The study selection is described in the PRISMA flowchart in Figure 1. Initially, 355 of 11.712 reviewed studies were included. Of these, 19 studies reported outcomes of interventions and thus were relevant to the aim of this review.
Characteristics of the studies
As seen in Figure 2 there has been an increase in published studies researching patient experience in transitions in healthcare settings, from less than one per year between 2003 and 2012, to up to three per year between 2013 and 2021. Ten studies originate from the US, Denmark, and Sweden. We identified five studies from the US (33-37), three studies from Sweden (38-40), and two studies from Denmark (41, 42). Only one study from each of the three continents of South America, Asia, and Australia was identified (43-45). The rest of the identified studies originated from other European countries (46-51). The characteristics of the studies can be seen in Table 2.
Figure 2: Graph depicting the number of published articles on interventions’ influence on patient experience in transitions between healthcare settings in 2003-2021 cumulated.
Most of the included studies used quantitative methods. Nine were randomized controlled trials (RCT) (33, 37, 38, 41, 42, 44-46, 49) and four were cohort studies (34, 35, 40, 50). Additionally, two included studies used other quantitative methods, one quasi-experimental study (43) and one cross-sectional study (48). Finally, five included studies used qualitative methods (36, 39, 47, 51, 52).
Most of the included studies used statistical analysis (33-35, 37, 38, 40-46, 48-50) reflecting their quantitative methods. The studies using qualitative methods had several different theoretical approaches ranging from use of analytical induction, deduction, and negative case comparison (36) and thematic content analysis (47, 51), to content analysis (39).
The populations of the studies were quite diverse, but all were limited to a single or specific population. Five studies included cancer patients (35, 37, 40, 41, 49), five studies included patients with chronic diseases (36, 42, 43, 45, 48), four studies looked at elderly people (33, 36, 38, 47), and three researched patients with mental illnesses (46, 50, 51). Furthermore, one study population consisted of people who needed emergency care (39), another of patients who had a total knee arthroplasty due to osteoarthritis (34), and the last study included kidney transplant recipients (44).
Table 2: The characteristics of the included articles on interventions’ impact on patient experience when transitioning between healthcare settings.
Year
|
Authors
|
Country of origin
|
Study design
|
Theoretical approach
|
Population
|
2003
|
Nielsen et al. (41)
|
Denmark
|
RCTa
|
Statistical analysis
|
Cancer-patients
|
2004
|
Byng et al. (46)
|
United Kingdom
|
RCT
|
Statistical analysis
|
Patients with long-term mental illnesses
|
2005
|
Preen et al. (45)
|
Australia
|
RCT
|
Statistical analysis
|
Patients with chronic cardio-respiratory disease
|
2006
|
Parry et al. (36)
|
USA
|
Qualitative study
|
Analytical induction, deduction, and negative case comparison
|
Chronically ill elderly adults
|
2007
|
Kautz et al. (34)
|
USA
|
Cohort study
|
Statistical analysis
|
Patients, who had total knee arthroplasty due to osteoarthritis
|
2011
|
Koh et al. (35)
|
USA
|
Cohort study
|
Statistical analysis
|
Breast-cancer patients
|
2013
|
Berglund et al. (38)
|
Sweden
|
RCT
|
Statistical analysis
|
Elderly people
|
2013
|
Boult et al. (33)
|
USA
|
RCT
|
Statistical analysis
|
Elderly patients
|
2013
|
Smidth et al. (42)
|
Denmark
|
RCT
|
Statistical analysis
|
People living with chronic obstructive pulmonary disease
|
2014
|
Schöttle et al. (50)
|
Germany
|
Cohort study
|
Statistical analysis
|
Patients with schizophrenia and/or bipolar disorder
|
2014
|
Wagner et al. (37)
|
USA
|
RCT
|
Statistical analysis
|
Cancer-patients
|
2017
|
Röttger et al. (48)
|
Germany
|
Cross-sectional study
|
Statistical analysis
|
People with chronic diseases
|
2017
|
Scherz et al. (49)
|
Switzerland
|
RCT
|
Statistical analysis
|
Cancer-patients
|
2018
|
Thomson et al. (51)
|
United Kingdom
|
Qualitative study
|
Thematic content analysis
|
People with depression
|
2019
|
Westman et al. (40)
|
Sweden
|
Cohort study
|
Statistical analysis
|
Cancer-patients
|
2020
|
Hu et al. (44)
|
China
|
RCT
|
Statistical analysis
|
Kidney-transplant recipients
|
2021
|
Espinel-Flores et al. (43)
|
Brazil, Chile, Colombia, Mexico, and Uruguay
|
Quasi-experimental study
|
Statistical analysis
|
People with chronic diseases
|
2021
|
Hallgren et al. (39)
|
Sweden
|
Qualitative study
|
Content analysis
|
People who need emergency care
|
2021
|
Jepma et al. (47)
|
Netherlands
|
Qualitative study
|
Thematic content analysis
|
Fragile, elderly heart-patients
|
a Randomized controlled trial
The interventions and their influence on patient-experience
Of the 19 included studies in this scoping review only two studies did not find a positive effect on the patient experience in transitions across healthcare settings when an intervention was conducted (34, 46). The remaining 17 articles found a positive effect on patients’ experience. The studies’ interventions can be divided into six intervention categories: 1. Care coordinator, 2. Program (an intervention with multiple components), 3. Integrated care, 4. Coaching, 5. Discharge care plan, and 6. Miscellaneous interventions (see Table 3).
Table 3: The included studies’ interventions and their effect on patient experience in transitions between healthcare settings.
Study
|
Intervention
|
Positive effect on patient experience (yes/no)
|
Berglund et al. 2013 (38)
|
Care coordinator
|
Yes
|
Koh et al. 2011 (35)
|
Care coordinator
|
Yes
|
Scherz et al. 2017 (49)
|
Care coordinator
|
Yes
|
Wagner et al. 2014 (37)
|
Care coordinator
|
Yes
|
Westman et al. 2019 (40)
|
Care coordinator
|
Yes
|
Boult et al. 2013 (33)
|
Program
|
Yes
|
Byng et al. 2004 (46)
|
Program
|
No
|
Hu et al. 2020 (44)
|
Program
|
Yes
|
Jepma et al. 2021 (47)
|
Program
|
Yes
|
Nielsen et al. 2003 (41)
|
Program
|
Yes
|
Röttger et al. 2017 (48)
|
Program
|
Yes
|
Smidth et al. 2013 (42)
|
Program
|
Yes
|
Thomson et al. 2018 (51)
|
Program
|
Yes
|
Hallgren et al. 2021 (39)
|
Integrated care
|
Yes
|
Kautz et al. 2007 (34)
|
Integrated care
|
No
|
Schöttle et al. 2014 (50)
|
Integrated care
|
Yes
|
Parry et al. 2006 (36)
|
Coaching
|
Yes
|
Preen et al. 2005 (45)
|
Discharge care plan
|
Yes
|
Espinel-Flores et al. 2021 (43)
|
Miscellaneous interventions
|
Yes
|
1. Care Coordinator
In five of the included studies, the intervention was a care coordinator (35, 37, 38, 40, 49). All five studies found a significant improvement in patient experience in patients who were helped by a care coordinator in their transition between healthcare settings, compared to patients without a care coordinator. However, one study found no significant difference in the patient-experienced quality of life (37).
2. Program
In eight of the studies, the interventions were programs. The programs were very different in character, but all of them consisted of a variety of interventions that were joined together in a program. As an example, one of the study’s programs consisted of interventions before, during, and after admission for patients who had received a kidney through transplantation. The program consisted of four phases where the patient was consecutively informed about the process ahead and thereby kept prepared for the next step in the process to receive a kidney (44).
In several of the programs, some sort of coordination of patient care by a healthcare professional, such as a nurse, general practitioner (GP), or care coordinator was prevalent. In one of the studies, the program consisted of home-based assessment of patients’ needs and goals, evidence-based care planning, proactive monitoring, care coordination, transitional care, coaching for self-management, caregiver support, and access to community-based services (33).
Seven out of eight of the included studies with a program as intervention found an improvement in patient experience (33, 41, 42, 44, 47, 48, 51). One study found that the intervention had a different influence on different patient groups, but that the intervention overall gave a better patient experience in transitions between healthcare settings (47). Only one study with a program as the intervention found no significant difference in patient experience (46).
3. Integrated care
In three studies, the interventions in transitions between healthcare settings were some sort of integrated care (34, 39, 50) defined as a care model where all treatments were gathered under one organization to ensure better communication between different healthcare providers. In one study the intervention consisted of assertive community treatment (ACT) (50), which is a way to organize all treatments under the same organization instead of a care coordinator and is often used in psychiatry (53). In two of the studies, they found that the intervention improved patient experience (39, 50), while the last study could not find a significant difference between patients who had received the intervention, and patients who had not (34).
4. Coaching
One study looked at coaching as an intervention in transitions between healthcare settings and found a very positive effect on patient experience (36).
5. Discharge care plan
In one study the intervention consisted of a thorough and individualized discharge plan, that was sent from the discharging hospital department to the patients’ GPs (45). The study found a significant positive effect on patient experience – both in patients’ perceptions of quality of life and patients’ satisfaction with discharge (45).
6. Miscellaneous interventions
The last study included in this scoping review investigated the effect of a range of diverse interventions from five South American countries (43). In the study, they found that it was possible to do a combined analysis of the effect of the interventions, despite their diversity (43). They concluded that it was the fact that an intervention was conducted that had positive effects on the patient experience in transitions in healthcare settings (43).