Evidence map›Paper›PMID 34090368›Full record

ArticleBMC geriatrics2021

A stepped-wedge randomised controlled trial assessing the implementation, effectiveness and cost-consequences of the EDDIE+ hospital avoidance program in 12 residential aged care homes: study protocol.

Hannah E Carter, Xing J Lee, Alison Farrington, Carla Shield, Nicholas Graves, Elizabeth V Cyarto, Lynne Parkinson, Florin I Oprescu, Claudia Meyer, Jeffrey Rowland and 2 more

Abstract readClinical Trial Protocol
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC geriatrics, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Hannah E CarterAustralian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, 4059, Queensland, Australia. hannah.carter@qut.edu.au.ORCID 0000-0002-0046-4126
Xing J LeeAustralian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, 4059, Queensland, Australia.
Alison FarringtonAustralian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, 4059, Queensland, Australia.
Carla ShieldAustralian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, 4059, Queensland, Australia.
Nicholas GravesAustralian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, 4059, Queensland, Australia.
Elizabeth V CyartoBolton Clarke Research Institute, 347 Burwood Hwy, Forest Hill, Victoria, 3131, Australia.
Lynne ParkinsonSchool of Medicine and Public Health, University of Newcastle, University Dr, Callaghan, NSW, 2308, Australia.
Florin I OprescuSchool of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, QLD, 4556, Australia.
Claudia MeyerBolton Clarke Research Institute, 347 Burwood Hwy, Forest Hill, Victoria, 3131, Australia.
Jeffrey RowlandFaculty of Medicine, University of Queensland, 20 Weightman St, Herston, QLD, 4006, Australia.
Trudy DwyerSchool of Nursing, Midwifery and Social Sciences, Central Queensland University, Rockhampton, QLD, 4702, Australia.
Gillian HarveyAustralian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, 4059, Queensland, Australia.

Funding

Medical Research Future Fund, administered by National Health and Medical Research Council (AU) APP1177501
6 · The paper itself

Abstract

backgroundOlder people living in residential aged care homes experience frequent emergency transfers to hospital. These events are associated with risks of hospital acquired complications and invasive treatments or interventions. Evidence suggests that some hospital transfers may be unnecessary or avoidable. The Early Detection of Deterioration in Elderly residents (EDDIE) program is a multi-component intervention aimed at reducing unnecessary hospital admissions from residential aged care homes by empowering nursing and care staff to detect and manage early signs of resident deterioration. This study aims to implement and evaluate the program in a multi-site randomised study in Queensland, Australia.

methodsA stepped-wedge randomised controlled trial will be conducted at 12 residential aged care homes over 58 weeks. The program has four components: education and training, decision support tools, diagnostic equipment, and implementation facilitation with clinical systems support. The integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework will be used to guide the program implementation and process evaluation. The primary outcome measure will be the number of hospital bed days used by residents, with secondary outcomes assessing emergency department transfer rates, admission rates, length of stay, family awareness and experience, staff self-efficacy and costs of both implementation and health service use. A process evaluation will assess the extent and fidelity of program implementation, mechanisms of impact and the contextual barriers and enablers. DISCUSSION: The intervention is expected to improve outcomes by reducing unnecessary hospital transfers. Fewer hospital transfers and admissions will release resources for other patients with potentially greater needs. Residential aged care home staff might benefit from feelings of empowerment in their ability to proactively manage early signs of resident deterioration. The process evaluation will be useful for supporting wider implementation of this intervention and other similar initiatives.

trial registrationThe trial is prospectively registered with the Australia New Zealand Clinical Trial Registry ( ACTRN12620000507987 , registered 23/04/2020).

Indexed as

Emergency Service, HospitalHospitalsAgedAustraliaHospitalizationHumansQueenslandRandomized Controlled Trials as TopicAcute careDeteriorationEarly detectionEconomic evaluationElderlyEmergency departmentHigh value careHospital transferNursing homeResidential aged care facility

Identifiers

PMID34090368
PMCPMC8179705

What OpenQuestion holds

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LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.