Introduction
Methods
Study design
Electronic searches and selection of systematic reviews
Data extraction
Quality assessment of the systematic reviews
Results
Yield of the literature review
Included systematic reviews
Reference | Intervention | RCTs reporting HRR (n) | Total number of patients | RR or OR of HRR in intervention / control (95% CI) |
---|---|---|---|---|
(AMSTAR score) | ||||
Disease management programs
| ||||
Rotter et al. 2010 [23] (10) | Multidisciplinary care plans for patients with a specific clinical problem | 6 | 672 | 0.60 (0.32-1.13) |
Auer et al. 2008 [24] (7) | Multidimensional interventions for secondary prevention of acute coronary syndrome | 3 | 405 | 0.78 (0.54-1.13)+ |
Kwan and Sandercock 2004[25] (10) | Care pathways for stroke | 1 | 60 | 0.15 (0.04-0.59) |
Geriatric case management units
| ||||
Ellis et al. 2011 [26] (7) | Comprehensive geriatric assessment | 8 | 3,543 | 1.01 (0.87-1.17) |
Van Craen et al. 2010 [27] (7) | Geriatric evaluation and management units | 2 | 799 | 0.85 (0.65-1.11) |
Baztán et al. 2009 [28] (8) | Acute geriatric units | 3 | * | 1.11 (0.92-1.35) |
Griffiths et al. 2007 [29] (9) | Nursing-led units for chronically ill or geriatric patients | 3 | 493 | 0.63 (0.36-1.12) |
Stuck et al. 1993 [30] (6) | Geriatric evaluation and management units | 1 | 123 | 0.54 (0.26-1.11)+ |
Geriatric consultations and assessment programs
| ||||
Ellis et al. 2011 [26] (7) | Comprehensive geriatric assessment | 1 | 279 | 1.25 (0.78-2.01) |
Parker et al. 2002 [18] (9) | Comprehensive geriatric assessment | 10 | 952 | 0.90 (0.73-1.11) |
Stuck et al. 1993 [30] (6) | Geriatric consultation service | 3+ | 449+ | 0.51 (0.27-0.95)+ |
Pharmacological consultations
| ||||
Kaboli et al. 2006 [31] (4) | Interventions by pharmacists: participation on rounds, medication reconciliation, drug-specific services | 8 | 1,350 | 0.85 (0.49-1.46) + |
Discharge planning
| ||||
Shepperd et al. 2010 [14] (9) | Discharge plan for inpatients. Studies that did not discern discharge planning from provision of care after discharge were excluded. | 12 | 2,612 | 0.85 (0.74-0.97) |
Parker et al. 2002 [18] (9) | Discharge arrangements for older patients : Comprehensive discharge protocols | 6 | 1,958 | 0.93 (0.80-1.09) |
Reference (AMSTAR score) | Intervention | RCTs reporting HRR (n) | Total number of patients | RR or OR of HRR in intervention / control (95% CI) |
---|---|---|---|---|
Heart failure
| ||||
Home care
| ||||
Lambrinou et al. 2012 [32] (9) | Before hospital discharge: individualized patient education and discharge planning. After discharge: home care by cardiac community nurses or physicians | 6 | 1,052 | 0.80 (0.70- 0.91) |
Takeda et al. 2012 [33] (10) | Disease management with home visits and phone calls | 7 | 2,199 | 0.75 (0.57-0.99) |
Multidisciplinary care | 2 | 403 | 0.46 (0.30-0.69) | |
Tsai et al. 2005 [34] (6) | Chronic care model including: follow-up, planned visits, self-management (patient education) | 16 | 4,324 | 0.73 (0.58-0.91)+ |
Whellan et al. 2005 [35] (3) | Discharge planning and disease management with home nursing | 6 | 2,710 | 0.7 (0.6 - 0.9) +++ |
