The Aged Residential Care Healthcare Utilization Study (ARCHUS): A Multidisciplinary, Cluster Randomized Controlled Trial Designed to Reduce Acute Avoidable Hospitalizations From Long-Term Care Facilities

Abstract

ObjectiveTo assess effect of a complex, multidisciplinary intervention aimed at reducing avoidable acute hospitalization of residents of residential aged care (RAC) facilities. DesignCluster randomized controlled trial. SettingRAC facilities with higher than expected hospitalizations in Auckland, New Zealand, were recruited and randomized to intervention or control. ParticipantsA total of 1998 residents of 18 intervention facilities and 18 control facilities. InterventionA facility-based complex intervention of 9 months' duration. The intervention comprised gerontology nurse specialist (GNS)-led staff education, facility bench-marking, GNS resident review, and multidisciplinary (geriatrician, primary-care physician, pharmacist, GNS, and facility nurse) discussion of residents selected using standard criteria. Main outcome measuresPrimary end point was avoidable hospitalizations. Secondary end points were all acute admissions, mortality, and acute bed-days. Follow-up was for a total of 14 months. ResultsThe intervention did not affect main study end points: number of acute avoidable hospital admissions (RR 1.07; 95% CI 0.85–1.36; P = .59) or mortality (RR 1.11; 95% CI 0.76–1.61; P = .62). ConclusionsThis multidisciplinary intervention, packaging selected case review, and staff education had no overall impact on acute hospital admissions or mortality. This may have considerable implications for resourcing in the acute and RAC sectors in the face of population aging.