Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA.
Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA.
J Racial Ethn Health Disparities. 2023 Aug;10(4):1962-1977. doi: 10.1007/s40615-022-01378-4. Epub 2022 Aug 1.
This systematic review aims to summarize interventions that effectively reduced hospital readmission rates for African Americans (AAs) aged 65 and older.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for this review. Studies were identified by searching PubMed for clinical trials on reducing hospital readmission among older patients published between 1 January 1990 and 31 January 2020. Eligibility criteria for the included studies were mean or median age ≥ 65 years, AAs included in the study, randomized clinical trial or quasi-experimental design, presence of an intervention, and hospital readmission as an outcome.
There were 5270 articles identified and 11 were included in the final review based on eligibility criteria. The majority of studies were conducted in academic centers, were multi-center trials, and included over 200 patients, and 6-90% of participants were older AAs. The length of intervention ranged from 1 week to over a year, with readmission assessed between 30 days and 1 year. Four studies which reported interventions that significantly reduced readmissions included both inpatient (e.g., discharge planning prior to discharge) and outpatient care components (e.g., follow-ups after discharge), and the majority used a multifaceted approach.
Findings from the review suggest successful interventions to reduce readmissions among AAs aged 65 and older should include inpatient and outpatient care components at a minimum. This systematic review showed limited evidence of interventions successfully decreasing readmission in older AAs, suggesting a need for research in the area to reduce readmission disparities and improve overall health.
本系统评价旨在总结有效降低 65 岁及以上非裔美国人（AA）住院再入院率的干预措施。
本综述遵循系统评价和荟萃分析的首选报告项目指南。通过在 PubMed 上搜索 1990 年 1 月 1 日至 2020 年 1 月 31 日期间发表的关于降低老年患者住院再入院率的临床试验，确定研究。纳入研究的标准为：平均或中位数年龄≥65 岁、研究中包括 AA、随机临床试验或准实验设计、存在干预措施以及住院再入院作为结局。
共确定了 5270 篇文章，根据纳入标准最终有 11 篇文章纳入了最终综述。大多数研究在学术中心进行，是多中心试验，纳入了超过 200 名患者，6%-90%的参与者为年长的 AA。干预措施的持续时间从 1 周到 1 年以上不等，再入院评估时间为 30 天至 1 年。四项报告了显著降低再入院率的干预措施的研究包括住院（例如，出院前的出院计划）和门诊护理（例如，出院后的随访），大多数研究采用了多方面的方法。
本综述的结果表明，降低 65 岁及以上 AA 住院再入院率的有效干预措施至少应包括住院和门诊护理部分。本系统评价表明，干预措施成功降低老年 AA 再入院率的证据有限，表明需要在该领域开展研究，以减少再入院差异，改善整体健康状况。
