Evaluation of a Region-wide Residential In-Reach (RIR) Program in Regional and Rural Health Services: A Stepped-wedge Trial
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 100
- 试验地点
- 8
- 主要终点
- Rate of presentations from residential aged care homes to emergency departments and emergency care centres
研究概览
简要总结
Residential In-Reach (RIR) programs are designed to provide responsive care for residents in residential aged care homes (RACH) with the aim of avoiding unnecessary hospital transfers. The evidence for their clinical and cost-effectiveness and implementation has been established in urban settings, but there is a small amount of low-quality evidence for rural and regional settings. The Grampians Region Health Service Partnership Resi-In-Reach Redesign Committee will be implementing a new RIR program to be offered to all RACHs in the Grampians region, this project aims to evaluate the clinical and cost-effectiveness of this program, and its implementation in the rural and regional setting. A stepped-wedge trial will be conducted so that as the RIR program is gradually rolled-out across the region, outcomes can be compared in the same facilities across time and between different facilities. The primary outcome measure will be presentation to emergency departments and urgent care centres, and data will also be collected on other clinical outcomes and barriers and enablers of implementing the program. It is anticipated that there will be a reduction in hospital presentations, and a range of barriers and enablers unique to the rural and regional setting will emerge.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 65 Years 至 —（Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Health services that have emergency departments and/or emergency care centres that admit residents from residential aged care homes (RACH)
- •RACHs that do not currently have access to RIR programs
- •health service staff who have been involved with the set-up and delivery of the RIR program,
- •RACH staff who have experience of or accessing the RIR service for residents at least once,
- •residents living at a RACH who has experienced receiving medical care from the RIR program and can provide informed consent, or a family member of the resident,
- •general practitioners whose case load includes residents from RACHs.
排除标准
- •RACHs that already have access to a RIR program will be excluded
研究组 & 干预措施
Residential-in-reach
All enrolled residential aged care homes will be able to access the residential-in-reach (RIR) program intervention. The RIR program provides a consultation service from a central hospital to an aged care facility in the Grampians region in the state of Victoria, Australia. Aged care staff will make a telehealth referral to central hub, where a nurse practitioner will triage the patient and make recommendations (for example, monitor resident condition, more examples: comprehensive assessment for unwell residents, liaison with the General Practitioners for diagnosis and treatment plan, provide education and support to staff) or further referrals (for example, refer to geriatrician or call an ambulance).
干预措施: Residential In-Reach Program (Other)
结局指标
主要结局
Rate of presentations from residential aged care homes to emergency departments and emergency care centres
时间窗: From enrolment to the end of the trial for 14 months
Primary clinical effectiveness outcome Collection schedule: * Once at the end of the evaluation * At the level of each residential aged care home presentation to hospital each month Collection approach: Extraction from hospital records and extraction from residential aged care home systems
次要结局
- Location of mortality in hospital(From enrolment to the end of the trial for 14 months)
- Number of barriers to residential-in-reach program implementation(From enrolment to 1 month after the end of the trial, for 15 months)
- Number of enablers to residential-in-reach program implementation(From enrolment to 1 month after the end of the trial, for 15 months)
- Stakeholder reported feasibility of the residential-in-reach program implementation(From enrolment to 1 month after the end of the trial, for 15 months)
- Stakeholder reported acceptability of the residential in-reach program(From enrolment to the end of the trial for 14 months)
- Stakeholder reported appropriateness of the residential in-reach program(From enrolment to the end of the trial for 14 months)
- Number of aged care staff who attend education sessions for the use of the residential in-reach program(From enrolment to the end of the trial for 14 months)
- Number of adaptations made to the residential in-reach program(From enrolment to the end of the trial fo)
- Days spent in hospital by aged care home resident(From enrolment to the end of the trial for 14 months)