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Evidence-based intervention to reduce avoidable hospital admissions in care home residents (the Better Health in Residents in Care Homes (BHiRCH) study): protocol for a pilot cluster randomised trial
  1. Elizabeth L Sampson1,
  2. Alexandra Feast1,
  3. Alan Blighe2,
  4. Katherine Froggatt3,
  5. Rachael Hunter4,
  6. Louise Marston4,
  7. Brendan McCormack5,
  8. Shirley Nurock1,
  9. Monica Panca4,
  10. Catherine Powell2,
  11. Greta Rait4,
  12. Louise Robinson6,
  13. Barbara Woodward-Carlton2,
  14. John Young7,
  15. Murna Downs2
  1. 1 Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
  2. 2 Centre for Applied Dementia Studies, University of Bradford, Bradford, West Yorkshire, UK
  3. 3 International Observatory on End of Life Care, Lancaster University, Lancaster, UK
  4. 4 Research Dept of Primary Care and Population Health and PRIMENT Clinical Trials Unit, University College London, London, UK
  5. 5 School of Health Studies, Queen Margaret University, Edinburgh, UK
  6. 6 Institute for Health and Society and Newcastle University Institute for Ageing, Newcastle University, Newcastle, UK
  7. 7 Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, University of Leeds, Bradford, UK
  1. Correspondence to Dr Elizabeth L Sampson; e.sampson{at}


Introduction Acute hospital admission is distressing for care home residents. Ambulatory care sensitive conditions, such as respiratory and urinary tract infections, are conditions that can cause unplanned hospital admission but may have been avoidable with timely detection and intervention in the community. The Better Health in Residents in Care Homes (BHiRCH) programme has feasibility tested and will pilot a multicomponent intervention to reduce these avoidable hospital admissions. The BHiRCH intervention comprises an early warning tool for noting changes in resident health, a care pathway (clinical guidance and decision support system) and a structured method for communicating with primary care, adapted for use in the care home. We use practice development champions to support implementation and embed changes in care.

Methods and analysis Cluster randomised pilot trial to test study procedures and indicate whether a further definitive trial is warranted. Fourteen care homes with nursing (nursing homes) will be randomly allocated to intervention (delivered at nursing home level) or control groups. Two nurses from each home become Practice Development Champions trained to implement the intervention, supported by a practice development support group. Data will be collected for 3 months preintervention, monthly during the 12-month intervention and 1 month after. Individual-level data includes resident, care partner and staff demographics, resident functional status, service use and quality of life (for health economic analysis) and the extent to which staff perceive the organisation supports person centred care. System-level data includes primary and secondary health services contacts (ie, general practitioner and hospital admissions). Process evaluation assesses intervention acceptability, feasibility, fidelity, ease of implementation in practice and study procedures (ie, consent and recruitment rates).

Ethics and dissemination Approved by Research Ethics Committee and the UK Health Research Authority. Findings will be disseminated via academic and policy conferences, peer-reviewed publications and social media (eg, Twitter).

Trial registration number ISRCTN74109734; Pre-results.

  • geriatric medicine
  • urinary tract infections
  • respiratory infections
  • heart failure
  • dementia
  • primary care

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  • Contributors ELS, AF, AB, KF, RH, LM, BMcC, SN, MP, CP, GR, LR, BW-C, JY, MD were involved in development of the intervention and made substantial contributions to the concept and design of the study and protocol. ELS and AF wrote the protocol paper. ELS, AF, AB, KF, RH, LM, BMcC, SN, MP, CP, GR, LR, BW-C, JY, MD critically revised the manuscript and approved the final version.

  • Funding This work was supported by the UK NIHR grant number RP-PG-0612-20010.

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

  • Competing interests None declared.

  • Ethics approval London Queen Square Research Ethics Committee (Reference: 17/LO/1542) and the UK Health Research Authority.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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