A Multi-Centre Randomised Controlled Trial to Compare the Effectiveness of Admission Avoidance Hospital at Home with Comprehensive Geriatric Assessment vs. Inpatient Comprehensive Geriatric Assessment on the Number of Frail Older People ‘Living at Home’
Award Number
12/209/66Programme
Health and Social Care Delivery ResearchStatus / Stage
CompletedDates
2 July 2014 -1 October 2019
Duration (calculated)
05 years 02 monthsFunder(s)
NIHRFunding Amount
£2,246,719.18Funder/Grant study page
NIHRContracted Centre
University of OxfordPrincipal Investigator
Professor Sasha Shepperd MS DPhilPI Contact
sasha.shepperd@ndph.ox.ac.ukPI ORCID
0000-0001-6384-8322WHO Catergories
Methodologies and approaches for risk reduction researchRisk reduction intervention
Disease Type
Dementia (Unspecified)CPEC Review Info
| Reference ID | 199 |
|---|---|
| Researcher | Reside Team |
| Published | 12/06/2023 |
Data
| Award Number | 12/209/66 |
|---|---|
| Status / Stage | Completed |
| Start Date | 20140702 |
| End Date | 20191001 |
| Duration (calculated) | 05 years 02 months |
| Funder/Grant study page | NIHR |
| Contracted Centre | University of Oxford |
| Funding Amount | £2,246,719.18 |
Abstract
Evidence is needed on how to provide high quality acute hospital level care to older adults in greater numbers with a fixed or shrinking hospital resource (1). We will test the cost-effectiveness of hospital at home (HaH) with comprehensive geriatric assessment (CGA) compared with hospital admission with CGA. A multi-centre randomised controlled trial (RCT), a parallel economic evaluation and interview study comparing CGA in an admission avoidance HaH setting with hospital admission with CGA; an update of the Cochrane Review of HaH. HaH and inpatient hospitals in England, Wales and Scotland. We will update the Cochrane Review of admission avoidance HaH. Older people with markers of frailty or prior dependence, this will include patients presenting with delirium, functional decline, dependence, falls, immobility or a background of dementia presenting with physical disease. We will exclude patients with acute coronary syndrome, requiring acute surgical assessment, a suspected stroke, refusing HaH or considered by the clinical staff to be too high risk for home based care. Admission avoidance HaH with CGA provides active treatment by healthcare professionals for a condition that otherwise would require acute in-patient care. CGA is a specialist led service providing multi-level assessment and management, a tailored management plan and co-ordinated care. Usual care will be hospital-based inpatient CGA. Primary outcome: living at home (the inverse of death or living in a residential care setting). Secondary outcomes: incidence of delirium (2), mortality, new long-term residential care, cognitive impairment (3), activities of daily living (4), quality of life and quality adjusted survival (EQ-5D) (5), length of stay, readmission or transfer to hospital, resource use, costs and cost-effectiveness. Follow-up will be at 6 and 12 months. SAMPLE SIZE With 90% power, a two tailed test of significance at the level of 0.05, we will need to recruit 1552 participants to detect a 10% absolute difference in the primary outcome living at 12 months, assuming a control group event rate at 12 months of 50% (1). This will be a two phase trial; in phase one (18 months) we will establish feasibility of recruitment, randomisation and data collection; if successful we will continue in phase 2 (30 months). An update of the Cochrane Review will start in year 2 and be completed in year 4.
Aims
We aim to combine and evaluate the effectiveness of these two models of care (admission avoidance hospital at home and specialist led care) in a study conducted in several centres. We will look at key health outcomes (such as death, living at home, transfer to hospital and admission to residential care) and will also look at the patient and carer experience as well as the cost effectiveness. We will randomise eligible patients to i) the provision of admission avoidance hospital at home setting with specialist led geriatric care vs. ii) specialist hospital care for the frailer older adult. We will recruit older people (>65 years) requiring hospital admission after they have been referred by their GP. A research nurse will discuss the research with patients who are eligible for our research and their carers, provide them with written information describing the research and will invite patients to participate.