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NCT Number: NCT06901167

Evaluation of a Residential In-Reach Program in Regional and Rural Australia

Residential In-Reach (RIR) programs are designed to provide responsive care for residents in residential aged care homes (RACH) with the aim of avoiding unnecessary hospital transfers. The evidence for their clinical and cost-effectiveness and implementation has been established in urban settings, but there is a small amount of low-quality evidence for rural and regional settings. The Grampians Region Health Service Partnership Resi-In-Reach Redesign Committee will be implementing a new RIR program to be offered to all RACHs in the Grampians region, this project aims to evaluate the clinical and cost-effectiveness of this program, and its implementation in the rural and regional setting. A stepped-wedge trial will be conducted so that as the RIR program is gradually rolled-out across the region, outcomes can be compared in the same facilities across time and between different facilities. The primary outcome measure will be presentation to emergency departments and urgent care centres, and data will also be collected on other clinical outcomes and barriers and enablers of implementing the program. It is anticipated that there will be a reduction in hospital presentations, and a range of barriers and enablers unique to the rural and regional setting will emerge.

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Key information

Conditions

Aged Acute Disease Disease Attributes Pathologic Processes Pathological Conditions, Signs and Symptoms

Age range

65 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

East Grampians Health Service, Ararat, Victoria, Australia

Loading trial locations.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Health services that have emergency departments and/or emergency care centres that admit residents from residential aged care homes (RACH)
  • RACHs that do not currently have access to RIR programs
  • health service staff who have been involved with the set-up and delivery of the RIR program,
  • RACH staff who have experience of or accessing the RIR service for residents at least once,
  • residents living at a RACH who has experienced receiving medical care from the RIR program and can provide informed consent, or a family member of the resident,
  • general practitioners whose case load includes residents from RACHs.

Exclusion criteria

  • RACHs that already have access to a RIR program will be excluded

Treatment and study plan

Residential In-Reach Program

Other

All enrolled residential aged care homes will be able to access the residential-in-reach (RIR) program intervention. The RIR program provides a consultation service from a central hospital to an aged care facility in the Grampians region in the state of Victoria, Australia. Aged care staff will make a telehealth referral to central hub, where a nurse practitioner will triage the patient and make recommendations (for example, monitor resident condition, more examples: comprehensive assessment for unwell residents, liaison with the General Practitioners for diagnosis and treatment plan, provide education and support to staff) or further referrals (for example, refer to geriatrician or call an ambulance).

Primary outcomes

  1. Rate of presentations from residential aged care homes to emergency departments and emergency care centres

    Time frame: From enrolment to the end of the trial for 14 months

    Primary clinical effectiveness outcome

    Collection schedule:

    • Once at the end of the evaluation
    • At the level of each residential aged care home presentation to hospital each month Collection approach: Extraction from hospital records and extraction from residential aged care home systems

Secondary outcomes

  1. Days spent in hospital by aged care home resident

    Time frame: From enrolment to the end of the trial for 14 months

    Secondary clinical effectiveness outcome

    Collection schedule:

    • Once at the end of the evaluation
    • At the level of each residential aged care home presentation to hospital each month Collection approach: Extraction from hospital records and extraction from residential aged care home systems

  2. Location of mortality in hospital

    Time frame: From enrolment to the end of the trial for 14 months

    Secondary clinical effectiveness outcome

    Collection schedule:

    • Once at the end of the evaluation
    • At the level of each residential aged care home presentation to hospital each month Collection approach: Extraction from hospital records and extraction from residential aged care home systems

  3. Number of barriers to residential-in-reach program implementation

    Time frame: From enrolment to 1 month after the end of the trial, for 15 months

    Secondary implementation outcome - collected once via semi-structured interviews with key stakeholders (health service staff, residential aged care home staff).

  4. Number of enablers to residential-in-reach program implementation

    Time frame: From enrolment to 1 month after the end of the trial, for 15 months

    Secondary implementation outcome - collected once via semi-structured interviews with key stakeholders (health service staff, residential aged care home staff).

