Evaluation of a Residential In-Reach Program in Regional and Rural Australia

NCT06901167 | Recruiting

• 1 other identifier: HREC/112397/GHSJOG-2025-462490
• Study Type: interventional
• Target: 100
• Locations: 1 country
• Sites: 8

Brief Summary

Residential In-Reach (RIR) programs are designed to provide responsive care for residents in residential aged care homes (RACH) with the aim of avoiding unnecessary hospital transfers. The evidence for their clinical and cost-effectiveness and implementation has been established in urban settings, but there is a small amount of low-quality evidence for rural and regional settings. The Grampians Region Health Service Partnership Resi-In-Reach Redesign Committee will be implementing a new RIR program to be offered to all RACHs in the Grampians region, this project aims to evaluate the clinical and cost-effectiveness of this program, and its implementation in the rural and regional setting. A stepped-wedge trial will be conducted so that as the RIR program is gradually rolled-out across the region, outcomes can be compared in the same facilities across time and between different facilities. The primary outcome measure will be presentation to emergency departments and urgent care centres, and data will also be collected on other clinical outcomes and barriers and enablers of implementing the program. It is anticipated that there will be a reduction in hospital presentations, and a range of barriers and enablers unique to the rural and regional setting will emerge.

Conditions

Aged; Acute Disease

Keywords

stepped-wedge trial; residential aged care home; residential in reach; hospital avoidance

Outcome Measures

Primary Outcomes (1)

• Rate of presentations from residential aged care homes to emergency departments and emergency care centres

  Primary clinical effectiveness outcome Collection schedule: * Once at the end of the evaluation * At the level of each residential aged care home presentation to hospital each month Collection approach: Extraction from hospital records and extraction from residential aged care home systems

  From enrolment to the end of the trial for 14 months

Secondary Outcomes (9)

• Days spent in hospital by aged care home resident

  From enrolment to the end of the trial for 14 months

• Location of mortality in hospital

  From enrolment to the end of the trial for 14 months

• Number of barriers to residential-in-reach program implementation

  From enrolment to 1 month after the end of the trial, for 15 months

• Number of enablers to residential-in-reach program implementation

  From enrolment to 1 month after the end of the trial, for 15 months

• Stakeholder reported feasibility of the residential-in-reach program implementation

  From enrolment to 1 month after the end of the trial, for 15 months

Other Outcomes (5)

• Number of times the residential in-reach program is utilised

  From enrolment to the end of the trial for 14 months

• Number of times the Victorian Virtual Emergency Department is utilised

  From enrolment to the end of the trial for 14 months

• Number of times that the general practitioner is utilised

  From enrolment to the end of the trial for 14 months

Study Arms (1)

Residential-in-reach

EXPERIMENTAL

All enrolled residential aged care homes will be able to access the residential-in-reach (RIR) program intervention. The RIR program provides a consultation service from a central hospital to an aged care facility in the Grampians region in the state of Victoria, Australia. Aged care staff will make a telehealth referral to central hub, where a nurse practitioner will triage the patient and make recommendations (for example, monitor resident condition, more examples: comprehensive assessment for unwell residents, liaison with the General Practitioners for diagnosis and treatment plan, provide education and support to staff) or further referrals (for example, refer to geriatrician or call an ambulance).

Other: Residential In-Reach Program

Interventions

Residential In-Reach Program OTHER

All enrolled residential aged care homes will be able to access the residential-in-reach (RIR) program intervention. The RIR program provides a consultation service from a central hospital to an aged care facility in the Grampians region in the state of Victoria, Australia. Aged care staff will make a telehealth referral to central hub, where a nurse practitioner will triage the patient and make recommendations (for example, monitor resident condition, more examples: comprehensive assessment for unwell residents, liaison with the General Practitioners for diagnosis and treatment plan, provide education and support to staff) or further referrals (for example, refer to geriatrician or call an ambulance).

Residential-in-reach

Eligibility Criteria

• Age: 65 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Older Adult (65+)

You may qualify if:

• Health services that have emergency departments and/or emergency care centres that admit residents from residential aged care homes (RACH)
• RACHs that do not currently have access to RIR programs
• health service staff who have been involved with the set-up and delivery of the RIR program,
• RACH staff who have experience of or accessing the RIR service for residents at least once,
• residents living at a RACH who has experienced receiving medical care from the RIR program and can provide informed consent, or a family member of the resident,
• general practitioners whose case load includes residents from RACHs.

