title: A longitudinal cohort study evaluating the impact of a geriatrician-led residential care outreach service on acute healthcare utilisation.
abstract: BACKGROUND
  over the last decade, high demand for acute healthcare services by long-term residents of residential care facilities (RCFs) has stimulated interest in exploring alternative models of care. The Residential Care Intervention Program in the Elderly (RECIPE) service provides expert outreach services to RCFs residents, interventions include comprehensive care planning, management of inter-current illness and rapid access to acute care substitution services.
  
  
  OBJECTIVE
  to evaluate whether the RECIPE service decreased acute healthcare utilisation.
  
  
  METHODS
  a retrospective cohort study using interrupted time series analysis to analyse change in acute healthcare utilisation before and after enrolment.
  
  
  METHODS
  a 300-bed metropolitan teaching hospital in Australia and 73 RCFs within its catchment.
  
  
  METHODS
  there were 1,327 patients enrolled in the service with a median age of 84 years; 61% were female.
  
  
  METHODS
  data were collected prospectively on all enrolled patients from 2004 to 2011 and linked to the acute health service administrative data set. Primary outcomes change in admission rates, length of stay and bed days per quarter.
  
  
  RESULTS
  in the 2 years prior to enrolment, the mean number of acute care admissions per patient per year was 3.03 (SD 2.9) versus post 2.4 (SD 3.3), the service reducing admissions by 0.13 admissions per patient per quarter (P = 0.046). Prior to enrolment, the mean length of stay was 8.6 (SD 11.0) versus post 3.5 (SD 5.0), a reduction of 1.5 days per patient per quarter (P = 0.003).
  
  
  CONCLUSIONS
  this study suggests that an outreach service comprising a geriatrician-led multidisciplinary team can reduce acute hospital utilisation rates.
authors.affiliation: Northern Clinical Research Centre, Northern Health, Melbourne, Victoria, Australia School of Nursing and Midwifery, Deakin University, Melbourne, Victoria, Australia.
authors.forename: A F
authors.initials: AF
authors.lastname: Hutchinson
authors.affiliation: Northern Clinical Research Centre, Northern Health, Melbourne, Victoria, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Parikh
authors.affiliation: Northern Clinical Research Centre, Northern Health, Melbourne, Victoria, Australia Melbourne Epicentre, Royal Melbourne Hospital, Melbourne, Victoria, Australia Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Tacey
authors.affiliation: Department of Medicine and Aged Care, Northern Health, Melbourne, Victoria, Australia.
authors.forename: P A
authors.initials: PA
authors.lastname: Harvey
authors.affiliation: Department of Medicine and Aged Care, Northern Health, Melbourne, Victoria, Australia Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: W K
authors.initials: WK
authors.lastname: Lim
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003159:Community-Institutional Relations; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005853:Geriatrics / Q000379:methods*; D006299:Health Services for the Aged / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D017146:Models, Organizational; D016016:Proportional Hazards Models; D012112:Residential Facilities / Q000379:methods*; D012189:Retrospective Studies; D014739:Victoria / Q000453:epidemiology
keywords: acute healthcare substitution services; acute healthcare utilisation; advance care plans; aged care nursing; geriatrician outreach teams; nursing outreach; older people; residential aged care facilities