title: Transitional Care for Patients With Congestive Heart Failure: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  We aimed to determine the impact of transitional care interventions (TCIs) on acute health service use by patients with congestive heart failure in primary care and to identify the most effective TCIs and their optimal duration.
  
  
  METHODS
  We conducted a systematic review and meta-analysis of randomized controlled trials, searching the Medline, PsycInfo, EMBASE, and Cochrane Library databases. We performed a meta-analysis to assess the impact of TCI on all-cause hospital readmissions and emergency department (ED) visits. We developed a taxonomy of TCIs based on intensity and assessed the methodologic quality of the trials. We calculated the relative risk (RR) and a 95% confidence interval for each outcome. We conducted a stratified analysis to identify the most effective TCIs and their optimal duration.
  
  
  RESULTS
  We identified 41 randomized controlled trials. TCIs significantly reduced risks of readmission and ED visits by 8% and 29%, respectively (relative risk = 0.92; 95% CI, 0.87-0.98; P = .006 and relative risk = 0.71; 95% CI, 0.51-0.98; P = .04). High-intensity TCIs (combining home visits with telephone followup, clinic visits, or both) reduced readmission risk regardless of the duration of follow-up. Moderate-intensity TCIs were efficacious if implemented for a longer duration (at least 6 months). In contrast, low-intensity TCIs, entailing only followup in outpatient clinics or telephone follow-up, were not efficacious.
  
  
  CONCLUSIONS
  Clinicians and managers who implement TCIs in primary care can incorporate these results with their own health care context to determine the optimal balance between intensity and duration of TCIs. High-intensity interventions seem to be the best option. Moderate-intensity interventions implemented for 6 months or longer may be another option.
authors.affiliation: Department of Family Medicine, McGill University, Montreal, Canada isabelle.vedel@mcgill.ca.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Vedel
authors.affiliation: Department of Family Medicine, McGill University, Montreal, Canada.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Khanassov
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D013689:Telephone; D013997:Time Factors; D000069341:Transitional Care / Q000706:statistics & numerical data*
keywords: congestive heart failure; meta-analysis; outcomes research; systematic review; transitional care; utilization