Connolly 2015.
| Methods | Cluster‐RCT (randomised by care facility) Total study duration: 14 months |
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| Participants | 36 facilities (18 intervention, 18 control). 1998 residents (1123 intervention, 875 control) Setting: Residential aged‐care (RAC) facilities Age: mean age not provided. Intervention: < 65, 6.4%; 65 to 74, 11.7%; 75 to 84, 29.5%; 85 to 94, 46.6%; 95 + 5.9%; control < 65, 7.5%; 65 to 74, 11.2%; 75 to 84, 29.1%; 85 to 94, 43.3%; 95 + 8.8% Gender: Intervention male 348 (31.0%), control male 242 (27.7%) Country: New Zealand Date of Study: 2010‐2012 |
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| Interventions | 1. Baseline facility assessment to identify areas of need and facility care plan developed in collaboration with the gerontology nurse specialist (GNS), and RAC facility clinical leadership (anonymised example available from authors on request) 2. Monitoring and benchmarking of resident indicators linked to quality of care provided (falls, nutrition, restraint use, weight loss, urinary tract infections, residents on nine medications); benchmarking was provided on three occasions during the intervention 3. Three 1‐hour multidisciplinary team (MDT) meetings, monthly for the first three months at each facility, including medication review by study geriatrician, GNS, general practitioner (GP), pharmacist, and nurse manager. Typically, six residents were considered per meeting with priority given to new admissions, the recently hospitalised, those with recent “incidents” (e.g., fall), and those on nine or more medications 4. Gerontology education and clinical coaching for RAC nurses and caregivers, including advanced (end‐of‐life) care planning, nutrition/hydration, early detection of illness, falls prevention, end‐stage dementia care, communication with families, and practical aspects of care |
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| Outcomes | Hospital admissions (ambulatory sensitive hospitalisations, total acute admissions) Mortality |
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| Notes | Funded by the Health Research Council of New Zealand | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Computer‐generated randomised numbers |
| Allocation concealment (selection bias) | Low risk | Cluster design |
| Blinding of participants and personnel (performance bias) All outcomes | High risk | Blinding not conducted |
| Blinding of outcome assessment (detection bias) Subjective outcomes | Unclear risk | No subjective outcomes measured |
| Blinding of outcome assessment (detection bias) Objective outcomes | Low risk | Authors state that "'care was taken to blind investigators to facility identification wherever possible". However outcomes not likely to be influenced by lack of blinding |
| Incomplete outcome data (attrition bias) Primary outcomes | Low risk | Reasons for attrition reported. Described as intention‐to‐treat by authors |
| Incomplete outcome data (attrition bias) Secondary outcomes | Low risk | Reasons for attrition reported. Described as intention‐to‐treat by authors |
| Selective reporting (reporting bias) | Low risk | Pre‐specified outcomes were reported in the pre‐specified way in the protocol |
| Similar baseline outcome measurements | Low risk | Similar baseline outcome measurements (no baseline measurement of hospital admissions) |
| Similar baseline characteristics | Low risk | Similar baseline characteristics reported |
| Reliable primary outcome measure | Low risk | Hospital admissions |
| Adequate protection against contamination | Unclear risk | Cluster design. However, it was theoretically possible that some healthcare professionals may have moved between intervention and control nursing homes [author contacted] |
| Other bias | High risk | Medication reviews were undertaken for a non‐random subsample of 23% of intervention residents selected by multidisciplinary team |