Hospital admissions and place of death of residents of care homes receiving specialist healthcare services. A systematic review review without meta-analysis

Deborah Buck, Sue Tucker, BRENDA ROE, Jane Hughes, David Challis

    Research output: Contribution to journalArticle (journal)peer-review

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    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
    Data sources: Fourteen electronic databases were searched from January 2010 to January
    2019. Reference lists of identified reviews, study protocols and included documents were
    scrutinised 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), US (22) and Australia (19). Twenty studies were randomised controlled
    trials and six clinical controlled trials. The review suggested interventions addressing
    residents’ general health needs (p<0.001), assessment and management services (p<0.0001)
    and non-training initiatives involving medical staff (p<0.0001) can reduce hospital
    admissions, whilst there was also promising evidence for services targeting residents at imminent risk of hospital entry or post-hospital discharge and training only initiatives. Endof-
    life care services may enable residents to remain in the home at end-of-life (p<0.001), 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.
    Original languageEnglish
    Pages (from-to)1-32
    JournalJournal of Advanced Nursing
    Early online date17 Sept 2021
    Publication statusE-pub ahead of print - 17 Sept 2021


    • care homes
    • hospital admissions
    • long-term care facilities
    • nursing homes
    • older people
    • outcomes
    • place-of-death
    • specialist health services
    • systematic review without meta-analysis
    • vote counting


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