title: Aged Residential Care Health Utilisation Study (ARCHUS): a randomised controlled trial to reduce acute hospitalisations from residential aged care.
abstract: BACKGROUND
  For residents of long term care, hospitalisations can cause distress and disruption, and often result in further medical complications. Multi-disciplinary team interventions have been shown to improve the health of Residential Aged Care (RAC) residents, decreasing the need for acute hospitalisation, yet there are few randomised controlled trials of these complex interventions. This paper describes a randomised controlled trial of a structured multi-disciplinary team and gerontology nurse specialist (GNS) intervention aiming to reduce residents' avoidable hospitalisations.
  
  
  METHODS
  This Aged Residential Care Healthcare Utilisation Study (ARCHUS) is a cluster- randomised controlled trial (n = 1700 residents) of a complex multi-disciplinary team intervention in long-term care facilities. Eligible facilities certified for residential care were selected from those identified as at moderate or higher risk of resident potentially avoidable hospitalisations by statistical modelling. The facilities were all located in the Auckland region, New Zealand and were stratified by District Health Board (DHB).
  
  
  METHODS
  The intervention provided a structured GNS intervention including a baseline facility needs assessment, quality indicator benchmarking, a staff education programme and care coordination. Alongside this, three multi-disciplinary team (MDT) meetings were held involving a geriatrician, facility GP, pharmacist, GNS and senior nursing staff.
  
  
  RESULTS
  Hospitalisations are recorded from routinely-collected acute admissions during the 9-month intervention period followed by a 5-month follow-up period. ICD diagnosis codes are used in a pre-specified definition of potentially reducible admissions.
  
  
  CONCLUSIONS
  This randomised-controlled trial will evaluate a complex intervention to increase early identification and intervention to improve the health of residents of long term care. The results of this trial are expected in early 2013.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry: ACTRN 12611000187943.
authors.affiliation: Freemasons' Department of Geriatric Medicine, University of Auckland, C/- WDHB, Private Bag 93503, Takapuna, Auckland, 0740, New Zealand. sue.foster@waitematadhb.govt.nz
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Foster
authors.forename: Michal
authors.initials: M
authors.lastname: Boyd
authors.forename: Joanna B
authors.initials: JB
authors.lastname: Broad
authors.forename: Noeline
authors.initials: N
authors.lastname: Whitehead
authors.forename: Ngaire
authors.initials: N
authors.lastname: Kerse
authors.forename: Thomas
authors.initials: T
authors.lastname: Lumley
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Connolly
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005500:Follow-Up Studies; D006707:Homes for the Aged / Q000639:trends*; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D009520:New Zealand / Q000453:epidemiology; D009735:Nursing Homes / Q000639:trends*; D010348:Patient Care Team / Q000639:trends*; D012112:Residential Facilities / Q000379:methods / Q000639:trends