Abstract:
Background and Aim Our aim is to reduce avoidable acute hospitalisations of residents of long-term care facilities. Such hospitalisations can cause distress, disruption, and complications for residents. Some conditions have been identified as better managed in the facility providing supports are in place. A randomised controlled trial is underway in Auckland, New Zealand of a targeted, multi-disciplinary team (MDT) to up-skill facility staff. We here outline the study design. Design Clustered randomised controlled trial (~1400 residents) of long-term care facilities, stratified by district health board (DHB). Randomisation and interventions commenced March 2011. Facilities certified for long-term care of older people in greater Auckland are eligible for selection if they have high levels of avoidable hospitalisation. Intervention MDTs supporting facility staff to provide evidence-based care. The supports and services provided comprise an initial stock-take assessment and development of facility plan, direct access to a geriatrician and gerontology nurse specialist (GNS), MDT meetings for individual cases, and provision of targeted education to facility nurses/caregivers, facilitated by a GNS. Education topics are based on modelling of risk factors for avoidable hospitalisation from long-term care in Auckland (2008-2010) and include recognition of illness, wound care, care planning, end-stage dementia care, nutrition/dehydration, family communication, specific clinical coaching with high-risk residents, role modelling of clinical reasoning processes, and provision of benchmarking systems. Control Usual care: the quality assurance, supports, and services routinely provided by the DHB Endpoints Primary endpoints include rate of hospitalisations in which the admission diagnosis code is one of a set pre-identified as being potentially avoidable (“Ambulatory Sensitive Hospitalisations”), emergency admission hospital bed days, and all-cause mortality. Secondary endpoints include number of emergency department presentations and number and type of medications prescribed. Residents’ outcomes will be tracked for 12 months from randomisation using their unique national health identifiers (NHIs).
