Clinical trial NCT06901167: Evaluation of a Residential In-Reach Program in Regional and Rural Australia
Official title: Evaluation of a Region-wide Residential In-Reach (RIR) Program in Regional and Rural Health Services: A Stepped-wedge Trial
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Aged
Acute Disease
Keywords: stepped-wedge trial
residential aged care home
residential in reach
hospital avoidance
Lead sponsor: Monash University
Sponsor class: OTHER
Collaborators: name: Deakin University
First posted: 2025-03-28
Enrollment: 100
Sex: ALL
Minimum age (years): 65
Standard ages: OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Intervention model description: This will be a stepped-wedge trial, in which all enrolled facilities and participants will receive the same intervention, but the intervention roll-out will be conducted in a sequential manner based on a randomised order. During the 14 months of the trial, all facilities and participants will receive the same intervention, but for different lengths of time depending on the randomisation.
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: Residential In-Reach (RIR) programs are designed to provide responsive care for residents in residential aged care homes (RACH) with the aim of avoiding unnecessary hospital transfers. The evidence for their clinical and cost-effectiveness and implementation has been established in urban settings, but there is a small amount of low-quality evidence for rural and regional settings. The Grampians Region Health Service Partnership Resi-In-Reach Redesign Committee will be implementing a new RIR program to be offered to all RACHs in the Grampians region, this project aims to evaluate the clinical and cost-effectiveness of this program, and its implementation in the rural and regional setting. A stepped-wedge trial will be conducted so that as the RIR program is gradually rolled-out across the region, outcomes can be compared in the same facilities across time and between different facilities. The primary outcome measure will be presentation to emergency departments and urgent care centres, and data will also be collected on other clinical outcomes and barriers and enablers of implementing the program. It is anticipated that there will be a reduction in hospital presentations, and a range of barriers and enablers unique to the rural and regional setting will emerge.


Eligibility criteria: Inclusion Criteria:

* Health services that have emergency departments and/or emergency care centres that admit residents from residential aged care homes (RACH)
* RACHs that do not currently have access to RIR programs
* health service staff who have been involved with the set-up and delivery of the RIR program,
* RACH staff who have experience of or accessing the RIR service for residents at least once,
* residents living at a RACH who has experienced receiving medical care from the RIR program and can provide informed consent, or a family member of the resident,
* general practitioners whose case load includes residents from RACHs.

Exclusion Criteria:

• RACHs that already have access to a RIR program will be excluded

Primary outcomes:
measure: Rate of presentations from residential aged care homes to emergency departments and emergency care centres
timeFrame: From enrolment to the end of the trial for 14 months
Secondary outcomes:
measure: Days spent in hospital by aged care home resident
timeFrame: From enrolment to the end of the trial for 14 months
measure: Location of mortality in hospital
timeFrame: From enrolment to the end of the trial for 14 months
measure: Number of barriers to residential-in-reach program implementation
timeFrame: From enrolment to 1 month after the end of the trial, for 15 months
measure: Number of enablers to residential-in-reach program implementation
timeFrame: From enrolment to 1 month after the end of the trial, for 15 months
measure: Stakeholder reported feasibility of the residential-in-reach program implementation
timeFrame: From enrolment to 1 month after the end of the trial, for 15 months
measure: Stakeholder reported acceptability of the residential in-reach program
timeFrame: From enrolment to the end of the trial for 14 months
measure: Stakeholder reported appropriateness of the residential in-reach program
timeFrame: From enrolment to the end of the trial for 14 months
measure: Number of aged care staff who attend education sessions for the use of the residential in-reach program
timeFrame: From enrolment to the end of the trial for 14 months
measure: Number of adaptations made to the residential in-reach program
timeFrame: From enrolment to the end of the trial fo
Other outcomes:
measure: Number of times the residential in-reach program is utilised
timeFrame: From enrolment to the end of the trial for 14 months
measure: Number of times the Victorian Virtual Emergency Department is utilised
timeFrame: From enrolment to the end of the trial for 14 months
measure: Number of times that the general practitioner is utilised
timeFrame: From enrolment to the end of the trial for 14 months
measure: Number of calls to Ambulance Victoria
timeFrame: From enrolment to the end of the trial for 14 months
measure: Number of transfers to hospital via Ambulance Victoria
timeFrame: From enrolment to the end of the trial for 14 months
Locations:
city: Ararat
country: Australia
facility: East Grampians Health Service
state: Victoria
city: Ballarat
country: Australia
facility: Grampians Health
state: Victoria
city: Beaufort
country: Australia
facility: Beaufort and Skipton Health Service
state: Victoria
city: Daylesford
country: Australia
facility: Central Highlands Rural Health
state: Victoria
city: Maryborough
country: Australia
facility: Maryborough District Health Service
state: Victoria
city: Nhill
country: Australia
facility: West Wimmera Health Service
state: Victoria
city: St Arnaud
country: Australia
facility: East Wimmera Health Service
state: Victoria
city: Warracknabeal
country: Australia
facility: Rural Northwest Health
state: Victoria
Study officials:
affiliation: Monash University
name: Terry Haines
role: PRINCIPAL_INVESTIGATOR
References:
citation: Sunner C, Giles MT, Parker V, Dilworth S, Bantawa K, Kable A, Oldmeadow C, Foureur M. PACE-IT study protocol: a stepped wedge cluster randomised controlled trial evaluating the implementation of telehealth visual assessment in emergency care for people living in residential aged-care facilities. BMC Health Serv Res. 2020 Jul 20;20(1):672. doi: 10.1186/s12913-020-05539-1.
citation: Sunner C, Giles MT, Kable A, Foureur M. Experiences of nurses working in RACFs and EDs utilising visual telehealth consultation to assess the need for RACF resident transfer to ED: A qualitative descriptive study. J Clin Nurs. 2023 Aug;32(15-16):4694-4709. doi: 10.1111/jocn.16529. Epub 2022 Sep 8.
citation: Lukin B, Fan LJ, Zhao JZ, Sun JD, Dingle K, Purtill R, Tapp S, Hou XY. Emergency department use among patients from residential aged care facilities under a Hospital in the Nursing Home scheme in public hospitals in Queensland Australia. World J Emerg Med. 2016;7(3):183-90. doi: 10.5847/wjem.j.1920-8642.2016.03.004.
citation: Hullick C, Conway J, Hall A, Murdoch W, Cole J, Hewitt J, Oldmeadow C, Attia J. Video-telehealth to support clinical assessment and management of acutely unwell older people in Residential Aged Care: a pre-post intervention study. BMC Geriatr. 2022 Jan 10;22(1):40. doi: 10.1186/s12877-021-02703-y.
citation: Haines TP, Palmer AJ, Tierney P, Si L, Robinson AL. A new model of care and in-house general practitioners for residential aged care facilities: a stepped wedge, cluster randomised trial. Med J Aust. 2020 May;212(9):409-415. doi: 10.5694/mja2.50565. Epub 2020 Apr 1.
citation: Chambers D, Cantrell A, Preston L, Marincowitz C, Wright L, Conroy S, Lee Gordon A. Reducing unplanned hospital admissions from care homes: a systematic review. Health Soc Care Deliv Res. 2023 Oct;11(18):1-130. doi: 10.3310/KLPW6338.