G425(P) A systematic review and meta-analysis of out of hospital nursing interventions to reduce emergency department attendances in children and young people
Bibliographic record
Abstract
Aims Rising use of emergency departments has resulted in increased costs and poor quality of care for children and young people. Clear evidence on which interventions work in reducing the number of unplanned admissions is important for those who use and commission emergency department services and to improve the quality of healthcare services. There is a policy imperative to shift care out of hospitals but insufficient evidence on the effectiveness of out of hospital care. This review aims to identify, critique, and collate outcomes in published evidence for nurse-led out hospital care for children and young people with chronic conditions. Methods Two databases were systematically searched from 1965–2017, to identify randomised controlled trials that used nurse-led out of hospital care to reduce emergency department attendances in children and young people (0–18 years) with at least one chronic condition. The pooled incidence rate ratio (IRR) was estimated using the R package metaphor. Results Five randomised controlled trials (3 USA, 1 Canada, 1 Scotland) met the inclusion criteria. All five trials were included in the qualitative review but four were included in the meta-analysis due to heterogeneity in outcome measures. Four papers reported on CYP with asthma and the fifth on chronic illness. Only three papers reported significant effect for a reduction in emergency department attendances. Study quality was moderate, with a medium risk of bias. The meta-analysis fitted a random-effects model, which estimated a pooled IRR of 0.65 (95% CI 0.40, 1.03) implying a non-significant positive effect of nurse-led out of hospital care on reducing emergency department attendance. Conclusions Although this review found no association between emergency department usage and nurse-led out of hospital care, the effect sizes were large and three papers found positive associations. Only five randomised controlled trials were included in this review, most of which studied children and young people with asthma, highlighting the need for further research in this area.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.049 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.012 | 0.025 |
| Bibliometrics | 0.005 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.014 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".