照顾者参与增强了过渡期护理干预随机对照试验的结果：系统评价和荟萃分析。
Caregiver Engagement Enhances Outcomes Among Randomized Control Trials of Transitional Care Interventions: A Systematic Review and Meta-analysis.
机构信息
Department of Community and Health Systems, Indiana University (IU) School of Nursing.
IU Center for Aging Research, Regenstrief Institute.
出版信息
Med Care. 2022 Jul 1;60(7):519-529. doi: 10.1097/MLR.0000000000001728. Epub 2022 May 16.
BACKGROUND
Fluctuations in health among chronically ill adults result in frequent health care transitions. Some interventions to improve patient outcomes after hospitalization include caregiver engagement as a core component, yet there is unclear evidence of the effects of this component on outcomes.
OBJECTIVE
The objective of this study was to synthesize evidence regarding the attention given to caregiver engagement in randomized control trials of transitional care interventions (TCIs), estimate the overall intervention effects, and assess caregiver engagement as a moderator of intervention effects.
METHODS
Three databases were systematically searched for randomized control trials of TCIs targeting adults living with physical or emotional chronic diseases. For the meta-analysis, overall effects were computed using the relative risk (RR) effect size and inverse variance weighting.
RESULTS
Fifty-four studies met criteria, representing 31,291 participants and 66 rehospitalizations effect sizes. Half (51%) the interventions lacked focus on caregiver engagement. The overall effect of TCIs on all-cause rehospitalizations was nonsignificant at 1 month (P=0.107, k=29), but significant at ≥2 months [RR=0.89; 95% confidence interval (CI): 0.82, 0.97; P=0.007, k=27]. Caregiver engagement moderated intervention effects (P=0.05), where interventions with caregiver engagement reduced rehospitalizations (RR=0.83; 95% CI: 0.75, 0.92; P=0.001), and those without, did not (RR=0.97; 95% CI: 0.87, 1.08; P=0.550). Interventions with and without caregiver engagement did not differ in the average number of components utilized, however, interventions with caregiver engagement more commonly employed baseline needs assessments (P=0.032), discharge planning (P=0.006), and service coordination (P=0.035).
DISCUSSION
Future TCIs must consistently incorporate the active participation of caregivers in design, delivery, and evaluation.
背景
慢性病患者的健康状况波动会导致频繁的医疗保健转衔。一些旨在改善住院后患者结局的干预措施包括将照护者的参与作为核心组成部分，但该组成部分对结局的影响证据尚不明确。
目的
本研究旨在综合有关过渡性护理干预（TCI）随机对照试验中对照护者参与关注度的证据，估计总体干预效果，并评估照护者参与作为干预效果的调节因素。
方法
系统检索了针对患有身体或情绪慢性疾病的成年人的 TCI 随机对照试验的三个数据库。对于荟萃分析，使用相对风险（RR）效应大小和倒数方差加权来计算总体效果。
结果
54 项研究符合标准，共纳入 31291 名参与者和 66 次再住院事件的效应量。半数（51%）的干预措施未聚焦于照护者的参与。TCI 在 1 个月时对所有原因再住院的总体效果无统计学意义（P=0.107，k=29），但在≥2 个月时具有统计学意义[RR=0.89；95%置信区间（CI）：0.82，0.97；P=0.007，k=27]。照护者的参与调节了干预效果（P=0.05），其中包含照护者参与的干预措施降低了再住院率（RR=0.83；95%CI：0.75，0.92；P=0.001），而不包含照护者参与的干预措施则未降低（RR=0.97；95%CI：0.87，1.08；P=0.550）。有和没有照护者参与的干预措施在使用的组件数量上没有差异，但有照护者参与的干预措施更常进行基线需求评估（P=0.032）、出院计划（P=0.006）和服务协调（P=0.035）。
讨论
未来的 TCI 必须始终将照护者的积极参与纳入设计、实施和评估中。
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