Effects of a nurse‐led transitional care programme on readmission, self‐efficacy to implement health‐promoting behaviours, functional status and life quality among Chinese patients with coronary artery disease: A randomised controlled trial

Zhang, Pan; Xing, Fengmei; Li, Changzai; Wang, Fenglan; Zhang, Xiaoli

doi:10.1111/jocn.14064

Cited by 38 publications

(96 citation statements)

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“…The results showed that the readmission rates were not statistically significant in the two groups after 2 months, but the rates in the intervention group was lower when compared with the control group. This is consistent with the findings of previous studies as per which transitional care model is insufficient to control the readmission rates at a significant level (Wong & Yeung, 2015;Zhang et al, 2018). It can be inferred that transitional care interventions can effectively raise the awareness of patients with self-management diseases and help them actively seek medical assistance (Zhao & Wong, 2009).…”

Section: Effectiveness Of Nurse-led Tcp On Hospital Readmissionsupporting

confidence: 90%

“…The Omaha System is an effective tool for assessing patient health issues and providing nursing interventions as well as effectiveness evaluations from a holistic approach. This system applies to patients with all ages, diseases, cultural backgrounds, religious beliefs, and socioeconomic status (Erci, 2012;Monsen, Holland, Fung-Houger, & Vanderboom, 2014;Topaz, Golfenshtein, & Bowles, 2014;Zhang, Xing, Li, Wang, & Zhang, 2018). A large number of studies have shown that implementing the Omaha system in TCP can drastically improve the quality of care and self-management of patients with chronic diseases (Erci, 2012;Monsen et al, 2014;Topaz et al, 2014;Zhang et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

“…This system denotes a standardized nursing language system approved by the American Nursing Association and comprises three parts (Martin, Monsen, & Bowles, 2011). The problem classification scheme encompasses four major areas, a total of 42 health problems (Wong & Yeung, 2015;Zhang et al, 2018). The intervention scheme divides nursing interventions into teaching, guidance and counselling, case management, monitoring, and treatment and procedures (Wong & Yeung, 2015;Zhang et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

“…The problem classification scheme encompasses four major areas, a total of 42 health problems (Wong & Yeung, 2015;Zhang et al, 2018). The intervention scheme divides nursing interventions into teaching, guidance and counselling, case management, monitoring, and treatment and procedures (Wong & Yeung, 2015;Zhang et al, 2018). The outcome evaluation system is a five-level evaluation of the issues in terms of knowledge, behaviour, and status (Wong & Yeung, 2015;Zhang et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

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Effects of a 4‐week Omaha System transitional care programme on rheumatoid arthritis patients' self‐efficacy, health status, and readmission in mainland China: A randomized controlled trial

Liu

Gao

Zhang

et al. 2020

Int J of Nursing Practice

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Background and aim To our knowledge, the practice of transitional care was not common in mainland China. This study was designed to test the intervention effects of a specific dose (4 weeks) of an Omaha‐based system transitional care programme for Chinese patients suffering from rheumatoid arthritis. Methods The intervention group adopted a 4‐week nurse‐led transitional care intervention based on the Omaha System. The control group used a comparable length of routine care. The outcome indexes were a Chinese version of the Arthritis Self‐Efficacy Scale‐8, Health Assessment Questionnaire‐Disability Index, and hospital readmission rates. Data were collected from June 2018 to December 2018. Results Finally, 88 patients (44 in the intervention group and 44 in the control group) entered the data analysis. Baseline sociodemographic data for both groups were not found to be statistically significant. The self‐efficacy and HAQ‐DI of the intervention group were significantly different from the control group. Although the readmission rates of the intervention group were lower than that of the control group, it was not statistically significant. Conclusions This 4‐week transitional care intervention dose is sufficient to provide evidence for improving self‐efficacy to implement disease management and enhancing physical function of patients diagnosed with rheumatoid arthritis.

