The effectiveness of telephone-based post-discharge nursing care in decreasing readmission rate in patients with heart failure: A systematic review

Centre conducting the review Yonsei JBI center, Seoul, Korea Review Question What is the effectiveness of telephone-based post-discharge nursing care in decreasing readmission rate in patients with heat failure? Background Heart failure (HF) is an extremely common disorder and one that is associated with significant morbidity, mortality, and cost1. The number of patients with heart failure is increasing, mainly because of the growing number of elderly heart failure patients, who are often hospitalized and readmitted due to worsening heart failure. Thus, the problem of frequent HF hospital readmissions appears to be a promising target for evaluating the potential impact of post-discharge nursing care strategies. Comprehensive discharge planning plus post discharge support may reduce readmission rates and improve health outcomes for patients with HF. Previous reviews of various HF disease management program have emphasized beneficial effects of outpatient care and multidisciplinary teams2, however, the efficacy of telephone-based post-discharge nursing care for this patient population has not been established. Telephone-based post-discharge nursing care is an intervention delivered by registered nurses. Within 2 days of discharge, patients receive a telephone call from the nurse to determine the well-being of the patient and to assess potential difficulties with medications or medical regimens, and to identify health problems arising since discharge. Telephone-based post-discharge nursing care is another approach that is believed to promote continuity of care and decrease the rehospitalization rate of patients with heart failure. The aim of this review is to summarize the best available evidence in order to determine the effectiveness of telephone-based post-discharge nursing care of patient with heart failure and to quantify the effect on readmission rates and all-cause readmission rates of these patients. Types of participants This review will consider studies that include patients with heart failure, who have been recently hospitalized regardless of age, cause of heart failure or readmission to hospital. Types of interventions This review will consider studies that evaluate effectiveness of telephone-based post-discharge nursing care by nurses in comparison to team management. Types of outcome This review will consider studies frequency of unplanned hospital readmission during the 6month after discharge. Types of studies This review will consider any randomized controlled trials that address the effectiveness of telephone-based post-discharge nursing care in decreasing hospital readmission rate in patients with heart failure. In the absence of RCTs, other methodologies will be considered, such as pseudo-randomized clinical trails will be considered for inclusion to enable the identification of current best evidence. Search strategy The search strategy aims to find published and unpublished studies. A three-step search strategy will be utilized in this review. An initial limited search of MEDLINE and CINAHL will be undertaken followed by analysis of the text words contained in the title and abstract, and of the index terms used to describe article. A second search using all identified keywords and index terms will then be undertaken across all included databases. Thirdly, the reference list of all identified reports and articles will be searched for additional studies. Only studies in English will be considered for inclusion. The databases to be searched include: MEDLINE CINHAL Cochrane Embase Science Direct ProQuest etc Initial keywords to be used will be “readmission,” “heart failure,” “*tele* ”, “nurs*, “post-discharge”, telephone-based” Assessment of methodological quality Quantitative papers selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (Appendix I). Any disagreements that arise between the reviewers will be resolved through discussion, in conclusion with a third reviewer. Data extraction Quantitative data will be extracted from papers included in the review using the standardized data extraction tool from JBI-MAStARI. The data extracted will include specific details about the interventions, populations, study methods and outcomes of significance to the review question and specific objectives. Data Synthesis Quantitative papers will, where possible be pooled in statistical meta-analysis using the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI Appendix II). All results will be subject to double data entry. Odds ratio (for categorical data) and weighted mean differences (for continuous data) and their 95% confidence intervals will be calculated for analysis. Heterogeneity will be assessed using the standard Chi-square. Where statistical pooling is not possible the findings will be presented in narrative form.