Table 4 Overview systematic reviews without meta- analysis (n = 7)
Intervention | Control | Outcome | Number of studies | Number of patients | Heterogeneity | Quality of evidence- risk of bias |
|---|---|---|---|---|---|---|
Allen et al., 2014 | ||||||
Discharge protocol and advanced practice nurse | Usual care | - Length of hospital stay - Length of time till re- hospitalization - Costs - Functional status - Depression - Patient satisfaction - Quality of life - GP satisfaction | 5 (RCT) | 918 | Due to heterogeneity in the transitional care interventions and outcomes, data were not pooled. | Cochrane Collaboration’s tool – high risk of performance bias in the included research articles |
General practitioner and primary care nurse models | Usual care | 3 (RCT) | 1949 | |||
Health Quality Ontario, 2013 | ||||||
Nurse and physician care | Physician care | - Hospitalizations - Length of stay - Mortality - ED visits - Specialist visits - Health- related quality of life - Patient satisfaction - Disease specific measures - Examination or medication prescribing - Health- system efficiencies - Number and length of primary health care visits - Physician workload | 6 (RCT) | Intervention: 1403 Control:1538 | Due to clinical heterogeneity in the study populations evaluated, and differences in provider roles and characteristics, the pooling of outcomes was thought to be inappropriate and a meta- analysis was not conducted. | Quality of evidence: GRADE Low- Moderate quality |
Martin et al., 2010 | ||||||
Inter- professional collaboration – new models of care | Usual care | - Mortality - Clinical outcomes - Functional outcomes - Social outcomes - Utilization of medical services - Patient- reported outcomes: quality of life, activities of daily living | 14 (RCT) | Intervention: 2788 Control: 2563 | NAV | NAV |
Newhouse et al., 2011 | ||||||
Nurse practitioner/clinical nurse specialist care groups | Care management exclusively by physicians | - Patient satisfaction - Self- reported perceived health - Functional status - Glucose control - Lipid control - Blood pressure - ED visits - Hospitalizations - Duration of mechanical ventilation - Length of stay - Mortality - Cost - Complications | 69: 20 (RCT) + 49 (obser- vational) | NAV | Effect sizes were not calculated for the multiple outcomes. Because of the widely varying populations, definitions, time periods, and study designs. Also, the publications did not consistently include the necessary data to calculate effect size. | Quality assessment by the Jadad scale 46 articles: High quality 12 articles: Low quality |
Renders et al., 2000 | ||||||
Interventions targeted at health care professionals or the structure in which health care professionals deliver their care. A more enhanced nursing role. | Usual care | - Glycemic control - Micro- or macro- vascular complications - Cardiovascular risk factors - Hospital admissions - Mortality - Well- being - Perceived health - Quality of life - Functional status - Patient satisfaction | 41: 27 (RCT) + 12 (CBA) + 2 (ITS) | 48,598 | Given the likely heterogeneity of interventions, there is decided a priori not to use meta- analysis to pool the results of studies. Differences in guidelines and also in methods and reference values to assess glycated hemoglobin meant that a uniform effect size could not be valued and presented, thereby hindering between- study comparisons. | The quality criteria applied to RCT’s, CBAs and ITS are described in detail in the EPOC module of the Cochrane library. Allocation concealment: 17 articles clearly concealed Blind outcome assessment: 20 articles adequate 16 articles partly adequate Reliable outcome assessment: 22 articles adequate |
Smith et al., 2014 | ||||||
Participation of APRNs/PAs in providing cancer screening and prevention recommendations in primary care settings | Cancer screening and prevention provider teams with physicians that do not include APRNs/PAs | - Cervical cancer (Pap test) - Breast cancer (Mammogram) - Colorectal cancer - Smoking cessation - Diet - Physical activity | 15: 3 intervention studies +12 observational studies | NAV | NAV | NAV |
Stalpers et al., 2015 | ||||||
Nurse- physician collaboration | Usual care | - Pressure ulcers - Patient falls - Pain management | 29: 1 RCT + 28 observational studies | NAV | Fundamental problems with assessing and comparing data from primary studies prevents conducting an adequate quantitative meta- analysis of the literature. | Dutch version of Cochrane’s critical appraisal instrument: validity: moderate reliability: moderate applicability: moderate |