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The 'Big Five'. Hypothesis generation: a multidisciplinary intervention package reduces disease-specific hospitalisations from long-term care: a post hoc analysis of the ARCHUS cluster-randomised controlled trial.
- Source :
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Age and ageing [Age Ageing] 2016 May; Vol. 45 (3), pp. 415-20. Date of Electronic Publication: 2016 Mar 28. - Publication Year :
- 2016
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Abstract
- Introduction: long-term care (LTC) residents have higher hospitalisation rates than non-LTC residents. Rapid decline may follow hospitalisations, hence the importance of preventing unnecessary hospitalisations. Literature describes diagnosis-specific interventions (for cardiac failure, ischaemic heart disease, chronic obstructive pulmonary disease, stroke, pneumonia-termed 'big five' diagnoses), impacting on hospitalisations of older community-dwellers, but few RCTs show reductions in acute admissions from LTC.<br />Methods: LTC facilities with higher than expected hospitalisations were recruited for a cluster-randomised controlled trial (RCT) of facility-based complex, non-disease-specific, 9-month intervention comprising gerontology nurse specialist (GNS)-led staff education, facility benchmarking, GNS resident review and multidisciplinary discussion of residents selected using standard criteria. In this post hoc exploratory analysis, the outcome was acute hospitalisations for 'big five' diagnoses. Re-randomisation analyses were used for end points during months 1-14. For end points during months 4-14, proportional hazards models are adjusted for within-facility clustering.<br />Results: we recruited 36 facilities with 1,998 residents (1,408 female; mean age 82.9 years); 1,924 were alive at 3 months. The intervention did not impact overall rates of acute hospitalisations or mortality (previously published), but resulted in fewer 'big five' admissions (RR = 0.73, 95% CI = 0.54-0.99; P = 0.043) with no significant difference in the rate of other acute admissions. When considering events occurring after 3 months (only), the intervention group were 34.7% (HR = 0.65; 95% CI = 0.49-0.88; P = 0.005) less likely to have a 'big five' acute admission than controls, with no differences in likelihood of acute admissions for other diagnoses (P = 0.96).<br />Conclusions: this generic intervention may reduce admissions for common conditions which the literature shows are impacted by disease-specific admission reduction strategies.<br /> (© The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)
- Subjects :
- Aged
Aged, 80 and over
Cluster Analysis
Confidence Intervals
Female
Geriatric Assessment
Hospital Mortality trends
Hospitalization statistics & numerical data
Humans
Male
New Zealand
Patient Care Team organization & administration
Proportional Hazards Models
Risk Assessment
Survival Analysis
Homes for the Aged organization & administration
Interdisciplinary Communication
Long-Term Care organization & administration
Nursing Homes organization & administration
Patient Admission statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1468-2834
- Volume :
- 45
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Age and ageing
- Publication Type :
- Academic Journal
- Accession number :
- 27021357
- Full Text :
- https://doi.org/10.1093/ageing/afw037