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BMJ Qual Saf 20:680-691 doi:10.1136/bmjqs.2010.047183
  • Original research

Effects of hospital-wide interventions to improve care for frail older inpatients: a systematic review

  1. Marcel G M Olde Rikkert
  1. Radboud University Nijmegen Medical Centre, Department of Geriatrics, Nijmegen, The Netherlands
  1. Correspondence to FC Bakker, Radboud University Nijmegen Medical Centre, Department of Geriatric Medicine 925, PO Box 9101, Nijmegen 6500 HB, The Netherlands; f.bakker{at}ger.umcn.nl
  1. Contributors All authors contributed to the study design, selection of articles, data extraction, analysis and interpretation, and writing of the manuscript.

  • Accepted 22 January 2011
  • Published Online First 25 February 2011

Abstract

Background Although it is widely recognised that frail older persons need adaptation of healthcare services, it is unclear how hospital care in general can best be tailored to their frailty.

Objective To systematically review the evidence for hospital-wide interventions for older patients.

Methods PubMed, Cochrane CENTRAL, Cinahl and reference lists of included articles (1980–2009) were searched. Papers describing (1) randomised controlled trials, controlled clinical trials, controlled before–after studies or interrupted time series, (2) patients ≥65 years admitted to hospital, (3) hospital-wide organisational interventions, and (4) patient-related outcomes, quality of care, patient safety, resource use or costs were included. Two reviewers extracted data and assessed risk of bias independently, according to Cochrane Effective Practice and Organization of Care Review Group guidelines.

Results The authors included 20 articles out of 1175. The mean age of the study populations ranged from 74.2 to 85.8 years. Interventions included multidisciplinary (consultative) teams, nursing care models, structural changes in physical environment and/or changes in site of service delivery. Small or no effects were found on patient-related outcomes such as functional performance, length of stay, discharge destination, resource use and costs compared with usual care. Methodological quality evaluation showed data incompleteness and contamination as main sources of bias.

Conclusions No single best hospital-wide intervention could be identified using strict methodological criteria. However, several interventions had positive results, and may be used in hospital practice. Since strict methodological designs are not optimal for evaluating highly complex interventions and settings, the authors recommend studying hospital-wide interventions for older persons using adapted quality and research criteria.

Footnotes

  • Funding The work was made possible by grant 60-6190-098-272 and grant 60-61900-98-129 of the National Programme for Elderly Care, coordinated and sponsored by ZonMw, The Netherlands, Organization for Health Research and Development.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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