@article{acd5fcc7a38042e9bd8b231b8795c0e7,
title = "Reducing time in acute hospitals: A stepped-wedge randomised control trial of a specialist palliative care intervention in residential care homes",
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.",
keywords = "hospitalisation, length of stay, nursing home, Palliative care",
author = "Liz Forbat and Liu, {Wai Man} and Jane Koerner and Lawrence Lam and Juliane Samara and Michael Chapman and Nikki Johnston",
note = "Funding Information: 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. Palliative care hospitalisation nursing home length of stay ACT Health https://doi.org/10.13039/501100001139 edited-state corrected-proof typesetter ts1 We thank and acknowledge the staff at all 12 care homes who facilitated access to the data and who engaged in Needs Rounds. We also acknowledge Karemah Fran{\c c}ois{\textquoteright}s role in data collection, Clare Lovell{\textquoteright}s role as a study clinician for part of the trial, and professors Meera Agar and Deb Parker for their input in early discussions about the study{\textquoteright}s design. Author contributions L.F. designed the study{\textquoteright}s methodology. L.F. was the chief investigator for the study. L.F. and J.K. were responsible for study administration and management, and all authors were involved in ongoing implementation, data collection or data cleaning. L.L. and W.L. analysed the data. L.L., W.L., L.F. and J.K. interpreted the data. L.F. and J.K. wrote the first draft of the manuscript. All authors revised it critically for important intellectual content. All authors read and approved the final manuscript. Data sharing Individual-level data collected for this study are subject to ethical and privacy restrictions. The conditions of ethical approval do not allow us to distribute or make available these data directly to other parties. However, the study protocol is available from the corresponding author. Applications for data access should be made by contacting the chief investigator. Researchers must have their study protocol approved by an appropriate research ethics review board. Declaration of conflicting interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Ethical approval Ethics committee approvals were obtained from Calvary Public Hospital, Canberra (Ref: 44-2016); National Capital Private Hospital, Canberra (Ref: 20/2/2017); and the Australian Catholic University, Canberra (Ref: 020685). Consent to run the trial was gained at site, rather than individual resident, level given the impracticalities of gaining informed consent from a large population (1700 people); many of whom were likely to have substantial cognitive impairment (with few appointed medical power of attorneys at commencement), with low risk to participants, and sufficient protection of participant privacy. This follows national guidelines for Australia from the National Health and Medical Research Council (NHMRC). Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by the Australian Capital Territory (ACT) Health Department, who played no further role in the study. ORCID iD Liz Forbat https://orcid.org/0000-0002-7218-5775 Supplemental material Supplemental material for this article is available online. Publisher Copyright: {\textcopyright} The Author(s) 2019.",
year = "2020",
month = may,
doi = "10.1177/0269216319891077",
language = "English",
volume = "34",
pages = "571--579",
journal = "Palliative Medicine",
issn = "0269-2163",
publisher = "SAGE Publications Ltd",
number = "5",
}