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Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit
Published on: September 30, 2020
The Aged Residential Care Healthcare Utilization Study (ARCHUS): a multidisciplinary, cluster randomized controlled
Martin J Connolly1, Michal Boyd2, Joanna B Broad3
1Freemasons' Department of Geriatric Medicine, University of Auckland, Takapuna, Auckland, New Zealand; Waitemata District Health Board, Auckland, New Zealand.
Objective:
To assess effect of a complex, multidisciplinary intervention aimed at reducing avoidable acute hospitalization of residents of residential aged care (RAC) facilities.
Design:
Cluster randomized controlled trial.
Setting:
RAC facilities with higher than expected hospitalizations in Auckland, New Zealand, were recruited and randomized to intervention or control.
Participants:
A total of 1998 residents of 18 intervention facilities and 18 control facilities.
Intervention:
A 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 Measures:
Primary 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.
Results:
The 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).
Conclusions:
This 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. Australian and New Zealand Clinical Trials Registry (ACTRN12611000187943).
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