Hospital admissions and place of death of residents of care homes receiving specialist healthcare services: A systematic review without meta‐analysis
Open Access
- 17 September 2021
- journal article
- review article
- Published by Wiley in Journal of Advanced Nursing
- Vol. 78 (3), 666-697
- https://doi.org/10.1111/jan.15043
Abstract
Aim To synthesize evidence on the ability of specialist care home support services to prevent hospital admission of older care home residents, including at end of life. Design Systematic review, without meta-analysis, with vote counting based on direction of effect. Data sources Fourteen electronic databases were searched from January 2010 to January 2019. Reference lists of identified reviews, study protocols and included documents were scrutinized for further studies. Review methods Papers on the provision of specialist care home support that addressed older, long-term care home residents’ physical health needs and provided comparative data on hospital admissions were included. Two reviewers undertook study selection and quality appraisal independently. Vote counting by direction of effect and binomial tests determined service effectiveness. Results Electronic searches identified 79 relevant references. Combined with 19 citations from an earlier review, this gave 98 individual references relating to 92 studies. Most were from the UK (22), USA (22) and Australia (19). Twenty studies were randomized controlled trials and six clinical controlled trials. The review suggested interventions addressing residents’ general health needs (p < .001), assessment and management services (p < .0001) and non-training initiatives involving medical staff (p < .0001) can reduce hospital admissions, while there was also promising evidence for services targeting residents at imminent risk of hospital entry or post-hospital discharge and training-only initiatives. End-of-life care services may enable residents to remain in the home at end of life (p < .001), but the high number of weak-rated studies undermined confidence in this result. Conclusion This review suggests specialist care home support services can reduce hospital admissions. More robust studies of services for residents at end of life are urgently needed. Impact The review addressed the policy imperative to reduce the avoidable hospital admission of older care home residents and provides important evidence to inform service design. The findings are of relevance to commissioners, providers and residents.Keywords
This publication has 124 references indexed in Scilit:
- Assessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological researchJournal of Evaluation in Clinical Practice, 2012
- A systematic review of integrated working between care homes and health care servicesBMC Health Services Research, 2011
- A Geriatric Multidisciplinary and Tailor-Made Hospital-At-Home Method in Nursing Home Residents With Hip FractureGeriatric Orthopaedic Surgery & Rehabilitation, 2011
- Effects of multidisciplinary integrated care on quality of care in residential care facilities for elderly people: a cluster randomized trialCMAJ : Canadian Medical Association Journal, 2011
- Effect of a Pharmacist‐Led Multicomponent Intervention Focusing on the Medication Monitoring Phase to Prevent Potential Adverse Drug Events in Nursing HomesJournal of the American Geriatrics Society, 2011
- Effect of interventions to reduce potentially inappropriate use of drugs in nursing homes: a systematic review of randomised controlled trialsBMC Geriatrics, 2011
- Interventions for improving palliative care for older people living in nursing care homesEmergencias, 2011
- The integrated implementation of two end-of-life care tools in nursing care homes in the UK: an in-depth evaluationPalliative Medicine, 2010
- Developing and evaluating complex interventions: the new Medical Research Council guidanceBMJ, 2008
- A Process for Systematically Reviewing the Literature: Providing the Research Evidence for Public Health Nursing InterventionsWorldviews on Evidence-Based Nursing, 2004