Which Interventions are Effective at Decreasing or Increasing Hospital Attendances or Hospital Admissions from Care Homes?

Which interventions are effective at decreasing or increasing hospital attendances or hospital admissions from care homes? A systematic review

Context: Care home residents in the UK care homes account for almost 1.5 million emergency bed days each year. Avoidance of unnecessary hospital transfers benefits residents, and reduces demand on the healthcare systems but is difficult to implement.

Objective: We synthesized evidence on interventions that influence unplanned hospital admissions or attendances by care home residents.

Study design: This is a Systematic Review of Randomised Controlled Trials.

Dataset: PUBMED, MEDLINE, EMBASE, ISI Web of Science, CINAHL and the Cochrane Library were searched from 2012 to 2021, building on a review published in 2013.

Population studied: Care home residents over the age of sixty-five years old.

Intervention: Interventions that influence (decrease or increase) acute hospital admissions or attendances from care home residents.

Outcome measures: Hospitalization, Emergency Department Attendance, and Rehospitalization.

Results Thirty-eight randomized studies were included in this review. A narrative synthesis was conducted and the weight of evidence was described with vote counting. Advance care planning and goals of care setting appear to be effective at reducing hospitalizations from care homes. Other effective interventions, in order of increasing risk of bias, were: nurse practitioner/specialist input, palliative care intervention, influenza vaccination, and enhancing access to intravenous therapies in care homes.

Factors that affect hospitalization and emergency department attendances of care home residents are complex. This review supports the already established use of advanced care planning and influenza vaccination to reduce unscheduled hospital attendances. It is likely that more than one intervention will be needed to impact on healthcare utilization across the care home population. The findings of this review are useful to identify effective interventions that can be combined, as well as highlighting interventions that either need evaluation or are not effective at decreasing healthcare utilization.