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| Name | Class |
|---|---|
| Deakin University | OTHER |
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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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Residential-in-reach | Experimental | 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). |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Residential In-Reach Program | Other | 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). |
| Measure | Description | Time Frame |
|---|---|---|
| Rate of presentations from residential aged care homes to emergency departments and emergency care centres | Primary clinical effectiveness outcome Collection schedule:
| From enrolment to the end of the trial for 14 months |
| Measure | Description | Time Frame |
|---|---|---|
| Days spent in hospital by aged care home resident | Secondary clinical effectiveness outcome Collection schedule:
| From enrolment to the end of the trial for 14 months |
| Measure | Description | Time Frame |
|---|---|---|
| Number of times the residential in-reach program is utilised | Cost-effectiveness outcome: number of times the RACHs enrolled in this trial utilises the residential in-reach program, both in-person and via telehealth. Collection schedule:
| From enrolment to the end of the trial for 14 months |
Inclusion Criteria:
Exclusion Criteria:
• RACHs that already have access to a RIR program will be excluded
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Dai Pu | Contact | 61 03 9904 4004 | debbie.pu@monash.edu | |
| Catherine Huggins | Contact | kate.huggins@deakin.edu.au |
| Name | Affiliation | Role |
|---|---|---|
| Terry Haines | Monash University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| East Grampians Health Service | Recruiting | Ararat | Victoria | 3377 | Australia |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 32690008 | Background | Sunner C, Giles MT, Parker V, Dilworth S, Bantawa K, Kable A, Oldmeadow C, Foureur M. PACE-IT study protocol: a stepped wedge cluster randomised controlled trial evaluating the implementation of telehealth visual assessment in emergency care for people living in residential aged-care facilities. BMC Health Serv Res. 2020 Jul 20;20(1):672. doi: 10.1186/s12913-020-05539-1. | |
| 36081333 |
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Individual participant data will not be analysed and reported on. Planned data management involves analysis and reporting of aggregated data from all participants from all sites.
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| ID | Term |
|---|---|
| D000208 | Acute Disease |
| ID | Term |
|---|---|
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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This will be a stepped-wedge trial, in which all enrolled facilities and participants will receive the same intervention, but the intervention roll-out will be conducted in a sequential manner based on a randomised order. During the 14 months of the trial, all facilities and participants will receive the same intervention, but for different lengths of time depending on the randomisation.
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| Location of mortality in hospital | Secondary clinical effectiveness outcome Collection schedule:
| From enrolment to the end of the trial for 14 months |
| Number of barriers to residential-in-reach program implementation | Secondary implementation outcome - collected once via semi-structured interviews with key stakeholders (health service staff, residential aged care home staff). | From enrolment to 1 month after the end of the trial, for 15 months |
| Number of enablers to residential-in-reach program implementation | Secondary implementation outcome - collected once via semi-structured interviews with key stakeholders (health service staff, residential aged care home staff). | From enrolment to 1 month after the end of the trial, for 15 months |
| Stakeholder reported feasibility of the residential-in-reach program implementation | Secondary implementation outcome - collected once via semi-structured interviews with key stakeholders (health service staff, residential aged care home staff). | From enrolment to 1 month after the end of the trial, for 15 months |
| Stakeholder reported acceptability of the residential in-reach program | Secondary implementation outcome - collected via semi-structured interviews with key stakeholders (health service staff, residential aged care home staff, general practitioners, aged care home residents) after occasions of service on a monthly basis. | From enrolment to the end of the trial for 14 months |
| Stakeholder reported appropriateness of the residential in-reach program | Secondary implementation outcome - collected via semi-structured interviews with key stakeholders (health service staff, residential aged care home staff, general practitioners, aged care home residents) after occasions of service on a monthly basis. | 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 | Secondary implementation outcome - recorded attendance of education sessions for residential aged care home staff 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 | Secondary implementation outcome - documented adaptations made to the program during the trial period. | From enrolment to the end of the trial fo |
| Number of times the Victorian Virtual Emergency Department is utilised | Cost-effectiveness outcome: number of times the RACHs enrolled in this trial uses the Victorian Virtual Emergency Department. Collection schedule:
| From enrolment to the end of the trial for 14 months |
| Number of times that the general practitioner is utilised | Cost-effectiveness outcome: number of times that the RACHs enrolled in this trial consults the general practitioner, both in-person and via telehealth, including in and out of hours consultations. Collection schedule:
| From enrolment to the end of the trial for 14 months |
| Number of calls to Ambulance Victoria | Cost-effectiveness outcome: number of times the RACHs enrolled in this trial calls an ambulance for their residents. Collection schedule:
| From enrolment to the end of the trial for 14 months |
| Number of transfers to hospital via Ambulance Victoria | Cost-effectiveness outcome: number of times that Ambulance Victoria transfers a resident from one of the RACHs enrolled in this trial to hospital. Collection schedule:
| From enrolment to the end of the trial for 14 months |
| Grampians Health | Recruiting | Ballarat | Victoria | 3350 | Australia |
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| Beaufort and Skipton Health Service | Recruiting | Beaufort | Victoria | 3373 | Australia |
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| Central Highlands Rural Health | Recruiting | Daylesford | Victoria | 3460 | Australia |
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| Maryborough District Health Service | Recruiting | Maryborough | Victoria | 3465 | Australia |
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| West Wimmera Health Service | Recruiting | Nhill | Victoria | 3418 | Australia |
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| East Wimmera Health Service | Recruiting | Saint Arnaud | Victoria | 3478 | Australia |
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| Rural Northwest Health | Recruiting | Warracknabeal | Victoria | 3393 | Australia |
|
| Background |
| Sunner C, Giles MT, Kable A, Foureur M. Experiences of nurses working in RACFs and EDs utilising visual telehealth consultation to assess the need for RACF resident transfer to ED: A qualitative descriptive study. J Clin Nurs. 2023 Aug;32(15-16):4694-4709. doi: 10.1111/jocn.16529. Epub 2022 Sep 8. |
| 27547277 | Background | Lukin B, Fan LJ, Zhao JZ, Sun JD, Dingle K, Purtill R, Tapp S, Hou XY. Emergency department use among patients from residential aged care facilities under a Hospital in the Nursing Home scheme in public hospitals in Queensland Australia. World J Emerg Med. 2016;7(3):183-90. doi: 10.5847/wjem.j.1920-8642.2016.03.004. |
| 35012480 | Background | Hullick C, Conway J, Hall A, Murdoch W, Cole J, Hewitt J, Oldmeadow C, Attia J. Video-telehealth to support clinical assessment and management of acutely unwell older people in Residential Aged Care: a pre-post intervention study. BMC Geriatr. 2022 Jan 10;22(1):40. doi: 10.1186/s12877-021-02703-y. |
| 32237279 | Background | Haines TP, Palmer AJ, Tierney P, Si L, Robinson AL. A new model of care and in-house general practitioners for residential aged care facilities: a stepped wedge, cluster randomised trial. Med J Aust. 2020 May;212(9):409-415. doi: 10.5694/mja2.50565. Epub 2020 Apr 1. |
| 37916580 | Background | Chambers D, Cantrell A, Preston L, Marincowitz C, Wright L, Conroy S, Lee Gordon A. Reducing unplanned hospital admissions from care homes: a systematic review. Health Soc Care Deliv Res. 2023 Oct;11(18):1-130. doi: 10.3310/KLPW6338. |