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