A growing number of frail older people living in nursing homes remain at risk of hospitalisations, which can be detrimental for them and their families and is related to high societal costs. While some hospitalisation is necessary and appropriate, about 67% of hospitalisations of nursing home residents are considered potentially avoidable and unnecessary. Yet, there remains a lack of strong evidence on effective interventions that could reduce potentially avoidable hospitalisations of nursing home residents and could be implemented and embedded successfully into daily practice in nursing homes. Hence, we aim to develop and pilot test RATHER-NH, an innovative complex intervention that could reduce potentially avoidable hospitalisations from nursing homes and could be implemented and embedded successfully into daily nursing home practice.
First, we will develop RATHER-NH and its implementation guidance by building on existing evidence, using an iterative process involving key stakeholders – at the levels of residents, families, health and social care professionals working in nursing homes, nursing home organisation and health services and systems, and paying attention to implementation in the real world using a novel implementation science theory (Extended Normalization Process Theory).
Second, we will test the preliminary effectiveness of RATHER-NH in reducing potentially avoidable hospitalisations from nursing homes and assess its implementation using multiple research methods, including the use of routinely-collected nationwide administrative databases to collect data on residents and intervention outcomes.