Table 2

Summary of reviewed quantitative and mixed methods studies

Quantitative studies
AuthorCountryComponents of interventionContinuity*NParticipantsMethodOutcomes relevant to reviewOutcomesMain findingsIntervention successful?
van de Mortel et al AustraliaCare 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.
(exp: n=99)
Adults ≥18 years with a terminal illness.A quasiexperimental design
(no pretest measures).
xxHospital 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
and Jonsdottir
IcelandSpecialist 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.
xx50COPD patientsInterrupted time series studyxBMI, capacity to use medications, length of hospitalisation, psychometrics (HRQL, HADS), smoking rateHospital 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
O’ConnerAustralia12-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.
Referred to service
105 records examined
Palliative care patientsMixed methods—Qualitative evaluation of nurse led practitioner role
And note review
(no pretest data collected)
XxHow 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 USAHealthcare 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.
x4551 admissions during study periodPatients referred to palliative and general medical oncology services.Interrupted time series designxReadmission ratesDuring 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.
Edwards et al CanadaGeneration of a seamless care report—shared with other professionals
Rounds with palliative care physicians twice weekly
Telephone consultations and point of contact for patients.
Xx200 (100 in intervention)Patients receiving chemotherapyRCTxSelf-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
Xx170Care home residentsPilot intervention study
No pretest data collected
XxServices provided
Changes to care plans
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 graffThe NetherlandsThe 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.
Xx130Patients living at home, with a life expectancy of less than 1 yearA cross-sectional evaluation study
(no baseline data collected)
xExpressed end-of-life preferences and the congruence between preferred and actual place of deathIf preferred place of death was known, 92/101
(91%) patients died in their preferred place of death.
  • *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.