The Effectiveness of Chronic Care Management for Heart Failure: Meta-Regression Analyses to Explain the Heterogeneity in Outcomes
The Effectiveness of Chronic Care Management for Heart Failure: Meta-Regression Analyses to Explain the Heterogeneity in Outcomes
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DOI：
10.1111/j.1475-6773.2012.01396.x
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发表时间：
2012-10-01
影响因子：
3.4
通讯作者：
Vrijhoef, Hubertus J. M.
中科院分区：
文献类型：
--
作者：
Drewes, Hanneke W.;Steuten, Lotte M. G.;Vrijhoef, Hubertus J. M.
目的通过研究心力衰竭慢性护理管理评价的有效性异质性，为优化慢性护理的决策提供依据。评估慢性护理管理干预措施的综述和初步研究。研究设计一项系统综述，包括荟萃回归分析，以调查有效性异质性的三个潜在来源：研究质量、随访时间和慢性护理模型组成部分的数量。我们的荟萃分析显示，在明尼苏达州心力衰竭患者生活问卷调查中，慢性护理管理平均降低了18%的死亡率（95% CI: 0.720.94），平均降低了18%的住院率（95% CI: 0.760.93），并将生活质量提高了7.14点（95% CI: -9.55至-4.72）。我们无法解释这些研究中住院治疗和生活质量的巨大差异。结论慢性护理管理可显著降低死亡率。然而，对住院治疗和生活质量的积极影响在有效性上存在很大的异质性。这种异质性不能用研究质量、随访时间或慢性护理模型组成部分的数量来解释。需要更多地关注慢性护理管理的发展和实施，以支持关于如何最好地重新设计慢性护理的知情决策。
Objective To support decision making on how to best redesign chronic care by studying the heterogeneity in effectiveness across chronic care management evaluations for heart failure. Data Sources Reviews and primary studies that evaluated chronic care management interventions. Study Design A systematic review including meta-regression analyses to investigate three potential sources of heterogeneity in effectiveness: study quality, length of follow-up, and number of chronic care model components. Principal Findings Our meta-analysis showed that chronic care management reduces mortality by a mean of 18 percent (95 percent CI: 0.720.94) and hospitalization by a mean of 18 percent (95 percent CI: 0.760.93) and improves quality of life by 7.14 points (95 percent CI: -9.55 to -4.72) on the Minnesota Living with Heart Failure questionnaire. We could not explain the considerable differences in hospitalization and quality of life across the studies. Conclusion Chronic care management significantly reduces mortality. Positive effects on hospitalization and quality of life were shown, however, with substantial heterogeneity in effectiveness. This heterogeneity is not explained by study quality, length of follow-up, or the number of chronic care model components. More attention to the development and implementation of chronic care management is needed to support informed decision making on how to best redesign chronic care.