PT  - JOURNAL ARTICLE
AU  - Elizabeth L Sampson
AU  - Alexandra Feast
AU  - Alan Blighe
AU  - Katherine Froggatt
AU  - Rachael Hunter
AU  - Louise Marston
AU  - Brendan McCormack
AU  - Shirley Nurock
AU  - Monica Panca
AU  - Catherine Powell
AU  - Greta Rait
AU  - Louise Robinson
AU  - Barbara Woodward-Carlton
AU  - John Young
AU  - Murna Downs
TI  - 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
AID  - 10.1136/bmjopen-2018-026510
DP  - 2019 May 01
TA  - BMJ Open
PG  - e026510
VI  - 9
IP  - 5
4099  - http://bmjopen.bmj.com/content/9/5/e026510.short
4100  - http://bmjopen.bmj.com/content/9/5/e026510.full
SO  - BMJ Open2019 May 01; 9
AB  - 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.