Preventing the rebound: improving care transition in hospital discharge processes
Preventing the rebound: improving care transition in hospital discharge processes
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DOI：
10.1071/ah09777
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发表时间：
2010-01-01
影响因子：
1.8
通讯作者：
Scott, Ian A.
中科院分区：
文献类型：
--
作者：
Scott, Ian A.
背景最近出院的病人的计划外再入院给床位有限的医院带来了沉重的负担。在放电过程中的缺陷有助于这种再入院，这促使实验与多种类型的围放电干预。确定出院前后干预的相对疗效，分为两组：（1）出院前或出院后实施的单组分干预（单独或主要）;（2）具有出院前和出院后元素的综合多组分干预。对照试验的系统荟萃评价。数据收集。检索1990年1月至2009年4月期间发表的4个电子数据库中的对照试验或试验系统综述，这些试验报告了对再入院的影响。在单组分干预措施中，只有四种（高风险患者的强化自我管理和过渡辅导以及心力衰竭患者的护士家访和电话支持）在减少再入院方面有效。多组分干预措施的特点是出院需求的早期评估，加强患者（和护理者）教育和咨询，以及高危患者出院后的早期随访，这些干预措施与获益证据相关，尤其是在老年患者和心力衰竭患者中。围出院期干预是高度异质性和报告的结果显示出相当大的变化。然而，针对高风险人群的多组分干预措施，包括出院前和出院后的元素，似乎是更有效地减少再入院比大多数单组分干预措施，不跨越医院-社区接口。
Background. Unplanned readmissions of recently discharged patients impose a significant burden on hospitals with limited bed capacity. Deficiencies in discharge processes contribute to such readmissions, which have prompted experimentation with multiple types of peridischarge interventions.Objective. To determine the relative efficacy of peridischarge interventions categorised into two groups: (1) single component interventions (sole or predominant) implemented either before or after discharge; and (2) integrated multicomponent interventions which have pre- and postdischarge elements.Design. Systematic metareview of controlled trials.Data collection. Search of four electronic databases for controlled trials or systematic reviews of trials published between January 1990 and April 2009 that reported effects on readmissions.Data synthesis. Among single-component interventions, only four (intense self-management and transition coaching of high-risk patients and nurse home visits and telephone support of patients with heart failure) were effective in reducing readmissions. Multicomponent interventions that featured early assessment of discharge needs, enhanced patient (and caregiver) education and counselling, and early postdischarge follow-up of high-risk patients were associated with evidence of benefit, especially in populations of older patients and those with heart failure.Conclusion. Peridischarge interventions are highly heterogenous and reported outcomes show considerable variation. However, multicomponent interventions targeted at high-risk populations that include pre- and postdischarge elements seem to be more effective in reducing readmissions than most single-component interventions, which do not span the hospital-community interface.