Effectiveness of care transition strategies for colorectal cancer patients: a systematic review and meta-analysis.

INTRODUCTION: Implementing effective strategies to transition care for individuals with colorectal cancer is an important tool to qualify care for affected individuals, as well as contribute to the dispensation of continuous and quality care to patients. OBJECTIVE: To evaluate the effectiveness of strategies to transition from hospital care to the community compared to usual care for colorectal cancer patients to reduce hospital stay, readmissions at 30 days, and visit to the emergency department up to 30 days. METHOD: Systematic review and meta-analysis followed the recommendations of PRISMA statement, with protocol registered in PROSPERO (CRD 42,020,162,249). Searches were carried out in May 2020 in the following databases: PubMed/MEDLINE, LILACS, EMBASE, and Cochrane Central. Meta-analysis was performed using a random-effects model. The measure of effect used for dichotomous outcomes was relative risk, and for continuous outcomes, the difference of means was used, with their confidence intervals of 95%. Heterogeneity was evaluated using inconsistency statistics. RESULTS: Of 631 identified studies, seven studies were included. The meta-analysis of the studies showed a reduction in readmissions at 30 days of 32% and a significant reduction in hospital stay time of approximately one and a half days, both of which were analyzed in favor of the group of care transition interventions. CONCLUSION: The findings showed effective care transition strategies for the transition of colorectal cancer patients, such as post-discharge active surveillance program, standardized protocol of improved recovery, and telephone follow-up. TRIAL REGISTRATION: CRD42020162249.

Care Transitions of Colorectal Cancer Patients from Hospital to Community: Systematic Review and Meta-analysis Protocol

Objective: To evaluate the effectiveness of care transition strategies from hospital-to-community compared to usual care for patients with colorectal cancer to reduce hospital stay, 30-day readmissions, and emergency room visits up to 30 days. Methods: Systematic review and meta­analysis protocol that followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). The protocol was registered on PROSPERO (CRD42020162249). We will include studies available in the electronic databases PubMed/Medline, Embase, Cochrane CENTRAL and LILACS with care transition strategies/actions from hospital to community as the primary outcome. Eligible studies will be selected, and data will be combined and synthesized using Review Manager (RevMan 5.4) software. We will combine risk ratios or odds ratios for dichotomous data and mean differences for continuous data using a random effects model. Discussion: This review will contribute to the practice and development of effective and safe care transition strategies from hospital to community for colorectal cancer patients. There is an expectation that this review will provide much needed evidence that effective care transitions could reduce short term hospital readmission, and may thus provide added value in the care of colorectal cancer patients. Conclusion: The results of the review will be used to provide clear recommendations for hospital and primary care management to improve care transitions and, as a result, also improve integration in the healthcare system.

Objetivo: Evaluar la efectividad de estrategias de transición de cuidados del hospital a la comunidad en comparación con el cuidado usual en pacientes con cáncer colorrectal para reducir el tiempo de estancia hospitalaria, readmisiones a los 30 días y visitas al departamento de emergencias dentro de los 30 días. Métodos: Protocolo de revisión sistemática y metaanálisis que siguió las recomendaciones de Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). El protocolo se registró en PROSPERO (CRD42020162249). Se incluirán estudios disponibles en las bases de datos electrónicas PubMed/Medline, Embase, Cochrane CENTRAL y LILACS con estrategias/acciones de transición del cuidado del hospital a la comunidad como desenlace principal. Se seleccionarán los estudios elegibles y los datos se combinarán y sintetizarán mediante el software Review Manager (RevMan 5.4). Serán combinados los riesgos relativos u odds ratios para los datos dicotómicos y las diferencias de medias para los datos continuos mediante un modelo de efectos aleatorios. Discusión: Esta revisión contribuirá a la práctica y el desarrollo de estrategias de transición de cuidado efectivas y seguras del hospital a la comunidad para los pacientes con cáncer colorrectal. Se espera que esta revisión proporcione evidencias muy necesarias de que las transiciones de cuidado efectivas podrían reducir la readmisión hospitalaria a corto plazo y, por lo tanto, pueden proporcionar un valor agregado en el cuidado de los pacientes con cáncer colorrectal. Conclusión: Los resultados de la revisión se utilizarán para proporcionar recomendaciones claras para la gestión hospitalaria y de cuidado primario para mejorar las transiciones de cuidado y, como resultado, también mejorar la integración en el sistema de salud.

Objetivo: Avaliar a efetividade de estratégias de transição do cuidado do hospital para a comunidade comparada aos cuidados habituais para pacientes com câncer colorretal para diminuir tempo de permanência hospitalar, readmissões aos 30 dias e visita ao setor de emergência até 30 dias. Métodos: Protocolo de revisão sistemática e meta-análise que seguiu as recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). O protocolo foi registrado no PROSPERO (CRD42020162249). Incluiremos estudos disponíveis nas bases de dados eletrônicas PubMed/Medline, Embase, Cochrane CENTRAL e LILACS tendo como desfecho primário as estratégias/ações de transição do cuidado do hospital para a comunidade. Os estudos elegíveis serão selecionados e os dados serão combinados e sintetizados usando o software Review Manager (RevMan 5.4). Serão combinados os riscos relativos ou odds ratios para dados dicotômicos e diferenças de médias para dados contínuos usando um modelo de efeitos aleatórios. Discussão: Esta revisão contribuirá para a prática e desenvolvimento de estratégias de transição de cuidados efetivas e seguras do hospital para a comunidade para pacientes com câncer colorretal. Espera-se que esta revisão forneça evidências muito necessárias de que as transições de cuidados efetivas podem reduzir a readmissão hospitalar de curto prazo e podem, assim, fornecer valor agregado no cuidado de pacientes com câncer colorretal. Conclusão: Os resultados da revisão serão usados ​​para fornecer recomendações claras para a gestão hospitalar e de cuidados primários para melhorar as transições de cuidados e, como resultado, também melhorar a integração no sistema de saúde.