个案管理模式对降低心力衰竭患者再入院率影响的Meta分析

Meta-analysis of case management model in reducing the rehospitalization rate of patients with chronic heart failure

目的 系统评价社区个案管理对减少心力衰竭患者住院相关费用、缩短患者住院时间和降低再入院率的有效性的研究.方法 计算机检索Cochrane图书馆、JBI循证护理中心图书馆、MEDLINE、Embase、Pubmed、中国知网数据库（CNKI）、维普数据库（VIP）、万方数据库,收集所有社区病例管理对出院患者再入院人数和平均住院时间的随机对照试验和临床对照研究.2名研究者按照纳入和排除标准独立检索文献、筛选文献、评价纳入文献的质量,并提取资料,使用Revman5.3软件进行Meta分析.结果 共纳入14篇文献,均为随机对照试验.Meta分析结果显示：与未进行社区个案管理相比,个案管理对于心力衰竭患者再入院率的影响[随机效应模式OR=0.76,95%CI（0.65,0.88）],差异有统计学意义（P＜0.01）;对患者住院时间的影响[随机效应模式OR=-1.23,95%CI（-1.58,-0.88）],差异有统计学意义（P＜0.01）.结论 社区个案管理能有效减少心力衰竭患者再入院率和缩短患者住院时间,建议临床推广使用.

Objective To systematically review the efficiency of community case management in reducing the rehospitalization rate and hospitalization time, and shortening the hospitalization costs of patients with chronic heart failure （CHD）.Methods Randomized controlled trials （RCTs） and clinical control trials （CCTs） of community case management about the number of hospitalized patients and the average hospitalization time were collected from Cochrane library, JBI evidence-based nursing center library, MEDLINE, Embase, Pubmed, CNKI, VIP, and Wanfang. Data were searched and extracted; captured citations were screened; and the methodological quality of all included studies was assessed by 2 reviewers independently. Revman 5.3 software was used to perform the meta-analysis.Results Totally 14 published studies were included in the systematic review, and they were all RCTs. The results of meta-analysis showed that, compared with patients without community case management, there was statistically significant difference in the effects of case management on the rehospitalization rate and hospitalization time of CHD patients [random effects model OR=0.76,95%CI（0.65,0.88）,P〈0.01] [random effects modelOR=-1.23,95%CI（-1.58,-0.88）,P〈0.01]. Conclusions Community case management can effectively reduce the rehospitalization rate and shorten the hospitalization time of CHD patients, so it is worth being popularized.