Abstract
Objective
To develop a taxonomy of interventions aimed at reducing emergency department (ED)
transfers and/or hospitalizations from long-term care (LTC) homes.
Design
A systematic scoping review.
Setting and participants
Permanent LTC home residents.
Methods
Experimental and comparative observational studies were searched in MEDLINE, CINAHL,
Embase Classic + Embase, the Cochrane Library, PsycINFO, Social Work Abstracts, AMED,
Global Health, Health and Psychosocial Instruments, Joanna Briggs Institute EBP Database,
Ovid Healthstar, and Web of Science Core Collection from inception until March 2020.
Forward/backward citation tracking and gray literature searches strengthened comprehensiveness.
The Mixed Methods Appraisal Tool was used to assess study quality. Intervention categories
and components were identified using an inductive-deductive thematic analysis. Categories
were informed by 3 intervention dimensions: (1) “when/at what point(s)” on the continuum
of care they occur, (2) “for whom” (ie, intervention target resident populations),
and (3) “how” these interventions effect change. Components were informed by the logistical
elements of the interventions having the potential to influence outcomes. All interventions
were mapped to the developed taxonomy based on their categories, components, and outcomes.
Distributions of components by category and study year were graphically presented.
Results
Ninety studies (25 randomized, 23 high quality) were included. Six intervention categories
were identified: advance care planning; palliative and end-of-life care; onsite care
for acute, subacute, or uncontrolled chronic conditions; transitional care; enhanced
usual care (most prevalent, 31% of 90 interventions); and comprehensive care. Four
components were identified: increasing human resource capacity (most prevalent, 93%),
training or reorganization of existing staff, technology, and standardized tools.
The use of technology increased over time. Potentially avoidable ED transfers and/or
hospitalizations were measured infrequently as primary outcomes.
Conclusions and Implications
This proposed taxonomy can guide future intervention designs. It can also facilitate
systematic reviews and precise effect size estimations for homogenous interventions
when outcomes are comparable.
Keywords
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References
- Dementia in long-term care.https://www.cihi.ca/en/dementia-in-canada/dementia-across-the-health-system/dementia-in-long-term-careDate accessed: December 4, 2022
- Unplanned transfer to emergency departments for frail elderly residents of aged care facilities: a review of patient and organizational factors.J Am Med Dir Assoc. 2015; 16: 551-562
- Potentially avoidable hospitalizations for elderly long-stay residents in nursing homes.Med Care. 2013; 51: 673-681
- Sources of Potentially Avoidable Emergency Department Visits.CIHI, 2014
- Predictors of nursing home hospitalization: a review of the literature.Med Care Res Rev. 2008; 65: 3-39
- Potentially avoidable hospitalizations of nursing home residents: frequency, causes, and costs.J Am Geriatr Soc. 2010; 58: 627-635
- Adverse events due to discontinuations in drug use and dose changes in patients transferred between acute and long-term care facilities.Arch Intern Med. 2004; 164: 545-550
- A systematic review of outcomes following emergency transfer to hospital for residents of aged care facilities.Age Ageing. 2014; 43: 759-766
- Frequency and costs of hospital transfers for ambulatory care-sensitive conditions.Am J Manag Care. 2015; 21: 51-59
- Decisions to transfer nursing home residents to emergency departments: a scoping review of contributing factors and staff perspectives.J Am Med Dir Assoc. 2016; 17: 994-1005
- The impact of nurse practitioners on hospitalizations and discharges from long-term nursing facilities: a systematic review.Healthcare (Basel). 2020; 8: 114
- Efficacy of interventions led by staff with geriatrics expertise in reducing hospitalisation in nursing home residents: A systematic review.Australas J Ageing. 2019; 38: 5-14
- The EPOC taxonomy of health systems interventions. EPOC Resources for review authors.(2016)http://epoc.cochrane.org/epoc-specific-resources-review-authorsDate accessed: August 17, 2022
- Reducing hospitalizations from long-term care settings.Med Care Res Rev. 2008; 65: 40-66
