As part of our work at Cochrane UK, we monitor the impact of Cochrane Reviews and other Cochrane outputs. In other words, ‘what happens next?’ after reviews are published.

1. The use of Cochrane Reviews in Clinical Guidelines

One way in which we monitor the impact of Cochrane Reviews in healthcare decision-making is to identify whether they have been used to inform evidence-based clinical guidelines.

Our Information Services Team - Anne Eisinga and Emma Carter - continually check guideline developers’ websites to capture newly published guidelines. This enables us to maintain the currency of the Cochrane UK guidelines data set of Cochrane Reviews that have informed healthcare guidance worldwide. Our data include a subset on UK-published guidance.

You can find this information alongside Cochrane Reviews in the Cochrane Library. If a given review has informed any guidelines, you can find out on the right-hand side of the page.

Clicking on the link which reads ‘used in [number of] guidelines’ will take you to details of the guidelines in which the review has featured. Links to guidelines are provided if available, although access will depend on the provider. You can see an example below:

2. Cochrane Reviews informing the research agenda

Another way in which we monitor impact is by charting ‘Cochrane Reviews which inform the research agenda’.

This includes monitoring any ‘threaded publications’. For instance, where reviews directly inform the rationale for future research.

One example comes from Cochrane Effective Practice and Organization of Care (EPOC).

In 2016, Cochrane EPOC published a review ‘Admission avoidance hospital at home’ which explored 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 one 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.

To find out more about Cochrane UK’s work monitoring the impact of Cochrane Reviews, you can contact Anne Eisinga and Emma Carter, our Information Services Team, via general@cochrane.nhs.uk

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