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

J Am Med Dir Assoc. 2015 Jan;16(1):49-55. doi: 10.1016/j.jamda.2014.07.008. Epub 2014 Sep 18.

Abstract

Objective: 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 randomized 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 was 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. Australian and New Zealand Clinical Trials Registry (ACTRN12611000187943).

Keywords: Residential facilities; aged; hospitalization; interdisciplinary health team; randomized controlled trial.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Female
  • Hospital Mortality
  • Hospitalization / trends*
  • Humans
  • Inservice Training
  • Interdisciplinary Studies
  • Length of Stay / statistics & numerical data
  • Long-Term Care*
  • Male
  • New Zealand
  • Patient Acceptance of Health Care