Denise Bryant-Lukosius1,2, Nancy Carter3,2, Kim Reid4, Faith Donald2,5, Ruth Martin-Misener2,6, Kelley Kilpatrick2,7, Patricia Harbman3,2,8, Sharon Kaasalainen3, Deborah Marshall9,10, Renee Charbonneau-Smith11, Alba DiCenso12. 1. School of Nursing and Department of Oncology, McMaster University, Hamilton, Ontario, Canada. 2. Affiliate Faculty, Canadian Centre for Advanced Practice Nursing Research, Hamilton, Ontario, Canada. 3. School of Nursing, McMaster University, Hamilton, Ontario, Canada. 4. KJResearch, Rosemere, Quebec, Canada. 5. Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada. 6. School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada. 7. Faculty of Nursing, Université de Montreal, Montréal, Quebec, Canada. 8. Health Interventions Research Centre, Ryerson University, Toronto, Ontario, Canada. 9. Health Services and Systems Research, University of Calgary, Calgary, Alberta, Canada. 10. Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada. 11. Canadian Centre for Advanced Practice Nursing Research, Hamilton, Ontario, Canada. 12. School of Nursing and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Abstract
RATIONALE, AIMS AND OBJECTIVES: Clinical nurse specialists (CNSs) are major providers of transitional care. This paper describes a systematic review of randomized controlled trials (RCTs) evaluating the clinical effectiveness and cost-effectiveness of CNS transitional care. METHODS: We searched 10 electronic databases, 1980 to July 2013, and hand-searched reference lists and key journals for RCTs that evaluated health system outcomes of CNS transitional care. Study quality was assessed using the Cochrane Risk of Bias and Quality of Health Economic Studies tools. The quality of evidence for individual outcomes was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. We pooled data for similar outcomes. RESULTS: Thirteen RCTs of CNS transitional care were identified (n = 2463 participants). The studies had low (n = 3), moderate (n = 8) and high (n = 2) risk of bias and weak economic analyses. Post-cancer surgery, CNS care was superior in reducing patient mortality. For patients with heart failure, CNS care delayed time to and reduced death or re-hospitalization, improved treatment adherence and patient satisfaction, and reduced costs and length of re-hospitalization stay. For elderly patients and caregivers, CNS care improved caregiver depression and reduced re-hospitalization, re-hospitalization length of stay and costs. For high-risk pregnant women and very low birthweight infants, CNS care improved infant immunization rates and maternal satisfaction with care and reduced maternal and infant length of hospital stay and costs. CONCLUSIONS: There is low-quality evidence that CNS transitional care improves patient health outcomes, delays re-hospitalization and reduces hospital length of stay, re-hospitalization rates and costs. Further research incorporating robust economic evaluation is needed.
RATIONALE, AIMS AND OBJECTIVES: Clinical nurse specialists (CNSs) are major providers of transitional care. This paper describes a systematic review of randomized controlled trials (RCTs) evaluating the clinical effectiveness and cost-effectiveness of CNS transitional care. METHODS: We searched 10 electronic databases, 1980 to July 2013, and hand-searched reference lists and key journals for RCTs that evaluated health system outcomes of CNS transitional care. Study quality was assessed using the Cochrane Risk of Bias and Quality of Health Economic Studies tools. The quality of evidence for individual outcomes was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. We pooled data for similar outcomes. RESULTS: Thirteen RCTs of CNS transitional care were identified (n = 2463 participants). The studies had low (n = 3), moderate (n = 8) and high (n = 2) risk of bias and weak economic analyses. Post-cancer surgery, CNS care was superior in reducing patient mortality. For patients with heart failure, CNS care delayed time to and reduced death or re-hospitalization, improved treatment adherence and patient satisfaction, and reduced costs and length of re-hospitalization stay. For elderly patients and caregivers, CNS care improved caregiver depression and reduced re-hospitalization, re-hospitalization length of stay and costs. For high-risk pregnant women and very low birthweight infants, CNS care improved infant immunization rates and maternal satisfaction with care and reduced maternal and infant length of hospital stay and costs. CONCLUSIONS: There is low-quality evidence that CNS transitional care improves patient health outcomes, delays re-hospitalization and reduces hospital length of stay, re-hospitalization rates and costs. Further research incorporating robust economic evaluation is needed.
Authors: Alison A Galbraith; David J Meyers; Dennis Ross-Degnan; Marguerite E Burns; Catherine E Vialle-Valentin; Marc R Larochelle; Sharon Touw; Fang Zhang; Meredith Rosenthal; Richard B Balaban Journal: Health Serv Res Date: 2017-12 Impact factor: 3.402
Authors: Thomas M Diehl; James R Barrett; Daniel E Abbott; Linda M Cherney Stafford; Bret M Hanlon; Qiuyu Yang; Rachel Van Doorn; Sharon M Weber; Corrine I Voils Journal: Contemp Clin Trials Date: 2021-12-22 Impact factor: 2.226