Zhong Claire C W, Wong Charlene H L, Cheung William K W, Yeoh Eng-Kiong, Hung Chi Tim, Yip Benjamin H K, Wong Eliza L Y, Wong Samuel Y S, Chung Vincent C H
Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, HK.
School of Chinese Medicine, The Chinese University of Hong Kong, Shatin, HK.
Int J Integr Care. 2022 Feb 3;22(1):7. doi: 10.5334/ijic.6018. eCollection 2022 Jan-Mar.
An overview of systematic reviews(SRs) and network meta-analysis(NMA) were conducted to evaluate the comparative effectiveness of peri-discharge complex interventions for reducing 30-day readmissions among chronic obstructive pulmonary disease(COPD) patients.
Five databases were searched for SRs of randomized controlled trials(RCTs). An additional search was conducted for updated RCTs from database inception until Jun 2020. Pooled effect of peri-discharge complex interventions was assessed using random-effect pairwise meta-analyses. Comparative effectiveness across different peri-discharge complex interventions was evaluated using NMA.
Nine SRs and 11 eligible RCTs(n = 1,422) assessing eight different peri-discharge complex interventions were included. For reducing 30-day all-cause readmissions, pairwise meta-analysis showed no significant difference between peri-discharge complex interventions and usual care, while NMA indicated no significant differences among different peri-discharge complex interventions as well as usual care. For reducing 30-day COPD-related readmissions, peri-discharge complex interventions were significantly more effective than usual care (pooled RR = 0.45, 95% CI:0.24-0.84).
Peri-discharge complex interventions may not differ from usual care in reducing 30-day all-cause readmissions among COPD patients but some are more effective for lowering 30-day COPD-related readmission. Thus, complex intervention comprising core components of patient education, self-management, patient-centred discharge instructions, and telephone follow up may be considered for implementation, but further evaluation is warranted.
进行了系统评价（SR）和网状Meta分析（NMA）综述，以评估出院时综合干预措施在降低慢性阻塞性肺疾病（COPD）患者30天再入院率方面的比较效果。
检索了五个数据库以查找随机对照试验（RCT）的系统评价。另外还进行了一次检索，以查找从数据库建立到2020年6月的最新RCT。使用随机效应成对Meta分析评估出院时综合干预措施的合并效应。使用NMA评估不同出院时综合干预措施的比较效果。
纳入了9项系统评价和11项符合条件的RCT（n = 1422），评估了8种不同的出院时综合干预措施。对于降低30天全因再入院率，成对Meta分析显示出院时综合干预措施与常规护理之间无显著差异，而NMA表明不同出院时综合干预措施以及常规护理之间也无显著差异。对于降低30天COPD相关再入院率，出院时综合干预措施比常规护理显著更有效（合并RR = 0.45，95%CI：0.24 - 0.84）。
出院时综合干预措施在降低COPD患者30天全因再入院率方面可能与常规护理无差异，但有些措施在降低30天COPD相关再入院率方面更有效。因此，可以考虑实施包括患者教育、自我管理、以患者为中心的出院指导和电话随访等核心组成部分的综合干预措施，但仍需进一步评估。
