Effect of a Transitional Care Intervention on Rehospitalization and Mortality after Sepsis: A 12-Month Follow-up of a Randomized Clinical Trial

Kowalkowski, Marc; Rios, Aleta; McSweeney, Joan; Murphy, Stephanie; McWilliams, Andrew; Chou, Shih-Hsiung; Hetherington, Timothy; Rossman, Whitney; Taylor, Stephanie Parks

doi:10.1164/rccm.202203-0590le

Cited by 12 publications

(16 citation statements)

References 11 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%

“…Across 42 studies (53 direct comparisons) involving 31 988 participants, none of the 3 intervention intensities were significantly associated with reducing mortality compared with usual care (Figure 5). Global heterogeneity of the network was seen to be very low ( I 2 = 0%; 95% CI, 0% to 36%), and there was no evidence of inconsistency in the model (eAppendix 5 in Supplement 1).…”

Section: Resultsmentioning

confidence: 99%

“…Moreover, an important but unintended finding of this review was that the range of outcomes reported by interventions was very narrow. Most trials reported hospital readmissions and, at best, some additional health care utilization outcomes (eg, ED visits, length of hospital stay), and adverse outcomes (mortality). Few trials have measured patient-reported outcomes (eg, QOL and patient satisfaction with the transitional care) and broader risks for patient harm and safety; none of the studies reported staff outcomes, despite the fact that transitional care interventions were mostly service delivery interventions relying on staff engagement for their success.…”

Section: Discussionmentioning

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%

Section: Discussionmentioning

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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“…readmission among high-risk sepsis survivors [34] and this effect was sustained at 12-month follow-up [35]. Further, secondary analysis of sepsis survivors discharged to postacute care facilities suggested that the nurse navigator program may reduce 30-day mortality and readmission rates among patients discharged to skilled nursing facilities, a population that has traditionally been challenging to support [36 & ].…”

Section: Key Pointsmentioning

confidence: 99%

Health system approaches to providing posthospital care for survivors of sepsis and critical illness

Eaton,

Taylor

2023

Current Opinion in Critical Care

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Purpose of review In the current review, we highlight developing strategies taken by healthcare systems to improve posthospital outcomes for sepsis and critical illness. Recent findings Multiple studies conducted in the adult population over the last 18 months have advanced current knowledge on postdischarge care after sepsis and critical illness. Effective interventions are complex and multicomponent, targeting the multilevel challenges that survivors face. Health systems can leverage existing care models such as primary care or invest in specialty programs to deliver postdischarge care. Qualitative and implementation science studies provide insights into important contextual factors for program success. Several studies demonstrate successful application of telehealth to improve reach of postdischarge support. Research is beginning to identify subtypes of survivors that may respond to tailored intervention strategies. Summary Several successful critical illness survivor models of care have been implemented and knowledge about effectiveness, cost, and implementation factors of these strategies is growing. Further innovation is needed in intervention development and evaluation to advance the field.

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“…The study found that the adjusted risk of 30-day hospital readmission or mortality was lower in the group of patients who treated in the intervention group when compared with the patients treated in the usual care arm [14]. This multicomponent programme that was delivered for 30 days was also associated with a durable effect on 12-month rehospitalization and mortality: compared with usual care [15 ▪▪ ].…”

Section: Transitions Of Care: Discharge Home From Hospitalmentioning

confidence: 99%

Healthcare delivery and recovery after critical illness

Hope

McPeake

2022

Current Opinion in Critical Care

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Purpose of reviewTo summarize improvements and innovations in healthcare delivery which could be implemented to improve the recovery experience after critical illness for adult survivors and their families.Recent findingsFor survivors of critical illness, the transitions in care during their recovery journey are points of heightened vulnerability associated with adverse events. Survivors of critical illness often have errors in the management of their medications during the recovery period. A multicomponent intervention delivered for 30 days that focused on four key principles of improved recovery care after sepsis care was associated with a durable effect on 12-month rehospitalization and mortality compared with usual care. A recent multicentre study which piloted integrating health and social care for critical care survivors demonstrated improvements in health-related quality of life and self-efficacy at 12 months. Multiple qualitative studies provide insights into how peer support programmes could potentially benefit survivors of critical illness by providing them mechanism to share their experiences, to give back to other patients, and to set more realistic expectations for recovery.SummaryFuture research could focus on exploring safety outcomes as primary endpoints and finding ways to develop and test implementation strategies to improve the recovery after critical illness.

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Effect of a Transitional Care Intervention on Rehospitalization and Mortality after Sepsis: A 12-Month Follow-up of a Randomized Clinical Trial

Cited by 12 publications

References 11 publications

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

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

Health system approaches to providing posthospital care for survivors of sepsis and critical illness

Healthcare delivery and recovery after critical illness

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