates of hospital readmission and mortality in high-risk chronic disease patient populations. We used random effects meta-analyses to estimate pooled risk ratios for all-cause and cause-specific mortality as well as all-cause and cause-specific hospitalization.
We included 31 randomized controlled trials encompassing 9654 patients (24 studies in CHF, 4 in COPD, 1 in both CHF and COPD, 1 in CKD and 1 in an undifferentiated population). Meta-analysis showed post-discharge interventions reduced cause-specific (RR = 0.71, 95% CI = 0.63-0.80) and all cause (RR = 0.90, 95% CI = 0.81-0.99) hospitalization, all-cause (RR = 0.73, 95% CI = 0.65-0.83) and cause-specific mortality (RR = 0.68, 95% CI = 0.54-0.84) in CHF studies, and all-cause hospitalization (RR = 0.52, 95% CI = 0.32-0.83) in COPD studies. The inclusion of a cardiac nurse in the multidisciplinary team was associated with greater efficacy in reducing all-cause mortality among patients discharged after heart failure admission (HR = 0.64, 95% CI = 0.54-0.75 vs. HR = 0.87, 95% CI = 0.73-1.03).
Post-discharge interventions reduced all-cause mortality, cause-specific mortality, and cause-specific hospitalization in CHF patients and all-cause hospitalization in COPD patients. The presence of a cardiac nurse was associated with greater efficacy in included studies. Additional research is needed on the impact of post-discharge intervention strategies in COPD and CKD patients.
出院后再入院是常见的，这对医疗保健系统造成了重大的财务负担。
我们的目的是 1）确定描述出院后干预措施及其降低死亡率和再入院率效果的研究；2）确定与疗效相关的干预措施特征。
对文献进行系统回顾。我们检索了 MEDLINE、PubMed、Cochrane、EMBASE 和 CINAHL。我们的入选标准包括比较高危慢性疾病患者人群中出院后干预措施与常规护理在再入院率和死亡率方面的随机对照试验。我们使用随机效应荟萃分析来估计全因和病因特异性死亡率以及全因和病因特异性住院的汇总风险比。
我们纳入了 31 项随机对照试验，共纳入 9654 名患者（24 项研究为心力衰竭，4 项为慢性阻塞性肺疾病，1 项为心力衰竭和慢性阻塞性肺疾病，1 项为慢性肾脏病，1 项为未分化人群）。荟萃分析显示，出院后干预措施降低了心力衰竭研究中的病因特异性（RR = 0.71，95%CI = 0.63-0.80）和全因（RR = 0.90，95%CI = 0.81-0.99）住院、全因（RR = 0.73，95%CI = 0.65-0.83）和病因特异性死亡率（RR = 0.68，95%CI = 0.54-0.84），以及慢性阻塞性肺疾病研究中的全因住院（RR = 0.52，95%CI = 0.32-0.83）。多学科团队中包括心脏护士与心力衰竭患者出院后降低全因死亡率的疗效更高相关（HR = 0.64，95%CI = 0.54-0.75 与 HR = 0.87，95%CI = 0.73-1.03）。
出院后干预措施降低了心力衰竭患者的全因死亡率、病因特异性死亡率和病因特异性住院率，以及慢性阻塞性肺疾病患者的全因住院率。在纳入的研究中，心脏护士的存在与更高的疗效相关。需要进一步研究慢性阻塞性肺疾病和慢性肾脏病患者出院后干预策略的影响。