  5. Stakeholder reported feasibility of the residential-in-reach program implementation

    Time frame: From enrolment to 1 month after the end of the trial, for 15 months

    Secondary implementation outcome - collected once via semi-structured interviews with key stakeholders (health service staff, residential aged care home staff).

  6. Stakeholder reported acceptability of the residential in-reach program

    Time frame: From enrolment to the end of the trial for 14 months

    Secondary implementation outcome - collected via semi-structured interviews with key stakeholders (health service staff, residential aged care home staff, general practitioners, aged care home residents) after occasions of service on a monthly basis.

  7. Stakeholder reported appropriateness of the residential in-reach program

    Time frame: From enrolment to the end of the trial for 14 months

    Secondary implementation outcome - collected via semi-structured interviews with key stakeholders (health service staff, residential aged care home staff, general practitioners, aged care home residents) after occasions of service on a monthly basis.

  8. Number of aged care staff who attend education sessions for the use of the residential in-reach program

    Time frame: From enrolment to the end of the trial for 14 months

    Secondary implementation outcome - recorded attendance of education sessions for residential aged care home staff for the use of the residential in-reach program.

  9. Number of adaptations made to the residential in-reach program

    Time frame: From enrolment to the end of the trial fo

    Secondary implementation outcome - documented adaptations made to the program during the trial period.

Other outcomes

  1. Number of times the residential in-reach program is utilised

    Time frame: From enrolment to the end of the trial for 14 months

    Cost-effectiveness outcome: number of times the RACHs enrolled in this trial utilises the residential in-reach program, both in-person and via telehealth.

    Collection schedule:

    • Once at the end of the evaluation
    • At the level of each residential aged care home each month Collection approach: Extraction from hospital records

  2. Number of times the Victorian Virtual Emergency Department is utilised

    Time frame: From enrolment to the end of the trial for 14 months

    Cost-effectiveness outcome: number of times the RACHs enrolled in this trial uses the Victorian Virtual Emergency Department.

    Collection schedule:

    • Once at the end of the evaluation
    • At the level of each residential aged care home each month Collection approach: Extraction from residential aged care home records

  3. Number of times that the general practitioner is utilised

    Time frame: From enrolment to the end of the trial for 14 months

    Cost-effectiveness outcome: number of times that the RACHs enrolled in this trial consults the general practitioner, both in-person and via telehealth, including in and out of hours consultations.

    Collection schedule:

    • Once at the end of the evaluation
    • At the level of each residential aged care home each month Collection approach: Extraction from residential aged care home records

  4. Number of calls to Ambulance Victoria

    Time frame: From enrolment to the end of the trial for 14 months

    Cost-effectiveness outcome: number of times the RACHs enrolled in this trial calls an ambulance for their residents.

    Collection schedule:

    • Once at the end of the evaluation
    • At the level of each residential aged care home each month Collection approach: Extraction from residential aged care home records and Ambulance Victoria records

  5. Number of transfers to hospital via Ambulance Victoria

    Time frame: From enrolment to the end of the trial for 14 months

    Cost-effectiveness outcome: number of times that Ambulance Victoria transfers a resident from one of the RACHs enrolled in this trial to hospital.

    Collection schedule:

    • Once at the end of the evaluation
    • At the level of each residential aged care home each month Collection approach: Extraction from residential aged care home records and Ambulance Victoria records

Study contacts

Contact information is provided by the study sponsor or research team.

Catherine Huggins

CONTACT

[email protected]

Dai Pu

CONTACT

[email protected]

61 03 9904 4004

Sponsors and collaborators

Lead sponsor

Monash University

Other

Collaborators

  • Deakin University

Registry information

Official study title

Evaluation of a Region-wide Residential In-Reach (RIR) Program in Regional and Rural Health Services: A Stepped-wedge Trial

Important dates

Study start
2025
Primary completion
2026
Study completion
2026
First posted
Mar 28, 2025
Registry last updated
May 30, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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