Effectiveness of hospital avoidance interventions among elderly patients: A systematic review

NA-PR-Elderly Hospital Avoidance Interventions

NA (ED)

Objective: Older patients with   complex care needs and limited personal and social resources are heavy users   of emergency department (ED) services and are often admitted when they   present to the ED. Updated information is needed regarding the most effective   strategies to appropriately avoid ED presentation and hospital admission   among older patients. 


Methods: This systematic review aimed to identify interventions that   have demonstrated effectiveness in decreasing ED use and hospital admissions   in older patients. We conducted a comprehensive literature search within Ovid   MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials   from database inception to July 2019 with no language restrictions.   Interventional study designs conducted in populations of 65 years and older   were included. Primary outcomes were ED visits and hospital admissions.   Secondary outcomes included hospital readmission, mortality, cost, and   patient-reported outcomes.


Results: Of 7,943 citations reviewed for eligibility, 53 studies were   included in our qualitative synthesis, including 26 randomized controlled   trials (RCT), 8 cluster-RCTs, and 19 controlled before-after studies. Data   characterization revealed that community-based strategies reduced ED visits,   particularly those that included comprehensive geriatric assessments and home   visits. These strategies reported decreases in mean ED use (for interventions   versus controls) ranging from -0.12 to -1.32 visits/patient. Interventions   that included home visits also showed reductions in hospital admissions   ranging from -6% to -14%. There was, however, considerable variability across   individual studies with respect to outcome reporting, statistical analyses,   and risk of bias, which limited our ability to further quantify the effect of   these interventions. 


Conclusion: Various interventional strategies to avoid ED presentations   and hospital admissions for older patients have been studied. While models of   care that include comprehensive geriatric assessments and home visits may   reduce acute care utilization, the standardization of outcome measures is   needed to further delineate which parts of these complex interventions are   contributing to efficacy. The potential effects of multidisciplinary team   composition on patient outcomes also warrant further investigation.


Authors: Caillie Pritchard, Alyssa Ness, Nicola Symonds, Michael Siarkowski, Michael Broadfoot, Kerry A. McBrien, Eddy Lang, Jayna Holroyd-Leduc, Paul E. Ronksley

Paul E. Ronksley - peronksl@ucalgary.ca

Preliminary data gathering/ baseline