Abstract
Background:An overview of systematic reviews(SRs) and network meta-analysis(NMA) were conducted to evaluate the comparative effectiveness of peri-discharge complex interventions for reducing 30-day readmissions among chronic obstructive pulmonary disease(COPD) patients.Methods:Five databases were searched for SRs of randomized controlled trials(RCTs). An additional search was conducted for updated RCTs from database inception until Jun 2020. Pooled effect of peri-discharge complex interventions was assessed using random-effect pairwise meta-analyses. Comparative effectiveness across different peri-discharge complex interventions was evaluated using NMA.Results:Nine SRs and 11 eligible RCTs(n = 1,422) assessing eight different peri-discharge complex interventions were included. For reducing 30-day all-cause readmissions, pairwise meta-analysis showed no significant difference between peri-discharge complex interventions and usual care, while NMA indicated no significant differences among different peri-discharge complex interventions as well as usual care. For reducing 30-day COPD-related readmissions, peri-discharge complex interventions were significantly more effective than usual care (pooled RR = 0.45, 95% CI:0.24–0.84).Conclusions:Peri-discharge complex interventions may not differ from usual care in reducing 30-day all-cause readmissions among COPD patients but some are more effective for lowering 30-day COPD-related readmission. Thus, complex intervention comprising core components of patient education, self-management, patient-centred discharge instructions, and telephone follow up may be considered for implementation, but further evaluation is warranted.
Highlights
Chronic obstructive pulmonary disease (COPD) is a progressive and life-limiting disease that imposes a huge clinical and economic burden on health system [1]
Existing studies have summarized the effectiveness of various peri-discharge complex interventions for reducing readmissions at different time points [21,22,23, 27, 28], but their comparative effectiveness is uncertain. In this overview of systematic review (SR) and network meta-analysis (NMA), we aimed to evaluate the comparative effectiveness of different peri-discharge complex interventions on reducing 30-day readmissions among COPD patients
OF PAIRWISE META-ANALYSES For the reduction of 30-day all-cause readmissions, there was no significant difference between peri-discharge complex interventions and controls from pairwise metaanalyses (Appendix 8a)
Summary
Chronic obstructive pulmonary disease (COPD) is a progressive and life-limiting disease that imposes a huge clinical and economic burden on health system [1]. The 30-day readmissions were associated with lower quality of life [12, 13] and irreversible damage on patients exercise capacity, muscle strength, and physical activity level. It increased mortality [14] and health care expenditure [15] for COPD patients. An overview of systematic reviews(SRs) and network meta-analysis(NMA) were conducted to evaluate the comparative effectiveness of peri-discharge complex interventions for reducing 30-day readmissions among chronic obstructive pulmonary disease(COPD) patients
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