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Table 4 Overview systematic reviews without meta- analysis (n = 7)

From: An overview of systematic reviews on the collaboration between physicians and nurses and the impact on patient outcomes: what can we learn in primary care?

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:
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
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
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
3 intervention studies +12 observational studies
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
  1. NAV ‘not available’, RCT ‘randomized controlled trial’, CBA ‘controlled before and after study’, ITS ‘interrupted time series’
  2. Table 4 presents the ‘collaboration intervention’, control, patient outcome, number of studies, number of patients (if available), a statement on heterogeneity (if available) and a measure of quality of evidence/risk of bias (if available) of seven included systematic reviews that did not conduct a meta- analysis