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Open Access Study protocol

Aged Residential Care Health Utilisation Study (ARCHUS): a randomised controlled trial to reduce acute hospitalisations from residential aged care

Susan J Foster1*, Michal Boyd1, Joanna B Broad1, Noeline Whitehead2, Ngaire Kerse3, Thomas Lumley4 and Martin J Connolly1

Author Affiliations

1 Freemasons’ Department of Geriatric Medicine, University of Auckland, C/- WDHB, Private Bag 93503, Takapuna, Auckland, 0740, New Zealand

2 Counties Manukau District Health Board, Auckland, New Zealand

3 General Practice and Primary Health Care, School of Population Health, University of Auckland, Auckland, New Zealand

4 Department of Statistics, University of Auckland, Auckland, New Zealand

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BMC Geriatrics 2012, 12:54  doi:10.1186/1471-2318-12-54

Published: 13 September 2012

Abstract

Background

For residents of long term care, hospitalisations can cause distress and disruption, and often result in further medical complications. Multi-disciplinary team interventions have been shown to improve the health of Residential Aged Care (RAC) residents, decreasing the need for acute hospitalisation, yet there are few randomised controlled trials of these complex interventions. This paper describes a randomised controlled trial of a structured multi-disciplinary team and gerontology nurse specialist (GNS) intervention aiming to reduce residents’ avoidable hospitalisations.

Methods/Design

This Aged Residential Care Healthcare Utilisation Study (ARCHUS) is a cluster- randomised controlled trial (n = 1700 residents) of a complex multi-disciplinary team intervention in long-term care facilities. Eligible facilities certified for residential care were selected from those identified as at moderate or higher risk of resident potentially avoidable hospitalisations by statistical modelling. The facilities were all located in the Auckland region, New Zealand and were stratified by District Health Board (DHB).

Intervention

The intervention provided a structured GNS intervention including a baseline facility needs assessment, quality indicator benchmarking, a staff education programme and care coordination. Alongside this, three multi-disciplinary team (MDT) meetings were held involving a geriatrician, facility GP, pharmacist, GNS and senior nursing staff.

Outcomes

Hospitalisations are recorded from routinely-collected acute admissions during the 9-month intervention period followed by a 5-month follow-up period. ICD diagnosis codes are used in a pre-specified definition of potentially reducible admissions.

Discussion

This randomised-controlled trial will evaluate a complex intervention to increase early identification and intervention to improve the health of residents of long term care. The results of this trial are expected in early 2013.

Trial registration

Australian New Zealand Clinical Trials Registry: ACTRN 12611000187943