Care coordination to enhance management of long-term enteral tube feeding: A systematic review and meta-analysis

Background: A systematic review and meta-analysis was completed to summarize care delivery models that used care coordination and/or team approach methods in the management of patients requiring long-term enteral tube feeding. Our aim was to evaluate team composition, implementation strategies, and the effectiveness of these methods. Methods: We conducted a broad search of 7 databases from inception to May 2012, cross-referenced clinical reviews and medical guidelines, and consulted clinical experts. Independent reviewers screened eligible studies, extracted data, and assessed study quality. Results: Fifteen studies enrolling 2145 patients were included in this review. The studies described multidisciplinary teams composed of primary care physicians, specialists, nurses, dietitians, and language or speech specialists. Patients and their families/caregivers were also an important part of the care team. The interventions were multifaceted and employed multiple simultaneous strategies that particularly included patient and family education, staff education, and continuous auditing and feedback methods. Meta-analysis suggested no significant reductions in complications (incidence rate ratio [IRR], 0.53; 95% confidence interval [CI], 0.27-1.05), infections (IRR, 0.77; 95% CI, 0.48-1.24), and overall hospital admissions (IRR, 0.36; 95% CI, 0.13-1.00) most likely due to lack of statistical power. We found significant reduction of total hospital costs (estimates in US dollars: -623.08; 95% CI, -745.64 to -500.53; P <.01) after the interventions. Conclusion: Studies suggested a positive association of care coordination by a multidisciplinary team approach and improved patient outcomes for long-term enteral feeding patients. However, the available evidence does not allow estimating the effectiveness of a particular intervention or team composition.