Title: Reducing unplanned hospital admissions from care homes: an updated and extended systematic review
Funder: Department of Health and Social Care

Abstract: Background_x000D_ _x000D_ Older people living in care homes often have complex health problems like dementia and frailty. This means they may need to be taken to hospital at short notice. This can lead to them being admitted for further assessment and treatment. Research suggests that many of these unplanned hospital admissions could be avoided if health and social care services were best organised to meet residents’ needs._x000D_ Ways of reducing these unplanned admissions, known as interventions, were summarised in a report in 2014, which looked at previous research. Interventions to reduce unplanned admissions could happen at different times and places, for example:_x000D_ • having a named GP responsible for care home residents_x000D_ • specialist paramedic assessment before taking a resident to hospital_x000D_ • discharge planning when people leave hospital to reduce risk of readmission_x000D_ • advance care planning so that people nearing the end of life are not taken to hospital unnecessarily._x000D_ _x000D_ Our planned research_x000D_ _x000D_ The 2014 report is now out of date and we want to see what new evidence has been published over the last 7 years. This will involve carrying out a systematic review. A systematic review aims to identify and evaluate published research to answer a clear question using criteria specified in advance. Methods for systematic reviews are well established and are outlined in the proposal and the attached research plan. Our research plan emphasises the importance of describing interventions in detail. This is because inconsistencies between authors may lead to the same name being used for different types of intervention or similar interventions given different names._x000D_ _x000D_ Ideally, we are looking for research that compares care homes that introduce a new intervention with similar homes that make no change. We will also include studies that compare results before and after an intervention. Studies involving interviews or focus groups with residents or staff (known as qualitative research) will also be included._x000D_ _x000D_ Who is involved?_x000D_ _x000D_ The research team includes experts in systematic review methods, emergency medicine, care home research and geriatric medicine. The team has a public member with extensive experience of involving patients and the public in research. A care home manager and a researcher with expertise in public involvement will have informal advisory roles. _x000D_ We will set up a public advisory group and engage with care home residents, staff and the general public in conducting the review and publicising the findings._x000D_ _x000D_ When?_x000D_ _x000D_ We will carry out the review over 11 months starting in November 2021._x000D_ _x000D_ What will change?_x000D_ _x000D_ The main outcome of our review will be to show, based on evidence, which interventions are more effective in reducing unplanned admissions. We will also assess how easy or difficult interventions may be to carry out in practice (feasibility) and whether people find them acceotable. The findings will enable us to identify key recommendations for decision-makers who plan services for care home residents. We will also point out areas where evidence is lacking._x000D_ _x000D_ The impact of the review will depend on the recommendations emerging from the findings. Reports and findings will be available for decision-makers, care homes and the public.

Lay abstract: Care home residents include many people with complex health and care needs and are at high risk of experiencing unplanned hospital admissions. While they are sometimes appropriate, such admissions can be costly for the NHS and distressing for the residents, their families and friends, and care home staff._x000D_ Interventions to reduce unplanned admissions may be implemented at various points in the health and social care system. In 2014, the University of York Centre for Reviews and Dissemination (CRD) published an evidence briefing on the topic for health service commissioners. We propose to update and extend their work._x000D_ _x000D_ _x000D_ The overall research questions are:_x000D_ • What interventions are used in the UK health and social care system to minimise unplanned hospital admissions of care home residents?_x000D_ • What candidate interventions, used in other high-income countries, could potentially be used in the UK?_x000D_ • What can we learn from research studies and ‘real-world’ evaluations about the effects of such interventions on admissions?_x000D_ • What is known about the feasibility of implementing such interventions in routine practice and their acceptability to care home residents and staff?_x000D_ • What is known about the costs and value for money associated with these interventions?_x000D_ _x000D_ The aim of this project is to carry out a systematic evidence review of interventions to reduce unplanned hospital admissions of residents in care homes (including nursing homes) for older people. Supporting objectives are to perform the review using rigorous methods and to involve the public and care home staff throughout._x000D_ _x000D_ Rigorous systematic review methods will be used throughout, including a robust search strategy, duplicate selection of studies for inclusion, and assessment of risk of bias. A provisional taxonomy of relevant interventions is included in the proposal. Our proposal emphasises the importance of describing interventions in detail (using the TiDiER-LIte checklist). We will not limit inclusion by study design and will include UK ‘grey’ literature. _x000D_ Given the nature of the review question and the diverse interventions potentially included, we anticipate performing a narrative synthesis. However, we will use meta-analysis to synthesise evidence where appropriate. Overall strength of evidence for each intervention will be classified as ‘stronger’, ‘weaker’, ‘very limited’ or ‘inconsistent’, based on the number and design of relevant studies. Evidence on effectiveness will be considered alongside that on feasibility, acceptability and ‘cost-effectiveness’ to provide an overall assessment of the intervention. _x000D_ _x000D_ We propose to conduct the review over 11 months, starting in November 2021. A timetable is included in the research plan._x000D_ _x000D_ We will identify and communicate the implications of the review findings for key stakeholders including health and social care commissioners, care home staff and residents, members of their social networks and the public. We will develop diverse outputs to meet the needs of different audiences in digital and printed formats._x000D_ The study report and other outputs will offer a resource for decision-makers considering which evidence-based interventions may be appropriate for use in their setting. We will identify areas of limited evidence and provide clear recommendations to support the HS&DR programme and other funders in commissioning new research

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE