Table 2

Description of the individual nutritional care plans in the included studies and the follow-up post-discharge from hospital

Study and country	Design of individual nutritional plan: (a) where, (b) when and (c) who	Individualised nutritional plan: (a) content and (b) based on	(a) Follow-up, (b) content in follow-up and (c) who	Oral nutritional supplement
1. Andersson et al³⁹ Norway	(a) Hospital	(a) Nutritional status, nutrient requirements and nutrient intake.	(a) One home visit 4 weeks post-discharge. Three telephone calls after 1, 7 and 10 weeks.	No
	(b) Before discharge	(b) Information regarding swallowing function, bowel function, appetite, food preferences and personal habits	(b) Nutritional counselling, patients’ adherence to nutritional plan was assessed. Individual adjustment if needed.
	(c) Clinical nutritionist		(c) Not reported
2. Beck et al¹⁸ Denmark	(a) Home	(a) Estimated nutritional requirements, nutritional rehabilitation goals, dietary counselling with attention to nutritional risk factors, timing, size and frequency of meals and meals-on-wheels (if needed).	(a) Four follow-up visits at 1, 3 (×2) and 8 weeks post-discharge.	Yes
	(b) 1 week post-discharge	(b) Standardised dietary interview	(b) Reviewing nutritional plan, dietary counselling, motivation and education and weight.
	(c) Registered dietitian		(c) Two follow-up visits by registered dietitians, 3 follow-up visits by general practitioners and the last visit together
3. Beck et al19 Denmark	(a) Home	(a) Estimated nutritional requirements and nutritional rehabilitation goals. Specific focus was on optimising the intake of protein and the distribution of protein during the day. Providers of meals-on-wheels were contacted if relevant to change the meals delivered.	(a) Two home visits at 3 and 8 weeks post-discharge.	Yes
	(b) The day of discharge	(b) Individual nutritional assessment focusing on dietary intake, activity level and weight	(b) Reviewing the nutritional care plan, dietary counselling, motivation, education, monitoring participant weight and ensuring that energy and protein requirements were achieved.
	(c) Dietitian		(c) Dietitian, the first visit together with the discharge liaison-team.
4. Feldblum et al⁴⁰ Israel	(a) Hospital	(a) Individual treatment goals, recommendations for nutrient intake and anthropometrical and biochemical goals. The basic approach was to develop a dietary menu based on inexpensive food sources and recipes.	(a) Three home visits 1 week, 1 month and 1 month post-discharge.	Yes
	(b) Before discharge	(b) Nutritional assessment during the first home visit	(b) Nutritional assessment including dietary intake, nutritional problems, food preferences and appetite status. During the second visit, the dietetic treatment was enforced and corrected as required by the patient and his or her caregivers. Family members or first-contact caregivers were also instructed, as necessary. During the last visit, patients and their caregivers received instructions on how to follow the recommended diet.
	(c) Dietitian		(c) Dietitian.
5. Pedersen et al⁴¹ Denmark	(a) Hospital	(a) Three daily meals, three between-meal snacks, supplements and instructions for implementing the plan. Individual arrangements with the primary healthcare provider; for example, concerning nutritional support post-discharge, meal service, food delivery and home care to supply daily meals.	(a) Three home visits or counselling over telephone 1, 2 and 4 weeks post-discharge.	Yes
	(b) Before discharge	(b) Nutritional needs identified during hospital stay and tailored to the individual preferences and circumstances	(b) Nutritional counselling, patients’ adherence to nutritional plan was assessed, identify inhibiting and restraining elements, motivation and adjusting the nutrition plan if needed.
	(c) Clinical nurse specialist		(c) Clinical dietitian, attended by the patients’ daily home care provider.
6. Pedersen et al²⁷ Denmark	(a) Hospital	(a) Three daily meals, three between-meal snacks, supplements and instructions for implementing the plan. Individual arrangements with the primary healthcare provider; for example, concerning nutritional support post-discharge, meal service, food delivery and home care to supply daily meals.	(a) Three home visits or counselling over telephone 1, 2 and 4 weeks post-discharge.	Yes
	(b) Before discharge	(b) Nutritional needs identified during hospital stay and tailored to the individual preferences and circumstances	(b) Nutritional counselling, patients’ adherence to nutritional plan was assessed, identify inhibiting and restraining elements, motivation and adjusting the nutrition plan if needed.
	(c) Clinical nurse specialist		(c) Clinical dietitian, attended by the patients’ daily home care provider.
7. Sharma et al²⁵ Australia	(a) Hospital	(a) A combination of strategies based on the individual patients’ food preferences; for example, mid-meal snack and food fortification. Intervention where appropriate, aimed to meet 100% of patients’ energy and protein requirements for ideal body weight.	(a) Monthly telephone call for 2 months.	Yes
	(b) 24 hours on receiving referral from the research dietitian	(b) Nutritional assessment	(b) Compliance with the dietetic plan was assessed, dietetic counselling, weight. In case patients were discharged to a nursing home, the dietitian contacted the nursing home manager and forwarded the nutritional care plan to be followed.
	(c) Ward dietitian		(c) Research dietitian.
8. Terp et al⁴² Denmark	(a) Hospital	(a) Advice on nutritional intake, everyday food if relevant combined with oral nutritional supplements.	(a) Three follow-up visits 1, 4 and 8 weeks post-discharge.	Yes
	(b) Before discharge	(b) Individual requirements and preferences	(b) Monitoring the nutritional status, evaluation of the dietary intake and identification and management of problems related to inadequate dietary intake.
	(c) Registered dietitian		(c) Nursing staff in municipality; the final 3 month follow-up visit, was conducted by the geriatric nurse from the hospital.
9. Yang et al⁴³ Taiwan	(a) Hospital	(a) Advice according to energy and protein intake requirements.	(a) Before discharge, a dietitian taught the post-discharge diet and provided dietary advice. Family caregivers participated in the dietary counselling. Post-discharge phone calls were adopted regularly. How often and how many phone calls were not reported.	No
	(b) Before discharge	(b) Nutritional status and physical activity	(b) Tracking the nutritional intake status and prescribing individualised nutritional plans.
	(c) Dietitian	(b) Nutritional status and physical activity	(c) Trained data collectors from clinical staff. The dietitian was in charge of anthropometry and nutritional intake status. The blood parameters were performed by the laboratory department.