Here is the structured PICO analysis for the forty-sixth article you uploaded:
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Full Title (verbatim and exact):
“Care home residents admitted to hospital through the emergency pathway: characteristics and associations with inpatient mortality”
Keevil VL, Martin GJ, Biram R, Wallis S, Romero-Ortuno R
Journal of the Royal College of Physicians of Edinburgh (2018); 48(3):202–209
DOI: https://doi.org/10.4997/JRCPE.2018.303
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Type of Article:
Retrospective observational cohort study (hospital-based service evaluation)
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PICO Analysis:
Population:
- 14,777 older adults (aged ≥75 years) admitted as emergency inpatients to a large NHS university hospital in Cambridge, UK (2014–2016)
- Of these, 1,143 (7.7%) were care home residents
- Characteristics:
- Higher rates of frailty (measured using the Clinical Frailty Scale)
- Greater prevalence of cognitive impairment and dementia
- Higher illness severity on arrival (ED-MEWS ≥4 in 42% of care home residents vs 26% of non-care home residents)
Intervention (Exposure of Interest):
- Admission from a care home as an emergency to hospital
- Compared to admission from a non-care home residence (i.e., own home)
Comparator:
- Older adults living in their own homes admitted under the same emergency conditions
- Comparison across multiple outcomes using regression models adjusting for age, sex, comorbidities, frailty, and illness acuity
Outcome:
1. Person-centred outcomes:
- 30-day inpatient mortality:
- Care home residents had significantly higher mortality (11.1% vs 5.7%)
- Even after full adjustment for confounders, being a care home resident remained independently associated with higher mortality (HR = 1.42; 95% CI 1.09–1.83)
2. Process outcomes:
- Acuity at presentation:
- 42% of care home residents scored ED-MEWS ≥4 vs 26% of non-care home residents
- Frailty:
- Severe or very severe frailty present in 40% of care home residents vs 7% of community dwellers
- Length of stay and delayed discharge:
- Care home residents had shorter median length of stay and lower odds of prolonged stay or delayed discharge, possibly due to fewer discharge planning needs (OR for prolonged LOS = 0.34; OR for delayed discharge = 0.33)
3. Health system outcomes:
- 30-day readmission:
- Significantly more likely in care home residents (OR = 1.41; 95% CI 1.16–1.72)
- The study suggests that care home residents contribute to high resource use due to frequent, acute, and sometimes preventable presentations
Summary Conclusion:
This study provides robust evidence that older adults from care homes admitted through emergency pathways are a high-risk group with greater frailty, acuity, and significantly increased inpatient mortality, even after adjusting for clinical covariates. While they have shorter hospital stays and fewer delays in discharge, they are more likely to be readmitted. These findings underscore the need for:
- Enhanced anticipatory care planning
- Hospital outreach models with geriatric expertise
- Better community capacity for early recognition and management of acute deteriorationIt also highlights the limitations of current community systems in preventing high-acuity presentations from RACFs.
Life In The Slower Lane 
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