IntroductionHome care clients are increasingly medically complex, have limited access to effective chronic disease management and have very high emergency department (ED) visitation rates. There is a need for more appropriate and targeted supportive chronic disease management for home care clients. We aim to evaluate the effectiveness and preliminary cost effectiveness of a targeted, person-centred cardiorespiratory management model.Methods and analysisThe Detection of Indicators and Vulnerabilities of Emergency Room Trips (DIVERT) — Collaboration Action Research and Evaluation (CARE) trial is a pragmatic, cluster-randomised, multicentre superiority trial of a flexible multicomponent cardiorespiratory management model based on the best practice guidelines. The trial will be conducted in partnership with three regional, public-sector, home care providers across Canada. The primary outcome of the trial is the difference in time to first unplanned ED visit (hazard rate) within 6 months. Additional secondary outcomes are to identify changes in patient activation, changes in cardiorespiratory symptom frequencies and cost effectiveness over 6 months. We will also investigate the difference in the number of unplanned ED visits, number of inpatient hospitalisations and changes in health-related quality of life. Multilevel proportional hazard and generalised linear models will be used to test the primary and secondary hypotheses. Sample size simulations indicate that enrolling 1100 home care clients across 36 clusters (home care caseloads) will yield a power of 81% given an HR of 0.75.Ethics and disseminationEthics approval was obtained from the Hamilton Integrated Research Ethics Board as well as each participating site’s ethics board. Results will be submitted for publication in peer-reviewed journals and for presentation at relevant conferences. Home care service partners will also be informed of the study’s results. The results will be used to inform future support strategies for older adults receiving home care services.Trial registration number NCT03012256.

SummaryObjectives: Parkinson disease (PD) frequently leads to acute hospitalisation resulting in increased cost to health care systems and reduced quality of life for patients. The objective of this review was to identify causes that lead to acute hospitalisation of patients with PD. Methods:A systematic review of English language literature from 1997 to present. Findings:The incidences of acute general medical or surgical problems that trigger acute hospitalisation in patients with PD are similar to those in the general population.However, falls, acute decompensation of PD symptoms and infections are far more common in PD patients and are responsible for more than 50% of the causes of hospitalisation in this patients' group. This may be due to the fact that the urgent care needed for the acute illness leading to hospitalisation overrides the routine care for administering PD medications buy a busy medical and nursing staff. 4 This could account for the increased length of hospital stay for patients with PD compared to the general population. 5 The aim of this review was to explore the causes of acute hospitalisation of people with PD to identify possible community-based preventive strategies. | METHODSWe have performed a literature search through MEDLINE, CINAHL, PSYCHINFO and EMBASE databases from 1997 to present. Relevant key words such as Parkinson disease, hospitalisation, admission and acute decompensation were used individually and in combination. We searched only studies published in English language. Studies were selected if they included hospitalised PD population and reported the cause of hospitalisation as the outcome. Hand search of the included studies for further relevant references was also undertaken (Figure 1).We utilised The Critical Appraisal Skills Programme (CASP) tools to critically appraise the quality of evidence provided by the studies. 6 We have analysed causes of admission for those admitted to neurological wards separate from those admitted to general wards to avoid skewing the data more towards neurological causes of admission as

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