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The clinical effectiveness and cost‐effectiveness of clinical nurse specialist‐led hospital to home transitional care: a systematic review
Author(s) -
BryantLukosius Denise,
Carter Nancy,
Reid Kim,
Donald Faith,
MartinMisener Ruth,
Kilpatrick Kelley,
Harbman Patricia,
Kaasalainen Sharon,
Marshall Deborah,
CharbonneauSmith Renee,
DiCenso Alba
Publication year - 2015
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1111/jep.12401
Subject(s) - medicine , transitional care , randomized controlled trial , clinical nurse specialist , clinical trial , health care , patient satisfaction , medline , emergency medicine , pediatrics , intensive care medicine , family medicine , nursing , political science , law , economics , economic growth
Rationale, aims and objectives Clinical nurse specialists ( CNSs ) are major providers of transitional care. This paper describes a systematic review of randomized controlled trials ( RCTs ) evaluating the clinical effectiveness and cost‐effectiveness of CNS transitional care. Methods We searched 10 electronic databases, 1980 to J uly 2013, and hand‐searched reference lists and key journals for RCTs that evaluated health system outcomes of CNS transitional care. Study quality was assessed using the C ochrane R isk of B ias and Q uality of H ealth E conomic S tudies tools. The quality of evidence for individual outcomes was assessed using the G rading of R ecommendations A ssessment, D evelopment and E valuation ( GRADE ) tool. We pooled data for similar outcomes. Results Thirteen RCTs of CNS transitional care were identified ( n = 2463 participants). The studies had low ( n = 3), moderate ( n = 8) and high ( n = 2) risk of bias and weak economic analyses. Post‐cancer surgery, CNS care was superior in reducing patient mortality. For patients with heart failure, CNS care delayed time to and reduced death or re‐hospitalization, improved treatment adherence and patient satisfaction, and reduced costs and length of re‐hospitalization stay. For elderly patients and caregivers, CNS care improved caregiver depression and reduced re‐hospitalization, re‐hospitalization length of stay and costs. For high‐risk pregnant women and very low birthweight infants, CNS care improved infant immunization rates and maternal satisfaction with care and reduced maternal and infant length of hospital stay and costs. Conclusions There is low‐quality evidence that CNS transitional care improves patient health outcomes, delays re‐hospitalization and reduces hospital length of stay, re‐hospitalization rates and costs. Further research incorporating robust economic evaluation is needed.