How can we tell whether our reviews make an impact?
One way in which we can assess impact is by tracking whether any of our reviews directly inform the rationale for future research.
An example of this comes from a review we published in 2016 ‘Admission avoidance hospital at home’, exploring whether caring for patients at home (in an ‘admission avoidance hospital at home’ setting) improves patient outcomes and reduces cost to the health service for people who would otherwise be admitted to hospital.
The review highlighted uncertainties that existed due to a lack of sufficiently large, well-conducted trials. The authors concluded that:
“Admission avoidance hospital at home, with the option of transfer to hospital, may provide an effective alternative to inpatient care for a select group of elderly patients requiring hospital admission. However, the evidence is limited by the small randomised controlled trials included in the review”.
In response, researchers set up a multi-centre randomized controlled trial - funded by the NIHR Health Service and Delivery Research Programme - to address this uncertainty. In their protocol, the researchers directly referred to the Cochrane Review when explaining the importance of, and need for, the trial:
“A meta-analysis of randomised trials of admission avoidance hospital at home is limited by the small number of small randomised controlled trials. The evidence suggests that these types of service, that include the option of transfer to hospital, may provide an effective alternative to inpatient care for a select group of older people who require hospital admission [4].” [Reference 4 is to the Cochrane Review].
The results of the trial were published in July 2021. There is a full text available from the following link: Is Comprehensive Geriatric Assessment Admission Avoidance Hospital at Home an Alternative to Hospital Admission for Older Persons?: A Randomized Trial
In the full publication, the authors – again - directly refer to the Cochrane Review when outlining the rationale for conducting the trial:
“Extending Comprehensive Geriatric Assessment (CGA) to admission avoidance hospital at home settings might reduce the risk of serious complications for older adults, who are more likely to maintain their existing care arrangements and routines when receiving healthcare in their home. Evidence to support the expansion of these services is limited to a small number of small single site randomised trials, with imprecise and inconsistent findings (9). We therefore conducted a multi-site randomised trial of CGA admission avoidance hospital admission at home, compared to inpatient care with CGA when possible, to generate evidence for planning health services for older people.” [Reference 9 is to the Cochrane Review].
The conclusions of the trial were:
“Hospital at home with Comprehensive Geriatric Assessment led to similar outcomes to hospital admission in the proportion of older people living at home, and a reduction in admissions to long-term residential care at six months. This type of service can provide an alternative to hospitalisation for selected older people.”
So, here we can see how our Cochrane Review played an important role in highlighting an evidence gap and encouraging researchers to conduct a trial to address key uncertainties. The results of the multi-centre trial should give greater clarity to those involved in the organisation and delivery of care and – ultimately, we hope – lead to better patient care.
Cochrane UK monitor the impact of Cochrane Reviews as part of their work. This includes charting reviews – such as this one – which have informed the research agenda. Find out more on their website.
References:
Shepperd S, Butler C, Cradduck-Bamford A, Ellis G, Gray A, Hemsley A, Khanna P, Langhorne P, Mort S, Ramsay S, Schiff R, Stott DJ, Wilkinson A, Yu LM, Young J. Is Comprehensive Geriatric Assessment Admission Avoidance Hospital at Home an Alternative to Hospital Admission for Older Persons?: A Randomized Trial. Ann Intern Med 2021 Jul;174(7):889-898. doi: 10.7326/M20-5688. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7612132/pdf/EMS138144.pdf
Shepperd S, Iliffe S, Doll HA, Clarke MJ, Kalra L, Wilson AD, Gonçalves‐Bradley DC. Admission avoidance hospital at home. Cochrane Database of Systematic Reviews 2016, Issue 9. Art. No.: CD007491. DOI: 10.1002/14651858.CD007491.pub2. Accessed 19 May 2022. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007491.pub2/full
Shepperd A, Cradduck-Bamford A, Butler C, Ellis G, Godfrey M, Gray A, Hemsley A, Khanna P, Langhorne P, McCaffrey P, Mirza L, Pushpangadan M, Ramsay S, Schiff R, Stott D, Young J & Yu L-M. A multi-centre randomised trial to compare the effectiveness of geriatrician-led admission avoidance hospital at home versus inpatient admission. Trials 2017 Oct; 18(491). https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-017-2214-y
See also two further publications from the trial:
Mäkelä P, Stott D, Godfrey M, Ellis G, Schiff R, Shepperd S. The work of older people and their informal caregivers in managing an acute health event in a hospital at home or hospital inpatient setting. Age and Ageing, September 2020; 49(5): 1–9. https://doi.org/10.1093/ageing/afaa085
Shepperd S, Butler C, Cradduck-Bamford A, Ellis G, Gray A, Hemsley A, Khanna P, Langhorne P, Mort S, Ramsay S, Schiff R, Stott DJ, Wilkinson A, Yu L-M, Young J. Is Comprehensive Geriatric Assessment Admission Avoidance Hospital at Home an Alternative to Hospital Admission for Older Persons?: A Randomized Trial. Age and Ageing, January 2022; 51(1): 1–11 https://doi.org/10.1093/ageing/afab220