Evaluation of a Residential In-Reach Program in Regional and Rural Australia

Official title

Evaluation of a Region-wide Residential In-Reach (RIR) Program in Regional and Rural Health Services: A Stepped-wedge Trial

Overview

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.

Interventions

• Other Residential In-Reach Program
  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

Primary outcome measures

• Rate of presentations from residential aged care homes to emergency departments and emergency care centres [Time frame: From enrolment to the end of the trial for 14 months]

Secondary outcome measures (9)

• Days spent in hospital by aged care home resident [Time frame: From enrolment to the end of the trial for 14 months]
• Location of mortality in hospital [Time frame: From enrolment to the end of the trial for 14 months]
• Number of barriers to residential-in-reach program implementation [Time frame: From enrolment to 1 month after the end of the trial, for 15 months]
• Number of enablers to residential-in-reach program implementation [Time frame: From enrolment to 1 month after the end of the trial, for 15 months]
• Stakeholder reported feasibility of the residential-in-reach program implementation [Time frame: From enrolment to 1 month after the end of the trial, for 15 months]
• Stakeholder reported acceptability of the residential in-reach program [Time frame: From enrolment to the end of the trial for 14 months]
• Stakeholder reported appropriateness of the residential in-reach program [Time frame: 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 [Time frame: From enrolment to the end of the trial for 14 months]
• Number of adaptations made to the residential in-reach program [Time frame: From enrolment to the end of the trial fo]

Eligibility criteria

Inclusion criteria

• 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.

Exclusion criteria

• RACHs that already have access to a RIR program will be excluded

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

N/A

Model

Single group

Masking

Open label

Primary purpose

Health services research

Study locations

Australia · 8 centers

• East Grampians Health Service — Ararat
• Grampians Health — Ballarat
• Beaufort and Skipton Health Service — Beaufort
• Central Highlands Rural Health — Daylesford
• Maryborough District Health Service — Maryborough
• West Wimmera Health Service — Nhill
• East Wimmera Health Service — Saint Arnaud
• Rural Northwest Health — Warracknabeal

Publications

• 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. PMID 32690008
• 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. PMID 36081333
• 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. PMID 27547277
• 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. PMID 35012480
• 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. PMID 32237279
• 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. PMID 37916580

Identifiers

NCT: NCT06901167 · HREC/112397/GHSJOG-2025-462490

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