Table 2.

Peer-reviewed articles included in realist review sample, by health system case and intervention

Health System	Intervention Name and Description	Author, Year	Study Design	Key Findings or Data Reported to Support Intervention
Geisinger	“Proven Health Navigator (PHN)”	Gilfillan, 2010 [17]	Pre-experimental static comparison case control	• Admissions of PHN members were reduced 18% per year (p < .01) when compared to the expected outcomes if PHN had not been implemented • Readmissions of PHN members were reduced 36% per year (p = .02) when compared to the expected outcomes if PHN had not been implemented • Total cumulative spending was reduced 7% per year (p = .21; not significant) when compared to the expected outcomes if PHN had not been implemented
		Maeng, 2012 [18]	Pre-experimental static comparison	• For elderly patient exposed to PHN, the estimated odds ratio of experiencing diabetic amputation or reaching the status of end-stage renal disease significantly deceased – OR: 0.178 and 0.688 respectively (p < .01).
	Patient Centered Medical Home (PCMH) model of care designed to improve the quality, efficiency, and patient experience of care by blending chronic and primary care to offer an integrated form of management to meet all needs	Tomcavage, 2012 [19]	N/A	• Not an effectiveness study. Commentary and background information on PHN by nursing leadership.
		Maeng, 2013 [20]	Pre-experimental static comparison	• PHN respondents were twice as likely as non-PHN respondents to have noticed differences in their care (29.2% vs. 15.4%), care coordination (34.3% vs. 14.7%), and service (31.4% vs 14.6%).• PHN respondents were more likely to cite their primary care office as their usual source of care (83% vs. 68%) and were less likely to cite the emergency room (ER) as their usual source of care (11% vs. 23%).
		Maeng, 2015 [21]	Pre-experimental static comparison	• Over a 90-month period, total costs associated with patient centered medical home exposure declined by 7.9%• Largest source of saving was acute inpatient care ($34 or 19% savings per month per member)
Geisinger	“Geisinger Monitoring Program (GMP)”	Graham, 2012 [22]	Pre-post parallel Quasi experimental matched	• Admissions during GMP enrollment had a significantly lower readmission rate than admissions before or after GMP enrollment (10.1% vs.27.1 and 18.8%, p < 0.0001). • 44% reduction in 30-day readmissions in the study cohort compared to the matched control group (p = 0.0004),
	Readmission prevention telemonitoring program for Medicaid recipients using interactive voice response (IVR) technology.
Geisinger	“Comprehensive Care Clinic (CCC)”	Maeng, 2017 [23]	Pre-post design, Pre-experimental. Cost focus.	• CCC enrollment associated with 78% reduction in acute hospital admissions (p = 0.053) and 60.3% reduction in ED visits (p = 0.017). • Estimated 28% reduction in per member per month total cost of care, primarily attributed to IP care reduction ($3931 observed vs. $5451 expected, P = 0.028) • Most significant source primarily attributed to IP care reduction (P = 0.028).
	Intensive primary care case management program for Adolescence and Young Adults with Special Care and Health Needs (AYASCHN)
Kaiser	“5-Element Transitional Bundle”	Rice, 2016 [24]	Prospective Cohort	• Readmission rates decreased from 12.1% before the implementation of the intervention to 10.6% after the intervention was in place (2008 vs 2014) (p < .0001). • HCAHPS scores for the discharge instruction composite increased from 80 to 90% (p < .0001) moving from below the 50th to above the 90th national percentile. • Average time to the first post discharge appointment decreased from 9.7 days to 5.3 days (p < .0001)
	Standardized, multidisciplinary protocol for discharge, created and maintained based on patient-identified post-discharge needs
Kaiser	“Nurse Knowledge Exchange Plus” (NKEPlus)”	Lin, 2015 [25]	Prospective Cohort	• Improvement in the mean HCAHPS score on the Nurse Knowledge Exchange Plus (NKEplus) nursing behavior bundle from 65.9 to 71.3% (p <. 001). (Behaviors reported were that the care board in room was updated with new caregiver’s names and patient plan, nurse reviewed patient’s daily care with the patient in a way they could understand, at change of shift the nurse caring for the patient introduced them to the new nurse, and that the nursing staff asked patient for input about daily care) • Improvement in the mean HCAHPS score for nurse communication from 73.1% before implementation to 76.4% after implementation (2010 vs 2014) (p <. 001).
	Model of nursing communication at shift change to reflect the principles of patient centered care
Kaiser	“Clinical Pharmacy Call Center (CCPC)”	Stubbings, 2005 [26]	Review case study/report	• Mean cost avoidance was $324 per member per year • Patients treated by CPCC pharmacists for allergic rhinitis were more likely to receive a nasal corticosteroid prescription than control patients (90.7% vs.77.8%, p = 0.009)
	Telephone pharmacy service that integrates primary care, specialty care, nursing facilities and clinical pharmacy. CCPC clinical pharmacists provide care via telephone using established communication, documentation, and interaction protocols with patients and caregivers.	McGaw, 2007 [27]	Single Arm Pre-Post Analysis	• Patients transitioned by CPCC clinical pharmacists were 78% less likely to die (95% confidence interval (CI), 0.06–0.88); 29% less likely to need an ED visit(95% CI, 0.36–1.39); and 17% more likely to follow-up with primary care clinicians (95% CI, 0.99–1.37) than patients in the Usual Care group• Demonstrated an annualized per patient savings of $5276.
