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Pilot cluster randomised trial of an evidence-based intervention to reduce avoidable hospital admissions in nursing home residents (Better Health in Residents of Care Homes with Nursing—BHiRCH-NH Study)

OBJECTIVES: To pilot a complex intervention to support healthcare and improve early detection and treatment for common health conditions experienced by nursing home (NH) residents. DESIGN: Pilot cluster randomised controlled trial. SETTING: 14 NHs (7 intervention, 7 control) in London and West Yorks...

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Autores principales: Sampson, Elizabeth L, Feast, Alexandra, Blighe, Alan, Froggatt, Katherine, Hunter, Rachael, Marston, Louise, McCormack, Brendan, Nurock, Shirley, Panca, Monica, Powell, Catherine, Rait, Greta, Robinson, Louise, Woodward-Carlton, Barbara, Young, John, Downs, Murna
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7737107/
https://www.ncbi.nlm.nih.gov/pubmed/33318118
http://dx.doi.org/10.1136/bmjopen-2020-040732
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author Sampson, Elizabeth L
Feast, Alexandra
Blighe, Alan
Froggatt, Katherine
Hunter, Rachael
Marston, Louise
McCormack, Brendan
Nurock, Shirley
Panca, Monica
Powell, Catherine
Rait, Greta
Robinson, Louise
Woodward-Carlton, Barbara
Young, John
Downs, Murna
author_facet Sampson, Elizabeth L
Feast, Alexandra
Blighe, Alan
Froggatt, Katherine
Hunter, Rachael
Marston, Louise
McCormack, Brendan
Nurock, Shirley
Panca, Monica
Powell, Catherine
Rait, Greta
Robinson, Louise
Woodward-Carlton, Barbara
Young, John
Downs, Murna
author_sort Sampson, Elizabeth L
collection PubMed
description OBJECTIVES: To pilot a complex intervention to support healthcare and improve early detection and treatment for common health conditions experienced by nursing home (NH) residents. DESIGN: Pilot cluster randomised controlled trial. SETTING: 14 NHs (7 intervention, 7 control) in London and West Yorkshire. PARTICIPANTS: NH residents, their family carers and staff. INTERVENTION: Complex intervention to support healthcare and improve early detection and treatment of urinary tract and respiratory infections, chronic heart failure and dehydration, comprising: (1) ‘Stop and Watch (S&W)’ early warning tool for changes in physical health, (2) condition-specific care pathway and (3) Situation, Background, Assessment and Recommendation tool to enhance communication with primary care. Implementation was supported by Practice Development Champions, a Practice Development Support Group and regular telephone coaching with external facilitators. OUTCOME MEASURES: Data on NH (quality ratings, size, ownership), residents, family carers and staff demographics during the month prior to intervention and subsequently, numbers of admissions, accident and emergency visits, and unscheduled general practitioner visits monthly for 6 months during intervention. We collected data on how the intervention was used, healthcare resource use and quality of life data for economic evaluation. We assessed recruitment and retention, and whether a full trial was warranted. RESULTS: We recruited 14 NHs, 148 staff, 95 family carers and 245 residents. We retained the majority of participants recruited (95%). 15% of residents had an unplanned hospital admission for one of the four study conditions. We were able to collect sufficient questionnaire data (all over 96% complete). No NH implemented intervention tools as planned. Only 16 S&W forms and 8 care pathways were completed. There was no evidence of harm. CONCLUSIONS: Recruitment, retention and data collection processes were effective but the intervention not implemented. A full trial is not warranted. TRIAL REGISTRATION NUMBER: ISRCTN74109734 (https://doi.org/10.1186/ISRCTN74109734). ORIGINAL PROTOCOL: BMJ Open. 2019;9(5):e026510. doi:10.1136/bmjopen-2018-026510.
