Transitional care after hospitalization for acute stroke or myocardial infarction

A systematic review

Janet Prvu Bettger, Karen P. Alexander, Rowena J. Dolor, DaiWai M. Olson, Amy S. Kendrick, Liz Wing, Remy R. Coeytaux, Carmelo Graffagnino, Pamela W. Duncan

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

Background: Transitional care is a time-limited service to prevent discontinuous care and adverse outcomes, including rehospitalization. Purpose: To describe transitional care interventions and evidence of benefit or harm in patients hospitalized for acute stroke or myocardial infarction (MI). Data Sources: Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Cochrane Database of Systematic Reviews, and EMBASE, supplemented with manual searches of reference lists of relevant studies and review articles (January 2000 to March 2012). Study Selection: 6 reviewers screened 5857 citations to identify English-language reports of trials or observational studies that compared transitional care with usual care among adults hospitalized for stroke or MI and that reported patient, caregiver, process, or systems outcomes within 1 year of hospital discharge. Data Extraction: Data on study design, quality, population, intervention characteristics, and patient- and system-level outcomes were extracted by 3 reviewers and confirmed by 1 additional reviewer. Data Synthesis: 62 articles representing 44 studies of transitional care for either acute stroke (27 studies) or MI (17 studies). Four intervention types were studied: Hospital-initiated support (n = 14), patient and family education (n = 7), community-based support (n = 20), and chronic disease management (n = 3). Most studies (68%) were of fair quality. Overall, moderate-strength evidence showed that hospital-initiated support reduced length of stay for patients who had a stroke, and low-strength evidence showed that it reduced mortality for patients who had an MI. Evidence about benefits of other interventions and harms from transitional care services was insufficient. Limitations: Few studies had high-quality research designs. The usual care comparator was often poorly defined. Applicability to U.S. clinical practice was limited; only 6 studies were conducted in the United States. Conclusion: Available evidence shows that hospital-initiated transitional care can improve some outcomes in adults hospitalized for stroke or MI. Finding additional transitional care interventions that improve functional outcomes and prevent rehospitalizations and adverse events is a high priority for the growing population of patients who have an MI or a stroke.

Original languageEnglish (US)
Pages (from-to)407-416
Number of pages10
JournalAnnals of Internal Medicine
Volume157
Issue number6
StatePublished - Sep 18 2012

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Hospitalization
Stroke
Myocardial Infarction
Patient Harm
Information Storage and Retrieval
Population Characteristics
Patient Education
Disease Management
Transitional Care
MEDLINE
Caregivers
Observational Studies
Length of Stay
Nursing
Chronic Disease
Research Design
Language
Databases
Mortality
Health

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Bettger, J. P., Alexander, K. P., Dolor, R. J., Olson, D. M., Kendrick, A. S., Wing, L., ... Duncan, P. W. (2012). Transitional care after hospitalization for acute stroke or myocardial infarction: A systematic review. Annals of Internal Medicine, 157(6), 407-416.

Transitional care after hospitalization for acute stroke or myocardial infarction : A systematic review. / Bettger, Janet Prvu; Alexander, Karen P.; Dolor, Rowena J.; Olson, DaiWai M.; Kendrick, Amy S.; Wing, Liz; Coeytaux, Remy R.; Graffagnino, Carmelo; Duncan, Pamela W.

In: Annals of Internal Medicine, Vol. 157, No. 6, 18.09.2012, p. 407-416.

Research output: Contribution to journalArticle

Bettger, JP, Alexander, KP, Dolor, RJ, Olson, DM, Kendrick, AS, Wing, L, Coeytaux, RR, Graffagnino, C & Duncan, PW 2012, 'Transitional care after hospitalization for acute stroke or myocardial infarction: A systematic review', Annals of Internal Medicine, vol. 157, no. 6, pp. 407-416.
Bettger JP, Alexander KP, Dolor RJ, Olson DM, Kendrick AS, Wing L et al. Transitional care after hospitalization for acute stroke or myocardial infarction: A systematic review. Annals of Internal Medicine. 2012 Sep 18;157(6):407-416.
Bettger, Janet Prvu ; Alexander, Karen P. ; Dolor, Rowena J. ; Olson, DaiWai M. ; Kendrick, Amy S. ; Wing, Liz ; Coeytaux, Remy R. ; Graffagnino, Carmelo ; Duncan, Pamela W. / Transitional care after hospitalization for acute stroke or myocardial infarction : A systematic review. In: Annals of Internal Medicine. 2012 ; Vol. 157, No. 6. pp. 407-416.
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