Table 2

Summary of reviewed quantitative and mixed methods studies

Quantitative studies
Author	Country	Components of intervention	Continuity*		N	Participants	Method	Outcomes relevant to review			Outcomes	Main findings	Intervention successful?
Author	Country	Components of intervention	R	I	N	Participants	Method	S	Pod	Ha	Outcomes	Main findings	Intervention successful?
van de Mortel et al	Australia	Care coordinated by GP registrar who conducted an initial patient assessment, and case conferenced with the medical and nursing teams and the family to develop the care plan. 3-month follow-up (for stable patients) or reassessed and updated the plan if the patient deteriorated. This service was initially available during business hours, but was extended to after hours as funding became available.	x	x	191 (exp: n=99)	Adults ≥18 years with a terminal illness.	A quasiexperimental design (no pretest measures).		x	x	Hospital admissions per 100 patient-days, proportion of deaths at home.	Controls were more likely to have ≥2 admissions than the intervention group (OR 2.67 (95% CI 1.39 to 5.11); p<0.003) per 100 days. Controls were significantly less likely to die at home than intervention group (OR 0.41 (95% CI 0.20 to 0.86); p=0.02)	Yes although some significant differences between control and intervention participants
Ingadottir and Jonsdottir	Iceland	Specialist nurse acts as a coordinator of interdisciplinary collaboration. Visits patients at home for initial assessment Regular telephone contact Nurse coordinates multidisciplinary response to acute exacerbations.	x	x	50	COPD patients	Interrupted time series study			x	BMI, capacity to use medications, length of hospitalisation, psychometrics (HRQL, HADS), smoking rate	Hospital admission rate and days spent in hospital because of COPD reduced by 79% and 78%, respectively. The number of days spent in the hospital because of other diseases was not significantly different in T1, T2 and T3	Yes
O’Conner	Australia	12-month evaluation of nurse practitioner role in palliative care. Aims of nurse practitioner were: To help patients achieved their preferred place of care. Enhance professional relationships between services Facilitate timely discharges and admissions between services.	x	x	683 Referred to service 105 records examined	Palliative care patients	Mixed methods—Qualitative evaluation of nurse led practitioner role And note review (no pretest data collected)		X	x	How quickly patient seen by NP after referral Decreased unplanned/preventable hospital admissions Place of death Qualitative feedback	Place of death 34 clients died in the evaluation period. Twenty died in their place of choice (59%). Hospital admissions 53 potential presentations to A&E had been averted, with only nine presentations in the 12-month period.	Yes—fewer hospital admissions for those being cared for at home Outcome measures not clearly reported No comparator so hard to assess impact of intervention
Montero et al	USA	Healthcare professional education Call back from nurse and appointment with oncologist within 5 days (to discuss symptom management, education, medication review/compliance, and follow-up appointment reminders) Mandatory early follow-up appointments with the patient’s primary oncology care team help facilitate the transition from the hospital to the outpatient setting.		x	4551 admissions during study period	Patients referred to palliative and general medical oncology services.	Interrupted time series design			x	Readmission rates	During the 11-month postintervention period there was a significant reduction in unplanned 30-day readmissions risk. Unplanned readmission rates declined by 4.5%–22.9% from baseline. Nurse call-backs improved a patient’s capacity for self-care at home and compliance with medication.	Yes
Edwards et al	Canada	Generation of a seamless care report—shared with other professionals Rounds with palliative care physicians twice weekly Telephone consultations and point of contact for patients.	X	x	200 (100 in intervention)	Patients receiving chemotherapy	RCT			x	Self-reported healthcare service use Number and type of drug related problems	Patients in intervention sough additional healthcare support (hospital admission, A&E) An average of 3.7 DRPs per patent in intervention arm	Not possible to tell from results provided—only gives % that accessed additional health support for example, hospital admission no comparator
Morris and Galicia-Castillo	USA	(CARES): a collaborative consultative PC programme Two PC physicians under a medical director contract provided consultation A part-time facility-based chaplain provided spiritual and psychosocial support	X	x	170	Care home residents	Pilot intervention study No pretest data collected		X	x	Services provided Changes to care plans Hospitalisations Place of death Hospice sage	Seven residents were hospitalised, despite orders for no hospitalisation, five died in hospital. 96% (54 of 56) of LTC residents died with hospice services. Two LTC residents declined hospice services and died in the hospital, which was consistent with their families expressed goals. Among the SNF residents, 36 (43%)of 82 have died: nine transitioned to hospice services at home, an inpatient hospice unit, or LTC prior to death; 19 died under SNF care and were unable to access their hospice benefit; and eight others died in the hospital	Not clear No comparison group and preference for place of death not reported.
De graff	The Netherlands	The Hospice Assist at Home service consists of four components. (1) A GP requested home visit from the hospice nurse consultant (2) Multidisciplinary consultation, once a fortnight, led by a hospice GP and Supported by two HNCs. (3) 24/7 hospice care telephone backup (4) one HCP selected by the patient, is responsible for coordination of care.	X	x	130	Patients living at home, with a life expectancy of less than 1 year	A cross-sectional evaluation study (no baseline data collected)		x		Expressed end-of-life preferences and the congruence between preferred and actual place of death	If preferred place of death was known, 92/101 (91%) patients died in their preferred place of death.	Yes

*Continuity.
BMI, Body Mass Index; COPD, Chronic Obstructive Pulmonary Disease; DRP, Drug related problem; Ha, reducing hospital admissions; HADS, Hospital anxiety and depression scale; HCP, Health care professional; HNC, Hospice Nurse Consultant; HRQL, Health related quality of life; I, informational; LTC, Long term condition; NP, Nurse Practitioner; poD, place of death; R, relational; S, satisfaction with care.