Pattar Badal S B, Ackroyd Abigail, Sevinc Emir, Hecker Taylor, Turino Miranda Keila, McClurg Caitlin, Weekes Kyle, James Matthew T, Pannu Neesh, Ravani Pietro, Ronksley Paul E, Ahmed Sofia B, Harrison Tyrone G
Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.
JAMA Netw Open. 2025 Jul 1;8(7):e2521785. doi: 10.1001/jamanetworkopen.2025.21785.
Hospital readmissions are associated with significant health care costs and poor patient outcomes. Despite the rapid adoption of electronic health record (EHR) systems, the use of EHR-based interventions to reduce the risk of hospital readmissions is unknown.
To systematically review and estimate the association of EHR-based interventions vs controls with preventing 30-day all-cause hospital readmissions as tested in randomized clinical trials (RCTs).
Ovid MEDLINE, Ovid Embase, CINAHL, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched from database inception to July 5, 2024, using text words with analogous terms within concept areas of "randomized controlled trial," "hospitalized adults," and "readmissions."
RCTs were included if they evaluated the effect of EHR-based interventions on hospital readmissions compared with a control arm without an EHR-embedded component. Studies were excluded if they involved nonhospitalized, pediatric, obstetric, or psychiatric populations or did not report readmission outcomes. Results were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline.
Data were extracted independently by 3 reviewers in duplicate. A random-effects model was used to pool data, and the quality of studies was assessed using the Cochrane Risk of Bias tool. Heterogeneity was quantified using the I2 statistic and explored with prespecified subgroup analyses and univariable meta-regression by population demographics, intervention complexity, and publication year.
The primary outcome was 30-day all-cause hospital readmission, and other readmission outcomes (eg, unplanned readmissions and readmissions at 3, 6, 12, and 24 months) were examined as secondary outcomes.
A total of 116 RCTs involving 204 523 participants (weighted mean [SD] males, 56% [16%]; weighted mean [SD] age, 68 [9] years) were included, with telemonitoring (76 studies [66%]) being the most common EHR-based intervention component followed by case management (45 studies [39%]) and medication reconciliation (33 [28%]). EHR-based interventions were associated with a statistically significant reduction in 30-day all-cause readmissions (OR, 0.83 [95% CI, 0.70-0.99]; I2 = 82%; τ = 0.44 [95% CI, 0.30-0.62]; prediction interval [PI], 0.34-2.06) and 90-day all-cause readmissions (OR, 0.72 [95% CI, 0.54-0.96]; I2 = 78%; τ = 0.34 [95% CI, 0.19-1.00]; PI, 0.33-1.55) compared with control arms.
In this systematic review and meta-analysis of RCTs, the use of EHR-based interventions was associated with a reduction in 30-day and 90-day hospital readmissions. Future research should examine additional components of EHR interventions to understand and account for remaining gaps in effectiveness.
医院再入院与高昂的医疗保健成本及患者不良预后相关。尽管电子健康记录（EHR）系统迅速普及，但基于EHR的干预措施对降低医院再入院风险的作用尚不清楚。
系统评价并估计在随机临床试验（RCT）中，基于EHR的干预措施与对照措施在预防30天全因医院再入院方面的关联。
从数据库建立至2024年7月5日，检索了Ovid MEDLINE、Ovid Embase、CINAHL、Cochrane对照试验中央注册库和ClinicalTrials.gov，使用了在“随机对照试验”、“住院成人”和“再入院”等概念领域内具有类似术语的文本词。
如果RCT评估了基于EHR的干预措施对医院再入院的影响，并与没有嵌入EHR组件的对照组进行比较，则纳入研究。如果研究涉及非住院患者、儿科患者、产科患者或精神科患者，或者未报告再入院结局，则排除该研究。结果按照系统评价和Meta分析的首选报告项目报告指南进行报告。
由3名评审员独立进行数据提取，重复提取两次。采用随机效应模型汇总数据，并使用Cochrane偏倚风险工具评估研究质量。使用I²统计量对异质性进行量化，并通过预先设定的亚组分析以及按人口统计学特征、干预复杂性和发表年份进行的单变量Meta回归进行探索。
主要结局是30天全因医院再入院，其他再入院结局（如非计划再入院以及3、6、12和24个月时的再入院）作为次要结局进行检查。
共纳入116项RCT，涉及204523名参与者（加权均值[标准差]男性为56%[16%]；加权均值[标准差]年龄为68[9]岁），其中远程监测（76项研究[66%]）是最常见的基于EHR的干预组件，其次是病例管理（45项研究[39%]）和用药核对（33项[28%]）。与对照组相比，基于EHR的干预措施与30天全因再入院率（比值比[OR]，0.83[95%置信区间，0.70 - 0.99]；I² = 82%；τ = 0.44[95%置信区间，0.30 - 0.62]；预测区间[PI]，0.34 - 2.06）和90天全因再入院率（OR，0.72[95%置信区间，0.54 - 0.96]；I² = 78%；τ = 0.34[95%置信区间，0.19 - 1.00]；PI = 表1。基于电子健康记录的干预措施与对照措施在预防医院再入院方面的关联
0.33 - 1.55）的统计学显著降低相关。
在这项对RCT的系统评价和Meta分析中，基于EHR的干预措施的使用与30天和90天医院再入院率的降低相关。未来的研究应检查EHR干预措施的其他组件，以了解并填补有效性方面的剩余差距。
