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.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
100
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 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).
East Grampians Health Service
Ararat, Victoria, Australia
RECRUITINGGrampians Health
Ballarat, Victoria, Australia
RECRUITINGBeaufort and Skipton Health Service
Beaufort, Victoria, Australia
RECRUITINGCentral Highlands Rural Health
Daylesford, Victoria, Australia
RECRUITINGMaryborough District Health Service
Maryborough, Victoria, Australia
RECRUITINGWest Wimmera Health Service
Nhill, Victoria, Australia
RECRUITINGEast Wimmera Health Service
Saint Arnaud, Victoria, Australia
RECRUITINGRural Northwest Health
Warracknabeal, Victoria, Australia
RECRUITINGRate 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 months
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 months
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 months
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 months
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 months
Stakeholder reported feasibility of the 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 months
Stakeholder reported acceptability of the residential in-reach program
Secondary implementation outcome - collected via semi-structured interviews with key stakeholders (health service staff, residential aged care home staff, general practitioners, aged care home residents) after occasions of service on a monthly basis.
Time frame: From enrolment to the end of the trial for 14 months
Stakeholder reported appropriateness of the residential in-reach program
Secondary implementation outcome - collected via semi-structured interviews with key stakeholders (health service staff, residential aged care home staff, general practitioners, aged care home residents) after occasions of service on a monthly basis.
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
Secondary implementation outcome - recorded attendance of education sessions for residential aged care home staff 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
Secondary implementation outcome - documented adaptations made to the program during the trial period.
Time frame: From enrolment to the end of the trial fo
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