TRANSITIONAL CARE EFFECTIVENESS FOR CHRONICALLY ILL OLDER ADULTS: SYSTEMATIC REVIEW AND META-ANALYSIS

摘要

Healthcare systems are facing an increasing number of vulnerable older patients with chronic diseases (CD). Transitions in care from hospital to primary care for this population are complex and lead to increased mortality and service use. In response to these challenges, transitional care (TC) interventions are being widely implemented to increase continuity and quality of care. They encompass education on self-management, discharge planning, structured follow-up and coordination among the different healthcare professionals. A systematic review of interventions targeting transitions from hospital to the primary care setting was conducted in order to determine the effectiveness of TC on all-cause mortality, ED visit, readmission, readmission days and quality of life (QoL). Randomized controlled trials on TC were identified through Medline, CINHAL, PsycInfo, EMBASE (1995–2015). Two independent reviewers performed the study selection, data extraction and assessment of study quality (Cochrane “Risk of Bias”). Relative risks and mean differences were calculated using a random-effects model. From 10,234 references, 92 studies were included. Compared to usual care, significantly better outcomes were observed in chronically ill older patients benefiting from TC: a lower mortality at 3, 6, 12 and 18 months post-discharge, a lower rate of ED visits at 3 months, a lower rate of readmissions at 6 and 12 months and a lower mean of readmission days at 3, 6, 12 and 18 months. No significant differences were observed in quality of life. In conclusion, TC improves transitions for older patients and should be included in the reorganization of healthcare services.