Department of Clinical Science, University of Bergen, P.O. box 7804, 5020, Bergen, Norway.
School of Healthcare, University of Leicester, Leicester, UK.
BMC Health Serv Res. 2023 Jun 22;23(1):684. doi: 10.1186/s12913-023-09712-0.
Patients with chronic obstructive pulmonary disease (COPD) are frequently readmitted to hospital resulting in avoidable healthcare costs. Many different interventions designed to reduce hospital readmissions are reported with limited evidence for effectiveness. Greater insight into how interventions could be better designed to improve patient outcomes has been recommended.
To identify areas for optimisation within previously reported interventions provided to reduce COPD rehospitalisation to improve future intervention development.
A systematic review was conducted by searching Medline, Embase, CINAHL, PsycINFO, and CENTRAL in June 2022. Inclusion criteria were interventions provided to patients with COPD in the transition from hospital to home or community. Exclusion criteria were lack of empirical qualitative results, reviews, drug trials, and protocols. Study quality was assessed using the Critical Appraisal Skills Programme tool and results were synthesised thematically.
A total of 2,962 studies were screened and nine studies included. Patients with COPD experience difficulties when transitioning from hospital to home. It is therefore important for interventions to facilitate a smooth transition process and give appropriate follow-up post-discharge. Additionally, interventions should be tailored for each patient, especially regarding information provided.
Very few studies specifically consider processes underpinning COPD discharge intervention implementation. There is a need to recognise that the transition itself creates problems, which require addressing, before introducing any new intervention. Patients report a preference for interventions to be individually adapted-in particular the provision of patient information. Whilst many intervention aspects were well received, feasibility testing may have enhanced acceptability. Patient and public involvement may address many of these concerns and greater use of process evaluations should enable researchers to learn from each other's experiences.
The review was registered in PROSPERO with registration number CRD42022339523.
慢性阻塞性肺疾病（COPD）患者经常住院治疗，导致不必要的医疗费用。许多不同的干预措施旨在减少住院人数，但有效性的证据有限。有人建议，需要更深入地了解如何更好地设计干预措施，以改善患者的结局。
确定先前报道的降低 COPD 再住院率以改善未来干预措施开发的干预措施中需要优化的领域。
于 2022 年 6 月，通过检索 Medline、Embase、CINAHL、PsycINFO 和 CENTRAL，进行了系统综述。纳入标准为为 COPD 患者从医院到家庭或社区过渡期间提供的干预措施。排除标准为缺乏实证定性结果、综述、药物试验和方案。使用批判性评估技能计划工具评估研究质量，并对结果进行主题综合。
共筛选了 2962 项研究，纳入了 9 项研究。COPD 患者在从医院过渡到家庭时会遇到困难。因此，干预措施应促进平稳过渡过程，并在出院后提供适当的随访。此外，干预措施应针对每个患者进行定制，尤其是在提供信息方面。
很少有研究专门考虑 COPD 出院干预实施的基础过程。在引入任何新的干预措施之前，需要认识到过渡本身会带来问题，需要加以解决。患者报告倾向于个性化的干预措施，特别是提供患者信息。虽然许多干预措施方面都得到了很好的接受，但可行性测试可能会提高可接受性。患者和公众的参与可以解决其中的许多问题，更多地使用过程评估可以使研究人员从彼此的经验中学习。
该综述在 PROSPERO 上进行了注册，注册号为 CRD42022339523。
