Evaluation of a Residential In-Reach Program in Regional and Rural Australia
Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age65+
SponsorMonash University
About this trial
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.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
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,
Disqualifiers
None
Trial design
Design model
Single group
Treatments tested in this trial
Residential In-Reach Program
Other interventionAll 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).
Treatment groups
100 Participants
are divided into 1 treatment groupGroup A: Residential-in-reachExperimental treatment 1 intervention
Trial outcomes
Primary outcomes
1
Rate of presentations from residential aged care homes to emergency departments and emergency care centres
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
Time frame
From enrolment to the end of the trial for 14 monthsSecondary outcomes
1
Days spent in hospital by aged care home resident
Secondary 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
Time frame
From enrolment to the end of the trial for 14 months2
Location of mortality in hospital
Secondary 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
Time frame
From enrolment to the end of the trial for 14 months3
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).
Time frame
From enrolment to 1 month after the end of the trial, for 15 months4
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).
Time frame
From enrolment to 1 month after the end of the trial, for 15 monthsOther outcomes
1
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: * Once at the end of the evaluation * At the level of each residential aged care home each month Collection approach: Extraction from hospital records
Time frame
From enrolment to the end of the trial for 14 months2
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: * Once at the end of the evaluation * At the level of each residential aged care home each month Collection approach: Extraction from residential aged care home records
Time frame
From enrolment to the end of the trial for 14 months3
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: * Once at the end of the evaluation * At the level of each residential aged care home each month Collection approach: Extraction from residential aged care home records
Time frame
From enrolment to the end of the trial for 14 months4
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: * Once at the end of the evaluation * At the level of each residential aged care home each month Collection approach: Extraction from residential aged care home records and Ambulance Victoria records
Time frame
From enrolment to the end of the trial for 14 monthsSponsors and contacts
Click on the lead sponsor to view all of their trials.
Monash University
Lead sponsor
Deakin University
Collaborator
Source ClinicalTrials.gov