Effects of transitional care on self-care, readmission rates, and quality of life in adult patients with systemic lupus erythematosus: a randomized controlled trial

Xie, Xiumin; Song, Young Sun; Yang, Hui; Nie, Anliu; Chen, Hong; Li, Jiping

doi:10.1186/s13075-018-1670-4

Cited by 16 publications

(47 citation statements)

References 34 publications

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“…Haro et al 22 reported that patients with SLE had a lower healthcare utilization rate, lower medication usage, and lack of rheumatology follow‐up after transition. Xie et al 23 noted that transitional care improved self‐care and quality of life, and decreased the hospital readmission rate. In the present study, we could not find any association between age, gender and TRAQ total score; while all female patients had higher TRAQ self‐management domain scores, and FMF patients who were colchicine‐resistant and treated with monthly canakinumab, and patients with active disease (3 SLE and 1 BD patients) at the time TRAQ was administered had lower total TRAQ scores.…”

Section: Discussionmentioning

confidence: 99%

The readiness of pediatric rheumatology patients and their parents to transition to adult‐oriented treatment

et al. 2021

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Introduction Transition is a planned process of pediatric patients from child‐centered to adult‐oriented treatment. Transitional care for patients with chronic diseases is essential. The present study aimed to evaluate the readiness of patients with rheumatic diseases and their parents for transition process. Method This is a cross‐sectional, single‐center study. All patients and their parents were questioned about their awareness of and willingness to undergo transitional care. Transition Readiness Assessment Questionnaire (TRAQ) was applied to all the participants. TRAQ is a tool for measuring readiness for transitional care in adolescents with chronic diseases. TRAQ includes 20 items that are divided into 2 domains: self‐management and self‐advocacy. Results A total of 157 (87 girls/70 boys) patients and their parents were enrolled. Of them 64 were diagnosed with familial Mediterranean fever, 52 with juvenile idiopathic arthritis, 21 with systemic lupus erythematosus, and 20 with Behçet's disease. The median age of the patients was 16 years (15‐18). However, all patients and parents accepted that transition to adult‐oriented care is necessary; only one‐third of them were aware about transitional care. Eighty (50.9%) patients and 147 (93.6%) of the parents stated that they were wishing to continue pediatric rheumatology treatment. The mean TRAQ self‐management domain and self‐advocacy domain total scores in the patients were 1.76 ± 0.51 and 1.72 ± 0.49, respectively (P = .48). The mean TRAQ total score was not different between patients and parents. When we assessed the factors affecting transition process, the TRAQ score was lower among patients with active disease, and requiring hospitalization during the previous year. Conclusion Assessment od the readiness of patients with chronic rheumatic diseases for transition care will increase the awareness of patients and their parents as well, and provide determination of the optimal time for transition.

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Section: Discussionmentioning

confidence: 99%

The readiness of pediatric rheumatology patients and their parents to transition to adult‐oriented treatment

et al. 2021

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“…While there are prior studies describing the problem of high readmission rates among SLE patients and risk factors for readmission, this is one of the first studies to look at an intervention to reduce the number of hospital readmissions. The study by Xie et al (11) assessed a transitional-care intervention to improve readmission rates among SLE patients. This study found a significant reduction in readmissions of patients with SLE who received the transitional-care model.…”

Section: Discussionmentioning

confidence: 99%

“…While there was likely overall cost savings with reduced hospital readmissions, the transitional-care model described in that study is a time and cost-intensive intervention. The model described by Xie et al (11) entails 4 in-person assessments and 4 phone calls per hospital discharge. In contrast, our model requires completion of a standardized template in the EMR and a single telephone call, and hence, may represent a more feasible intervention for clinics with limited resources.…”

Section: Discussionmentioning

confidence: 99%

“…There have been few studies focusing on interventions to reduce readmission rates among patients with SLE. Xie et al (11) published a single‐center study performed at a university hospital in China examining the effects of a transitional‐care model on readmission rates among SLE patients. The transitional‐care model was a 12‐week intervention performed by 2 nurses and included 4 in‐person assessments as well as 4 telephone follow‐up visits.…”

Section: Introductionmentioning

confidence: 99%

“…The intervention group also had significantly greater improvement in their self‐care score and quality of life score. The study did not report the time or cost involved in the intervention (11).…”

Section: Introductionmentioning

confidence: 99%

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Quality Improvement Intervention to Reduce Thirty‐Day Hospital Readmission Rates Among Patients With Systemic Lupus Erythematosus

Bowers¹,

Griffith²,

Kolfenbach³

et al. 2021

Arthritis Care & Research

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Objective Systemic lupus erythematosus (SLE) has one of the highest 30‐day hospital readmission rates among chronic diseases in the US. This quality improvement initiative developed and assessed the feasibility of a multidisciplinary postdischarge intervention to reduce 30‐day readmission rates among SLE patients. Methods A retrospective study was performed using electronic health records of patients with SLE admitted to a university hospital prior to (nonintervention group) and after initiation of the study intervention (intervention group). The study population included patients with a diagnosis of SLE who were admitted to the hospital for any reason during an 8‐month time period. The intervention involved sending a templated message at the time of discharge to the rheumatology clinic nurses, which prompted the nurses to call the patient to coordinate future visits and provide education. The primary outcome was the 30‐day hospital readmission rate. Data were analyzed using a multivariate mixed binomial regression model. Results There were 59 hospitalizations in the nonintervention group and 73 hospitalizations in the intervention group during the 8‐month study period. The 30‐day readmission rate was 29% in the nonintervention group and 19% in the intervention group. The difference in readmission rates between the 2 groups was not statistically significant based on the multivariate model. Conclusion Our study demonstrates the feasibility of implementing a multidisciplinary postdischarge intervention to reduce readmission rates for patients with SLE in a large academic medical center. Further investigation is warranted to determine if this approach reduces the unacceptably high hospital readmission rates among SLE patients.

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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 transitional care on self-care, readmission rates, and quality of life in adult patients with systemic lupus erythematosus: a randomized controlled trial

Cited by 16 publications

References 34 publications

The readiness of pediatric rheumatology patients and their parents to transition to adult‐oriented treatment

The readiness of pediatric rheumatology patients and their parents to transition to adult‐oriented treatment

Quality Improvement Intervention to Reduce Thirty‐Day Hospital Readmission Rates Among Patients With Systemic Lupus Erythematosus

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

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