A nurse‐led Asthma Care Team transitioning patients from hospital to home improves asthma control: A pilot study exploring an alternative model of care

Jayaram, Lata; Gillman, Andrew; Casanelia, Sue; Yee, Valerie; Hocking, Valerie; Wasgewatta, Sanjiwika; Reid-Price, Lynnette; Botlero, Roslin; Southcott, Anne Marie

doi:10.1002/hpja.620

Cited by 1 publication

(8 citation statements)

References 17 publications

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“…Following title and abstract screening, 274 full texts were retrieved. A total of 126 RCTs involving 97 408 participants met our inclusion criteria (Figure 2). The study characteristics are presented in eAppendix 3 in Supplement 1.…”

Section: Resultsmentioning

confidence: 99%

“…Pooling data from 27 studies (34 direct comparisons) involving 13 039 participants, low-complexity (OR, 0.45; 95% CI, 0.30 to 0.66), medium-complexity (OR, 0.57; 95% CI, 0.35 to 0.91), and high-complexity (OR, 0.78; 95% CI, 0.62 to 0.98) interventions were associated decreased odds of readmission at 180 days compared with usual care (Figure 4). The P -score showed that low-complexity interventions ( P -Score = 94%) were most effective in reducing the 180-day readmission odds.…”

Section: Resultsmentioning

confidence: 99%

“…Moreover, we obtained preliminary evidence from pairwise meta-analysis that medium-complexity interventions might be best for reducing patient and medication harms (ie, adverse events 11,102,104,134,138 and medication adherence 44,93,94,103,130,134,138 ) whereas highcomplexity interventions might be best for improving patient satisfaction. 9,74,81,91,105,133,143 In general, the intervention complexity did not affect the intervention uptake; the only exception was that the uptake of medium-complexity interventions might be lower in low-resource settings, such as…”

Section: Discussionmentioning

confidence: 98%

“…High-complexity interventions were associated with increased patient satisfaction (7 studies 9,74,81,91,105,133,143 : SMD, 0.52; 95% CI, 0.22 to 0.82). Heterogeneity was moderate (I 2 = 58%; 95% CI, 3% to 82%).…”

Section: Patient Satisfactionmentioning

confidence: 99%

“…Most trials reported hospital readmissions and, at best, some additional health care utilization outcomes (eg, ED visits, 7, 9, 29-31, 34, 35, 37, 39, 47-50, 52, 56-58, 60, 61, 67, 68, 73, 78, 80, 87, 88, 94, 102, 105, 106, 113, 115, 119, 121, 125, 130, 132, 137, 145, 146, 148 length of hospital stay 8,13,30,38,43,51,55,56,65,71,72,74,80,87,89,90,99,101,109,110,112,121,126 ), and adverse outcomes (mortality 7, 9, 10, 12, 32, 35, 37, 39, 40, 44, 47, 48, 56, 57, 70, 76-79, 83, 89, 91-94, 97, 98, 100, 106, 110, 111, 114, 116, 121, 123, 125, 127, 137, 139, 141, 142, 148 ). Few trials have measured patient-reported outcomes (eg, QOL 9, 32, 38, 44, 56, 65, 66, 83-85, 91, 97, 105, 107, 110, 112, 114, 123, 125, 126, 132, 133, 140, 141, 145, 148 and patient satisfaction with the transitional care 7,9,13,32,43,62,67,74,80,81,91,105,115,130,133,143 ) and broader risks for patient harm and safety 11,…”

Section: Jama Network Open | Health Policymentioning

confidence: 99%

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Transitional Care Interventions From Hospital to Community to Reduce Health Care Use and Improve Patient Outcomes

Tyler,

Hodkinson,

Planner

et al. 2023

JAMA Netw Open

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ImportanceDischarge from the hospital to the community has been associated with serious patient risks and excess service costs.ObjectiveTo evaluate the comparative effectiveness associated with transitional care interventions with different complexity levels at improving health care utilization and patient outcomes in the transition from the hospital to the community.Data SourcesCENTRAL, Embase, MEDLINE, and PsycINFO were searched from inception until August 2022.Study SelectionRandomized clinical trials evaluating transitional care interventions from hospitals to the community were identified.Data Extraction and SynthesisAt least 2 reviewers were involved in all data screening and extraction. Random-effects network meta-analyses and meta-regressions were applied. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed.Main Outcomes and MeasuresThe primary outcomes were readmission at 30, 90, and 180 days after discharge. Secondary outcomes included emergency department visits, mortality, quality of life, patient satisfaction, medication adherence, length of stay, primary care and outpatient visits, and intervention uptake.ResultsOverall, 126 trials with 97 408 participants were included, 86 (68%) of which were of low risk of bias. Low-complexity interventions were associated with the most efficacy for reducing hospital readmissions at 30 days (odds ratio [OR], 0.78; 95% CI, 0.66 to 0.92) and 180 days (OR, 0.45; 95% CI, 0.30 to 0.66) and emergency department visits (OR, 0.68; 95% CI, 0.48 to 0.96). Medium-complexity interventions were associated with the most efficacy at reducing hospital readmissions at 90 days (OR, 0.64; 95% CI, 0.45 to 0.92), reducing adverse events (OR, 0.42; 95% CI, 0.24 to 0.75), and improving medication adherence (standardized mean difference [SMD], 0.49; 95% CI, 0.30 to 0.67) but were associated with less efficacy than low-complexity interventions for reducing readmissions at 30 and 180 days. High-complexity interventions were most effective for reducing length of hospital stay (SMD, −0.20; 95% CI, −0.38 to −0.03) and increasing patient satisfaction (SMD, 0.52; 95% CI, 0.22 to 0.82) but were least effective for reducing readmissions at all time periods. None of the interventions were associated with improved uptake, quality of life (general, mental, or physical), or primary care and outpatient visits.Conclusions and RelevanceThese findings suggest that low- and medium-complexity transitional care interventions were associated with reducing health care utilization for patients transitioning from hospitals to the community. Comprehensive and consistent outcome measures are needed to capture the patient benefits of transitional care interventions.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%