title: The Aged Residential Care Healthcare Utilization Study (ARCHUS): a multidisciplinary, cluster randomized controlled trial designed to reduce acute avoidable hospitalizations from long-term care facilities.
abstract: OBJECTIVE
  To assess effect of a complex, multidisciplinary intervention aimed at reducing avoidable acute hospitalization of residents of residential aged care (RAC) facilities.
  
  
  METHODS
  Cluster randomized controlled trial.
  
  
  METHODS
  RAC facilities with higher than expected hospitalizations in Auckland, New Zealand, were recruited and randomized to intervention or control.
  
  
  METHODS
  A total of 1998 residents of 18 intervention facilities and 18 control facilities.
  
  
  METHODS
  A facility-based complex intervention of 9 months' duration. The intervention comprised gerontology nurse specialist (GNS)-led staff education, facility bench-marking, GNS resident review, and multidisciplinary (geriatrician, primary-care physician, pharmacist, GNS, and facility nurse) discussion of residents selected using standard criteria.
  
  
  METHODS
  Primary end point was avoidable hospitalizations. Secondary end points were all acute admissions, mortality, and acute bed-days. Follow-up was for a total of 14 months.
  
  
  RESULTS
  The intervention did not affect main study end points: number of acute avoidable hospital admissions (RR 1.07; 95% CI 0.85-1.36; P = .59) or mortality (RR 1.11; 95% CI 0.76-1.61; P = .62).
  
  
  CONCLUSIONS
  This multidisciplinary intervention, packaging selected case review, and staff education had no overall impact on acute hospital admissions or mortality. This may have considerable implications for resourcing in the acute and RAC sectors in the face of population aging. Australian and New Zealand Clinical Trials Registry (ACTRN12611000187943).
authors.affiliation: Freemasons' Department of Geriatric Medicine, University of Auckland, Takapuna, Auckland, New Zealand; Waitemata District Health Board, Auckland, New Zealand. Electronic address: martin.connolly@waitematadhb.govt.nz.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Connolly
authors.affiliation: Freemasons' Department of Geriatric Medicine, University of Auckland, Takapuna, Auckland, New Zealand; Waitemata District Health Board, Auckland, New Zealand; Department of Nursing, University of Auckland, Auckland, New Zealand.
authors.forename: Michal
authors.initials: M
authors.lastname: Boyd
authors.affiliation: Freemasons' Department of Geriatric Medicine, University of Auckland, Takapuna, Auckland, New Zealand.
authors.forename: Joanna B
authors.initials: JB
authors.lastname: Broad
authors.affiliation: School of Population Health, University of Auckland, Auckland, New Zealand.
authors.forename: Ngaire
authors.initials: N
authors.lastname: Kerse
authors.affiliation: Department of Statistics, University of Auckland, Auckland, New Zealand.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lumley
authors.affiliation: Bethesda Care, Manukau City, New Zealand.
authors.forename: Noeline
authors.initials: N
authors.lastname: Whitehead
authors.affiliation: Freemasons' Department of Geriatric Medicine, University of Auckland, Takapuna, Auckland, New Zealand.
authors.forename: Susan
authors.initials: S
authors.lastname: Foster
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D007318:Inservice Training; D058025:Interdisciplinary Studies; D007902:Length of Stay / Q000706:statistics & numerical data; D008134:Long-Term Care; D008297:Male; D009520:New Zealand; D010342:Patient Acceptance of Health Care
keywords: Residential facilities; aged; hospitalization; interdisciplinary health team; randomized controlled trial