PMID- 27021357
OWN - NLM
STAT- MEDLINE
DCOM- 20171109
LR  - 20180628
IS  - 1468-2834 (Electronic)
IS  - 0002-0729 (Linking)
VI  - 45
IP  - 3
DP  - 2016 May
TI  - The 'Big Five'. Hypothesis generation: a multidisciplinary intervention package 
      reduces disease-specific hospitalisations from long-term care: a post hoc 
      analysis of the ARCHUS cluster-randomised controlled trial.
PG  - 415-20
LID - 10.1093/ageing/afw037 [doi]
AB  - INTRODUCTION: long-term care (LTC) residents have higher hospitalisation rates 
      than non-LTC residents. Rapid decline may follow hospitalisations, hence the 
      importance of preventing unnecessary hospitalisations. Literature describes 
      diagnosis-specific interventions (for cardiac failure, ischaemic heart disease, 
      chronic obstructive pulmonary disease, stroke, pneumonia-termed 'big five' 
      diagnoses), impacting on hospitalisations of older community-dwellers, but few 
      RCTs show reductions in acute admissions from LTC. METHODS: LTC facilities with 
      higher than expected hospitalisations were recruited for a cluster-randomised 
      controlled trial (RCT) of facility-based complex, non-disease-specific, 9-month 
      intervention comprising gerontology nurse specialist (GNS)-led staff education, 
      facility benchmarking, GNS resident review and multidisciplinary discussion of 
      residents selected using standard criteria. In this post hoc exploratory 
      analysis, the outcome was acute hospitalisations for 'big five' diagnoses. 
      Re-randomisation analyses were used for end points during months 1-14. For end 
      points during months 4-14, proportional hazards models are adjusted for 
      within-facility clustering. RESULTS: we recruited 36 facilities with 1,998 
      residents (1,408 female; mean age 82.9 years); 1,924 were alive at 3 months. The 
      intervention did not impact overall rates of acute hospitalisations or mortality 
      (previously published), but resulted in fewer 'big five' admissions (RR = 0.73, 
      95% CI = 0.54-0.99; P = 0.043) with no significant difference in the rate of 
      other acute admissions. When considering events occurring after 3 months (only), 
      the intervention group were 34.7% (HR = 0.65; 95% CI = 0.49-0.88; P = 0.005) less 
      likely to have a 'big five' acute admission than controls, with no differences in 
      likelihood of acute admissions for other diagnoses (P = 0.96). CONCLUSIONS: this 
      generic intervention may reduce admissions for common conditions which the 
      literature shows are impacted by disease-specific admission reduction strategies.
CI  - (c) The Author 2016. Published by Oxford University Press on behalf of the British 
      Geriatrics Society. All rights reserved. For Permissions, please email: 
      journals.permissions@oup.com.
FAU - Connolly, Martin J
AU  - Connolly MJ
AD  - Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, 
      New Zealand Waitemata District Health Board, Auckland, New Zealand.
FAU - Broad, Joanna B
AU  - Broad JB
AD  - Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, 
      New Zealand.
FAU - Boyd, Michal
AU  - Boyd M
AD  - Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, 
      New Zealand Waitemata District Health Board, Auckland, New Zealand Department of 
      Nursing, University of Auckland, Auckland, New Zealand.
FAU - Zhang, Tony Xian
AU  - Zhang TX
AD  - Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, 
      New Zealand.
FAU - Kerse, Ngaire
AU  - Kerse N
AD  - School of Population Health, University of Auckland, Auckland, New Zealand.
FAU - Foster, Susan
AU  - Foster S
AD  - Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, 
      New Zealand Waitemata District Health Board, Auckland, New Zealand.
FAU - Lumley, Thomas
AU  - Lumley T
AD  - Department of Statistics, University of Auckland, Auckland, New Zealand.
FAU - Whitehead, Noeline
AU  - Whitehead N
AD  - Department of Nursing, University of Auckland, Auckland, New Zealand.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20160328
PL  - England
TA  - Age Ageing
JT  - Age and ageing
JID - 0375655
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Cluster Analysis
MH  - Confidence Intervals
MH  - Female
MH  - Geriatric Assessment
MH  - Homes for the Aged/*organization & administration
MH  - Hospital Mortality/trends
MH  - Hospitalization/statistics & numerical data
MH  - Humans
MH  - *Interdisciplinary Communication
MH  - Long-Term Care/*organization & administration
MH  - Male
MH  - New Zealand
MH  - Nursing Homes/*organization & administration
MH  - Patient Admission/*statistics & numerical data
MH  - Patient Care Team/organization & administration
MH  - Proportional Hazards Models
MH  - Risk Assessment
MH  - Survival Analysis
OTO - NOTNLM
OT  - aged
OT  - hospitalisation
OT  - long-term care
OT  - older people
EDAT- 2016/03/30 06:00
MHDA- 2017/11/10 06:00
CRDT- 2016/03/30 06:00
PHST- 2015/08/10 00:00 [received]
PHST- 2016/01/15 00:00 [accepted]
PHST- 2016/03/30 06:00 [entrez]
PHST- 2016/03/30 06:00 [pubmed]
PHST- 2017/11/10 06:00 [medline]
AID - afw037 [pii]
AID - 10.1093/ageing/afw037 [doi]
PST - ppublish
SO  - Age Ageing. 2016 May;45(3):415-20. doi: 10.1093/ageing/afw037. Epub 2016 Mar 28.