- Reducing hospital admissions from nursing homes: a systematic review.BMC Health Serv Res. 2014; 14: 36
- Reducing preventable patient transfers from long-term care facilities to emergency departments: a scoping review.CJEM. 2020; 22: 844-856
- Guidance for conducting systematic scoping reviews.JBI Evid Implement. 2015; 13: 141-146
- Methodologic problems of common terminology, measurement, and classification. 11. Modifications and new approaches to taxonomy in long-term care: advantages and limitations of the ICD.Med Care. 1976; 14: 109-115
- A systematic mixed studies review of interventions aiming at reducing potentially avoidable acute care transfers and improving transfer processes from long-term care facilities to acute care settings. PROSPERO 2016: CRD42016048128.http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016048128Date accessed: February 15, 2023
- PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation.Ann Intern Med. 2018; 169: 467-473
- The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.BMJ. 2021; 372: n71
- Long-term care homes in Canada: How many and who owns them?.(2021)https://www.cihi.ca/en/long-term-care-homes-in-canada-how-many-and-who-owns-themDate accessed: December 4, 2022
- An international definition for "nursing home".J Am Med Dir Assoc. 2015; 16: 181-184
- EndNote X9 citation manager: Web of Science Group.https://endnote.com/Date accessed: February 15, 2023
- Covidence systematic review software, VHI, Melbourne, Australia.www.covidence.orgDate accessed: February 15, 2023
- Cochrane handbook for systematic reviews of interventions version 6.3 (updated February 2022).6.3 ed. Cochrane, 2022
- How do authors of systematic reviews deal with research malpractice and misconduct in original studies? A cross-sectional analysis of systematic reviews and survey of their authors.BMJ Open. 2016; 6: e010442
- Systematic Reviews and Librarians.Libr Trends. 2006; 55: 202-215
- Sixth International Conference on Grey Literature (GL6).Libr Hi Tech News. 2005; 22: 20-22
- Applying systematic review search methods to the grey literature: a case study examining guidelines for school-based breakfast programs in Canada.Syst Rev. 2015; 4: 138
- Systematic reviews to support evidence-based medicine : how to review and apply findings of healthcare research.Hodder Annold, 2011
- The Mixed Methods Appraisal Tool (MMAT) Version 2018 for Information Professionals and Researchers.Educ Inf. 2018; 34: 285-291
- Health System Performance Frameworks: Aligning Frameworks for Sectors and Organizations to Health Systems.CIHI, 2015
- Demonstrating rigor using thematic analysis: A hybrid approach of inductive and deductive coding and theme development.Int J Qual Methods. 2006; 5: 1-11
- Conceptual decomposition of complex health care interventions for evidence synthesis: a literature review.J Eval Clin Pract. 2015; 21: 817-823
- Improving the use of hospice services in nursing homes: a randomized controlled trial.JAMA. 2005; 294: 211-217
- Improving the quality of care of long-stay nursing home residents in France.J Am Geriatr Soc. 2016; 64: 193-199
- Measuring factors affecting implementation of health innovations: a systematic review of structural, organizational, provider, patient, and innovation level measures.Implement Sci. 2013; 8: 22
- Effects of a geriatric nurse practitioner on process and outcome of nursing home care.Am J Public Health. 1989; 79: 1271-1277
- The Effect of a Physician Assistant on the Hospitalization of Nursing Home Residents.J Am Geriatr Soc. 1998; 46: 610-614
- Emergency department use among patients from residential aged care facilities under a Hospital in the Nursing Home scheme in public hospitals in Queensland Australia.World J Emerg Med. 2016; 7: 183-190
- Integrated medicare and medicaid managed care and rehospitalization of dual eligibles.Am J Manag Care. 2015; 21: 711-717
- The effect of assigning dedicated general practitioners to nursing homes.Health Serv Res. 2019; 54: 547-554
- Medicaid reimbursement and the quality of nursing home care: a case study of medi-cal long-term care reimbursement Act of 2004 in California.World Med Health Pol. 2016; 8: 329-343
- Improving primary care in nursing-homes.J Am Geriatr Soc. 1991; 39: 359-367
