Phillips Sarah A, Sill Julie D, Qayyum Rehan
Eastern Virginia Medical School, Norfolk, Virginia, USA.
J Hosp Med. 2025 Sep;20(9):988-997. doi: 10.1002/jhm.70073. Epub 2025 May 14.
Preventable hospital readmissions, reflecting suboptimal healthcare quality and increased costs, highlight the need for evidence to shape healthcare delivery.
This systematic review assesses interventions to reduce readmissions following pneumonia-related hospitalizations.
PubMed, Cochrane Library, and CINAHL were searched from inception to May 29, 2024. English language peer-reviewed studies examining interventions to reduce readmissions after pneumonia hospitalization were selected. Two authors independently extracted data, assessed risk of bias, and evaluated certainty of evidence using standardized assessment tools. When possible, study results were pooled using random-effects models.
Of the 601 articles initially identified, 15 studies met inclusion criteria. Eight interventions were evaluated from eight retrospective cohort studies, five randomized controlled trials, and two pre-post trials. Hospital-based skilled nursing facilities, patient education, early postdischarge follow-up, nutrition supplementation, and a high physician-to-bed ratio were linked to reduced readmissions. Early mobilization also showed a significant reduction in readmissions (pooled odds ratio = 0.84, 95% confidence interval [CI]: 0.75, 0.95; p = .005). Hospital participation in Accountable Care Organizations did not affect readmissions, and pharmacist-involved discharge similarly found no significant impact (pooled odds ratio = 0.66, 95% CI: 0.44, 1.01; p = .06). Risk of bias was high across most studies due to inadequate controlling for confounding variables.
Certainty of evidence was high for early mobilization, low for hospital-based skilled nursing facilities, and very low for pharmacist-involved discharge processes. Small sample size and single-center intervention implementation limited study generalizability. Randomized controlled trials are needed to determine the efficacy of interventions for reducing readmissions after pneumonia hospitalization.
可预防的医院再入院情况反映了医疗质量欠佳和成本增加，凸显了获取证据以优化医疗服务的必要性。
本系统评价评估了降低肺炎相关住院后再入院率的干预措施。
检索了自数据库建库至2024年5月29日的PubMed、Cochrane图书馆和CINAHL数据库。纳入了经同行评审的英文研究，这些研究探讨了降低肺炎住院后再入院率的干预措施。两位作者独立提取数据，评估偏倚风险，并使用标准化评估工具评估证据的确定性。如有可能，使用随机效应模型汇总研究结果。
在最初识别的601篇文章中，15项研究符合纳入标准。从8项回顾性队列研究、5项随机对照试验和2项前后对照试验中评估了8种干预措施。基于医院的专业护理机构、患者教育、出院后早期随访、营养补充以及高医生床位比与再入院率降低相关。早期活动也显示再入院率显著降低（合并比值比 = 0.84，95%置信区间[CI]：0.75，0.95；p = 0.00５）。医院参与 accountable care organizations（可问责医疗组织）对再入院率没有影响，药剂师参与出院指导同样未发现显著影响（合并比值比 = 0.66，95% CI：0.44，1.01；p = 0.06）。由于对混杂变量控制不足，大多数研究的偏倚风险较高。
早期活动的证据确定性高，基于医院的专业护理机构的证据确定性低，药剂师参与出院流程的证据确定性非常低。样本量小和单中心干预实施限制了研究的可推广性。需要进行随机对照试验来确定降低肺炎住院后再入院率干预措施的疗效。
