0
selected
-
1.
Effects of Transitional Care on Hospital Readmission and Mortality Rate in Subjects With COPD: A Systematic Review and Meta-Analysis.
Ridwan, ES, Hadi, H, Wu, YL, Tsai, PS
Respiratory care. 2019;(9):1146-1156
Abstract
BACKGROUND Studies on the effect of transitional care on hospital readmissions have reported inconsistent findings, and the effect on mortality has not been reviewed systematically. This systematic review and meta-analysis of randomized controlled trials aims to examine the effect of transitional care interventions on COPD-related readmissions, all-cause hospital readmissions, and all-cause mortality rates in subjects with COPD. METHODS Electronic databases (CINAHL, Embase, Scopus, MEDLINE, Cochrane, PubMed, Web of Science, Airity, BMJ Respiratory Research Journal, and National Digital Library of Theses and Dissertations) were searched from inception to April 26, 2017. Online searches were conducted using key words and MeSH terms for COPD and transitional care. Entry terms for searching included chronic obstructive pulmonary disease, COPD, COPD transitional care or care transition, continuity of patient care, patient discharge, and patient transfer. The quality of the included trials was assessed using the Cochrane Collaboration tool. RESULTS 13 randomized controlled trials met the inclusion criteria. Transitional care significantly reduced the risk of COPD-related readmissions (odds ratio = 0.599, 95% CI 0.421-0.852) and all-cause hospital readmissions (odds ratio = 0.720, 95% CI 0.531-0.978), but not that of all-cause mortality (odds ratio = 0.863, 95% CI 0.576-1.294) in subjects with COPD. The effects of transitional care on hospital readmissions were moderated by the duration of interventions, type of care providers, and use of telephone follow-up as an element of the intervention. CONCLUSIONS There was a significant effect of transitional care on both COPD-related and all-cause hospital readmissions in subjects with COPD. Duration of interventions, type of care providers, and use of telephone follow-up appeared to moderate the beneficial effects of transitional care.
-
2.
Thirty-Day Readmission After Radical Gastrectomy for Gastric Cancer: A Meta-analysis.
Dan, Z, YiNan, D, ZengXi, Y, XiChen, W, JieBin, P, LanNing, Y
The Journal of surgical research. 2019;:180-188
Abstract
BACKGROUND Readmission is a commonly accepted parameter to evaluate surgical quality, but previous studies reported inconsistent results in radical gastrectomy. The purpose of our study is to clarify the prevalence, potential causes, and risk factors of 30-d readmission after radical gastrectomy for gastric cancer. METHODS PubMed and Embase were systematically searched from inception to September 2018 for any possible inclusion. Prevalence, potential causes, and risk factors of 30-d readmission in included studies were extracted using a standardized EXCEL table. The overall 30-d readmission rate was pooled using a random-effects model. Odds ratios with 95% confidence intervals were used to estimate potential risk factors for 30-d readmission. Publication bias was assessed using a funnel plot and statistical tests. RESULTS A total of nine studies with 16,581 patients were included in the current meta-analysis. The pooled 30-d readmission rate after radical gastrectomy was 8% (95% confidence interval, 0.04-0.12). Nutritional difficulty and surgical site infections were the main causes for 30-d readmission. Cardiovascular comorbidity, total gastrectomy, nutritional risk screening 2002 score ≥3, any complications, laparoscopic gastrectomy, and C-reactive protein on postoperative day 3 ≥12 were strong predictors for 30-d readmission, whereas combined multiorgan resection was a weaker predictor. No significant publication bias was identified through the funnel plot and statistical tests. CONCLUSIONS The 30-d readmission rate after radical gastrectomy ranges from 4% to 12% and can mainly result from nutritional difficulty and surgical site infections. Nutritional risk screening 2002 score ≥3, cardiovascular comorbidity, total gastrectomy, any complications, and laparoscopic gastrectomy were potential risk factors for 30-d readmission.
-
3.
Lower mortality after early supervised pulmonary rehabilitation following COPD-exacerbations: a systematic review and meta-analysis.
