The clinical effectiveness and cost-effectiveness of clinical nurse specialist-led hospital to home transitional care: a systematic review

• Published in: Journal of evaluation in clinical practice Vol. 21; no. 5; pp. 763 - 781
• Main Authors: Bryant-Lukosius, Denise, Carter, Nancy, Reid, Kim, Donald, Faith, Martin-Misener, Ruth, Kilpatrick, Kelley, Harbman, Patricia, Kaasalainen, Sharon, Marshall, Deborah, Charbonneau-Smith, Renee, DiCenso, Alba
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.10.2015
• Subjects: advanced practice nursing; Age Factors; Caregivers - psychology; clinical nurse specialist; Cost-Benefit Analysis; cost-effectiveness; economic evaluation; Female; health services research; Heart Failure - mortality; Heart Failure - therapy; Home Care Services - organization & administration; Home Care Services - statistics & numerical data; Humans; meta-analysis; Neoplasms - mortality; Neoplasms - therapy; Nurse Clinicians - economics; Nurse Clinicians - organization & administration; Nurse Clinicians - statistics & numerical data; Patient Discharge - statistics & numerical data; Patient Satisfaction; Pregnancy; Pregnancy Outcome - epidemiology; randomized controlled trial; Randomized Controlled Trials as Topic; Risk Factors; systematic review; Time Factors; transition care; Transitional Care - economics; Transitional Care - organization & administration; Transitional Care - statistics & numerical data; Treatment Outcome; cost-effectiveness; health services research; transition care; clinical nurse specialist; advanced practice nursing; meta-analysis; economic evaluation; systematic review; randomized controlled trial
• ISSN: 1356-1294; 1365-2753
• DOI: 10.1111/jep.12401

Rationale, aims and objectives Clinical nurse specialists (CNSs) are major providers of transitional care. This paper describes a systematic review of randomized controlled trials (RCTs) evaluating the clinical effectiveness and cost‐effectiveness of CNS transitional care. Methods We searched 10 electronic databases, 1980 to July 2013, and hand‐searched reference lists and key journals for RCTs that evaluated health system outcomes of CNS transitional care. Study quality was assessed using the Cochrane Risk of Bias and Quality of Health Economic Studies tools. The quality of evidence for individual outcomes was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. We pooled data for similar outcomes. Results Thirteen RCTs of CNS transitional care were identified (n = 2463 participants). The studies had low (n = 3), moderate (n = 8) and high (n = 2) risk of bias and weak economic analyses. Post‐cancer surgery, CNS care was superior in reducing patient mortality. For patients with heart failure, CNS care delayed time to and reduced death or re‐hospitalization, improved treatment adherence and patient satisfaction, and reduced costs and length of re‐hospitalization stay. For elderly patients and caregivers, CNS care improved caregiver depression and reduced re‐hospitalization, re‐hospitalization length of stay and costs. For high‐risk pregnant women and very low birthweight infants, CNS care improved infant immunization rates and maternal satisfaction with care and reduced maternal and infant length of hospital stay and costs. Conclusions There is low‐quality evidence that CNS transitional care improves patient health outcomes, delays re‐hospitalization and reduces hospital length of stay, re‐hospitalization rates and costs. Further research incorporating robust economic evaluation is needed.