title: The Alice Springs Hospital Readmission Prevention Project (ASHRAPP): a randomised control trial.
abstract: Hospitals are frequently faced with high levels of emergency department presentations and demand for inpatient care. An important contributing factor is the subset of patients with complex chronic diseases who have frequent and preventable exacerbations of their chronic diseases. Evidence suggests that some of these hospital readmissions can be prevented with appropriate transitional care. Whilst there is a growing body of evidence for transitional care processes in urban, non-indigenous settings, there is a paucity of information regarding rural and remote settings and, specifically, the indigenous context.
  
  
  
  This randomised control trial compares a tailored, multidimensional transitional care package to usual care. The objective is to evaluate the efficacy of the transitional care package for Indigenous and non-Indigenous Australian patients with chronic diseases at risk of recurrent readmission with the aim of reducing readmission rates and improving transition to primary care in a remote setting. Patients will be recruited from medical and surgical admissions to Alice Springs Hospital and will be followed for 12 months. The primary outcome measure will be number of admissions to hospital with secondary outcomes including number of emergency department presentations, number of ICU admissions, days alive and out of hospital, time to primary care review post discharge and cost-effectiveness.
  
  
  
  Successful transition from hospital to home is important for patients with complex chronic diseases. Evidence suggests that a coordinated transitional care plan can result in a reduction in length of hospital stay and readmission rates for adults with complex medical needs. This will be the first study to evaluate a tailored multidimensional transitional care intervention to prevent readmission in Indigenous and non-Indigenous Australian residents of remote Australia who are frequently admitted to hospital. If demonstrated to be effective it will have implications for the care and management of Indigenous Australians throughout regional and remote Australia and in other remote, culturally and linguistically diverse populations and settings.
  
  
  
  Australian New Zealand Clinical Trials Registry, ACTRN12615000808549 - Retrospectively registered on 4/8/15.
authors.affiliation: Monash University and Baker IDI Heart & Diabetes Institute, Melbourne, Australia. gabrielle.diplock@bakeridi.edu.au.
authors.forename: Gabrielle
authors.identifier: 0000-0002-2371-612X
authors.initials: G
authors.lastname: Diplock
authors.affiliation: South Australian Health & Medical Research Institute, Adelaide, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Ward
authors.affiliation: Monash University and Baker IDI Heart & Diabetes Institute, Melbourne, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Stewart
authors.affiliation: Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Scuffham
authors.affiliation: Alice Springs Hospital, Alice Springs, Australia.
authors.forename: Penny
authors.initials: P
authors.lastname: Stewart
authors.affiliation: Alice Springs Hospital, Alice Springs, Australia.
authors.forename: Carole
authors.initials: C
authors.lastname: Reeve
authors.affiliation: Alice Springs Hospital, Alice Springs, Australia.
authors.forename: Lea
authors.initials: L
authors.lastname: Davidson
authors.affiliation: Monash University and Baker IDI Heart & Diabetes Institute, Melbourne, Australia.
authors.forename: Graeme
authors.initials: G
authors.lastname: Maguire
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000208:ethnology / Q000628:therapy*; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D006303:Health Services, Indigenous / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015876:Northern Territory / Q000208:ethnology; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data; D012008:Recurrence; D012423:Rural Health / Q000191:economics / Q000208:ethnology; D000069341:Transitional Care / Q000191:economics / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Discharge planning; Health service intervention; Indigenous health; Readmission prevention; Transitional care