Impact of Quality Improvement Interventions on Hospital Admissions from Nursing Homes: A Systematic Review and Meta-Analysis

Objective

To synthesize evidence assessing the effectiveness of quality improvement (QI) interventions in reducing hospital service use from nursing homes (NHs).

Design

Systematic review and meta-analysis of randomized controlled trials (RCTs), controlled before-after (CBA), uncontrolled before-after (UBA), and interrupted time series studies. Searches were conducted in MEDLINE, CINAHL, The Cochrane Library, Embase, and Web of Science from 2000 to August 2023 (PROSPERO: CRD42022364195).

Setting and Participants

Long-stay NH residents (>30 days).

Methods

Included QI interventions using a continuous and data-driven approach to assess solutions aimed at reducing hospital service use. Risk of bias was assessed using JBI tools. Delivery arrangements and implementation strategies were categorized through EPOC taxonomy.

Results

Screening of 14,076 records led to the inclusion of 22 studies describing 29 QI interventions from 6 countries across 964 NHs. Ten studies, comprising 4 of 5 RCTs, 3 of 4 CBAs, and 1 of 12 UBAs were deemed to have a low risk of bias. All but 3 QI interventions used multiple component delivery arrangements (median 6; IQR 3-8), focusing on the “coordination of care and management of care processes” alone or combined with “changes in how, when, where, and by whom health care is delivered.” The most frequently used implementation strategies were educational meetings (n = 25) and materials (n = 20). The meta-analysis of 11 studies showed a significant reduction in “all-cause hospital admissions” for QI interventions compared with standard care (rate ratio, 0.60; 95% CI, 0.41-0.87; I² = 99.3%), with heterogeneity due to study design, QI intervention duration, type of delivery arrangements, and number of implementation strategies. No significant effects were found for emergency department (ED) visits or potentially avoidable hospitalizations.

Conclusions and Implications

The study provides preliminary evidence supporting the implementation of QI interventions seeking to reduce hospital admissions from NHs. However, these findings require confirmation through future experimental research.