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Section: Effectiveness Of Nurse-led Tcp On Hospital Readmissionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effects of a 4‐week Omaha System transitional care programme on rheumatoid arthritis patients' self‐efficacy, health status, and readmission in mainland China: A randomized controlled trial

Liu

Gao

Zhang

et al. 2020

Int J of Nursing Practice

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“…According to a systematic review and meta-analysis, nursing activities such as home visits, case management, and disease management clinics where physicians and cardiac nurses work together with a multidisciplinary HF management team showed significantly decreased all-cause readmission and death [9]. Moreover, in some interventions for heart diseases, the effects of nurse-led transitional care programs appeared excellent [16,48]. We confirmed that nurses are the most important healthcare providers of transitional care for patients with HF.…”

Section: Discussionsupporting

confidence: 57%

Transitional Care Interventions for Patients with Heart Failure: An Integrative Review

Son

Lee

et al. 2020

IJERPH

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Heart failure (HF) is a life-limiting illness and presents as a gradual functional decline with intermittent episodes of acute deterioration and some recovery. In addition, HF often occurs in conjunction with other chronic diseases, resulting in complex comorbidities. Hospital readmissions for HF, including emergency department (ED) visits, are considered preventable. Majority of the patients with HF are often discharged early in the recovery period with inadequate self-care instructions. To address these issues, transitional care interventions have been implemented with the common objective of reducing the rate of hospital readmission, including ED visits. However, there is a lack of evidence regarding the benefits and adverse effects of transitional care interventions on clinical outcomes and patient-related outcomes of patients with HF. This integrative review aims to identify the components of transitional care interventions and the effectiveness of these interventions in improving health outcomes of patients with HF. Five databases were searched from

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Transitional Care Interventions From Hospital to Community to Reduce Health Care Use and Improve Patient Outcomes

Tyler,

Hodkinson,

Planner

et al. 2023

JAMA Netw Open

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ImportanceDischarge from the hospital to the community has been associated with serious patient risks and excess service costs.ObjectiveTo evaluate the comparative effectiveness associated with transitional care interventions with different complexity levels at improving health care utilization and patient outcomes in the transition from the hospital to the community.Data SourcesCENTRAL, Embase, MEDLINE, and PsycINFO were searched from inception until August 2022.Study SelectionRandomized clinical trials evaluating transitional care interventions from hospitals to the community were identified.Data Extraction and SynthesisAt least 2 reviewers were involved in all data screening and extraction. Random-effects network meta-analyses and meta-regressions were applied. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed.Main Outcomes and MeasuresThe primary outcomes were readmission at 30, 90, and 180 days after discharge. Secondary outcomes included emergency department visits, mortality, quality of life, patient satisfaction, medication adherence, length of stay, primary care and outpatient visits, and intervention uptake.ResultsOverall, 126 trials with 97 408 participants were included, 86 (68%) of which were of low risk of bias. Low-complexity interventions were associated with the most efficacy for reducing hospital readmissions at 30 days (odds ratio [OR], 0.78; 95% CI, 0.66 to 0.92) and 180 days (OR, 0.45; 95% CI, 0.30 to 0.66) and emergency department visits (OR, 0.68; 95% CI, 0.48 to 0.96). Medium-complexity interventions were associated with the most efficacy at reducing hospital readmissions at 90 days (OR, 0.64; 95% CI, 0.45 to 0.92), reducing adverse events (OR, 0.42; 95% CI, 0.24 to 0.75), and improving medication adherence (standardized mean difference [SMD], 0.49; 95% CI, 0.30 to 0.67) but were associated with less efficacy than low-complexity interventions for reducing readmissions at 30 and 180 days. High-complexity interventions were most effective for reducing length of hospital stay (SMD, −0.20; 95% CI, −0.38 to −0.03) and increasing patient satisfaction (SMD, 0.52; 95% CI, 0.22 to 0.82) but were least effective for reducing readmissions at all time periods. None of the interventions were associated with improved uptake, quality of life (general, mental, or physical), or primary care and outpatient visits.Conclusions and RelevanceThese findings suggest that low- and medium-complexity transitional care interventions were associated with reducing health care utilization for patients transitioning from hospitals to the community. Comprehensive and consistent outcome measures are needed to capture the patient benefits of transitional care interventions.

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Effects of a nurse‐led transitional care programme on readmission, self‐efficacy to implement health‐promoting behaviours, functional status and life quality among Chinese patients with coronary artery disease: A randomised controlled trial

Abstract: The nurse-led transitional care programme is helpful for coronary artery disease patients to promote their effective transfer from hospital to community and provide an evidence for nursing managers to train their nurses for transitional care knowledge and skills.

Cited by 38 publications

References 32 publications

Effects of a 4‐week Omaha System transitional care programme on rheumatoid arthritis patients' self‐efficacy, health status, and readmission in mainland China: A randomized controlled trial

Effects of a 4‐week Omaha System transitional care programme on rheumatoid arthritis patients' self‐efficacy, health status, and readmission in mainland China: A randomized controlled trial

Transitional Care Interventions for Patients with Heart Failure: An Integrative Review

Transitional Care Interventions From Hospital to Community to Reduce Health Care Use and Improve Patient Outcomes

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