Abstract：
Team-based palliative care interventions have shown positive results for patients at the end of life in both hospital and community settings. However, evidence on the effectiveness of transmural, that is, spanning hospital and home, team-based palliative care collaborations is limited.
To systematically review whether transmural team-based palliative care interventions can prevent hospital admissions and increase death at home.
Systematic review and meta-analysis.
MEDLINE (Ovid), Embase (Ovid), CINAHL (Ebsco), PsychINFO (Ovid), and Cochrane Library (Wiley) were systematically searched until January 2021. Studies incorporating teams in which hospital and community professionals co-managed patients, hospital-based teams with community follow-up, and case-management interventions led by palliative care teams were included. Data was extracted by two researchers independently.
About 19 studies were included involving 6614 patients, of whom 2202 received an intervention. The overall pooled odds ratio of at least one hospital (re)admissions was 0.46 (95% confidence interval (CI) 0.34-0.68) in favor of the intervention group. The highest reduction in admission was in the hospital-based teams with community follow-up: OR 0.21 (95% CI 0.07-0.66). The pooled effect on home deaths was 2.19 (95% CI 1.26-3.79), favoring the intervention, with also the highest in the hospital-based teams: OR 4.77 (95% CI 1.23-18.47). However, studies had high heterogeneity regarding intervention, study population, and follow-up time.
Transmural team-based palliative care interventions, especially hospital-based teams that follow-up patients at home, show an overall effect on lowering hospital admissions and increasing the number of patients dying at home. However, broad clinical and statistical heterogeneity of included studies results in uncertainty about the effect size.
To systematically review whether transmural team-based palliative care interventions can prevent hospital admissions and increase death at home.
Systematic review and meta-analysis.
MEDLINE (Ovid), Embase (Ovid), CINAHL (Ebsco), PsychINFO (Ovid), and Cochrane Library (Wiley) were systematically searched until January 2021. Studies incorporating teams in which hospital and community professionals co-managed patients, hospital-based teams with community follow-up, and case-management interventions led by palliative care teams were included. Data was extracted by two researchers independently.
About 19 studies were included involving 6614 patients, of whom 2202 received an intervention. The overall pooled odds ratio of at least one hospital (re)admissions was 0.46 (95% confidence interval (CI) 0.34-0.68) in favor of the intervention group. The highest reduction in admission was in the hospital-based teams with community follow-up: OR 0.21 (95% CI 0.07-0.66). The pooled effect on home deaths was 2.19 (95% CI 1.26-3.79), favoring the intervention, with also the highest in the hospital-based teams: OR 4.77 (95% CI 1.23-18.47). However, studies had high heterogeneity regarding intervention, study population, and follow-up time.
Transmural team-based palliative care interventions, especially hospital-based teams that follow-up patients at home, show an overall effect on lowering hospital admissions and increasing the number of patients dying at home. However, broad clinical and statistical heterogeneity of included studies results in uncertainty about the effect size.
摘要：
UNASSIGNED：在医院和社区环境中，基于团队的姑息治疗干预措施对临终患者都显示出积极的效果。然而,关于透壁有效性的证据，也就是说,跨越医院和家庭，基于团队的姑息治疗合作是有限的.
UNASSIGNED：系统评估基于团队的透壁姑息治疗干预措施是否可以预防住院和增加家庭死亡。
未经评估：系统评价和荟萃分析。
未经批准：MEDLINE(Ovid)，Embase(Ovid),CINAHL(Ebsco),心理信息(Ovid),和Cochrane图书馆（Wiley）进行了系统搜索，直到2021年1月。研究纳入了医院和社区专业人员共同管理患者的团队，以医院为基础的团队与社区后续行动，纳入了姑息治疗团队主导的病例管理干预措施.数据由两名研究人员独立提取。
未经评估：纳入了约19项研究，涉及6614名患者，其中2202人接受了干预。至少一次住院（重新入院）的总体合并比值比为0.46（95％置信区间（CI）0.34-0.68），有利于干预组。入院率下降幅度最大的是社区随访的医院团队：OR0.21（95％CI0.07-0.66）。对家庭死亡的综合影响为2.19(95%CI1.26-3.79)，赞成干预，在医院团队中也最高：OR4.77（95%CI1.23-18.47）。然而,研究在干预方面具有高度异质性，研究人群,和后续时间。
未经评估：以团队为基础的透壁性姑息治疗干预措施，尤其是在家中跟踪患者的医院团队，显示对降低住院率和增加在家中死亡的患者数量的总体影响。然而,纳入研究的广泛临床和统计学异质性导致效应大小的不确定性.
UNASSIGNED：系统评估基于团队的透壁姑息治疗干预措施是否可以预防住院和增加家庭死亡。
未经评估：系统评价和荟萃分析。
未经批准：MEDLINE(Ovid)，Embase(Ovid),CINAHL(Ebsco),心理信息(Ovid),和Cochrane图书馆（Wiley）进行了系统搜索，直到2021年1月。研究纳入了医院和社区专业人员共同管理患者的团队，以医院为基础的团队与社区后续行动，纳入了姑息治疗团队主导的病例管理干预措施.数据由两名研究人员独立提取。
未经评估：纳入了约19项研究，涉及6614名患者，其中2202人接受了干预。至少一次住院（重新入院）的总体合并比值比为0.46（95％置信区间（CI）0.34-0.68），有利于干预组。入院率下降幅度最大的是社区随访的医院团队：OR0.21（95％CI0.07-0.66）。对家庭死亡的综合影响为2.19(95%CI1.26-3.79)，赞成干预，在医院团队中也最高：OR4.77（95%CI1.23-18.47）。然而,研究在干预方面具有高度异质性，研究人群,和后续时间。
未经评估：以团队为基础的透壁性姑息治疗干预措施，尤其是在家中跟踪患者的医院团队，显示对降低住院率和增加在家中死亡的患者数量的总体影响。然而,纳入研究的广泛临床和统计学异质性导致效应大小的不确定性.
