The JAHEE Joint Action (JA) aims to build a shared understanding among policy makers and stakeholders across Europe on how to prevent and manage frailty through the development of a Frailty Prevention Approach. Work Package (WP) 7 of the JA and the State of the Art Report (SoAR) document produced by member of the WP presents evidence on models of care to prevent or delay progression of frailty.
The evidence summarised in the SoAR highlights the importance of comprehensive assessment, enablement and rehabilitation to optimise function, particularly at times of a deterioration in health, or when moving between home, hospital or care home. Transitional care and intermediate care are two important elements of the continuum of services that enable older people to maintain or recover their independence following a period of illness, injury or hospitalisation.
However, the many definitions and descriptors applied to this diverse range of services limit our ability to fully understand their contribution to the Frailty Prevention Approach. In order to better understand this contribution, WP 7 partners conducted two complementary studies: an e-Delphi study to build consensus amongst experts on the definitions and principles of transitional care and intermediate care for older adults, and a systematic review of the evidence for their effectiveness. This report presents the results of the systematic review. Annex 1 outlines the e-Delphi process and the ten consensus statements agreed by the experts.
Objective
Although transitional care and intermediate care are increasingly proposed as a means to deliver care closer to home, support earlier hospital discharge and reduce readmissions, there is limited data on outcomes and costs from studies in older adults.
This systematic review seeks to identify and analyse the effectiveness of transitional care and intermediate care and to understand the benefits and costs of these interventions in an older adult population, with a specific focus on hospital utilisation and (re)admissions as well as health-related outcomes including function and continuity of care. The key messages will guide policy makers, funders, commissioners, providers and professionals to design, deliver and scale-up effective transitional care and intermediate care interventions as an important part of the Frailty Prevention Approach.
Methods
Search strategy
Peer-reviewed medical literature published from 01/01/2002 to 05/02/2019 in English, French, Italian, and Spanish were analysed to identify articles that assessed the effectiveness of transitional or intermediate care interventions for older adults in any care setting. The search was conducted in CINAHL, EMBASE, PubMed and Cochrane Library databases by combining following search terms: ((“intermediate care” OR “transitional care”) AND (frailty OR frail OR “older person*” OR “older adult*” OR “hospital at home” OR “reablement” OR “independ*” OR “readmission” OR “prolonged stay” OR “community hospital”)).
This search yielded 1891 records. Cross referencing of systematic review and narrative review articles resulted in an additional 79 articles for screening. A search of OpenGrey using “intermediate care” OR “transitional care” for grey literature reports published from 01/01/2002 to 05/02/2019 resulted in 14 reports for screening.
Search output and eligibility criteria
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used as illustrated in Figure 1. Articles and grey literature were included if they were (1) report of an intervention for intermediate care and/or transitional care for older adults, (2) conducted in a health care setting, (3) published in English, French, Italian or Spanish, (4) published between 01/01/2002 and 05/02/2019, and (5) had full text available.
Titles and/or abstracts (where available) of 1984 records retrieved using the search strategy were independently screened by pairs of review authors (AH-DS, AMC-LLS, CA-RRA) considering inclusion and exclusion criteria. Any disagreements were first discussed by the paired reviewers before a third reviewer was invited to resolve any persisting conflict. After removal of 1762 records (duplicates or exclusions), data extraction was performed by four reviewers (AH, DS, MS, MOD) on 222 full-text records, with support from a native Spanish speaker (LSS) for one paper.