Isabelle Vedel1, Vladimir Khanassov2. 1. Department of Family Medicine, McGill University, Montreal, Canada isabelle.vedel@mcgill.ca. 2. Department of Family Medicine, McGill University, Montreal, Canada.
Abstract
PURPOSE: We aimed to determine the impact of transitional care interventions (TCIs) on acute health service use by patients with congestive heart failure in primary care and to identify the most effective TCIs and their optimal duration. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials, searching the Medline, PsycInfo, EMBASE, and Cochrane Library databases. We performed a meta-analysis to assess the impact of TCI on all-cause hospital readmissions and emergency department (ED) visits. We developed a taxonomy of TCIs based on intensity and assessed the methodologic quality of the trials. We calculated the relative risk (RR) and a 95% confidence interval for each outcome. We conducted a stratified analysis to identify the most effective TCIs and their optimal duration. RESULTS: We identified 41 randomized controlled trials. TCIs significantly reduced risks of readmission and ED visits by 8% and 29%, respectively (relative risk = 0.92; 95% CI, 0.87-0.98; P = .006 and relative risk = 0.71; 95% CI, 0.51-0.98; P = .04). High-intensity TCIs (combining home visits with telephone followup, clinic visits, or both) reduced readmission risk regardless of the duration of follow-up. Moderate-intensity TCIs were efficacious if implemented for a longer duration (at least 6 months). In contrast, low-intensity TCIs, entailing only followup in outpatient clinics or telephone follow-up, were not efficacious. CONCLUSIONS: Clinicians and managers who implement TCIs in primary care can incorporate these results with their own health care context to determine the optimal balance between intensity and duration of TCIs. High-intensity interventions seem to be the best option. Moderate-intensity interventions implemented for 6 months or longer may be another option.
PURPOSE: We aimed to determine the impact of transitional care interventions (TCIs) on acute health service use by patients with congestive heart failure in primary care and to identify the most effective TCIs and their optimal duration. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials, searching the Medline, PsycInfo, EMBASE, and Cochrane Library databases. We performed a meta-analysis to assess the impact of TCI on all-cause hospital readmissions and emergency department (ED) visits. We developed a taxonomy of TCIs based on intensity and assessed the methodologic quality of the trials. We calculated the relative risk (RR) and a 95% confidence interval for each outcome. We conducted a stratified analysis to identify the most effective TCIs and their optimal duration. RESULTS: We identified 41 randomized controlled trials. TCIs significantly reduced risks of readmission and ED visits by 8% and 29%, respectively (relative risk = 0.92; 95% CI, 0.87-0.98; P = .006 and relative risk = 0.71; 95% CI, 0.51-0.98; P = .04). High-intensity TCIs (combining home visits with telephone followup, clinic visits, or both) reduced readmission risk regardless of the duration of follow-up. Moderate-intensity TCIs were efficacious if implemented for a longer duration (at least 6 months). In contrast, low-intensity TCIs, entailing only followup in outpatient clinics or telephone follow-up, were not efficacious. CONCLUSIONS: Clinicians and managers who implement TCIs in primary care can incorporate these results with their own health care context to determine the optimal balance between intensity and duration of TCIs. High-intensity interventions seem to be the best option. Moderate-intensity interventions implemented for 6 months or longer may be another option.
Authors: Christiane E Angermann; Stefan Störk; Götz Gelbrich; Hermann Faller; Roland Jahns; Stefan Frantz; Markus Loeffler; Georg Ertl Journal: Circ Heart Fail Date: 2011-09-28 Impact factor: 8.790
Authors: Jeffrey A Alexander; Michael Paustian; Christopher G Wise; Lee A Green; Michael D Fetters; Margaret Mason; Darline K El Reda Journal: Ann Fam Med Date: 2013 May-Jun Impact factor: 5.166
Authors: William Claiborne Dunagan; Benjamin Littenberg; Gregory A Ewald; Catherine A Jones; Valerie Beckham Emery; Brian M Waterman; Daniel C Silverman; Joseph G Rogers Journal: J Card Fail Date: 2005-06 Impact factor: 5.712
Authors: Bonnie J Wakefield; Marcia M Ward; John E Holman; Annette Ray; Melody Scherubel; Trudy L Burns; Michael G Kienzle; Gary E Rosenthal Journal: Telemed J E Health Date: 2008-10 Impact factor: 3.536
Authors: A Giordano; S Scalvini; E Zanelli; U Corrà; G L Longobardi; V A Ricci; P Baiardi; F Glisenti Journal: Int J Cardiol Date: 2008-01-28 Impact factor: 4.164
Authors: Khadijah Breathett; Rachel D'Amico; T M Ayodele Adesanya; Stefanie Hatfield; Shannon Willis; Rodney X Sturdivant; Randi E Foraker; Sakima Smith; Philip Binkley; William T Abraham; Pamela N Peterson Journal: Circ Heart Fail Date: 2017-06 Impact factor: 8.790
Authors: Òscar Miró; V Íctor Gil; Francisco Javier Martín-Sánchez; Javier Jacob; Pablo Herrero; Aitor Alquézar; Lluís Llauger; Sira Aguiló; Gemma Martínez; José Ríos; Alberto Domínguez-Rodríguez; Veli-Pekka Harjola; Christian Müller; John Parissis; W Frank Peacock; Pere Llorens Journal: Clin Res Cardiol Date: 2018-03-28 Impact factor: 5.460
Authors: Òscar Miró; Koji Takagi; Étienne Gayat; Víctor Gil; Pere Llorens; Francisco J Martín-Sánchez; Javier Jacob; Pablo Herrero-Puente; Rosa Escoda; María Pilar López-Díez; Amparo Valero; Marta Fuentes; José M Garrido; Eva Salvo; Miguel A Rizzi; Alfons Aguirre; Lissete Travería Bécquer; Alberto Domínguez-Rodríguez; Joan Padrosa; Gemma Martínez; Mattia Arrigo; Yonathan Freund; Alexandre Mebazaa Journal: Clin Res Cardiol Date: 2019-04-29 Impact factor: 5.460
Authors: Cheryl D Bushnell; Pamela W Duncan; Sarah L Lycan; Christina N Condon; Amy M Pastva; Barbara J Lutz; Jacqueline R Halladay; Doyle M Cummings; Martinson K Arnan; Sara B Jones; Mysha E Sissine; Sylvia W Coleman; Anna M Johnson; Sabina B Gesell; Laurie H Mettam; Janet K Freburger; Blair Barton-Percival; Karen M Taylor; Janet Prvu-Bettger; Gladys Lundy-Lamm; Wayne D Rosamond Journal: J Am Geriatr Soc Date: 2018-03-23 Impact factor: 7.538
Authors: Rosalia Santesmases-Masana; Luis González-de Paz; Elvira Hernández-Martínez-Esparza; Belchin Kostov; Maria Dolors Navarro-Rubio Journal: Int J Environ Res Public Health Date: 2019-05-09 Impact factor: 3.390
Authors: Lian Leng Low; Wei Yi Tay; Shu Yun Tan; Elian Hui San Chia; Rachel Marie Towle; Kheng Hock Lee Journal: Int J Integr Care Date: 2017-08-14 Impact factor: 5.120