To identify, critically appraise, and synthesize the current body of randomized controlled trials investigating the effectiveness of multidisciplinary transitional care interventions addressing complex care needs (i.e., needs related to physical, nutritional, cognitive, and/or psychological status) in reducing hospital readmissions and mortality and enhancing patient satisfaction, quality of life, physical, cognitive, and psychological status.
Medline, Embase, CINAHL, and CENTRAL were searched for randomized controlled trials assessing multidisciplinary transitional care interventions’ impact on readmissions, mortality, and health-related outcomes from inception to July 2024. Risk of bias was evaluated with the Risk of Bias-2 tool. Subgroup analyses assessed whether different intervention types affected outcomes differently. The certainty of the evidence was assessed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach and the credibility of subgroup analyses with the Instrument to evaluate the Credibility of Effect Modification Analyses (ICEMAN).
Forty-nine trials involving 25,246 patients were included. There was low certainty that multidisciplinary transitional care interventions reduced readmissions (RR=0.88; 95%CI:0.80 to 0.96) and high certainty that they reduced mortality (RR=0.92; 95%CI:0.84 to 1.01). There was low to moderate certainty that multidisciplinary transitional care interventions improved physical quality of life (SMD=0.76; 95%CI: -0.23 to 1.75), mental quality of life (SMD=0.58; 95%CI: -0.05 to 1.21), patient satisfaction (SMD=0.49; 95%CI: -0.14 to 1.12), and physical performance (SMD=0.49; 95%CI: -0.11 to 1,10). Subgroup analysis revealed a larger and statistically significant effect on physical performance in more complex interventions (SMD=0.83; 95%CI:0.02 to 1,65). Heterogeneity across studies was generally high for each comparison (I2>75%).
These findings suggest that multidisciplinary transitional care interventions addressing (older) patients’ complex care needs can reduce readmissions and mortality while improving quality of life and physical performance.
Multidisciplinary transitional care interventions have the potential to support patients in gaining more autonomy to perform their daily activities, while improving their quality of life. However, given the varying effects observed across studies, we recommend tailoring strategies to implement such interventions to the environments, settings, and populations in which they are implemented to maximize their impact on health-related outcomes. A systematic and thorough needs assessment before implementing a transitional care intervention might improve its chances of success. Further research is needed to determine how to tailor strategies to implement these interventions successfully.
Quality of Life
Patient Readmission
