Abstract 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 CNStransitional care. Methods
We searched 10 electronic databases, 1980 to
July 2013, and hand‐searched reference lists and key journals for RCTsthat evaluated health system outcomes of CNStransitional 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
RCTsof CNStransitional 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, CNScare was superior in reducing patient mortality. For patients with heart failure, CNScare 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, CNScare improved caregiver depression and reduced re‐hospitalization, re‐hospitalization length of stay and costs. For high‐risk pregnant women and very low birthweight infants, CNScare 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
CNStransitional 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.