Cleveland	“Connected Care SNF”	Kim, 2017 [28]	Pre experimental static comparison Retrospective cohort	• Improvement in the 30-day readmission rates at the intervention SNFs (28.1 to 21.7%, P < 0.001) and slight increase in the 30-day readmission rates at the control SNFs (27.1 to 28.5%, P < 0.001). • Absolute reductions in 30-day readmission rates ranged from 4.6% reduction for patients at low risk for readmission and 9.1% reduction for patients at high risk. • Improvements in 30-day readmission rates were greater for medical patients (31.0 to 24.6%, p < 0.001) than surgical patients (22.4 to 17.7%, p < 0.001).
	Transitions of care model to prevent readmissions for patients discharged to SNF. “Connected Care team” of 2 geriatricians, 1 internist, 1 family physician and 5 APP provided care directly within participating SNFs 4-5 days per week.
Cleveland	“R.E.D.E. (Relationship: Establishment, Development and Engagement) to Communicate: Foundations of Health Care Communication”	Windover, 2014 [29]	N/A	• Model explaining intervention
	Communication course for physician targeting relationship centered training.	Boissy, 2016 [30]	Observational study (qualitative/pre-post)	• Following the course, overall CGCAHPS scores for physician communication were higher for intervention physicians than for controls (92.09 vs. 91.09, p = 0.03).• Significant improvement in the post-course HCAHPS respect was seen in intervention versus control groups (91.08 vs. 88.79, p = 0.02)• Physicians also showed significant improvement in empathy (116.4 ± 12.7 vs. 124 ± 11.9, p < 0.001)
Cleveland	“Mobile Stroke Treatment Unit (MSTU)”	Taqui, 2017 [31]	Unmatched Quasi experimental	• Significant reduction of median alarm-to-CT scan completion times (33 minutes MSTU vs 56 minutes control group (traditional ambulance), p < 0.0001) • Significant reduction of median alarm-to-thrombolysis times (55.5 minutes MSTU vs 94 minutes control group (traditional ambulance), p < 0.0001) • Significant reduction of median door-to-thrombolysis times (31.5 minutes MSTU vs 58 minutes control group (traditional ambulance), p = 0.0012), and symptom-onset-to-thrombolysis times (97 minutes MSTU vs 122.5 minutes control group (traditional ambulance), p = 0.0485).
	EMS vehicle equipped with CT scanner allows for remote assessment and instruction by neuroradiologist and vascular neurologist
Mayo	Teleneonatology service with hub and spoke model	Fang, 2016 [32]	Case study: measurements included reason for consult and a survey	• After completion of the telemedicine consultation, 27 neonates (32.1%) were able to remain at the referring hospital • User assessment of the technology revealed that audio and video quality were poor or unusable in 16 (25%) and 12 (18.8%) of cases, respectively. Providers failed to establish a video connection in 8 consults (9.5%). • 93.3% (n = 14 of 15) of surveyed local providers agreed that the telemedicine consult improved patient safety, quality of care, or both
		Fang, 2018 [33]	Pre-experimental: RCT [33]	• Greater resuscitation quality rating for the teleneonatology group vs control group (7 vs 4, median difference 1, (P = .002)• Newborns in the teleneonatology group were significantly more likely than their matched control to undergo measurement of temperature (79% vs 55%, P = .02), blood glucose (94% vs 81%, p = .03), and blood gas (49% vs 28%, P = .008).• When analyzing the matched pairs that had a consult within 1 h of birth, the positive impact of teleneonatology was greater (median resuscitation quality rating of 8 vs 4, median difference 2, p = .003)
		Fang, 2018 [34]	Qualitative Study [34]	• 94.6% of survey respondents agreed that teleneonatology was needed at their hospitals• 96.2% of respondents believed that teleneonatology consults were helpful.• 90.3% agreed that teleneonatology enhances communication between sites and 84.9% agreed that teleneonatology ensures standardization of care across sites
Mayo	Integrated, Colocated Specialist (ICS) model with neurologists embedded in primary care	Young, 2017 [35]	Pre-experimental - Pre-post design (with elements of a review)	• Reduced total face-to-face neurology visits per month by 25%, reduced referrals to tertiary neurology by 64% • 33% of curbside visits resulted in agreement with the Primary Care Physician and Provider (PCP) care plan without the need for additional diagnosis testing or face-to-face consults • Diagnostic testing or a face-to-face visit was estimated to have been avoided in 22% of patients if a curbside visit had been obtained earlier in the care planning process.
	Includes the integration of curbside, electronic and face to face consultations with the goal of enhancing care coordination and communication
Mayo	“Mayo Expert Advisor (MEA)” Cardiovascular Risk Tool	Scheitel, 2017 [36]	Static comparison: with and without cardiovascular decision tool.	• Saved 3 minutes and 42 seconds in calculating the ASCVD score (p < 0.05) • Saved 3 minutes and 38 seconds in determining the recommendation (p < 0.05). • Improved accuracy from 60.61 to 100% for both the risk score calculation and guideline-consistent treatment recommendation.
	Informatics-based, EHR-integrated clinical decision support tool delivering patient-specific, automated cardiovascular risk scores and treatment recommendations