Roccaforte et al. 2005 [36] (9) | Disease management interventions before and after discharge (education, discharge planning, home or clinic care) | 25 | 2,603 | 0.80 (0.68-0.94) |
Holland et al. 2005 [37] (8) | Multidisciplinary interventions with 1–8 home visits | 10 | 1,519 | 0.80 (0.71-0.89) |
Kim and Soeken 2005 [38] (7) | Inhospital assessment and education with follow up by phone and home visits | 4 | 817 | 0.75 (0.45-1.05) |
Gonseth et al. 2004 [39] (9) | Discharge planning and patient education with home visits, or telephone follow-up, or clinic follow-up | 16 | 4,440 | 0.88 (0.79-0.97) |
Phillips et al. 2004 [40] (9) | Discharge planning with | |||
A single home visit | 3 | 476 | 0.76 (0.63-0.93) | |
Home visits / frequent telephone contact | 6 | 970 | 0.79 (0.69-0.91) | |
Extended home care services | 4 | 859 | 0.82 (0.68-1.00) | |
Day Hospital services | 1 | 234 | 0.25 (0.15-0.44) | |
McAlister et al. 2004 [41] (6) | Multidisciplinary team providing follow-up in a non-clinic setting | 8 | 1,646 | 0.81 (0.72-0.91) |
Gwadry et al. 2004 [42] (7) | Patient education and post discharge follow-up at home or by phone | 8 | 1,239 | 0.79 (0.68-0.91) |
Self-management
| ||||
Kozak et al. 2007 [43] (6) | Education for self-management before or after discharge | |||
Face-to-face contact | 9 | 1,747 | 0.42 (0.22-0.81) ++++ | |
Combined telephone and face to face contact | 5 | 1,253 | 0.37 (0.21–0.64)++++ | |
Jovicic et al. 2006 [44] (8) | Patients assume primary role in managing their health after receiving education before discharge, with limited follow-up phone calls or home visits after discharge | 5 | 787 | 0.59 (0.44-0.80) |
McAlister et al. 2004 [41] (6) | Enhanced patient self-care activities | 4 | 568 | 0.73 (0.57-0.93) |
Pharmacist care
| ||||
Koshman et al. 2008 [45] (8) | Pharmacist care in a multidisciplinary team, in hospital or in outpatient clinic, with or without home visits | 11 | 2,026 | 0.71 (0.54-0.94) |
Telemonitoring / structured telephone support
| ||||
Inglis et al. 2011 [46] (10) | Telemonitoring Structured telephone support | 8 | 2,343 | 0.91 (0.84-0.99) |
11 | 4,295 | 0.92 (0.85-0.99) | ||
Klersy et al. 2011 [47] (7) | Remote monitoring | 18 | 5,312 | 0.87 (0.79-0.96) |
Exercise training
| ||||
Lloyd-Williams et al. 2002 [48](5) | Exercise training | 1 | 99 | 0.29 (0.11-0.84) |
Clinic follow up / telephone contact
| ||||
Lambrinou et al. 2012 [32] (9) | Telephone follow-up | 3 | 634 | 0.83 (0.66-1.04) |
Clinic follow-up | 3 | 944 | 1.03 (0.75-1.40) | |
Combination of settings | 5 | 1,422 | 0.81 (0.64-1.03) | |
Takeda et al. 2012 [33] (10) | Clinic care | 4 | 1,129 | 0.78 (0.48-1.26) |
Kozak et al. 2007 [43] (6) | Education for self-management before or after discharge | 7 | 1,671 | 0.67 (0.36-1.26) ++++ |
Telephone contact | ||||
Mistiaen and Poot 2006 [49] (8) | Telephone follow-up | 2 | 258 | 0.67 (0.19-2.33)+ |
Phillips et al. 2005 [50] (8) | Specialist nurse-led clinics: | |||
With hospital discharge planning | 2 | 288 | 0.30 (0.04-2.60) | |
No hospital discharge planning | 4 | 661 | 1.00 (0.86-1.17) | |
Whellan et al. 2005 [35] (3) | Discharge planning and disease management with | |||
Follow up with cardiologist supervision | 4 | 825 | 0.6 (0.3-0.9) +++ | |
