اولین همایش بین المللی تحول خدمات سلامت: تلفیق مراقبت، درمان، بازتوانی و امیدبخشی

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کد مقاله 1542

عنوان Effectiveness of Digital Transitional Care Models from Hospital to Home in Reducing Readmission and Improving Self-Care in Patients with Chronic Bronchitis: A Systematic Review

نویسندگان Yasin Nakhaei Moghaddam - Zahra Kazemi Korani - Habiballah Pordelinezhad

چکیده Background: Chronic bronchitis, a prevalent phenotype of chronic obstructive pulmonary disease (COPD), is characterised by recurrent exacerbations that frequently necessitate hospitalisation and impose a substantial burden on patients and healthcare systems. Readmission after an index hospitalisation for acute exacerbation remains persistently high, and inadequate self-care capacity is a principal modifiable driver of recurrent utilisation. Digital transitional care models-encompassing telemonitoring, mobile health applications, and remote patient monitoring-have emerged as promising strategies to bridge the hospital-to-home gap. However, the evidence base for their effectiveness remains heterogeneous, with notable trials reporting null and even harmful effects. Objective: To evaluate the effectiveness of digital transitional care models from hospital to home in reducing readmission and improving self-care in patients with chronic bronchitis, with explicit attention to studies reporting null, negative, or mixed findings. Methods: A systematic search was conducted across PubMed, Scopus, Web of Science, Embase, CINAHL, and the Cochrane Library for peer-reviewed English-language articles published from 2015 onward, supplemented by targeted searches for landmark trials and meta-analyses published between 2017 and 2026. The PICO framework was applied: Population, adults with chronic bronchitis or COPD with a chronic bronchitic phenotype; Intervention, digital transitional care models initiated during or immediately after hospitalisation; Comparator, usual post-discharge care; Outcomes, readmission rates and validated self-care measures. Study quality and risk of bias were assessed using the Cochrane Risk of Bias tool and the Newcastle-Ottawa Scale. Findings were synthesised narratively, and meta-analysis was performed where clinical and methodological homogeneity permitted. The review was conducted in accordance with PRISMA 2020 guidelines. Results: Twelve studies (n = 4,318) met inclusion criteria. The evidence was mixed, and readmission outcomes varied according to intervention design and target population. A meta-analysis of transitional care programmes in COPD found that the relative risk of readmission was lower in the intervention group, but this difference did not reach statistical significance (no statistically significant difference in COPD-related readmissions or emergency department visits). An earlier meta-analysis of 13 randomised controlled trials, however, reported that transitional care significantly reduced both COPD-related readmissions (odds ratio [OR] 0.60, 95% CI 0.42-0.85) and all-cause hospital readmissions (OR 0.72, 95% CI 0.53-0.98), though the benefit weakened over time and was moderated by intervention duration and the use of telephone follow-up. A rigorous randomised trial of a combined transition and self-management programme reported significantly greater COPD-related hospitalisations and emergency department visits in the intervention group (1.40 vs 0.72 events per participant; P = .004), without improvement in quality of life. A systematic review of digital interventions similarly found mixed results: of 12 randomised controlled trials, only four demonstrated a positive effect on hospital readmission, while seven showed no clear evidence of significant reduction. A meta-analysis of virtual ward transitional care found that reductions in readmissions were seen only in patients with heart failure (risk ratio [RR] 0.84; 95% CI 0.74-0.96), not in those with other diagnoses including COPD (RR 0.96; 95% CI 0.88-1.05). Conversely, a comparative effectiveness review of telemedicine using telemonitoring instruments found a clearer association with reduced all-cause readmissions in patients with COPD than in those with heart failure (100% vs. 8% of prospective studies), and certain telemonitoring programmes with structured clinical escalation pathways demonstrated reductions in readmission rates. Mobile- and web-based interventions improved self-management efficacy and adherence to action plans. Subgroup analysis suggested that interventions incorporating two-way communication and personalised feedback yielded larger effects on self-care outcomes than passive monitoring alone. Heterogeneity was high across studies in intervention components, follow-up duration, and outcome definitions. Conclusion: The evidence on digital transitional care for chronic bronchitis is mixed and does not uniformly support a reduction in readmission. Some telemonitoring models with responsive clinical support appear promising, particularly when targeted at high-risk patients with recent exacerbation history, but null and negative findings from rigorous trials and meta-analyses underscore the need for caution. The unexpected increase in healthcare utilisation observed in one trial highlights the potential for well-intentioned transitional care programmes to cause harm if not carefully designed and targeted. Intervention design factors-including duration, the presence of structured escalation pathways, and the intensity of clinical support-appear to moderate effectiveness more than the digital modality itself. Standardisation of intervention components, clearer definitions of the target population, and adequately powered trials with harmonised outcome metrics are essential before widespread implementation can be recommended.

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