The Community In-reach Rehabilitation and Care Transition (CIRACT) clinical and cost-effectiveness randomisation controlled trial in older people admitted to hospital as an acute medical emergency.
To compare the clinical and cost-effectiveness of a Community In-reach Rehabilitation and Care Transition (CIRACT) service with the traditional hospital-based rehabilitation (THB-Rehab) service.



Pragmatic randomised controlled trial with an integral health economic study.



Large UK teaching hospital, with community follow-up.



Frail older people aged 70 years and older admitted to hospital as an acute medical emergency.



Primary outcome: hospital length of stay; secondary outcomes: readmission, day 91-super spell bed days, functional ability, co-morbidity and health-related quality of life; cost-effectiveness analysis.



A total of 250 participants were randomised. There was no significant difference in length of stay between the CIRACT and THB-Rehab service (median 8 versus 9 days; geometric mean 7.8 versus 8.7 days, mean ratio 0.90, 95% confidence interval (CI) 0.74–1.10). Of the participants who were discharged from hospital, 17% and 13% were readmitted within 28 days from the CIRACT and THB-Rehab services, respectively (risk difference 3.8%, 95% CI −5.8% to 13.4%). There were no other significant differences in any of the other secondary outcomes between the two groups. The mean costs (including NHS and personal social service) of the CIRACT and THB-Rehab service were £3,744 and £3,603, respectively (mean cost difference £144; 95% CI −1,645 to 1,934).



The CIRACT service does not reduce major hospital length of stay nor reduce short-term readmission rates, compared to the standard THB-Rehab service; however, a modest (<2.3 days) effect cannot be excluded. Further studies are necessary powered with larger sample sizes and cluster randomisation.



ISRCTN 94393315, 25th April 2013
Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK.
Opinder
O
Sahota
University of Warwick, CoventryCV4 7AL, UK.
Ruth
R
Pulikottil-Jacob
University of Nottingham Business School, Jubilee Campus, Nottingham NG8 1BB, UK.
Fiona
F
Marshall
School of Medicine, University of Nottingham, NottinghamNG7 2UH, UK.
Alan
A
Montgomery
School of Medicine, University of Nottingham, NottinghamNG7 2UH, UK.
Wei
W
Tan
Norwich Medical School, University of East Anglia, NorwichNR4 7TJ, UK.
Tracey
T
Sach
School of Medicine, University of Nottingham, NottinghamNG7 2UH, UK.
Pip
P
Logan
School of Medicine, University of Nottingham, NottinghamNG7 2UH, UK.
Denise
D
Kendrick
Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK.
Alison
A
Watson
Nottingham CityCare Partnership CIC, Nottingham NG1 6GN, UK.
Maria
M
Walker
University of Nottingham Business School, Jubilee Campus, Nottingham NG8 1BB, UK.
Justin
J
Waring
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D003153:Community Health Services / Q000191:economics*; D015897:Comorbidity; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D004632:Emergency Medical Services / Q000191:economics*; D004739:England; D005260:Female; D017721:Hospital Costs; D006784:Hospitals, Teaching / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D010343:Patient Admission / Q000191:economics*; D010359:Patient Readmission / Q000191:economics; D010360:Patient Transfer / Q000191:economics*; D011788:Quality of Life; D012046:Rehabilitation / Q000191:economics*; D012307:Risk Factors; D013997:Time Factors