Comparing the cost-effectiveness and clinical effectiveness of a new community in-reach rehabilitation service with the cost-effectiveness and clinical effectiveness of an established hospital-based rehabilitation service for older people: a pragmatic randomised controlled trial with microcost and qualitative analysis – the Community In-reach Rehabilitation And Care Transition (CIRACT) study

Sahota, Opinder; Pulikottil-Jacob, Ruth; Marshall, Fiona; Montgomery, Alan; Tan, Wei; Sach, Tracey; Logan, Pip; Kendrick, Denise; Watson, Alison; Walker, Moira; Waring, Justin

doi:10.3310/hsdr04070

Cited by 4 publications

(4 citation statements)

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“…The HOME intervention was assessed in a randomized control trial (RCT) involving 400 older patients with varied medical conditions treated in five acute Australian hospitals [28]. Consistent with other evidence-based interventions [30,31], no between-group differences were found between HOME compared to the in-hospital occupational therapy consultation on the main outcomes (independence in ADL, participation in life roles, and hospital and ED readmissions) in this trial [28].…”

Section: Introductionmentioning

confidence: 76%

Supporting at-risk older adults transitioning from hospital to home: who benefits from an evidence-based patient-centered discharge planning intervention? Post-hoc analysis from a randomized trial

et al. 2020

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Background: Subgroups of older patients experience difficulty performing activities of daily living (ADL) following hospital discharge, as well as unplanned hospital readmissions and emergency department (ED) presentations. We examine whether these subgroups of "at-risk" older patients benefit more than their counterparts from an evidence-based discharge planning intervention, on the following outcomes: (1) independence in ADL, (2) participation in life roles, (3) unplanned re-hospitalizations, and (4) ED presentations. Trial design and methods: This study used data from a randomized control trial involving 400 hospitalized older patients with acute and medical conditions, recruited through 5 sites in Australia. Participants receive either HOME, a patient-centered discharge planning intervention led by an occupational therapist; or a structured in-hospital consultation. HOME uses a collaborative approach for goal setting and includes pre and post-discharge home visits as well as telephone follow-up. Characteristics associated with higher risks of adverse outcomes were recorded and at-risk subgroups were created (mild cognitive impairment, walking difficulty, comorbidity, living alone and no support from family). Independence in ADL and participation in life roles were assessed with validated questionnaires. The number of unplanned re-hospitalizations and ED presentations were extracted from medical files. Linear regression models were conducted to detect variation in response to the intervention at 3-months, according to patients' characteristics.

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Section: Introductionmentioning

confidence: 76%

Supporting at-risk older adults transitioning from hospital to home: who benefits from an evidence-based patient-centered discharge planning intervention? Post-hoc analysis from a randomized trial

et al. 2020

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“…Manageable transitions exhibit features consistent with the goals of the GEM model of care (Ellis et al , 2011) and components of successful care transition interventions (Sahota et al , 2016). Numerous studies have reported the importance of active engagement of patients and the need to make adjustments to care plans based on patient experience (Coleman et al , 2004; Walker et al , 2015; Allen et al , 2016; Cheek et al , 2006) As reported elsewhere (Allen et al , 2016; Baillie et al , 2014; Giosa et al , 2014; Byrne et al , 2011) carers in this study had a critical role in optimising care transitions by seeking out information, negotiating with providers and promoting self-management.…”

Section: Discussionmentioning

confidence: 94%

“…Interventions to improve older people’s care transition experiences and reduce readmission rates and length of stay have shown mixed results. A recent synthesis of international systematic reviews identified the essential components of successful interventions as: more intensive rehabilitation, working more closely with older people and carers, and a dedicated transition provider to advocate for and facilitate care co-ordination and outreach to patients following discharge from hospital (Sahota et al , 2016). Despite this, an intervention utilising these approaches showed no benefit in reducing hospital readmissions or length of stay (Sahota et al , 2017).…”

Section: Introductionmentioning

confidence: 99%

Care transition types across acute, sub-acute and primary care

Harvey

Foster

Quigley

et al. 2018

JICA

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Purpose-The purpose of the paper is to examine the care transitions of older people who transfer between home, acute and sub-acute care to determine if there were common transition types and areas for improvements. Design/methodology/approach-A longitudinal case study design was used to examine care transitions of 19 older people and their carers as a series of transitions and a whole-of-system experience. Case study accounts synthesising semi-structured interviews with function and service use data from medical records were compared. Findings-Three types of care transitions were derived from the analysis: manageable, unstable and disrupted. Each type had distinguishing characteristics and older people could experience elements of all types across the system. Transition types varied according to personal and systemic factors. Originality/value-This study identifies types of care transition experiences across acute, sub-acute and primary care from the perspective of older people and their carers. Understanding transition types and their features can assist health professionals to better target strategies within and across the system and improve patient experiences as a whole.

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“…A number of different initiatives have been trialled to reduce length of hospital stay and readmission rates; including tailored structured discharge plans, which may have a small effect, but overall cost benefits are still inconclusive (Shepperd et al ., 2010). A randomised controlled trial comparing a community in-reach rehabilitation and care transition with the ‘usual’ discharge to rehabilitation service on length of hospital stay and readmission rates found no difference between the two approaches (Sahota et al ., 2016).…”

Section: Introductionmentioning

confidence: 99%

Okay to Stay? A new plan to help people with long-term conditions remain in their own homes

Chapman

Farndon

Matthews

et al. 2018

Prim Health Care Res Dev

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AimsTo assess the ‘Okay to Stay’ plan to investigate if this reduces visits to emergency departments, unplanned admissions and elective admission to hospital in elderly patients with long-term health conditions.BackgroundThe incidence of long-term conditions is rising as the elderly population increases, resulting in more people from this group attending emergency departments and being admitted to hospital. Okay to Stay is a simple plan for people with long-term conditions to help them remain in their own home if they suffer an acute exacerbation in their health. It was co-designed with professional and patient representatives with the aim of empowering patients and their carers to more effectively manage their long-term conditions.MethodsData from 50 patients (20 males, 30 females, mean baseline age 77.5 years) were compared 12 months before implementation of the plan and in the subsequent 12 months, with the significance of effects assessed at the 5 per cent significance level using t-tests.FindingsVisits to emergency departments were reduced by 1.86; unplanned emergency admissions were reduced by 1.28 and planned elective admissions were raised by 0.22 admissions per annum. The reduction in visits to the emergency department was significant (p = 0.009) and the reduction in emergency admissions was significant (p = 0.015). The change in elective admissions was not significant (p = 0.855). The Okay to Stay plan is effective in reducing visits to the emergency department and unplanned hospital admissions in people with long-term conditions. This is a positive step to supporting vulnerable and complex patients who are cared for at home, and facilitates the recognition by the individual of the possibility to stay at home with the support of health professionals. There are potential cost benefits to the investment of initiating an Okay to Stay plan through the avoidance of visits to the emergency department and non-elective admissions to hospital.

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Cited by 4 publications

References 58 publications

Supporting at-risk older adults transitioning from hospital to home: who benefits from an evidence-based patient-centered discharge planning intervention? Post-hoc analysis from a randomized trial

Supporting at-risk older adults transitioning from hospital to home: who benefits from an evidence-based patient-centered discharge planning intervention? Post-hoc analysis from a randomized trial

Care transition types across acute, sub-acute and primary care

Okay to Stay? A new plan to help people with long-term conditions remain in their own homes

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