The Aged Residential Care Healthcare Utilization Study (ARCHUS): A multidisciplinary, cluster randomized controlled trial designed to reduce acute avoidable hospitalizations from long-term care facilities

Martin J. Connolly, Michal Boyd, Joanna Broad, Ngaire Kerse, Thomas Lumley, Noeline Whitehead, Susan Foster

Research output: Contribution to journalArticlepeer-review

27 Citations (Scopus)

Abstract

Objetive: To assess effect of a complex, multidisciplinary intervention aimed at reducing avoidable acute hospitalization of residents of residential aged care (RAC) facilities.
Design: Cluster randomized controlled trial.
Setting: RAC facilities with higher than expected hospitalizations in Auckland, New Zealand, were recruited and radomized to intervention or control.
Participants: A total of 1998 residents of 18 intervention facilities and 18 control facilities.
Intervention: A facility-based complex intervention of 9 months' duration. The intervention comprised gerontology nurse specialist (GNS)-led staff education, facility bench-marking, GNS resident review, and multidisciplinary (geriatrician, primary-care physician, pharmacist, GNS, and facility nurse) discussion of residents selected using standard criteria.
Main outcome measures: Primary end point was avoidable hospitalizations. Secondary end points were all acute admissions, mortality, and acute bed-days. Follow-up for a total of 14 months.
Results: The intervention did not affect main study end points: number of acute avoidable hospital admissions (RR 1.07; 95% CI 0.85–1.36; P = .59) or mortality (RR 1.11; 95% CI 0.76–1.61; P = .62).
Conclusions: This multidisciplinary intervention, packaging selected case review, and staff education had no overall impact on acute hospital admissions or mortality. This may have considerable implications for resourcing in the acute and RAC sectors in the face of population aging.
Original languageEnglish
Pages (from-to)49-55
Number of pages7
JournalJournal of the American Medical Directors Association
Volume16
Issue number1
Early online date2014
DOIs
Publication statusPublished - 2015

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