Effectiveness of Peri-Discharge Complex Interventions for Reducing 30-Day Readmissions among COPD Patients: Overview of Systematic Reviews and Network Meta-Analysis

Claire C W Zhong; Charlene H L Wong; William K W Cheung; Eng-Kiong Yeoh; Chi Tim Hung; Benjamin H K Yip; Eliza L Y Wong; Samuel Y S Wong; Vincent C H Chung

doi:10.5334/ijic.6018

Effectiveness of Peri-Discharge Complex Interventions for Reducing 30-Day Readmissions among COPD Patients: Overview of Systematic Reviews and Network Meta-Analysis

Int J Integr Care. 2022 Feb 3;22(1):7. doi: 10.5334/ijic.6018. eCollection 2022 Jan-Mar.

Authors

Claire C W Zhong¹, Charlene H L Wong¹, William K W Cheung¹, Eng-Kiong Yeoh¹, Chi Tim Hung¹, Benjamin H K Yip¹, Eliza L Y Wong¹, Samuel Y S Wong¹, Vincent C H Chung^{1

2}

Affiliations

¹ Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, HK.
² School of Chinese Medicine, The Chinese University of Hong Kong, Shatin, HK.

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.

Keywords: 30-day readmissions; chronic obstructive pulmonary disease; network meta-analysis; overview of systematic reviews; peri-discharge complex Interventions.