Evidence-based intervention to reduce avoidable hospital admissions in care home residents (the Better Health in Residents in Care Homes (BHiRCH) study): Protocol for a pilot cluster randomised trial
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Date
2019-05-27Author
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
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Sampson, E. L., Feast, A., Blighe, A., Froggatt, K., Hunter, R., Marston, L., McCormack, B., Nurock, S., Panca, M., Powell, C., Rait, G., Robinson, L., Woodward-Carlton, B., Young, J. & Downs, M. (2019) Evidence-based intervention to reduce avoidable hospital admissions in care home residents (the Better Health in Residents in Care Homes (BHiRCH) study): Protocol for a pilot cluster randomised trial. BMJ Open, 9 (5).
Abstract
Introduction Acute hospital admission is distressing
for care home residents. Ambulatory care sensitive
conditions, such as respiratory and urinary tract infections,
are conditions that can cause unplanned hospital
admission but may have been avoidable with timely
detection and intervention in the community. The Better
Health in Residents in Care Homes (BHiRCH) programme
has feasibility tested and will pilot a multicomponent
intervention to reduce these avoidable hospital admissions.
The BHiRCH intervention comprises an early warning tool
for noting changes in resident health, a care pathway
(clinical guidance and decision support system) and
a structured method for communicating with primary
care, adapted for use in the care home. We use practice
development champions to support implementation and
embed changes in care. Methods and analysis Cluster randomised pilot trial to test study procedures and indicate whether a further definitive trial is warranted. Fourteen care homes with nursing (nursing homes) will be randomly allocated to intervention (delivered at nursing home level) or control groups. Two nurses from each home become Practice Development Champions trained to implement the intervention, supported by a practice development support group. Data will be collected for 3 months preintervention, monthly during the 12-month intervention and 1 month after. Individual-level data includes resident, care partner and staff demographics, resident functional status, service use and quality of life (for health economic analysis) and the extent to which staff perceive the organisation supports person centred care. System-level data includes primary and secondary health services contacts (ie, general practitioner and hospital admissions). Process evaluation assesses intervention acceptability, feasibility, fidelity, ease of implementation in practice and study procedures (ie, consent and recruitment rates). Ethics and dissemination Approved by Research Ethics Committee and the UK Health Research Authority. Findings will be disseminated via academic and policy conferences, peer-reviewed publications and social media (eg, Twitter). Trial registration number ISRCTN74109734; Pre-results.