Impact of health service interventions on acute hospital use in community-dwelling persons with dementia: A systematic literature review and meta-analysis

• Published in: PloS one 2019-06, Vol.14 (6), p.e0218426-e0218426
• Main Authors: Godard-Sebillotte, Claire, Le Berre, Mélanie, Schuster, Tibor, Trottier, Miguel, Vedel, Isabelle
• Format: Article
• Language: English
• Subjects: Aged; Ambulatory Care - methods; Ambulatory Care - standards; Analysis; Bias; Care and treatment; Caregivers; Case management; Clinical trials; Crisis Intervention; Data collection; Death; Dementia; Dementia - epidemiology; Dementia - rehabilitation; Dementia - therapy; Dementia disorders; Elderly; Emergency medical services; Engineering and Technology; Female; Geriatric Assessment; Health care; Health care costs; Health services; Heterogeneity; Hospital admission and discharge; Hospitalization - statistics & numerical data; Hospitals; Humans; Identification methods; Independent Living - statistics & numerical data; Intervals; Intervention; Literature reviews; Male; Medical care quality; Medical research; Medicine; Medicine and Health Sciences; Meta-analysis; Older people; Patient Education as Topic; Patient outcomes; People and places; Physical Sciences; Primary care; Psychological aspects; Public health; Quality of life; Randomized Controlled Trials as Topic; Research and Analysis Methods; Self-Management; Services; Social Sciences; Subgroups; Synthesis; Systematic review
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0218426

Persons with dementia have twice the acute hospital use as older persons without dementia. In addition to straining overburdened healthcare systems, acute hospital use impacts patient and caregiver quality of life and is associated with increased risk of adverse outcomes including death. Reducing avoidable acute hospital use in persons with dementia is thus a global healthcare priority. However, evidence regarding the impact of health service interventions as defined by the Effective Practice and Organization of Care Cochrane Group on acute hospital use is scant and inconclusive. The aim of this systematic review and meta-analysis was to synthesize available evidence on the impact of health service interventions on acute hospital use in community-dwelling persons with dementia compared to usual care. Data Sources: MEDLINE, EMBASE, CINAHL and Cochrane CENTRAL (from 01/1995 to 08/2017). Study eligibility criteria: Randomised controlled trials measuring the impact of health service interventions on acute hospital use (proportion and mean number of emergency department visits and hospitalisations, mean number of hospital days, measured at 12 months, and at longest follow-up) in community-dwelling persons with dementia, compared to usual care. Study selection, appraisal and synthesis methods: Reviewers independently identified studies, extracted data, and assessed the risk of bias, with the Cochrane risk of bias tool. Authors of relevant trials were queried about unpublished data. Random effects model was used for meta-analyses. Effect heterogeneity was assessed through prediction intervals, and explored using sub-group analyses. Seventeen trials provided data on 4,549 persons. Unpublished data were obtained for 13 trials, representing 65% of synthesized data. Most interventions included a case management or a self-management component. None of the outcome comparisons provided conclusive evidence supporting the hypothesis that these interventions would lead to a decrease in acute hospital use. Furthermore, prediction intervals indicated possible and important increased service use associated with these interventions, such as emergency department visits, hospital admissions, and hospital days. Subgroup analyses did not favour any type of intervention. A limitation of this study is the inclusion of any type of health service intervention, which may have increased the observed heterogeneity. Despite a comprehensive systematic review and meta-analysis, including pr