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

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
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.