Reducing time in acute hospitals : A stepped-wedge randomised control trial of a specialist palliative care intervention in residential care homes

Journal article


Forbat, Liz, Liu, Wai-Man, Koerner, Jane, Lam, Lawrence, Samara, Juliane, Chapman, Michael and Johnston, Nikki. (2020). Reducing time in acute hospitals : A stepped-wedge randomised control trial of a specialist palliative care intervention in residential care homes. Palliative Medicine. 34(5), pp. 571-579. https://doi.org/10.1177/0269216319891077
AuthorsForbat, Liz, Liu, Wai-Man, Koerner, Jane, Lam, Lawrence, Samara, Juliane, Chapman, Michael and Johnston, Nikki
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.

Keywordspalliative care; hospitalisation; nursing home; length of stay
Year2020
JournalPalliative Medicine
Journal citation34 (5), pp. 571-579
PublisherSage Publications Ltd.
ISSN0269-2163
Digital Object Identifier (DOI)https://doi.org/10.1177/0269216319891077
Scopus EID2-s2.0-85077376498
Research or scholarlyResearch
Page range571-579
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online02 Jan 2020
Publication process dates
Deposited27 Aug 2021
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