Preventing 30-day hospital readmissions: a systematic review and meta-analysis of randomized trials.
Preventing 30-day hospital readmissions: a systematic review and meta-analysis of randomized trials.
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DOI：
10.1001/jamainternmed.2014.1608
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发表时间：
2014-07
影响因子：
39
通讯作者：
Montori, Victor M.
中科院分区：
文献类型：
--
作者：
Leppin, Aaron L.;Gionfriddo, Michael R.;Kessler, Maya;Brito, Juan Pablo;Mair, Frances S.;Gallacher, Katie;Wang, Zhen;Erwin, Patricia J.;Sylvester, Tanya;Boehmer, Kasey;Ting, Henry H.;Murad, M. Hassan;Shippee, Nathan D.;Montori, Victor M.
减少早期（<30天）住院再入院是一项旨在提高医疗质量的政策重点。累积复杂性模型概念化了患者的环境。它预测，高度支持的出院干预措施将提高患者制定繁重的自我护理和避免再入院的能力。综合干预措施减少早期住院再入院的有效性的证据，并确定干预措施的特征——包括它们对治疗负担的影响和对患者制定出院后自我护理能力的影响——这可能解释它们不同的效果。我们检索了电子数据库（1990年至2013年4月1日），联系了专家，并查阅了参考文献。评估干预措施对因内科或外科原因住院24小时并出院的成年患者出院后30天内全因或计划外再入院的影响的随机试验。审稿人对提取试验特征，并使用基于活动的编码策略来描述干预措施；与作者确认了保真度。对试验结果不知情，根据累积复杂性模型，审稿人注意到干预措施在出院后对患者施加额外工作或支持其自我护理能力的程度。在出院后30天，有或没有院外死亡的全因或计划外再入院的相对风险。在42项试验中，所测试的干预措施预防了早期再入院[综合随机效应相对风险（RR） 0.82, 95% CI 0.73至0.91；p = .03点;I2= 32%]，这一发现在患者亚组中是一致的。2002年以前发表的试验报告的干预措施比后来测试的干预措施有效1.6倍（p相互作用= 0.01）。在探索性亚组分析中，多成分干预（p < 0.01）、更多个体参与护理（p < 0.05）和支持患者自我护理能力（p < 0.05）的干预效果是其他干预的1.4倍、1.3倍和1.3倍。事后回归模型显示，为患者和护理人员提供全面的出院后支持的增量价值。经过测试的干预措施在减少再入院方面是有效的，但更有效的干预措施是复杂的，并支持患者自我护理的能力。最近测试的干预措施效果较差。普洛斯彼罗,CRD42013004773
Reducing early (<30 days) hospital readmissions is a policy priority aimed at improving healthcare quality. The Cumulative Complexity Model conceptualizes patient context. It predicts that highly supportive discharge interventions will enhance patient capacity to enact burdensome self-care and avoid readmissions. To synthesize the evidence of the efficacy of interventions to reduce early hospital readmissions and identify intervention features—including their impact on treatment burden and on patients’ capacity to enact post-discharge self-care—that might explain their varying effects. We searched electronic databases (1990 until April 1st, 2013), contacted experts, and reviewed bibliographies. Randomized trials that assessed the effect of interventions on all-cause or unplanned readmissions within 30 days of discharge in adult patients admitted to the hospital for a medical or surgical cause for > 24 hours and discharged to home. Reviewer pairs extracted trial characteristics and used an activity-based coding strategy to characterize the interventions; fidelity was confirmed with authors. Blinded to trial outcomes, reviewers noted the extent to which interventions placed additional work on patients after discharge or supported their capacity for self-care in accordance with the Cumulative Complexity Model. Relative risk of all-cause or unplanned readmission with or without out of hospital deaths at 30 days post-discharge. In 42 trials, the tested interventions prevented early readmissions [pooled random effects relative risk (RR) 0.82, 95% CI 0.73 to 0.91; p=.03; I2= 32%], a finding that was consistent across patient subgroups. Trials published before 2002 reported interventions that were 1.6 times more effective than those tested later (pinteraction = .01). In exploratory subgroup analyses, interventions with many components (pinteraction <.01), involving more individuals in care delivery (pinteraction = .05), and supporting patient capacity for self-care (pinteraction = .04) were 1.4, 1.3, and 1.3 times more effective than other interventions. A post-hoc regression model showed incremental value in providing comprehensive, post-discharge support to patients and caregivers. Tested interventions are effective at reducing readmissions, but more effective interventions are complex and support patient capacity for self-care. Interventions tested more recently are less effective. PROSPERO, CRD42013004773
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影响因子：
8
作者：
Braun, Eyal;Baidusi, Amjad;Azzam, Zaher S.
通讯作者：
Azzam, Zaher S.
影响因子：
2.2
作者：
DerSimonian, Rebecca;Kacker, Raghu
通讯作者：
Kacker, Raghu
影响因子：
18.2
作者：
Davis, Karen K.;Mintzer, Miriam;Allen, Jerilyn
通讯作者：
Allen, Jerilyn
影响因子：
1.9
作者：
Herrera-Espiñeira, Carmen;Rodríguez del Águila, María del Mar;Reyes Sánchez, Isabel
通讯作者：
Reyes Sánchez, Isabel
影响因子：
24.3
作者：
Casas, A.;Troosters, T.;Decramer, M.
通讯作者：
Decramer, M.