Follow up with primary care physician supervision | 2 | 662 | 1.2 (0.9-1.5) +++ | |
Telephone follow up | 3 | 730 | 0.8 (0.7-0.9) +++ | |
Holland et al. 2005 [37] (8) | Multidisciplinary interventions | |||
Phone/mailing | 9 | 3,349 | 0.86 (0.73-1.02) | |
2 | 1,701 | |||
Hospital/clinic/general practice | 0.99 (0.90-1.10) | |||
Phillips et al. 2004 [40] (9) | Comprehensive discharge planning with | |||
Clinic follow up / frequent telephone contact | 4 | 765 | 0.64 (0.32-1.28) | |
McAlister et al. 2004 [41] (6) | Multidisciplinary team providing care | |||
In clinic | 7 | 1,183 | 0.76 (0.58-1.01) | |
By telephone follow-up | 10 | 2,923 | 0.98 (0.80-1.20) | |
Coronary heart disease
| ||||
Heran et al. 2011 [51] (10) | Exercise-based cardiac rehabilitation | |||
Follow-up of 6 to 12 months | 4 | 463 | 0.69 (0.51-0.93) | |
Follow-up of 12 months or more | 7 | 2,009 | 0.98 (0.87-1.11) | |
McAlister et al. 2001 [52] (6) | Secondary prevention programs | 6 | 4,186 | 0.84 (0.76-0.94) |
Bronchial asthma
| ||||
McLean et al. 2011 [53] (9) | Telehealthcare (personalized care at a distance) | |||
Readmissions within 3 months | 2 | 138 | 0.91 (0.07-12.7) | |
Readmissions within 12 months | 4 | 499 | 0.25 (0.09-0.66) | |
Tapp et al. 2007 [54] (10) | Education interventions for adults who attend the emergency room for acute asthma | 5 | 566 | 0.50 (0.27-0.91) |
Tsai et al. 2005 [34] (6) | All types of interventions to improve care for asthma | 8 | 1,876 | 0.76 (0.60-0.97)+ |
Gibson et al. 2002 [55] (10) | Self-management education of adults with asthma | 12 | 2,418 | 0.64 (0.50-0.82) |
Prevention of falls in older people in the community
| ||||
Gillespie et al. 2012 [56] (11) | Outcome: number of people sustaining fractures: | |||
Exercise | 5 | 570 | 0.72 (0.47-1.11) | |
Vitamin D (with or without calcium) | 10 | 27,070 | 0.94 (0.82-1.09) | |
Multifactorial intervention after assessment | 11 | 3,808 | 0.84 (0.67-1.05) | |
Beswick et al. 2008 [57] (7) | Falls prevention interventions and community based care after hospital discharge | 41 | 20,047 | 0·94 (0·91–0·97) |
Critically ill patients
| ||||
Kim & Soeken 2005 [38] (7) | Inhospital assessment and education with phone follow-up | 1 | 220 | 0.34 (0.12-0.94) |
Stroke
| ||||
Fearon et al. 2012 [58] (11) | Early supported discharge services | 7 | 918 | 1.26 (0.94-1.67) |
Shepperd et al. 2009 [59] (10) | Hospital at home early discharge: | |||
Patients after a stroke at 3 months | 3 | 179 | 1.06 (0.47-2.38) | |
Orthopedic surgery
| ||||
Handoll et al. 2011 [60] (11) | Improving mobility after surgery for hip fractures: | |||
Resistance training – at 12 weeks | 1 | 51 | 0.78 (0.19-3.14) | |
Resistance training – at 12 months | 1 | 51 | 1.39 (0.59-3.43) | |
High dose weight bearing (HRR at 16 weeks) | 1 | 150 | 0.79 (0.35-1.77) | |
Khan et al. 2008 [61] (9) | Home-based multidisciplinary rehabilitation programs after joint replacement in chronic arthropathy | 1 | 172 | 0.84 (0.33-2.14) |
Cancer
| ||||
Smeenk et al. 1998 [62] (6) | Home care for patients with incurable cancer | 4 | 923 | 0.79 (0.55-1.15)+ |
Epilepsy
| ||||
Kim & Soeken 2005 [38] (7) | Inhospital assessment and education with phone follow-up | 1 | 42 | 0.29 (0.07-1.19) |
Chronic obstructive pulmonary disease
