The Alice Springs Hospital Readmission Prevention Project (ASHRAPP): a randomised control trial

Gabrielle Diplock,Carole Reeve,Penny Stewart,Lea Davidson,James Ward,Paul Scuffham,Graeme Maguire,Simon Stewart

doi:10.1186/s12913-017-2077-7

Abstract

BackgroundHospitals are frequently faced with high levels of emergency department presentations and demand for inpatient care. An important contributing factor is the subset of patients with complex chronic diseases who have frequent and preventable exacerbations of their chronic diseases. Evidence suggests that some of these hospital readmissions can be prevented with appropriate transitional care. Whilst there is a growing body of evidence for transitional care processes in urban, non-indigenous settings, there is a paucity of information regarding rural and remote settings and, specifically, the indigenous context.MethodsThis randomised control trial compares a tailored, multidimensional transitional care package to usual care. The objective is to evaluate the efficacy of the transitional care package for Indigenous and non-Indigenous Australian patients with chronic diseases at risk of recurrent readmission with the aim of reducing readmission rates and improving transition to primary care in a remote setting. Patients will be recruited from medical and surgical admissions to Alice Springs Hospital and will be followed for 12 months. The primary outcome measure will be number of admissions to hospital with secondary outcomes including number of emergency department presentations, number of ICU admissions, days alive and out of hospital, time to primary care review post discharge and cost-effectiveness.DiscussionSuccessful transition from hospital to home is important for patients with complex chronic diseases. Evidence suggests that a coordinated transitional care plan can result in a reduction in length of hospital stay and readmission rates for adults with complex medical needs. This will be the first study to evaluate a tailored multidimensional transitional care intervention to prevent readmission in Indigenous and non-Indigenous Australian residents of remote Australia who are frequently admitted to hospital. If demonstrated to be effective it will have implications for the care and management of Indigenous Australians throughout regional and remote Australia and in other remote, culturally and linguistically diverse populations and settings.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN12615000808549- Retrospectively registered on 4/8/15.

Highlights

Hospitals are frequently faced with high levels of emergency department presentations and demand for inpatient care
Given the lack of evidence, we aim to extend and adapt the principles of what are often disease-specific, non-Indigenous and urban based models of readmission prevention and to evaluate such a more generic model linking hospitals with primary health care and other community-based resources in a remote setting with a large Aboriginal Australian population
To achieve this we aim to evaluate the efficacy of a tailored multidimensional case-based intervention for people with frequent admissions to the adult specialist medical and surgical service of a remote Australian hospital with a particular focus on the needs of Aboriginal people

Summary

Introduction

An important contributing factor to this mismatch between the demand for inpatient care and its availability is the admission of an often small but important sub-set of patients who have frequent and preventable exacerbations of their chronic diseases [5]. This is often compounded by a lack of, or limited access to, community-based social and primary health care supports. Many of these are patients with chronic and other diseases that can, with appropriate communitybased management and support, avoid de-compensation and the need for inpatient care [6,7,8]

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