A Systematic Review on Nurse-Led Transitional Care Programs for Discharged Patients from Hospital to Home

퇴원환자를 위한 간호사 주도 전환 프로그램의 내용과 효과에 관한 체계적 문헌고찰

  • Lee, Hyun Joo (College of Nursing, Graduate School, Yonsei University) ;
  • Kim, Yukyung (Korea Armed Forces Nursing Academy) ;
  • Oh, Eui Geum (College of Nursing.Mo-Im Kim Nursing Research Institute.Yonsei Evidence Based Nursing Center of Korea: A Joanna Briggs Institute Center of Excellence, Yonsei University)
  • 이현주 (연세대학교 대학원 간호학과 대학원) ;
  • 김유경 (국군간호사관학교 임상간호학처) ;
  • 오의금 (연세대학교 간호대학.김모임간호학연구소.연세근거기반간호센터)
  • Received : 2017.09.29
  • Accepted : 2017.11.08
  • Published : 2017.12.31


Purpose: This study was to systematically review the contents and effects of nurse-led transitional care programs for discharged patients from hospital to home. Methods: Randomized controlled trials published between 2005 and 2015 were searched in Pubmed, Embase, Cochrane(Central Register of Controlled Trials) and CINAHL. Data were analyzed using Cochrane Review Manager(Revman) software 5.3. Results: Nine studies were selected and analyzed. Patient assessment, education and discharge planning were included in pre-discharge phase. Referring, communication and care planning were performed by nurses in transition phase. Home and phone visits, monitoring and multidisciplinary advices were included in post-discharge phase. Various outcome measures such as hospital utilization(30 days readmission and emergency department visit), quality of life, and cost were used to identify effectiveness of nurse-led transitional care programs. 30 days readmission(OR=.73, 95% CI 0.54, 0.98; p=.03) and emergency department visit(OR=.67, 95% CI 0.50, 0.88; p=.005) were statistically significant in meta-analysis. However, participant blinding was not done in seven studies which put at the risk of performance bias. Conclusion: The results indicated that nurse-led transitional care program is effective in reducing unnecessary hospital utilization. Nevertheless, small sample size and risk at performance bias are the limitation of this study. Thus, we suggest that well-designed randomized controlled trials need to be conducted.


Supported by : 한국보건산업진흥원


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