Transitional care interventions to reduce readmission in patients with chronic obstructive pulmonary disease:A meta-analysis of randomized controlled trials

摘要

Objective:To objectively assess the effect of transitional care on readmission for patients with chronic obstructive pulmonary disease.Methods:The PubMed,Science Direct,Web of Science,Cochrane Library,CNKI,and Wanfang databases were searched for relevant randomized controlled trials(RCTs) published from January 1990 through April 2016.The quality of eligible studies was assessed by two investigators.The primary outcome assessed was readmission for COPD and all-cause readmission.The pooled effect sizes were expressed as the relative risk and standard mean difference with 95%confidence intervals.Heterogeneity among studies was assessed using the Cochrane Handbook for Systematic Reviews of Interventions(Version5.1.0) and determined with an I^2 statistic.Results:A total of seven RCTs that included 1879 participants who met the inclusion criteria were analyzed.The results of subgroup analysis showed significant differences in readmission for COPD at the6 month and 18 month time points and all-cause readmission at the 18 month follow-up.Transitional care could reduce readmission for COPD at the 6 month[RR = 0.51,95%CI(0.38,0.68),P < 0.00001]and18 month time points[RR = 0.56,95%CI(0.45,0.69),P < 0.00001,and also reduce all-cause readmission after 18 months[RR = 0.72,95%CI(0.62,0.84),P < 0.0001].The reduction of all-cause readmission between the intervention and control groups in the 2nd year,however,was less than that in the 1st year.Conclusions:Transitional care is beneficial to reducing readmission for patients with COPD.Duration of≥ 6 and ≤ 18 months are more effective,and the effect weakens over intervention time,especially after the end of intervention.Both durations point to the importance of ongoing intervention and reinforcement after the end of intervention.