Assessment tools for determining appropriateness of admission to acute care of persons transferred from long-term care facilities: a systematic review

BMC Geriatrics

Eva Mann²  Gabriele Meyer³  Lisbeth Uhrenfeldt⁴  Anna Renom-Guiteras¹ 

[1] Institute of General Practice and Family Medicine, Faculty of Health, University of Witten/Herdecke, Alfred-Herrhausen-Str. 50, Witten D-58448, Germany;Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria;Medical Faculty, Institute of Health and Nursing Science, Martin-Luther-University Halle-Wittenberg, Magdeburger Straße 8, Halle (Saale) D-06112, Germany;Department of Research, Horsens Hospital, Department of Public Health, Aarhus University, Aarhus, Denmark

关键词: Systematic review;    Hospitalization;    Patient transfer;    Nursing home;   

Others  :  848342
DOI  :  10.1186/1471-2318-14-80

 received in 2014-01-31, accepted in 2014-06-11,  发布年份 2014

【 摘 要 】

Background

Residents of long-term care facilities have a high risk of acute care admission. Estimates of the frequency of inappropriate transfers vary substantially throughout the studies and various assessment tools have been used. The purpose of this study is to systematically review and describe the internationally existing assessment tools used for determining appropriateness of hospital admissions among long-term care residents.

Method

Systematic review of the literature of two databases (PubMed and CINAHL®). The search covered seven languages and the period between January 2000 and December 2012. All quantitative studies were included if any assessment tool for appropriateness of hospital and/or emergency department admission of long-term care residents was used. Two pairs of independent researchers extracted the data.

Results

Twenty-nine articles were included, covering study periods between 1991 and 2009. The proportion of admissions considered as inappropriate ranged from 2% to 77%. Throughout the studies, 16 different assessment tools were used; all were based on expert opinion to some extent; six also took into account published literature or interpretation of patient data. Variation between tools depended on the concepts studied, format and application, and aspects evaluated. Overall, the assessment tools covered six aspects: specific medical diagnoses (assessed by n = 8 tools), acuteness/severity of symptoms (n = 7), residents’ characteristics prior to admission (n = 6), residents’ or families’ wishes (n = 3), existence of a care plan (n = 1), and availability or requirement of resources (n = 10). Most tools judged appropriateness based on one fulfilled item; five tools judged appropriateness based on a balance of aspects. Five tools covered only one of these aspects and only six considered four or more aspects. Little information was available on the psychometric properties of the tools.

Conclusions

Most assessment tools are not comprehensive and do not take into account residents’ individual aspects, such as characteristics of residents prior to admission and wishes of residents or families. The generalizability of the existing tools is unknown. Further research is needed to develop a tool that is evidence-based, comprehensive and generalizable to different regions or countries in order to assess the appropriateness of hospital admissions among long-term care residents.

【 授权许可】

   
2014 Renom-Guiteras et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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