| ||||
Jeppesen et al. 2012 [63] (11) | Hospital at home for acute exacerbations | 8 | 870 | 0.76 (0.59-0.99) |
Puhan et al. 2011 [64] (9) | Respiratory rehabilitation after acute exacerbations | 5 | 250 | 0.22 (0.08–0.58) |
Wong et al. 2011 [10] (11) | Nurses visited patients' homes, provided support, education, and monitoring of health. | 5 | 684 | 1.01 (0.71-1.44) |
Lemmens et al. 2009 [65] (7) | Disease-management interventions. | 4 | 602 | 0.64 (0.51-0.81) + |
Shepperd et al. 2009b [59] (10) | Hospital at home after early discharge | 4 | 357 | 0.83 (0.61-1.13) |
Effing et al. 2007 [66] (11) | Self-management education | 8 | 966 | 0.64 (0.47-0.89)++++ |
Adams et al. 2007 [67] (7) | Chronic Care Model Multicomponent intervention | 4 | 716 | 0.79 (0.66-0.94) |
Self-management | 3 | 325 | 1.02 (0.66-1.57) | |
Kim & Soeken 2005 [38] (7) | Inhospital assessment and education with phone follow-up | 1 | 66 | 1.00 (0.02-51.9) |
Patients with chronic disease or geriatric patients
| ||||
Conroy et al. 2011 [68] (9) | Comprehensive geriatric assessment at hospital aimed at rapid discharge with varying degrees of community support | 5 | 2,287 | 0.95 (0.83–1.08) |
Vázquez & Martines 2011 [69](6) | Inhospital and at home medication reconciliation to prevent adverse events | 2 | 1,259 | 0.87 (0.63-1.19) |
Elkan et al. 2001 [70] (10) | Home visiting programs that offer health promotion and preventive care to older people. | 6 | 2,743 | 0.95 (0.80-1.09) |
Shepperd et al. 2009 [59] (10) | Hospital at home early discharge: Older patients with a mix of conditions | 5 | 969 | 1.35 (1.03-1.76) |
Shepperd et al. 2009 [71] (8) | Avoiding hospital admission through provision of hospital care at home | 3 | 416 | 1.49 (0.96–2.33) |
Latour et al. 2007 [72] (7) | Nurse-led case management for ambulatory complex patients in general health care | 5 | 2,395 | 0.80 (0.60-1.09)+ |
Kripalani et al. 2007 [73] (5) | Interventions to enhance medication adherence | 4 | 670 | 0.76 (0.38-1.49)+ |
Royal et al. 2006 [74] (10) | Pharmacists-led interventions in primary care to reduce medication related adverse events | 9 | 13,132 | 0.92 (0.80-1.04) |
Kim & Soeken 2005 [38] (7) | Inhospital assessment of frail patients with follow up by phone and home visits | 3 | 1,458 | 0.97 (0.75-1.19) |
Parker et al. 2002 [18] (9) | Discharge arrangements in hospital and/or in the community after discharge from hospital care. | |||
Both in hospital and in the patient’s home | 15 | * | 0.83 (0.69-1.00) | |
Patient’s home only | 10 | * | 0.80 (0.61-1.03) | |
Patient education and home follow up. | 5 | * | 0.67 (0.57-0.78) | |
Mitchell et al. 2002 [75] (4) | Primary medical practitioner involvement with a specialist team | 1 | 364 | 1.20 (0.86-1.69)+ |
Hyde et al. 2000 [76] (6) | Supported discharge after acute admission of older patients. Home visits, with or without rehabilitation, commencing 1 week after discharge. | 6 | 916 | 0.90 (0.77-1.04)+ |
Stuck et al. 1993 [30] (6) | Comprehensive geriatric assessment. | |||
Home assessment service | 7 | 5,240 | 0.84 (0.73-0.96) | |
Hospital and home assessment service | 3 | 847 | 1.03 (0.56-1.90) | |
Outpatient assessment service | 4 | 999 | 1.24 (0.89-1.73) |