Life In The Slower Lane

Here is the structured PICO analysis for the eighth article you uploaded:

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Full Title (verbatim and exact):

“Reducing unplanned hospital admissions from care homes: a systematic review”

Chambers D, Cantrell A, Preston L, Marincowitz C, Wright L, Conroy S, Gordon AL

Health and Social Care Delivery Research 2023; Vol. 11, No. 18

DOI: https://doi.org/10.3310/KLPW6338

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Type of Article:

Systematic review of interventions to reduce unplanned hospital admissions from care homes, including both quantitative and qualitative studies (124 included publications)

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PICO Analysis:

Population:

• Older adults living in care homes (both nursing and residential), primarily in the UK, USA, Australia, and New Zealand
• Also included residents of assisted living or extra-care housing in some studies 

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Intervention:

A wide range of interventions categorised into the following models:

• Quality improvement (QI) programmes – e.g. INTERACT, OPTIMISTIC, MOQI, EDDIE
• Integrated care models – linking care homes with GPs, geriatricians, and hospital outreach
• Training/workforce development
• Advance care planning (ACP) and end-of-life care initiatives
• Emergency department (ED) and paramedic interventions
• Targeted management of specific issues – e.g. medication reviews, infection control

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Comparator:

• Usual care or historical controls
• Many studies were before–after designs or non-randomised evaluations, limiting robust comparisons

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Outcome:

1. Person-centred outcomes:

• Advance care planning: shown to help avoid unnecessary hospitalisations but “do-not-hospitalise” orders were inconsistently applied
• Acceptability: Mixed; staff and family often supported interventions, but decision-making around hospital transfers was often conflicted 

2. Process outcomes:

• Unplanned hospital admissions:
  • Integrated care models and QI programmes (especially in Australia and some UK Vanguard initiatives) consistently reduced unplanned admissions by 18–39% in several studies
• ED attendances:
  • Frequently tracked but effect sizes varied; some showed reductions, others did not
• Training and staff development:
  • Had inconsistent effects; outcomes dependent on staffing stability and intervention intensity
• Barriers to implementation:
  • High staff turnover, resistance from managers, digital literacy gaps, and lack of baseline data for evaluations

3. Health system outcomes:

• Cost-effectiveness:
  • Limited evidence overall; 11 UK and 14 international studies reported cost data, but most were not full economic evaluations
  • Most suggested potential cost savings, especially from hospital avoidance and reduced length of stay 

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Summary Conclusion:

This review provides stronger evidence that integrated care models and structured QI programmes can reduce unplanned hospital admissions from care homes. However, successful implementation depends heavily on local context, leadership, and continuity of care. Evidence for training-only interventions or single-component changes is inconsistent. Economic evaluation remains a significant evidence gap.

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