Here is the standardised PICO analysis for the twenty-third uploaded article:
Full Title
Pflegeheim-sensitive Krankenhausfälle und Ansätze zur Verringerung der Hospitalisierung von Pflegeheimbewohnerinnen und -bewohnern
Authors: Maria Paula Valk-Draad, Sabine Bohnet-Joschko, PSK-Studiengruppe
Journal: Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz, 2023; 66:199–211
DOI: 10.1007/s00103-022-03654-4
Type of Study
Mixed-methods study with Delphi consensus, secondary data analysis, and expert consultation
PICO Summary
Population (P)
- Older adults living in nursing homes in Germany (Pflegeheimbewohner*innen – PHB)
- Based on analysis of statutory health insurance data from a sample of 242,236 residents, representing ~30% of the total PHB population in Germany in 2017
Intervention (I)
- Catalogue of Pflegeheim-sensitive Krankenhausfälle (PSK):
- Identifies 58 hospital admission diagnoses deemed potentially avoidable with optimal in-facility care
- Recommended interventions include:
- Enhanced interprofessional collaboration and digital communication (e.g. telemedicine)
- Expanded geriatric and pharmacological expertise (e.g. PRISCUS awareness)
- Delegation models (e.g. VerAH, AGnES, EVA)
- Standardised care processes (e.g. ACP, early warning systems, shared care records)
- Infrastructure improvements (e.g. diagnostic equipment in facilities)
- Financial and legal reform to support better in-place care
Comparison (C)
- Implicit comparison to current standard practice in which avoidable hospitalisations from nursing homes occur due to suboptimal coordination, knowledge gaps, or lack of resources
Outcomes (O)
Health system outcomes:
- Estimated 35% of all hospitalisations from nursing homes are potentially avoidable
- Equivalent to ~220,000 hospital cases annually and a savings potential of €768 million across the German system
Process outcomes:
- Detailed cost estimates by disease group (see Table 1, p. 203)
- Leading preventable conditions:
- Heart failure (25,000 avoidable cases/year)
- UTIs & fluid disorders
- Non-dementia neurological conditions
- Gastrointestinal illness
- Pneumonia and sepsis were excluded from PSK list due to estimated avoidability <70% but are still noted for practical significance
Person-centred outcomes:
- Anticipated improvements in patient safety, quality of life, and care aligned with individual preferences
Findings Summary
This comprehensive, consensus-based study identifies a robust set of 58 nursing home-sensitive hospital conditionsand lays out actionable, multi-level strategies for reducing hospital transfers. Through a combination of secondary data analysis, a large Delphi panel (n=107), and six sector-based expert reports, the study presents a nuanced map of how interdisciplinary communication, telemedicine, workforce reform, and legal-financial realignment can drive sustainable improvements. With implementation, nearly one in three hospitalisations from nursing homes could be prevented .
Life In The Slower Lane 
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