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Table 2 Care/nursing home education programmes

From: A scoping review of initiatives to reduce inappropriate or non-beneficial hospital admissions and bed days in people nearing the end of their life: much innovation, but limited supporting evidence

Author, date and journal Study design Sample and setting Research focus Relevant results Wider implications Limitations
Garden et al.; 2016; Clinical Medicine [28] Mixed methods. 7 dementia care homes in Boston, UK, registered for the intervention programme, commencing in March 2011. 250 staff were trained. To explore the impact of a care home educational programme (Bromhead Care Home Service) on hospital admissions/place of death for palliative residents. From baseline, admissions were reduced by 66 in the first year and 111 by the third year, which represented a 55% decrease.
102 care plans were completed by April 2013. 4 of 102 patients wanted to die in hospital. Of the 68 residents who died during follow up, 67 died in preferred place.
Care home educational programmes such as the Bromhead Care Home Service could reduce hospital admissions for dementia patients. Evaluation done in-house.
Evaluation was done retrospectively, chance of recall bias.
Livingston et al.; 2013; International Psychogeriatrics [29] Mixed-methods retrospective. 120 Jewish residents with dementia and 90 nursing and care staff at a care home in London, UK. The educational intervention was a 10-session, manualised, interactive staff training programme. To analyse the impact of a care home educational programme on outcomes, including place of death. Significant increase in residents dying in the care home vs. hospital (47% vs.76%, p = 0.02).
Trend toward a decrease in the number of days spent in hospital during the last 3 months of life after intervention (median 4 vs. 1.25).
Increased care home education is associated with a decrease in hospital deaths and hospital days during the last months of life. May not replicate in non-Jewish care homes.
Rantz et al.; 2015; Journal of Nursing Care Quality [30] Mixed-methods longitudinal. 16 American nursing homes where hospital rates were among the country’s highest for hospital 30-day readmission and the Missouri Quality Initiativea intervention was in place. To examine the Missouri Quality Initiative’s effect on avoidable hospital admissions (other variables measured were polypharmacy and antipsychotic medication use, care discussions and completion of Advance Directive and the introduction of secure communication for electronic transfer of health information to other services). Transfer rates steadily declined approximately 9 months after programme implementation. Hospital transfers per 1000 days were 1.7 in 2014 and 1.3 in 2015 and was on track for 1.1 in 2016.
Education was a theme that care staff believed reduced hospital admissions. They believed the advanced practice registered nurses were key in improving assessment skills through training. All staff members were willing to be involved in the programme, aiding the reduction further. Reports provided a visual picture of nursing staff progress.
The Missouri Quality Initiative reduced unnecessary hospital admissions in a nursing home setting.  
Chapman et al.; 2016; BMJ Supportive & Palliative Care [31] Quasi-experimental, quantitative comparative. 250 Australian palliative care patients spread across 4 residential facilities over a 6-month period.
77 were included in the intervention group. The control group of 173 decedents was retrospective.
To examine the effect of a ‘Palliative Care Needs Rounds’ programme (supporting clinical decision-making, education and training) on hospital utilisation. The intervention group had on average a shorter length of hospital stay, than those not enrolled in the programme (1.9 vs. 4.8 p = 0.02).
No significant difference in number of hospital admissions.
Care home education could decrease the length of hospital stay. Historical data used for the control group.
Some residents were excluded due to incomplete data.
Kane et al.; 2017; JAMA Internal Medicine [32] Clustered randomised clinical trial. 36,717 residents at 85 nursing homes, 33 intervention sites and 52 control sites that had not previously implemented the INTERACT (Interventions to Reduce Acute Care Transfers) quality improvement programme. To establish whether training and support for implementation of a nursing home quality improvement programme reduce hospitalisations and ED visits. There was no significant difference between intervention and control nursing homes regarding overall hospital admissions, 30-day readmission rates or emergency department visits that resulted in hospitalisation.
Intervention homes showed a 6.5% reduction in overall hospitalisations, and 15% reduction in potentially avoidable hospitalisations compared with the pre-intervention rate amongst intervention homes.
Training and support for INTERACT implementation had no impact on hospitalisation or emergency department visits. The original sample contained a substantial number of nursing homes that reported prior use of INTERACT.
  1. aThe MOQI is 4-year intervention which assists care-staff training using advanced practice registered nurses, care transitions, health information technology and assessment tools