Reducing time in acute hospitals: A stepped-wedge randomised control trial of a specialist palliative care intervention in residential care homes.

Forbat, L; Liu, W-M; Koerner, J; Lam, L; Samara, J; Chapman, M; Johnston, N

Reducing time in acute hospitals: A stepped-wedge randomised control trial of a specialist palliative care intervention in residential care homes.

Forbat, L Liu, W-M Koerner, J Lam, L

Samara, J Chapman, M Johnston, N

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Publisher:: SAGE Publications
Publication Type:: Journal Article
Citation:: Palliative medicine, 2020, 34, (5), pp. 571-579
Issue Date:: 2020-05

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Field	Value	Language
dc.contributor.author	Forbat, L
dc.contributor.author	Liu, W-M
dc.contributor.author	Koerner, J
dc.contributor.author	Lam, L https://orcid.org/0000-0001-6183-6854
dc.contributor.author	Samara, J
dc.contributor.author	Chapman, M
dc.contributor.author	Johnston, N
dc.date.accessioned	2020-09-14T06:40:20Z
dc.date.available	2020-09-14T06:40:20Z
dc.date.issued	2020-05
dc.identifier.citation	Palliative medicine, 2020, 34, (5), pp. 571-579
dc.identifier.issn	0269-2163
dc.identifier.issn	1477-030X
dc.identifier.uri	http://hdl.handle.net/10453/142669
dc.description.abstract	BACKGROUND:Care home residents are frequently transferred to hospital, rather than provided with appropriate and timely specialist care in the care home. AIM:To determine whether a model of care providing specialist palliative care in care homes, called Specialist Palliative Care Needs Rounds, could reduce length of stay in hospital. DESIGN:Stepped-wedge randomised control trial. The primary outcome was length of stay in acute care (over 24-h duration), with secondary outcomes being the number and cost of hospitalisations. Care homes were randomly assigned to cross over from control to intervention using a random number generator; masking was not possible due to the nature of the intervention. Analyses were by intention to treat. The trial was registered with ANZCTR: ACTRN12617000080325. Data were collected between 1 February 2017 and 30 June 2018. SETTING/PARTICIPANTS:1700 residents in 12 Australian care homes for older people. RESULTS:Specialist Palliative Care Needs Rounds led to reduced length of stay in hospital (unadjusted difference: 0.5 days; adjusted difference: 0.22 days with 95% confidence interval: -0.44, -0.01 and p = 0.038). The intervention also provided a clinically significant reduction in the number of hospitalisations by 23%, from 5.6 to 4.3 per facility-month. A conservative estimate of annual net cost-saving from reduced admissions was A$1,759,011 (US$1.3 m; UK£0.98 m). CONCLUSION:The model of care significantly reduces hospitalisations through provision of outreach by specialist palliative care clinicians. The data offer substantial evidence for Specialist Palliative Care Needs Rounds to reduce hospitalisations in older people approaching end of life, living in care homes.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	SAGE Publications
dc.relation.ispartof	Palliative medicine
dc.relation.isbasedon	10.1177/0269216319891077
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	1117 Public Health and Health Services, 1199 Other Medical and Health Sciences
dc.subject.classification	Gerontology
dc.title	Reducing time in acute hospitals: A stepped-wedge randomised control trial of a specialist palliative care intervention in residential care homes.
dc.type	Journal Article
utslib.citation.volume	34
utslib.location.activity	England
utslib.for	1117 Public Health and Health Services
utslib.for	1199 Other Medical and Health Sciences
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Strength - CHSP - Health Services and Practice
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
pubs.organisational-group	/University of Technology Sydney
utslib.copyright.status	closed_access	*
pubs.consider-herdc	false
dc.date.updated	2020-09-14T06:40:04Z
pubs.issue	5
pubs.publication-status	Published
pubs.volume	34
utslib.citation.issue	5

Abstract:

BACKGROUND:Care home residents are frequently transferred to hospital, rather than provided with appropriate and timely specialist care in the care home. AIM:To determine whether a model of care providing specialist palliative care in care homes, called Specialist Palliative Care Needs Rounds, could reduce length of stay in hospital. DESIGN:Stepped-wedge randomised control trial. The primary outcome was length of stay in acute care (over 24-h duration), with secondary outcomes being the number and cost of hospitalisations. Care homes were randomly assigned to cross over from control to intervention using a random number generator; masking was not possible due to the nature of the intervention. Analyses were by intention to treat. The trial was registered with ANZCTR: ACTRN12617000080325. Data were collected between 1 February 2017 and 30 June 2018. SETTING/PARTICIPANTS:1700 residents in 12 Australian care homes for older people. RESULTS:Specialist Palliative Care Needs Rounds led to reduced length of stay in hospital (unadjusted difference: 0.5 days; adjusted difference: 0.22 days with 95% confidence interval: -0.44, -0.01 and p = 0.038). The intervention also provided a clinically significant reduction in the number of hospitalisations by 23%, from 5.6 to 4.3 per facility-month. A conservative estimate of annual net cost-saving from reduced admissions was A$1,759,011 (US$1.3 m; UK£0.98 m). CONCLUSION:The model of care significantly reduces hospitalisations through provision of outreach by specialist palliative care clinicians. The data offer substantial evidence for Specialist Palliative Care Needs Rounds to reduce hospitalisations in older people approaching end of life, living in care homes.

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http://hdl.handle.net/10453/142669