You may not qualify if:

• RACHs that already have access to a RIR program will be excluded

Sponsors & Collaborators

• Monash University: lead
• Deakin University: collaborator

Study Sites (8)

East Grampians Health Service

Ararat, Victoria, 3377, Australia

RECRUITING

Grampians Health

Ballarat, Victoria, 3350, Australia

RECRUITING

Beaufort and Skipton Health Service

Beaufort, Victoria, 3373, Australia

RECRUITING

Central Highlands Rural Health

Daylesford, Victoria, 3460, Australia

RECRUITING

Maryborough District Health Service

Maryborough, Victoria, 3465, Australia

RECRUITING

West Wimmera Health Service

Nhill, Victoria, 3418, Australia

RECRUITING

East Wimmera Health Service

Saint Arnaud, Victoria, 3478, Australia

RECRUITING

Rural Northwest Health

Warracknabeal, Victoria, 3393, Australia

RECRUITING

Related Publications (6)

• Sunner C, Giles MT, Parker V, Dilworth S, Bantawa K, Kable A, Oldmeadow C, Foureur M. PACE-IT study protocol: a stepped wedge cluster randomised controlled trial evaluating the implementation of telehealth visual assessment in emergency care for people living in residential aged-care facilities. BMC Health Serv Res. 2020 Jul 20;20(1):672. doi: 10.1186/s12913-020-05539-1.

  PMID: 32690008 BACKGROUND

• Sunner C, Giles MT, Kable A, Foureur M. Experiences of nurses working in RACFs and EDs utilising visual telehealth consultation to assess the need for RACF resident transfer to ED: A qualitative descriptive study. J Clin Nurs. 2023 Aug;32(15-16):4694-4709. doi: 10.1111/jocn.16529. Epub 2022 Sep 8.

  PMID: 36081333 BACKGROUND

• Lukin B, Fan LJ, Zhao JZ, Sun JD, Dingle K, Purtill R, Tapp S, Hou XY. Emergency department use among patients from residential aged care facilities under a Hospital in the Nursing Home scheme in public hospitals in Queensland Australia. World J Emerg Med. 2016;7(3):183-90. doi: 10.5847/wjem.j.1920-8642.2016.03.004.

  PMID: 27547277 BACKGROUND

• Hullick C, Conway J, Hall A, Murdoch W, Cole J, Hewitt J, Oldmeadow C, Attia J. Video-telehealth to support clinical assessment and management of acutely unwell older people in Residential Aged Care: a pre-post intervention study. BMC Geriatr. 2022 Jan 10;22(1):40. doi: 10.1186/s12877-021-02703-y.

  PMID: 35012480 BACKGROUND

• Haines TP, Palmer AJ, Tierney P, Si L, Robinson AL. A new model of care and in-house general practitioners for residential aged care facilities: a stepped wedge, cluster randomised trial. Med J Aust. 2020 May;212(9):409-415. doi: 10.5694/mja2.50565. Epub 2020 Apr 1.

  PMID: 32237279 BACKGROUND

• Chambers D, Cantrell A, Preston L, Marincowitz C, Wright L, Conroy S, Lee Gordon A. Reducing unplanned hospital admissions from care homes: a systematic review. Health Soc Care Deliv Res. 2023 Oct;11(18):1-130. doi: 10.3310/KLPW6338.

  PMID: 37916580 BACKGROUND

MeSH Terms

Conditions

Acute Disease

Condition Hierarchy (Ancestors)

Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• Terry Haines

  Monash University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Dai Pu

CONTACT

61 03 9904 4004; debbie.pu@monash.edu

Catherine Huggins

CONTACT

kate.huggins@deakin.edu.au

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: This will be a stepped-wedge trial, in which all enrolled facilities and participants will receive the same intervention, but the intervention roll-out will be conducted in a sequential manner based on a randomised order. During the 14 months of the trial, all facilities and participants will receive the same intervention, but for different lengths of time depending on the randomisation.

Study Record Dates

• First Submitted: March 4, 2025
• First Posted: March 28, 2025
• Study Start: May 1, 2025
• Primary Completion (Estimated): May 31, 2026
• Study Completion (Estimated): June 30, 2026
• Last Updated: May 30, 2025

Record last verified: 2025-03

Data Sharing

• IPD Sharing: Will not share

Locations

AU (8)