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spelling pubmed-77371072020-12-28 Pilot cluster randomised trial of an evidence-based intervention to reduce avoidable hospital admissions in nursing home residents (Better Health in Residents of Care Homes with Nursing—BHiRCH-NH Study) Sampson, Elizabeth L Feast, Alexandra Blighe, Alan Froggatt, Katherine Hunter, Rachael Marston, Louise McCormack, Brendan Nurock, Shirley Panca, Monica Powell, Catherine Rait, Greta Robinson, Louise Woodward-Carlton, Barbara Young, John Downs, Murna BMJ Open Geriatric Medicine OBJECTIVES: To pilot a complex intervention to support healthcare and improve early detection and treatment for common health conditions experienced by nursing home (NH) residents. DESIGN: Pilot cluster randomised controlled trial. SETTING: 14 NHs (7 intervention, 7 control) in London and West Yorkshire. PARTICIPANTS: NH residents, their family carers and staff. INTERVENTION: Complex intervention to support healthcare and improve early detection and treatment of urinary tract and respiratory infections, chronic heart failure and dehydration, comprising: (1) ‘Stop and Watch (S&W)’ early warning tool for changes in physical health, (2) condition-specific care pathway and (3) Situation, Background, Assessment and Recommendation tool to enhance communication with primary care. Implementation was supported by Practice Development Champions, a Practice Development Support Group and regular telephone coaching with external facilitators. OUTCOME MEASURES: Data on NH (quality ratings, size, ownership), residents, family carers and staff demographics during the month prior to intervention and subsequently, numbers of admissions, accident and emergency visits, and unscheduled general practitioner visits monthly for 6 months during intervention. We collected data on how the intervention was used, healthcare resource use and quality of life data for economic evaluation. We assessed recruitment and retention, and whether a full trial was warranted. RESULTS: We recruited 14 NHs, 148 staff, 95 family carers and 245 residents. We retained the majority of participants recruited (95%). 15% of residents had an unplanned hospital admission for one of the four study conditions. We were able to collect sufficient questionnaire data (all over 96% complete). No NH implemented intervention tools as planned. Only 16 S&W forms and 8 care pathways were completed. There was no evidence of harm. CONCLUSIONS: Recruitment, retention and data collection processes were effective but the intervention not implemented. A full trial is not warranted. TRIAL REGISTRATION NUMBER: ISRCTN74109734 (https://doi.org/10.1186/ISRCTN74109734). ORIGINAL PROTOCOL: BMJ Open. 2019;9(5):e026510. doi:10.1136/bmjopen-2018-026510. BMJ Publishing Group 2020-12-13 /pmc/articles/PMC7737107/ /pubmed/33318118 http://dx.doi.org/10.1136/bmjopen-2020-040732 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Geriatric Medicine
Sampson, Elizabeth L
Feast, Alexandra
Blighe, Alan
Froggatt, Katherine
Hunter, Rachael
Marston, Louise
McCormack, Brendan
Nurock, Shirley
Panca, Monica
Powell, Catherine
Rait, Greta
Robinson, Louise
Woodward-Carlton, Barbara
Young, John
Downs, Murna
Pilot cluster randomised trial of an evidence-based intervention to reduce avoidable hospital admissions in nursing home residents (Better Health in Residents of Care Homes with Nursing—BHiRCH-NH Study)
title Pilot cluster randomised trial of an evidence-based intervention to reduce avoidable hospital admissions in nursing home residents (Better Health in Residents of Care Homes with Nursing—BHiRCH-NH Study)
title_full Pilot cluster randomised trial of an evidence-based intervention to reduce avoidable hospital admissions in nursing home residents (Better Health in Residents of Care Homes with Nursing—BHiRCH-NH Study)
title_fullStr Pilot cluster randomised trial of an evidence-based intervention to reduce avoidable hospital admissions in nursing home residents (Better Health in Residents of Care Homes with Nursing—BHiRCH-NH Study)
title_full_unstemmed Pilot cluster randomised trial of an evidence-based intervention to reduce avoidable hospital admissions in nursing home residents (Better Health in Residents of Care Homes with Nursing—BHiRCH-NH Study)
title_short Pilot cluster randomised trial of an evidence-based intervention to reduce avoidable hospital admissions in nursing home residents (Better Health in Residents of Care Homes with Nursing—BHiRCH-NH Study)
title_sort pilot cluster randomised trial of an evidence-based intervention to reduce avoidable hospital admissions in nursing home residents (better health in residents of care homes with nursing—bhirch-nh study)
topic Geriatric Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7737107/
https://www.ncbi.nlm.nih.gov/pubmed/33318118
http://dx.doi.org/10.1136/bmjopen-2020-040732
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