Hospital admissions and place of death of residents of care homes receiving specialist healthcare services: Protocol for a systematic review

Abstract

Aim To synthesize the evidence relating to the ability of specialist care home support services to prevent the hospital admission of older care home residents, including hospital admission at the end‐of‐life. Design Systematic review and narrative synthesis. Methods Ten electronic databases will be searched from 2010 – 31 December 2018 using predetermined search terms. All studies of specialist healthcare services to meet care home residents’ physical healthcare needs which provide outcome data on hospital admission or place of death compared with usual care will be included. Two reviewers will independently assess studies’ eligibility and methodological quality using the Effective Public Health Practice Project Quality Assessment Tool. Data will be extracted by one reviewer and checked by a second according to predetermined categories. Data will be synthesized in evidence tables and narrative. Funder: National Institute for Health Research School for Social Care Research, November 2016. Discussion Care of older people in care home settings is a key aspect of nursing nationally and internationally. This review will increase understanding of the extent to which different models of specialist healthcare support for care homes are associated with key resident outcomes. Impact Standard healthcare support for care home residents is often inadequate, resulting in avoidable hospital admissions and lack of resident choice as to place of death. Although a range of specialist healthcare services are emerging, little is known about their relative effectiveness. This paper marshalls evidence of relevance to commissioners investing in healthcare provision to care homes to meet NHS targets.

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

“…A systematic review, without meta-analysis, with vote counting based on direction of effect updated and extended the review by Clarkson et al (2018) in seeking studies published post 2010 and appraising outcomes. The review followed established guidance (CRD, 2009;Rutter et al, 2010) and the protocol was registered (PROSPERO) and published (Tucker et al, 2019). Reporting used the SWiM reporting guideline (Campbell et al, 2020) in conjunction with the 2020 PRISMA checklist (Page et al, 2021) to promote transparency.…”

“…Historically, a patchwork of specialist healthcare support services for care homes has emerged. For the purpose of this review, these are defined as services whereby healthcare professionals, with time dedicated to this role, provide specialist clinical support to identify and address residents' healthcare needs (Tucker et al, 2019). Some enhance standard primary care, allocating named practitioners to specific care homes or supplementing medical care with specialist nurse input; others involve partnerships between primary and secondary care and some are led by pharmacists.…”

Specialist healthcare services for UK care home residents: a latent class analysis

“…It is also possible that the latter will have changed in the six years since the data were collected. Recent years have certainly seen an upsurge of interest in the best ways to provide enhanced support for care home residents with a view to preventing avoidable hospital admissions and enabling care home residents to remain in the care home at the end of life (Tucker et al, 2018). However, research on the (generic and specialist) healthcare support received by care homes across Greater Manchester currently being undertaken by the research team suggests that most services are continuing to focus on the provision of direct support.…”