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

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Although transitional care interventions can improve health among patients hospitalized with acute conditions, few interventions use patient quality of life (QOL) as the primary outcome. Existing interventions use a variety of intervention components, are not effective for patients of all races and ethnicities, do not address age-related patient needs, and do not incorporate the needs of families. The purpose of this study was to systematically review characteristics of transitional care intervention studies that aimed to improve QOL for younger adult patients of all race and ethnicities who were hospitalized with acute conditions.


A systematic review was conducted of empirical literature available in PubMed, Embase, CINAHL, and PsycINFO by November 19, 2019 to identify studies of hospital to home care transitions with QOL as the primary outcome. Data extraction on study design and intervention components was limited to studies of patients aged 18-64.


Nineteen articles comprising 17 studies met inclusion criteria. There were a total of 3,122 patients across all studies (range: 28-536). Populations of focus included cardiovascular disease, chronic obstructive pulmonary disease, stroke, breast cancer, and kidney disease. Seven QOL instruments were identified. All interventions were multi-component with a total of 31 different strategies used. Most interventions were facilitated by a registered nurse. Seven studies discussed intervention facilitator training and eight discussed intervention materials utilized. No studies specified cultural tailoring of interventions or analyzed findings by racial/ethnic subgroup.


Future research is needed to determine which intervention components, either in isolation or in combination, are effective in improving QOL. Future studies should also elaborate on the background and training of intervention facilitators and on materials utilized and may also consider incorporating differences in culture, race and ethnicity into all phases of the research process in an effort to address and reduce any health disparities.


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Oyesanya, Tolu O, Callan Loflin, Lindsey Byom, Gabrielle Harris, Kaitlyn Daly, Lesley Rink and Janet Prvu Bettger (2021). Transitions of care interventions to improve quality of life among patients hospitalized with acute conditions: a systematic literature review. Health and quality of life outcomes, 19(1). p. 36. 10.1186/s12955-021-01672-5 Retrieved from

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Tolulope Oyesanya

Associate Professor in the School of Nursing

Dr. Oyesanya is an Associate Professor at Duke University School of Nursing. Her research program centers on care of patients with traumatic brain injury (TBI) in acute and post-acute treatment settings, as well as support of their family caregivers. Her current research focuses on transitional care needs of patients with TBI, with an emphasis on improving patient and family quality of life post-discharge and self- and family-management of care.

Dr. Oyesanya earned her BSN, MSN, and PhD in Nursing from University of Wisconsin-Madison. She completed a post-doctoral fellowship in Brain Injury Research at Shepherd Center in Atlanta, GA. Her research has been supported by federally- and internally funded awards. Dr. Oyesanya is actively involved in several professional organizations, including serving as Chair of the Mentoring Task Force and Chair-Elect of the Career Development Networking Group of the American Congress of Rehabilitation Medicine and as a member of the Association of Rehabilitation Nurses and the International Brain Injury Association.


Lesley Rink

Consulting Associate in the School of Nursing

Lesley Rink is a PhD student at Duke University School of Nursing.  Her research interests are in contemplative sciences with a focus on mindfulness-based practices.  As a nurse in the Surgery Trauma ICU at UNC Health Care for more than three years, she has conducted research projects for both health care providers and patients with an aim to assess changes in stress levels with brief mindfulness-based interventions. 

She has presented her research findings at national and local nursing conferences.  Lesley has frequently presented across the UNC Health Care System sharing information on stress reduction and resilience tools for health care providers.  Her passion for mindfulness-based interventions to reduce stress has inspired her research and pursuit of a PhD in Nursing.  She has a personal daily mindfulness meditation practice, has attended multiple silent meditation retreats, and has completed mindfulness-based stress reduction and integrative health coaching courses at Duke Integrative Medicine.  Lesley plans to continue integrating her mindfulness education and experience here at the Duke School of Nursing.  Lesley graduated with honors from the Duke University School of Nursing Accelerated Bachelor of Science in Nursing program in 2015 and was inducted into the Sigma Theta Tau Honors Society. 

Before her nursing career, Lesley received her Bachelor of Science in Criminology and spent eight years working in public policy, budgetary development, and legislative advocacy work at the North Carolina General Assembly and the University of North Carolina System Office.   

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