Ryrsø, CK, Godtfredsen, NS, Kofod, LM, Lavesen, M, Mogensen, L, Tobberup, R, Farver-Vestergaard, I, Callesen, HE, Tendal, B, Lange, P, et al
BMC pulmonary medicine. 2018;(1):154
Abstract
BACKGROUND Pulmonary rehabilitation (PR), delivered as a supervised multidisciplinary program including exercise training, is one of the cornerstones in the chronic obstructive pulmonary disease (COPD) management. We performed a systematic review and meta-analysis to assess the effect on mortality of a supervised early PR program, initiated during or within 4 weeks after hospitalization with an acute exacerbation of COPD compared with usual post-exacerbation care or no PR program. Secondary outcomes were days in hospital, COPD related readmissions, health-related quality of life (HRQoL), exercise capacity (walking distance), activities of daily living (ADL), fall risk and drop-out rate. METHODS We identified randomized trials through a systematic search using MEDLINE, EMBASE and Cocharne Library and other sources through October 2017. Risk of bias was assessed regarding randomization, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting, and other biases using the Cochrane Risk of Bias tool. RESULTS We included 13 randomized trials (801 participants). Our meta-analyses showed a clinically relevant reduction in mortality after early PR (4 trials, 319 patients; RR = 0.58 (95% CI: [0.35 to 0.98])) and at the longest follow-up (3 trials, 127 patients; RR = 0.55 (95% CI: [0.12 to 2.57])). Early PR reduced number of days in hospital by 4.27 days (1 trial, 180 patients; 95% CI: [- 6.85 to - 1.69]) and hospital readmissions (6 trials, 319 patients; RR = 0.47 (95% CI: [0.29 to 0.75])). Moreover, early PR improved HRQoL and walking distance, and did not affect drop-out rate. Several of the trials had unclear risk of bias in regard to the randomization and blinding, for some outcome there was also a lack of power. CONCLUSION Moderate quality of evidence showed reductions in mortality, number of days in hospital and number of readmissions after early PR in patients hospitalized with a COPD exacerbation. Long-term effects on mortality were not statistically significant, but improvements in HRQoL and exercise capacity appeared to be maintained for at least 12 months. Therefore, we recommend early supervised PR to patients with COPD-related exacerbations. PR should be initiated during hospital admission or within 4 weeks after hospital discharge.
-
4.
Comparative effectiveness of transitional care services in patients discharged from the hospital with heart failure: a systematic review and network meta-analysis.
Van Spall, HGC, Rahman, T, Mytton, O, Ramasundarahettige, C, Ibrahim, Q, Kabali, C, Coppens, M, Brian Haynes, R, Connolly, S
European journal of heart failure. 2017;(11):1427-1443
Abstract
AIMS: To compare the effectiveness of transitional care services in decreasing all-cause death and all-cause readmissions following hospitalization for heart failure (HF). METHODS AND RESULTS We searched PubMed, Embase, CINAHL, and Cochrane Clinical Trials Register for randomized controlled trials (RCTs) published in 2000-2015 that tested the efficacy of transitional care services in patients hospitalized for HF, provided ≥1 month of follow-up, and reported all-cause mortality or all-cause readmissions. Our network meta-analysis included 53 RCTs (12 356 patients). Among services that significantly decreased all-cause mortality compared with usual care, nurse home visits were most effective [ranking P-score 0.6794; relative risk (RR) 0.78, 95% confidence intervals (CI) 0.62-0.98], followed by disease management clinics (DMCs) (ranking P-score 0.6368; RR 0.80, 95% CI 0.67-0.97). Among services that significantly decreased all-cause readmission, nurse home visits were most effective [ranking P-score 0.8365; incident rate ratio (IRR) 0.65, 95% CI 0.49-0.86], followed by nurse case management (NCM) (ranking P-score 0.6168; IRR 0.77, 95% CI 0.63-0.95), and DMCs (ranking P-score 0.5691; IRR 0.80, 95% CI 0.66-0.97). There was no significant difference in the comparative effectiveness of services that improved each outcome. Nurse home visits had the greatest pooled cost-savings (3810 USD, 95% CI 3682-3937), followed by NCM (3435 USD, 95% CI 3224-3645), and DMCs (245 USD, 95% CI -70 to 559). Telephone, telemonitoring, pharmacist, and education interventions did not significantly improve clinical outcomes. CONCLUSION Nurse home visits and DMCs decrease all-cause mortality after hospitalization for HF. Along with NCM, they also reduce all-cause readmissions, with no significant difference in comparative effectiveness. These services reduce healthcare system costs to varying degrees.