Plain English Summary
Background and study aims
Hospital at home is a service that is provided in some parts of the U.K, but we do not know how this service compares to being admitted to hospital. The aim of this study is to find out if providing healthcare in hospital at home (sometimes called healthcare in the home), instead of
hospital, helps older people to recover from a deterioration in their health. We also aim to find out how much this type of healthcare costs, compared to hospital care, and how people experience healthcare in the home and in hospital.
Who can participate?
Older people who experienced a change in their health, and for whom healthcare in hospital was considered, were invited to participate in this research from nine locations across the UK
What does the study involve?
We collected data on various aspects of their health that included possible confusion, ability to move around and look after themselves and where they were living at six and twelve months after the study had started. We also collected data on resources used, so we could calculate the cost of this type of healthcare.
What are the possible benefits and risks of participating?
None
Where is the study run from?
Nuffield Department of Population Health, University of Oxford (UK)
When is the study starting and how long is it expected to run for?
November 2014 to January 2020 (updated 10/07/2020, previously: July 2019)
Who is funding the study?
National Institute for Health Research (NIHR) (UK)
Who is the main contact?
Prof. Sasha Shepperd, sasha.shepperd@ndph.ox.ac.uk
Study website
Contact information
Type
Scientific
Contact name
Prof Sasha Shepperd
ORCID ID
Contact details
Nuffield Department of Population Health
Richard Doll Building
Old Road Campus
Headington
Oxford
OX3 7LF
United Kingdom
+44 (0)1865 289 237
sasha.shepperd@ndph.ox.ac.uk
Additional identifiers
EudraCT/CTIS number
IRAS number
ClinicalTrials.gov number
Protocol/serial number
17311; HS&DR 12/209/66
Study information
Scientific title
A multi-centre randomised controlled trial to compare the effectiveness of admission avoidance hospital at home with comprehensive geriatric assessment vs. inpatient comprehensive geriatric assessment on the number of frail older people living at home
Acronym
RCT of Comprehensive Geriatric Assessment in a HAH setting v 1.0
Study hypothesis
The aim of this study is to test the cost-effectiveness of admission avoidance HaH with CGA compared with hospital admission with CGA and investigate the generalizability and cost-effectiveness of CGA in settings where health and social care provision vary.
Ethics approval(s)
Wales REC 4, 06/08/2014, ref: 14/WA/1081
Study design
Randomised; Interventional; Design type: Process of Care, Treatment
Primary study design
Interventional
Secondary study design
Randomised controlled trial
Study setting(s)
Hospital
Study type
Treatment
Patient information sheet
Not available in web format, please use the contact details to request a patient information sheet
Condition
Topic: Primary Care, Ageing; Subtopic: Other Primary Care, Ageing, Ageing; Disease: All Ageing
Intervention
CGA in hospital at home: Admission avoidance HaH with CGA is a specialist led service providing assessment and a tailored management plan, multidisciplinary management and coordinated care in the patients own home. If this service was not available then the patient would be admitted to an acute ward. Usual care will be hospital-based inpatient CGA. CGA is specialist led co-ordinated care involving simultaneous multi-level assessment by a multidisciplinary team to ensure that problems are identified, quantified and mana; Follow Up Length: 12 month(s); Study Entry : Single Randomisation only
Intervention type
Other
Primary outcome measure
Living at home; Timepoint(s): 6 and 12 months
Secondary outcome measures
1. Activities of daily living; Timepoint(s): 6 and 12 months
2. Cognitive impairment; Timepoint(s): 6 and 12 months
3. Delirium; Timepoint(s): 3 and 5 days, 1 month
4. Mortality; Timepoint(s): 6 and 12 months
5. New long-term residential care; Timepoint(s): 6 and 12 months
6. Quality of life; Timepoint(s): 6 and 12 months
7. Resource use; Timepoint(s): 6 and 12 months
8. Transfer to hospital; Timepoint(s): 6 and 12 months
Overall study start date
30/11/2014
Overall study end date
31/01/2020
Reason abandoned (if study stopped)
Eligibility
Participant inclusion criteria
Older patients with frailty who are aged >65 years and who have been referred to the admission avoidance HaH service with CGA and who would otherwise require admission to hospital for an acute medical event. This will include patients presenting with delirium, functional decline, dependence, falls, immobility or a background of dementia presenting with physical disease
Participant type(s)
Patient
Age group
Senior
Sex
Both
Target number of participants
1055
Total final enrolment
1055
Participant exclusion criteria
1. Patient with acute coronary syndrome
2. Patients needing acute surgical assessment
3. Patients presenting with a suspected stroke
4. Patients who are receiving end of life care as part of a palliative care pathway
5. Patients who refuse the HaH service
6. Patients considered by the clinical staff to be too high risk for home based care, for example those who are physiologically unstable, who are at risk to themselves or if the carer reports HaH care would not be acceptable (in keeping with existing clinical practices for HaH)
7. The presence of a carer will not be a requirement for enrolment and will depend on the individual circumstances of the patient; this will be at the discretion of the clinician responsible for the patient (as is current clinical practice in each centre)
Recruitment start date
30/11/2014
Recruitment end date
31/07/2018
Locations
Countries of recruitment
England, United Kingdom
Study participating centre
University of Oxford
Nuffield Department of Population Health
Old Road Headington
Oxford
OX3 7LF
United Kingdom
Sponsor information
Organisation
University of Oxford
Sponsor details
Old Road Campus
Roosevelt Drive Headington
Oxford
OX3 7DQ
England
United Kingdom
Sponsor type
University/education
Website
ROR
Funders
Funder type
Government
Funder name
NIHR - Health Services & Delivery Research Programme (HS&DR); Grant Codes: 12/209/66
Alternative name(s)
Funding Body Type
Funding Body Subtype
Location
Results and Publications
Publication and dissemination plan
Current publication and dissemination plan as of 02/06/2020:
We have published the findings for the process evaluation that was embedded in the trial, submitted a manuscript with the main trial findings for consideration and are drafting a manuscript of the findings from the cost-effectiveness analysis
Previous publication and dissemination plan:
Not provided at time of registration
Intention to publish date
31/12/2020
Individual participant data (IPD) sharing plan
IPD sharing plan summary
Not provided at time of registration
Study outputs
| Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
|---|---|---|---|---|---|
| Protocol article | protocol | 01/12/2017 | 12/05/2020 | Yes | No |
| Results article | 01/07/2021 | 20/04/2021 | Yes | No | |
| HRA research summary | 26/07/2023 | No | No |