key: cord-0953481-z6faexkw authors: Birtwell, Kelly; Planner, Claire; Hodkinson, Alexander; Hall, Alex; Giles, Sally; Campbell, Stephen; Tyler, Natasha; Panagioti, Maria; Daker-White, Gavin title: Transitional Care Interventions for Older Residents of Long-term Care Facilities: A Systematic Review and Meta-analysis date: 2022-05-04 journal: JAMA Netw Open DOI: 10.1001/jamanetworkopen.2022.10192 sha: e6d445022518bf58495d237e66610f324e098f2a doc_id: 953481 cord_uid: z6faexkw IMPORTANCE: Residents of long-term care facilities (LTCFs) experience high hospitalization rates, yet little is known about the effects of transitional care interventions for these residents. OBJECTIVE: To assess the association of transitional care interventions with readmission rates and other outcomes for residents of LTCFs who are 65 years and older and LTCF staff and to explore factors that potentially mitigate the association. DATA SOURCES: MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature were searched for English-language studies published until July 21, 2021. Associated qualitative studies were identified using aspects of the CLUSTER (citations, lead authors, unpublished materials, searched Google Scholar, tracked theories, ancestry search for early examples, and follow-up of related projects) methodology. STUDY SELECTION: Controlled design studies evaluating transitional care interventions for residents of LTCFs 65 years and older were included. Records were independently screened by 2 reviewers; disagreements were resolved through discussion and involvement of a third reviewer. From 14 538 records identified, 15 quantitative and 4 qualitative studies met the eligibility criteria. DATA EXTRACTION AND SYNTHESIS: The study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Data were extracted by one reviewer and checked by a second reviewer. Fixed-effect and random-effects models were used according to the number of studies reporting the outcomes of interest. MAIN OUTCOMES AND MEASURES: The primary outcome consisted of 30-, 60-, and 90-day readmission rates (hospital and emergency department [ED]). Other outcomes included length of stay, functional independence (Barthel score), and quality of life. The I(2) statistic was used to quantify heterogeneity. RESULTS: Of 14 538 records identified from searches, 15 quantitative studies (totaling 32 722 participants or records) and 4 qualitative studies were included. People allocated to transitional care interventions were 1.7 times less likely to be readmitted to the hospital or ED compared with those in control groups (14 studies; odds ratio, 1.66 [95% CI, 1.18-2.35]; I(2) = 81% [95% CI, 70%-88%]). Length of stay in the ED was significantly decreased for intervention groups (3 studies; standardized mean difference, −3.00 [95% CI, −3.61 to −2.39]; I(2) = 99% [95% CI, 98%-99%]). There were no significant differences for other outcomes. Factors associated with outcomes included communication and referral processes between health care professionals. CONCLUSIONS AND RELEVANCE: Emerging evidence suggests that transitional care interventions are associated with lower readmissions for residents of LTCFs 65 years and older. Despite this and with aging populations, investment in such interventions has been remarkably low across most countries. Search block Source 1 Nursing Homes/ or nursing home*.mp. 2 Homes for the Aged/ or home* for the aged.mp. 3 Residential Facilities/ or Assisted Living Facilities/ or Group Homes/ or Halfway houses/ 4 care home*.mp. 5 (aged adj2 (care or nursing or healthcare or residential) adj2 (facility or facilities or home*)).ti,ab. 6 ((geriatric or elderly) adj2 (facility or facilities or care home*)).ti,ab. 7 Hospitals, Veterans/ 8 1 or 2 or 3 or 4 or 5 or 6 or 7 9 ((care or convalescent) adj (home* or center* or centre* or facility or facilities)).ti,ab. 10 ((skilled or intermediate) adj (nursing facility or nursing facilities)).ti,ab. 11 (resident* adj2 (care or facility or facilities)).ti,ab. 12 ((nursing or group or residential) adj home*).ti,ab. 13 ((longterm or long term) adj3 (care or facility or facilities)).ti,ab. 14 (healthcare adj2 (facility or facilities)).ti,ab. 15 aged/ or "aged, 80 and over"/ or frail elderly/ 24 (gerontol* or ageing or aging or elder* or geriatric* or seniors or old age or older or late* life).ti,ab. 25 (older adj (person* or people or adult* or patient* or inpatient* or outpatient*)).ti,ab. 26 veteran*.ti,ab. 27 (transition* adj10 (care or service* or center* or centre* or clinic* or facility or facilities or unit* or department* or patient*)).ti,ab. 35 ((transfer* or transferred or transferral or transferring) adj10 (care or service* or center* or centre* or clinic* or facility or facilities or unit* or department* or patient*) 68 2020 Wrong patient population Flyer et al. 69 1988 Wrong patient population Forbat et al., 70 2020 Wrong intervention Foster et al., 71 2012 Ongoing study Franks, 72 2016 Wrong intervention Galvin, 73 2018 Wrong setting Garcia-Gollarte et al., 74 2014 Wrong intervention Genkin, 75 2006 Wrong publication type Germain et al., 76 1995 Wrong patient population Gilissen et al., 77 2020 Study protocol Gladman, 78 2004 Wrong setting Grando et al., 79 2009 Wrong study design Gregersen et al., 80 2010 Wrong study design 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2006 Wrong patient population Newcomer et al., 134 2006 Duplicate record Nicholson, 135 2019 Wrong publication type Nouvenne et al., 136 2020 Wrong intervention Olson et al., 137 1995 Wrong outcomes O'Mahony, 138 Wrong setting Parry et al., 145 2003 Wrong publication type Parry et al., 146 2009 Wrong patient population Parry et al., 146 2009 Duplicate record Paskulin, 147 2016 Wrong setting Patel et al., 148 2018 Wrong patient population Pedersen, 149 2011 Wrong setting Pilgram et al., 150 2012 Wrong publication type Piotrowski et al., 151 2020 Wrong intervention Popejoy et al., 152 2020 Wrong setting Provencher, 153 2019 Wrong patient population Ravn-Nielsen et al., 154 2018 Wrong publication type Riley et al., 155 2020 Wrong patient population Rojido et al., 156 2014 Wrong publication type Rolland et al., 157 2020 Wrong study design Ross, 158 2008 Wrong setting Sankaran et al., 159 2010 Wrong study design Singh et al., 160 2021 Wrong publication type Sorkin et al., 161 2016 Study protocol Stansfield, 162 2012 Wrong publication type Storm et al., 163 2018 Wrong study design Stranges et al., 164 2013 Wrong patient population Straus et al., 165 2018 Wrong publication type Sullivan, 166 2017 Wrong intervention Sullivan, 167 2018 Wrong intervention Sunner et al., 168 2020 Study protocol Sunner, 169 2019 Ongoing study Swift, 170 2006 Wrong publication type Tappen et al., 171 2014 Wrong study design Tappen et al., 172 2018 Wrong outcomes Tappen et al., 173 2020 Wrong outcomes Tappen, 174 2015 Duplicate record Tchalla, 175 2019 Ongoing study Testa et al., 176 2021 Wrong intervention Tew Jr, 177 2012 Wrong publication type Toles et al., 178 2017 Wrong setting Toles et al., 179 2018 Wrong setting Trappes-Lomax et al., 180 2006 Wrong setting Turner et al., 181 2001 Wrong patient population Vangimalla et al., 182 2010 Wrong study design Vogelsmeier et al., 183 2020 Wrong intervention Voigt-Radloff, 184 2018 Ongoing study Whitehead et al., 185 2006 Wrong publication type Wysocki et al., 186 2014 Wrong patient population Yu et al., 187 2019 Wrong publication type Zamora et al., 188 2011 Wrong publication type eTable 3. 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