title: Continuity, coordination, and transitions of care for patients with serious and advanced illness: a systematic review of interventions.
abstract: OBJECTIVE
  Continuity, coordination, and transitions of care are key to high-quality medical care for patients with serious and advanced illness. We conducted a systematic review to evaluate the impact of interventions targeting these areas in this population.
  
  
  METHODS
  We searched PubMed, CINAHL, PsycINFO, Cochrane, and DARE from 2000 through 2011. We included prospective controlled studies targeting continuity, coordination, and transitions for patients with advanced illness that reported patient centered outcomes. Of 13,014 citations, 23 studies met inclusion criteria. Two investigators extracted and checked data on population, interventions, methods, outcomes, and methodological quality.
  
  
  RESULTS
  Four of the six studies evaluating patient satisfaction (67%) and four of the six studies evaluating caregiver satisfaction (67%) showed statistically significant improvements in these outcomes in the intervention compared to the control group. Only three of the nine studies (33%) measuring quality of life and five of the 16 (31%) measuring health care utilization showed improvement. Results were similar across different types of interventions.
  
  
  CONCLUSIONS
  Many studies were limited by methodologic issues such as use of measurement tools not developed for patients with advanced disease and small sample size. Interventions and outcomes were too heterogeneous for meta-analysis. We found moderate evidence that interventions targeting continuity, coordination, and transitions in patients with advanced and serious illness improve patient and caregiver satisfaction, but low evidence for other outcomes. Further research is needed on how to target these domains for outcomes such as health care utilization.
authors.affiliation: Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA. sdy@jhsph.edu
authors.forename: Sydney M
authors.initials: SM
authors.lastname: Dy
authors.forename: Colleen
authors.initials: C
authors.lastname: Apostol
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Martinez
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Aslakson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care / Q000458:organization & administration*; D016638:Critical Illness / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D010360:Patient Transfer; D012720:Severity of Illness Index