背景:长期患病的老年患者通常容易受到有害健康后果的影响,并且可预防的再入院风险增加。利用电信和监视技术的远程护理干预措施有助于监测患者出院后的状况,以防止负面的健康结果。
目的:本系统评价和荟萃分析旨在确定和综合现有证据,证明远程转换护理干预措施对急性再次入院高危老年人各种健康结局的有效性。
方法:已发布,未发表的研究和灰色文献通过搜索PubMed,Medline,Embase,PsycINFO,科克伦图书馆,CINAHL,Scopus,ProQuest论文和论文以及Google学者从成立到2021年12月。仅包括以英语发表的随机对照试验,该试验评估了高危老年人的护理干预措施的远程过渡。使用RevMan5.4中的随机效应模型进行Meta分析。进行敏感性和亚组和叙事分析。
结果:纳入14项研究,其中13项被考虑进行荟萃分析。远程过渡护理干预措施可有效降低再入院率(RR=0.59,95CI0.50-0.69,z=6.28,p<0.00001),死亡率(RR=0.72,95CI0.53-0.98,z=2.12,p=0.03),改善健康相关生活质量(SMD=0.24,Z=2.04,p=0.04)。然而,干预后未观察到急诊就诊减少(RR=1.10,95CI0.59-2.06,z=0.31,p=0.76)和功能状态改善(SMD=-0.06,Z=0.19,p=0.85).亚组分析发现,即使在干预后,远程转换护理干预的积极作用仍持续到180天。
结论:本系统综述和荟萃分析得出的结论是,护理干预措施的远程过渡对再入院具有良好的影响,死亡率和健康相关生活质量。护理干预的远程过渡具有成本效益,适合在医疗机构中大规模实施。
背景:该协议已在PROSPERO(CRD42022295665)上注册。
结论:系统评价表明,监测再次入院高风险的老年患者,出院后,使用电信和监视技术可以大大降低再入院率和死亡率,并提高其生活质量。
BACKGROUND: Chronically ill older patients are often vulnerable to detrimental health outcomes and have increased risk of preventable readmission. Tele-transitions of care interventions utilizing telecommunications and surveillance technologies help monitor patients\' conditions after discharge to prevent negative health outcomes.
OBJECTIVE: This systematic review and meta-analysis aimed to identify and synthesize available evidence on the effectiveness of tele-transitions of care interventions on various health outcomes in older adults at high risk for readmission discharged from acute setting.
METHODS: Published, unpublished studies and gray literatures were identified through searching PubMed, Medline, Embase, PsycINFO, Cochrane Library, CINAHL, Scopus, ProQuest Dissertations and theses and Google Scholar from inception to December 2021. Only randomized controlled trials published in English language assessing tele-transitions of care interventions on high-risk older adults were included. Meta-analyses were performed using random-effects model in RevMan 5.4. Sensitivity and subgroup and narrative analyses were conducted.
RESULTS: Fourteen studies were included, of which thirteen were considered for meta-analyses. Tele-transitions of care interventions were effective in reducing readmission rate (RR = 0.59, 95%CI 0.50-0.69, z = 6.28, p < 0.00001), mortality rate (RR = 0.72, 95%CI 0.53-0.98, z = 2.12, p = 0.03), and improving health-related quality of life (SMD = 0.24, Z = 2.04, p = 0.04). However, reduction of emergency department visit (RR = 1.10, 95%CI 0.59-2.06, z = 0.31, p = 0.76) and improvement of functional status (SMD = -0.06, Z = 0.19, p = 0.85) was not observed following intervention. Subgroup analysis found that the positive effects of tele-transitions of care interventions persist up to 180 days even after the intervention.
CONCLUSIONS: This systematic review and meta-analysis concluded that tele-transitions of care interventions have promising effects on readmission, mortality rate and health-related quality of life. Tele-transitions of care interventions are cost-effective and suitable for large-scale implementation in healthcare settings.
BACKGROUND: The protocol was registered on PROSPERO (CRD42022295665).
CONCLUSIONS: Systematic review demonstrates that monitoring older patients at high risk of readmission, following discharge from hospital, using telecommunication and surveillance technologies significantly reduces readmission and mortality rates and improves their quality of life.