The Community In-reach Rehabilitation and Care Transition (CIRACT) clinical and cost-effectiveness randomisation controlled trial in older people admitted to hospital as an acute medical emergency

Sahota, Opinder and Pulikottil-Jacob, Ruth and Marshall, Fiona and Montgomery, Alan and Tan, Wei and Sach, Tracey and Logan, Pip and Kendrick, Denise and Watson, Alison and Walker, Maria and Waring, Justin (2016) The Community In-reach Rehabilitation and Care Transition (CIRACT) clinical and cost-effectiveness randomisation controlled trial in older people admitted to hospital as an acute medical emergency. Age and Ageing . ISSN 1468-2834

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Abstract

Objective: To compare the clinical and cost-effectiveness of a Community In-reach Rehabilitation and Care Transition (CIRACT) service with the traditional hospital-based rehabilitation (THB-Rehab) service.

Design: Pragmatic randomised controlled trial with an integral health economic study.

Settings: Large UK teaching hospital, with community follow-up.

Subjects: Frail older people aged 70 years and older admitted to hospital as an acute medical emergency.

Measurements: Primary outcome: hospital length of stay; secondary outcomes: readmission, day 91-super spell bed days, functional ability, co-morbidity and health-related quality of life; cost-effectiveness analysis.

Results: A total of 250 participants were randomised. There was no significant difference in length of stay between the CIRACT and THB-Rehab service (median 8 versus 9 days; geometric mean 7.8 versus 8.7 days, mean ratio 0.90, 95% confidence interval (CI) 0.74–1.10). Of the participants who were discharged from hospital, 17% and 13% were readmitted within 28 days from the CIRACT and THB-Rehab services, respectively (risk difference 3.8%, 95% CI −5.8% to 13.4%). There were no other significant differences in any of the other secondary outcomes between the two groups. The mean costs (including NHS and personal social service) of the CIRACT and THB-Rehab service were £3,744 and £3,603, respectively (mean cost difference £144; 95% CI −1,645 to 1,934).

Conclusion: The CIRACT service does not reduce major hospital length of stay nor reduce short-term readmission rates, compared to the standard THB-Rehab service; however, a modest (<2.3 days) effect cannot be excluded. Further studies are necessary powered with larger sample sizes and cluster randomisation.

Trial registration: ISRCTN 94393315, 25th April 2013

Item Type: Article
Keywords: older people; care transition; transition coach; community rehabilitation; in-reach; readmission; hospital length of stay; cost-effectiveness
Schools/Departments: University of Nottingham UK Campus > Faculty of Social Sciences > Nottingham University Business School
University of Nottingham UK Campus > Faculty of Medicine and Health Sciences > School of Medicine > Division of Primary Care
University of Nottingham UK Campus > Faculty of Medicine and Health Sciences > School of Medicine > Division of Rehabilitation and Ageing
University of Nottingham UK Campus > Faculty of Medicine and Health Sciences > School of Medicine
University of Nottingham UK Campus > Faculty of Medicine and Health Sciences > School of Medicine > Units > Clinical Trials Unit
Identification Number: https://doi.org/10.1093/ageing/afw149
Depositing User: McCambridge, Mrs April
Date Deposited: 18 Oct 2016 07:19
Last Modified: 20 Oct 2016 04:44
URI: http://eprints.nottingham.ac.uk/id/eprint/37617

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