Reducing Hospital Transfers from Aged Care Facilities: A Large-Scale Stepped Wedge Evaluation.

Older people living in residential aged care facilities (RACFs) experience acute deterioration requiring assessment and decision making. We evaluated the impact of a large-scale regional Aged Care Emergency (ACE) program in reducing hospital admissions and emergency department (ED) transfers. A stepped wedge nonrandomized cluster trial with 11 steps, implemented from May 2013 to August 2016. A large regional and rural area of northern and western New South Wales, Australia. Nine hospital EDs and 81 RACFs participated in the evaluation. The ACE program is an integrated nurse-led intervention underpinned by a community of practice designed to improve the capability of RACFs managing acutely unwell residents. It includes telephone support, evidence-based algorithms, defining goals of care for ED transfer, case management in the ED, and an education program. ED transfers and subsequent hospital admissions were collected from administrative data including 13 months baseline and 9 months follow-up. A total of 18,837 eligible ED visits were analyzed. After accounting for clustering by RACFs and adjusting for time of the year as well as RACF characteristics, a statistically significant reduction in hospital admissions (adjusted incident rate ratio = .79; 95% confidence interval [CI] = .68-.92); P = .0025) was seen (i.e., residents were 21% less likely to be admitted to the hospital). This was also observed in ED visit rates (adjusted incidence rate ratio = .80; 95% CI = .69-.92; P = .0023) (i.e., residents were 20% less likely to be transferred to the ED). Seven-day ED re-presentation fell from 5.7% to 4.9%, and 30-day hospital readmissions fell from 12% to 10%. The stepped wedge design allowed rigorous evaluation of a real-world large-scale intervention. These results confirm that the ACE program can be scaled up to a large geographic area and can reduce ED visits and hospitalization of older people with complex healthcare needs living in RACFs.

Hullick CJ ，Hall AE ，Conway JF ，Hewitt JM ，Darcy LF ，Barker RT ，Oldmeadow C ，Attia JR ... -  《-》

Emergency department transfers and hospital admissions from residential aged care facilities: a controlled pre-post design study.

Hullick C ，Conway J ，Higgins I ，Hewitt J ，Dilworth S ，Holliday E ，Attia J ... -  《BMC Geriatrics》

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.

Sunner C ，Giles MT ，Parker V ，Dilworth S ，Bantawa K ，Kable A ，Oldmeadow C ，Foureur M ... -  《BMC HEALTH SERVICES RESEARCH》

Cost analysis of an integrated aged care program for residential aged care facilities.

Ling R ，Searles A ，Hewitt J ，Considine R ，Turner C ，Thomas S ，Thomas K ，Drinkwater K ，Higgins I ，Best K ，Conway J ，Hullick C ... -  《-》

Implementation and evaluation of a nurse-led intervention to augment an existing residential aged care facility outreach service with a visual telehealth consultation: stepped-wedge cluster randomised controlled trial.

Sunner C ，Giles M ，Ball J ，Barker R ，Hullick C ，Oldmeadow C ，Foureur M ... -  《BMC HEALTH SERVICES RESEARCH》