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Unplanned hospital admissions are a major concern for UK health services, costing an estimated £12.5 billion annually. Many are for older people who are more likely to end up in the hospital; if they do, they may get stuck there due to a lack of community resources. Thus community-based models of care need to be developed based on robust evidence synthesis to address this pressing need. Similarly, NHS England has proposed an enhanced service to provide more personalised support for patients most at risk of unplanned admission, readmission and A&E attendances, but currently, the evidence for advanced care planning is lacking.

Planned Reviews

1.1  Accuracy of self-diagnosis in ambulatory sensitive conditions- Diagnostic accuracy review

Annette Pluddemann, Hayley Jones, Carl Heneghan

Lay summary


1.2  Accuracy of diagnosing serious infection in the elderly 

1.2.1   Accuracy of testing for serious infection in the immunocompromised in ambulatory care

1.2.2   Diagnostic utility of biomarkers in diagnosing serious bacterial infections in older adults in the ambulatory care setting: a systematic review and meta-analysis. 

Oghenekome Gbinigie, Igho Onakpoya, Jose Ordonez-Mena, Christopher Butler, Carl Heneghan (co-funded with NIHR SPCR round 13)







1.3  Does health and social care provision for the community dwelling older population help to reduce unplanned secondary care, support timely appropriate discharge, and improve patient wellbeing? A mixed method meta-review of systematic reviews. 

Alyson Huntley, Lorna Duncan, Shoba Dawson, Dawn Craig, Fiona Beyer, Patience Kunonga, Chris Salisbury, Matthew Booker, Ailsa Cameron, Ruth McDonald, Barbara Hanratty, Gemma Spiers


1.4  Does advanced care planning (ACP) for older people help to reduce unplanned hospital admissions and improve quality of life? 

Dawn Craig, Joy Adamson, Fiona Beyer, Patience Kunonga, Alyson Huntley, Louise Robinson, Shoba Dawson

Lay summary

1.5 What are predictors of unplanned admissions in older people?  Lay summary Protocol

1.6 A systematic review and evidence synthesis of patient outcomes, healthcare resource use, acceptability and feasibility of triage, self-referral and direct access services for patients with musculoskeletal pain. 

Opeyemi Babatunde, Annette Bishop, Elizabeth Cottrell, Joanne Jordan, Nadia Corp, Kym Snell, Katrina Humphries, Tina Hadley-Barrows, Alyson Huntley, Danielle van der Windt

Lay summary


1.7 Examining moderators of the effectiveness of self-management support in reducing urgent healthcare use in patients with respiratory conditions


workstream OUTPUTS


Diagnostic value of symptoms and signs for identifying urinary tract infection in older adult outpatients: Systematic review and meta-analysis.

Gbinigie OA, Ordóñez-Mena JM, Fanshawe TR, Plüddemann A, Heneghan C.

J Infect. 2018 Jun 30. pii: S0163-4453(18)30190-7. doi: 10.1016/j.jinf.2018.06.012.

 • Symptoms and signs traditionally associated with UTI (e.g. nocturia, urgency and abnormal vital signs) may have limited utility in diagnosing these infections in older adult outpatients.

• Disability in performing a number of acts of daily living may be better predictors of UTI; high quality studies should be conducted in this area to confirm this.


CEBM blog post: Taking the sting out of UTIs

 August 24, 2018 Diagnosing Urinary Tract Infections in older adults – Can we take the sting out of it? Dr Oghenekome Gbinigie