- Essential Conversations. A Guide to Advance Care Planning in Long-Term Care Settings.2021https://www.advancecareplanning.ca/wp-content/uploads/2021/06/LongTermCare-Toolkit_EN.pdfDate accessed: February 15, 2023
- An old challenge with new promises: a systematic review on comprehensive geriatric assessment in long-term care facilities.Rejuvenation Res. 2018; 21: 3-14
- Reducing time in acute hospitals: a stepped-wedge randomised control trial of a specialist palliative care intervention in residential care homes.Palliat Med. 2020; 34: 571-579
- Improving end-of-life outcomes in nursing homes by targeting residents at high-risk of mortality for palliative care: program description and evaluation.J Palliat Med. 2008; 11: 217-225
- Improving the end-of-life for people with dementia living in a care home: an intervention study.Int Psychogeriatr. 2013; 25: 1849-1858
- Palliative care consultations in nursing homes and reductions in acute care use and potentially burdensome end-of-life transitions.J Am Geriatr Soc. 2016; 64: 2280-2287
- Do gerontology nurse specialists make a difference in hospitalization of long-term care residents? Results of a randomized comparison trial.J Am Geriatr Soc. 2014; 62: 1962-1967
- The Aged Residential Care Healthcare Utilization Study (ARCHUS): a multidisciplinary, cluster randomized controlled trial designed to reduce acute avoidable hospitalizations from long-term care facilities.J Am Med Dir Assoc. 2015; 16: 49-55
- A clinical trial of nurse practitioner care in residential aged care facilities.Arch Gerontol Geriatr. 2018; 77: 129-132
- Network meta-analysis of multicomponent interventions.Biom J. 2020; 62: 808-821
- CADTH Rapid Response Reports.in: Telemedicine Consultations for Patients in Long Term Care: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines. Canadian Agency for Drugs and Technologies in Health Copyright © 2015 Canadian Agency for Drugs and Technologies in Health, 2015
- Launching an emergency department telehealth program during COVID-19: real-world implementations for older adults.J Geriatric Emerg Med. 2020; 1: 1-7
- The ResidentialCare Transition Module: a single-blinded randomized controlled evaluation of a telehealth support intervention for family caregivers of persons with dementia living in residential long-term care.BMC Geriatr. 2020; 20: 133
- Interventions to reduce hospitalizations from nursing homes: evaluation of the INTERACT II collaborative quality improvement project.J Am Geriatr Soc. 2011; 59: 745-753
- Experience of establishing an acute geriatric outreach service versus subacute service to nursing homes.Intern Med J. 2018; 48: 1396-1399
- An outcomes evaluation of an Australian hospital in the nursing home admission avoidance programme.J Clin Nurs. 2011; 20: 1178-1187
- Assessing quality of older persons' emergency transitions between long-term and acute care settings: a proof-of-concept study.BMJ Open Qual. 2022; 11: e001639
- Quality Indicators for older persons' transitions in care: a systematic review and Delphi process.Can J Aging. 2022; 41: 40-54
- Impact of community paramedic interventions on transfers from long term care to emergency departments: results of a systematic review.CJEM. 2022; 24: 101-102
- Reducing hospital admissions from nursing homes: a systematic review.BMC Health Serv Res. 2014; 14: 36
- The interventions to reduce acute care transfers (INTERACT) quality improvement program: an overview for medical directors and primary care clinicians in long term care.J Am Med Dir Assoc. 2014; 15: 162-170
- EPOC Taxonomy.(2015)https://epoc.cochrane.org/epoc-taxonomyDate accessed: August 17, 2022
- Organizing an academic nursing home. Impacts on institutionalized elderly.JAMA. 1986; 255: 2622-2627
- Prevalence of information gaps for seniors transferred from nursing homes to the emergency department.CJEM. 2009; 11: 462-472
Article info
Publication history
Published online: February 06, 2023
Footnotes
This study received financial support from the Fonds de recherche du Québec–Santé (FRQ-S) in the form of a doctoral training award and from the Donald Berman Maimonides Medical Research Foundation in the form of a research fellowship. The sponsors did not contribute to or influence the findings or conclusions.
The authors declare no conflicts of interest.
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© 2023 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
