Life In The Slower Lane

Here is the standardised PICO analysis for the twenty-fifth uploaded article:

---

Full Title

Taxonomy of Interventions to Reduce Acute Care Transfers From Long-term Care Homes: A Systematic Scoping Review

Authors: Deniz Cetin-Sahin et al.

Journal: Journal of the American Medical Directors Association (JAMDA), 2023; 24(3): 343–355

DOI: 10.1016/j.jamda.2022.12.025

Type of Study

Systematic scoping review of experimental and observational studies with a proposed taxonomy

---

PICO Summary

Population (P)

• Permanent residents of long-term care (LTC) homes with 24-hour nursing care
• 90 studies included, from settings across the US, Canada, UK, Australia, and other countries
• Population included both all-cause and condition-specific cohorts (e.g. advanced dementia, COPD, frailty)

Intervention (I)

• Development of a taxonomy of interventions, categorised into 6 types:
  1. Advance care planning (ACP)
  2. Palliative and end-of-life care
  3. Onsite care for acute/subacute/uncontrolled chronic conditions
  4. Transitional care
  5. Enhanced usual care
  6. Comprehensive care
• Interventions were also described by 4 implementation components:
  • Human resource augmentation
  • Training/reorganisation of staff
  • Technology (e.g. telehealth, diagnostics)
  • Standardised tools (e.g. care pathways, communication aids)

Comparison (C)

• Comparators varied by study: usual care or alternative service delivery model
• Study designs included RCTs (n=25) and non-randomised comparative studies (n=65)

Outcomes (O)

Primary outcome(s) (reported across studies):

• Emergency department (ED) transfers
• Hospitalisations
• Composite outcomes (e.g. ICU stay, observation days)

Potentially avoidable transfers were specifically reported in:

• 3 studies (ED)
• 11 studies (hospitalisations)
• 3 studies (composite outcomes)

Distribution of outcomes across intervention types:

• 40% measured only hospitalisations
• 42% measured both ED and hospitalisation
• Only 8% measured ED transfers alone 

---

Findings Summary

This scoping review developed a practical classification framework for organising interventions aimed at reducing acute care transfers from LTC facilities. Most interventions relied on human resource augmentation (93%), with training (72%) and tools (49%) being common supports. Use of technology (30%) was rising, especially post-2019.

Key insights:

• Enhanced usual care was the most frequent category (31%), often involving policy, staffing, or process changes
• Advance care planning and palliative care were clearly distinguished as independent intervention categories
• Comprehensive interventions (e.g. INTERACT, Missouri Quality Initiative) addressed multiple domains and included all four components

This taxonomy is intended to reduce heterogeneity in terminology and outcome reporting in future research and policy evaluation, and to support effectiveness and cost-effectiveness comparisons between interventions targeting acute care transfer reduction from LTC.

---