title: Do gerontology nurse specialists make a difference in hospitalization of long-term care residents? Results of a randomized comparison trial.
abstract: Residents of long-term care facilities have highly complex care needs and quality of care is of international concern. Maintaining resident wellness through proactive assessment and early intervention is key to decreasing the need for acute hospitalization. The Residential Aged Care Integration Program (RACIP) is a quality improvement intervention to support residential aged care staff and includes on-site support, education, clinical coaching, and care coordination provided by gerontology nurse specialists (GNSs) employed by a large district health board. The effect of the outreach program was evaluated through a randomized comparison of hospitalization 1 year before and after program implementation. The sample included 29 intervention facilities (1,425 residents) and 25 comparison facilities (1,128 residents) receiving usual care. Acute hospitalization rate unexpectedly increased for both groups after program implementation, although the rate of increase was significantly less for the intervention facilities. The hospitalization rate after the intervention increased 59% for the comparison group and 16% for the intervention group (rate ratio (RR) = 0.73, 95% confidence interval (CI) = 0.61-0.86, P < .001). Subgroup analysis showed a significantly lower rate change for those admitted for medical reasons for the intervention group (13% increase) than the comparison group (69% increase) (RR = 0.67, 95% CI = 0.56-0.82, P < .001). Conversely, there was no significant difference in the RR for surgical admissions between the intervention and comparison groups (RR = 1.0, 95% CI = 0.68-1.46, P = .99). The integration of GNS expertise through the RACIP intervention may be one approach to support staff to provide optimal care and potentially improve resident health.
authors.affiliation: Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand; School of Nursing, University of Auckland, Auckland, New Zealand; Waitemata District Health Board, Auckland, New Zealand.
authors.forename: Michal
authors.initials: M
authors.lastname: Boyd
authors.forename: Delwyn
authors.initials: D
authors.lastname: Armstrong
authors.forename: Janet
authors.initials: J
authors.lastname: Parker
authors.forename: Carole
authors.initials: C
authors.lastname: Pilcher
authors.forename: Lifeng
authors.initials: L
authors.lastname: Zhou
authors.forename: Barbara
authors.initials: B
authors.lastname: McKenzie-Green
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Connolly
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005851:Geriatric Nursing; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008134:Long-Term Care; D009520:New Zealand; D009720:Nurse Clinicians; D009735:Nursing Homes; D015397:Program Evaluation; D058996:Quality Improvement
keywords: clinical nurse specialist; community outreach; frail older adults; homes for the aged