Evidence map›Paper›PMID 28765132›Full record

SynthesisBMJ open2017

A systematic review to identify and assess the effectiveness of alternatives for people over the age of 65 who are at risk of potentially avoidable hospital admission.

Alyson L Huntley, Melanie Chalder, Ali R G Shaw, William Hollingworth, Chris Metcalfe, Jonathan Richard Benger, Sarah Purdy

Registry-linked trialAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05221697 (Effect of an Electronic Alert Management System Using Caregivers' Observations and Machine Learning Algorithm to Reduce the Use of Emergency Department Visits and Unplanned Hospitalizations Among Older People), which is not on this map. Cited by 26 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
26citing papers in PubMed, 6 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05221697 naunknown statusnot on this mapstarted 2020, after this paper: background citation

Effect of an Electronic Alert Management System Using Caregivers' Observations and Machine Learning Algorithm to Reduce the Use of Emergency Department Visits and Unplanned Hospitalizations Among Older People

TypeinterventionalSponsorPresageRan2020 to 2024Enrolled800ConditionsEmergenciesArmsPRESAGE CARE
3 · Its place in the literature

Who cites it

26 citing papers in PubMed, 6 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Challenges to Systems of Long-Term Care: Mapping of the Central Concepts from an Umbrella Review.International journal of environmental research and public health · 2023
    Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Cost-Effectiveness of Hospital-at-Home and Fecal Microbiota Transplantation in Treating Older Patients With Clostridioides difficile.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025
    Trial
  8. Trial
  9. Article
  10. Article
  11. What Is Important to Older People When Accessing Urgent Health Care: Key Considerations and Recommendations From Consumer Consultations.Health expectations : an international journal of public participation in health care and health policy · 2025
    Article
  12. Article
  13. Review
  14. Article
  15. Article
  16. Article
  17. Article
  18. Do we need a neurosurgical frailty index?Surgical neurology international · 2024
    Article
  19. Article
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Alyson L HuntleyCentre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.ORCID http://orcid.org/0000-0001-9409-7891
Melanie ChalderCentre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
Ali R G ShawCentre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
William HollingworthHealth Economics at Bristol, School of Social and Community Medicine University of Bristol, Bristol, UK.
Chris MetcalfeCentre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
Jonathan Richard BengerFaculty of Health and Applied Sciences, University of the West of England, Bristol, UK.
Sarah PurdyCentre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.

Funding

Department of Health PB-PG-1111-26018
6 · The paper itself

Abstract

BACKGROUND/

objectivesThere are some older patients who are 'at the decision margin' of admission. This systematic review sought to explore this issue with the following objective: what admission alternatives are there for older patients and are they safe, effective and cost-effective? A secondary objective was to identify the characteristics of those older patients for whom the decision to admit to hospital may be unclear.

designSystematic review of controlled studies (April 2005-December 2016) with searches in Medline, Embase, Cinahl and CENTRAL databases. The protocol is registered at PROSPERO (CRD42015020371). Studies were assessed using Cochrane risk of bias criteria, and relevant reviews were assessed with the AMSTAR tool. The results are presented narratively and discussed.

settingPrimary and secondary healthcare interface.

participantsPeople aged over 65 years at risk of an unplanned admission.

interventionsAny community-based intervention offered as an alternative to admission to an acute hospital. PRIMARY AND SECONDARY OUTCOMES MEASURES: Reduction in secondary care use, patient-related outcomes, safety and costs.

resultsNineteen studies and seven systematic reviews were identified. These recruited patients with both specific conditions and mixed chronic and acute conditions. The interventions involved paramedic/emergency care practitioners (n=3), emergency department-based interventions (n=3), community hospitals (n=2) and hospital-at-home services (n=11). Data suggest that alternatives to admission appear safe with potential to reduce secondary care use and length of time receiving care. There is a lack of patient-related outcomes and cost data. The important features of older patients for whom the decision to admit is uncertain are: age over 75 years, comorbidities/multi-morbidities, dementia, home situation, social support and individual coping abilities.

conclusionsThis systematic review describes and assesses evidence on alternatives to acute care for older patients and shows that many of the options available are safe and appear to reduce resource use. However, cost analyses and patient preference data are lacking.

Indexed as

Community Health ServicesHealth Services for the AgedHospitalizationAgedCost-Benefit AnalysisDelivery of Health CareHumansSafetyagedemergency medical serviceshospital alternativehospitalizationsystematic review

Identifiers

PMID28765132
PMCPMC5642761

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.