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Table 3 Transitional care intervention characteristics (N = 17 studies)

From: Transitions of care interventions to improve quality of life among patients hospitalized with acute conditions: a systematic literature review

Intervention characteristics Study citations Number of studies
Type of facilitator   
 Nurse(s) [26, 27, 31,32,33,34,35,36,37,38,39,40, 42] 13
 Social worker(s) [28] 1
 Interdisciplinary team [29, 30, 41] 3
Training of facilitator   
 Reported [24,25,26, 31,32,33, 36, 38, 39] 7
 Not reported [27,28,29,30, 34, 35, 37, 40,41,42] 10
Intervention materials   
 Reported [24, 32,33,34,35,36, 39,40,41] 8
 Not reported [25,26,27,28,29,30,31, 37, 38, 42] 9
Intervention components   
 Patient needs assessment [24, 25, 28, 29, 31,32,33, 35, 38,39,40,41,42] 11
 Family needs assessment [28, 39] 2
 Identification/involvement of family caregiver [32, 33, 38, 42] 4
 Problem-solving [24, 28, 31, 39] 3
 Phone calls [24,25,26,27,28,29, 31,32,33,34, 37, 39, 41, 42] 12
 Hospital visits [24,25,26, 37, 38] 3
 Clinic visits [25, 29, 30, 41] 3
 Home visits [24, 26, 28, 30, 33, 36, 38,39,40,41,42] 10
 Telehealth (i.e., video conferencing) [35] 1
 Discharge planning/preparation [24, 26, 32, 34] 3
 Patient education [24,25,26, 28,29,30,31,32,33,34,35,36,37,38,39,40,41,42] 16
 Family education [24, 26, 28, 31, 32, 37,38,39] 7
 Use of teach-back method [24] 1
 Distribution of educational materials [24, 34, 36, 39,40,41] 5
 Care coordination/patient navigation [28, 29, 33, 41] 4
 Referral to other services [24, 28, 29, 32, 37, 38, 40, 41] 7
 Development of nursing report [24, 38] 1
 Development of individualized health plan [24, 30,31,32, 34, 38, 40] 6
 Contact with primary care providers or other community providers [25, 27, 29, 34, 38, 40,41,42] 7
 Encourage patient to contact PCP [31, 39, 40] 3
 Motivational interviewing [24, 32] 1
 On-call provider line [24, 25, 29, 31, 32, 37, 41, 42] 6
 Monitoring patient progress [25, 27, 28, 33, 35, 40] 5
 Interdisciplinary rehabilitation/physical training [30, 33, 41] 3
 Goal setting [31, 33] 2
 Regular data collection [25, 27, 29, 35, 41] 4
 Distribution of medical records to patient [42] 1
 Medication reconciliation [29, 41] 2
 Medication management [25, 29, 41] 2
 Interdisciplinary cooperation [24, 25, 29, 30, 34, 41] 4
 Other [27, 33, 35,36,37, 41, 42] 7
Cultural tailoring of intervention   0