Assessing the impact of intermediate care interventions on healthcare and patient-related outcomes: a systematic overview of systematic reviews

Introduction Intermediate care interventions are widely used to support patients transitioning between hospital and home, aiming to reduce the burden on acute healthcare services. The effectiveness however of such interventions remains unclear. Previous reviews have highlighted mixed findings, with limited high-quality evidence available to guide policy and practice.

Aim & objectives This overview aims to assess the impact of intermediate care interventions on key outcomes such as hospital length of stay (LOS), emergency department (ED) visits, readmissions, mortality, quality of life (QoL), and healthcare costs in developed countries. This overview has two key objectives: (i) to map existing widely-disseminated intermediate care interventions, and (ii) summarise evidence regarding the effectiveness of such interventions.

Methods We conducted a comprehensive search of eight databases up to February 2024. Systematic reviews with or without meta-analyses assessing intermediate care interventions in OECD developed countries were included. Two reviewers independently assessed study quality using AMSTAR 2. Data on length of stay (LOS), ED visits, readmissions, mortality, quality of life (QoL), and costs were extracted and synthesised.

Results Twenty-two reviews (570 unique primary studies) were included. Consistent evidence showed transitional care interventions (TCIs), rapid response teams, and virtual wards (VWs) were effective in reducing in-hospital LOS and ED/hospital readmissions. TCIs, person- and family-centred care, VWs, and telephone-based interventions were generally effective in lowering subsequent ED visits. Limited evidence supported effectiveness in reducing mortality, with VWs showing the most promise. No clear evidence was found for improving QoL. Cost-effectiveness findings were inconclusive. Most reviews reported low overall confidence ratings, and reviews reported that about half of primary studies were rated high risk of bias.

Discussion While intermediate care interventions show promise in addressing ED overcrowding, the generally low-certainty evidence highlights the need for further high-quality research. Future studies should focus on long-term effectiveness, cost-effectiveness, and identifying the most effective intervention components across different patient populations.