Results
Search Results
A total of 5,506 references were initially identified from the databases
searches. Of these, 5,375 were not eligible based on title/abstract
screening and 121 based on full text reading. Eleven studies were
finally included in the review: two randomized controlled trials (RCTs)
and nine nonrandomized studies (Figure 1).
Characteristics of Included
Studies
All the articles were published in English. The characteristics of the
included studies are summarized in Table 1.
Quality of care
Eight different studies reported on quality of care indicators (Table
2): six reported on medication
problems12,16,18,20,27,28 and two on advance
directives.21,29
Overall, the effects of TCi on medication problems were inconclusive:
Four studies reported favorable TCi results12,16,27,28with significantly fewer medication errors per
patient,27,28 significantly lower odds of having
discrepancy-related adverse drug events16 and
significantly fewer patients with one or more missed or delayed
doses.12 One study reported no significant differences
between the intervention and control groups.18 One
study also reported better results in the control
group.20
Among studies reporting TCi involving advance directives, two reported
positive effects on the quality of care. One study found that the
satisfaction with Advance Care Planning was significantly higher in
patients and caregivers enrolled in a TCi.29 Another
study reported significantly less discrepancy in advance directives
documentation and Do-Not-Resuscitate orders between the acute and LTC
settings.21
Clinical outcomes
Four different studies reported on clinical outcomes (Table 3): three on
mortality,16,17,29 two on mobility, function and
pain17,18 and one on confusion/behavioral
symptoms.18
No studies reported a beneficial effect of TCi on mortality. One study
only reported composite data, combining deaths and readmissions, with no
significant differences between the post-intervention and
pre-intervention groups.16 Another study reported very
similar results for both the intervention and usual care
groups.29 Lastly, in a study that compared two
interventions and did not include a control group, the authors reported
reduced mortality with a tailored TCi as compared with standardized
TCi.17 In tailored TCi, the number of follow-up visits
and the healthcare professional performing them (physician, nurse or
physiotherapist) was adapted according to the case and needs, whereas a
strict protocol was followed in standardized TCi.
In terms of mobility, function and pain outcomes, reported results have
been inconclusive. One study which reported on multiple outcomes found
significantly fewer cases of worsening pain with TCi, compared with the
control group, and fewer cases of decline in mobility with TCi but this
difference was not statistically significant. This same study also
reported a slightly higher number of falls in the TCi group, but this
was also not statistically significant.18 One study
found very similar effect between a tailored intervention and a
standardized intervention when looking at functional autonomy
differences measured using the “modified Barthel index” by Gregersen
et al (2011) before and after the intervention period.
Finally, one study reported on confusion and behavioral symptoms. The
authors reported fewer cases of confusion and fewer cases of worsening
behavior with TCi but these differences were not statistically
significant.18
Satisfaction
Three different studies reported on satisfaction with TCi by either
healthcare professionals or patients/caregivers (Table
3).12,29,30 In all three studies, patients, caregiver
and healthcare professionals interviewed all reported high levels of
satisfaction with TCi.12,29,30
Healthcare services use
Seven different studies reported on healthcare services use (Table 4):
six evaluated hospital readmissions and ED visit
outcomes,16-19,21,29 and five assessed changes in the
number of hospital days.16,17,21,28,29 The results
pertaining to hospital readmissions and ED visits are inconclusive. Two
studies out of six showed a beneficial effect of TCi, with a
significantly lower percentage of patients
readmitted,19 and significantly reduced hospital usage
(combining readmissions and ED visits) associated with
TCi.18 A third study also reported fewer patients
readmitted after TCi implementation, but this difference was not
statistically significant.21 Two studies found no
significant differences between TCi and usual care on hospital
readmissions or on the combination of deaths and hospital
readmissions.16,29 Lastly, the study that compared two
interventions which did not include a control group reported reduced
readmissions rate with the tailored as compared with the standardized
TCi.17
Results have also been inconclusive as it pertains to studies measuring
changes in length of stay. In one study, the authors reported a
significantly shorter index stay with TCi.16 Two other
studies found very similar numbers, both for index stay hospital
days28,29 and hospital days during
readmissions.29 An additional study found a longer
index stay with the implementation of TCi but the difference was not
statistically significant.21 Lastly, one study found
no differences in index length of stay between the participants enrolled
in the tailored TCi or standardized TCi.17