A multi-centre randomised trial to compare the effectiveness of geriatrician-led admission avoidance hospital at home versus inpatient admission View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2017-12

AUTHORS

Sasha Shepperd, Andrea Cradduck-Bamford, Chris Butler, Graham Ellis, Mary Godfrey, Alastair Gray, Anthony Hemsley, Pradeep Khanna, Peter Langhorne, Patricia McCaffrey, Lubena Mirza, Maj Pushpangadan, Scott Ramsay, Rebekah Schiff, David Stott, John Young, Ly-Mee Yu

ABSTRACT

BACKGROUND: There is concern that existing models of acute hospital care will become unworkable as the health service admits an increasing number of frail older people with complex health needs, and that there is inadequate evidence to guide the planning of acute hospital level services. We aim to evaluate whether geriatrician-led admission avoidance to hospital at home is an effective alternative to hospital admission. METHODS/DESIGN: We are conducting a multi-site randomised open trial of geriatrician-led admission avoidance hospital at home, compared with admission to hospital. We are recruiting older people with markers of frailty or prior dependence who have been referred to admission avoidance hospital at home for an acute medical event. This includes patients presenting with delirium, functional decline, dependence, falls, immobility or a background of dementia presenting with physical disease. Participants are randomised using a computerised random number generator to geriatrician-led admission avoidance hospital at home or a control group of inpatient admission in a 2:1 ratio in favour of the intervention. The primary endpoint 'living at home' (the inverse of death or living in a residential care setting) is measured at 6 months follow-up, and we also collect data on this outcome at 12 months. Secondary outcomes include the incidence of delirium, mortality, new long-term residential care, cognitive impairment, activities of daily living, quality of life and quality-adjusted survival, length of stay, readmission or transfer to hospital. We will conduct a parallel economic evaluation, and a process evaluation that includes an interview study to explore the experiences of patients and carers. DISCUSSION: Health systems around the world are examining how to provide acute hospital-level care to older adults in greater numbers with a fixed or shrinking hospital resource. This trial is the first large multi-site randomised trial of geriatrician-led admission avoidance hospital at home, and will provide evidence on alternative models of healthcare for older people who require hospital admission. TRIAL REGISTRATION: ISRCTN60477865 : Registered on 10 March 2014. Trial Sponsor: University of Oxford. Version 3.1, 14/06/2016. More... »

PAGES

491

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s13063-017-2214-y

DOI

http://dx.doi.org/10.1186/s13063-017-2214-y

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1092310827

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/29061154


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curl -H 'Accept: application/ld+json' 'https://scigraph.springernature.com/pub.10.1186/s13063-017-2214-y'

N-Triples is a line-based linked data format ideal for batch operations.

curl -H 'Accept: application/n-triples' 'https://scigraph.springernature.com/pub.10.1186/s13063-017-2214-y'

Turtle is a human-readable linked data format.

curl -H 'Accept: text/turtle' 'https://scigraph.springernature.com/pub.10.1186/s13063-017-2214-y'

RDF/XML is a standard XML format for linked data.

curl -H 'Accept: application/rdf+xml' 'https://scigraph.springernature.com/pub.10.1186/s13063-017-2214-y'


 

This table displays all metadata directly associated to this object as RDF triples.

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328 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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330 https://www.grid.ac/institutes/grid.5600.3 schema:alternateName Cardiff University
331 schema:name Nuffield Department of Primary Care Health Sciences, University of Oxford and Cardiff University, Cardiff, UK
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333 https://www.grid.ac/institutes/grid.8756.c schema:alternateName University of Glasgow
334 schema:name Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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336 https://www.grid.ac/institutes/grid.9909.9 schema:alternateName University of Leeds
337 schema:name Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Leeds, UK
338 Institute of Health Sciences, University of Leeds, Leeds, UK
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