The Community In-reach Rehabilitation and Care Transition (CIRACT) clinical and cost-effectiveness randomisation controlled trial in older people admitted to hospital as an acute medical emergency
Objective: To compare the clinical and cost-effectiveness of a Community In-reach Rehabilitation and Care Transition (CIRACT) service with the traditional hospital-based rehabilitation (THB-Rehab) service. Design: Pragmatic randomised controlled trial with an integral health economic study....
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| Format: | Article |
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Oxford University Press
2016
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| Online Access: | https://eprints.nottingham.ac.uk/37617/ |
| _version_ | 1848795498256793600 |
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| author | Sahota, Opinder Pulikottil-Jacob, Ruth Marshall, Fiona Montgomery, Alan Tan, Wei Sach, Tracey Logan, Pip Kendrick, Denise Watson, Alison Walker, Maria Waring, Justin |
| author_facet | Sahota, Opinder Pulikottil-Jacob, Ruth Marshall, Fiona Montgomery, Alan Tan, Wei Sach, Tracey Logan, Pip Kendrick, Denise Watson, Alison Walker, Maria Waring, Justin |
| author_sort | Sahota, Opinder |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | Objective: To compare the clinical and cost-effectiveness of a Community In-reach Rehabilitation and Care Transition (CIRACT) service with the traditional hospital-based rehabilitation (THB-Rehab) service.
Design: Pragmatic randomised controlled trial with an integral health economic study.
Settings: Large UK teaching hospital, with community follow-up.
Subjects: Frail older people aged 70 years and older admitted to hospital as an acute medical emergency.
Measurements: Primary outcome: hospital length of stay; secondary outcomes: readmission, day 91-super spell bed days, functional ability, co-morbidity and health-related quality of life; cost-effectiveness analysis.
Results: A total of 250 participants were randomised. There was no significant difference in length of stay between the CIRACT and THB-Rehab service (median 8 versus 9 days; geometric mean 7.8 versus 8.7 days, mean ratio 0.90, 95% confidence interval (CI) 0.74–1.10). Of the participants who were discharged from hospital, 17% and 13% were readmitted within 28 days from the CIRACT and THB-Rehab services, respectively (risk difference 3.8%, 95% CI −5.8% to 13.4%). There were no other significant differences in any of the other secondary outcomes between the two groups. The mean costs (including NHS and personal social service) of the CIRACT and THB-Rehab service were £3,744 and £3,603, respectively (mean cost difference £144; 95% CI −1,645 to 1,934).
Conclusion: The CIRACT service does not reduce major hospital length of stay nor reduce short-term readmission rates, compared to the standard THB-Rehab service; however, a modest (<2.3 days) effect cannot be excluded. Further studies are necessary powered with larger sample sizes and cluster randomisation.
Trial registration: ISRCTN 94393315, 25th April 2013 |
| first_indexed | 2025-11-14T19:33:02Z |
| format | Article |
| id | nottingham-37617 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T19:33:02Z |
| publishDate | 2016 |
| publisher | Oxford University Press |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-376172024-08-15T15:20:40Z https://eprints.nottingham.ac.uk/37617/ The Community In-reach Rehabilitation and Care Transition (CIRACT) clinical and cost-effectiveness randomisation controlled trial in older people admitted to hospital as an acute medical emergency Sahota, Opinder Pulikottil-Jacob, Ruth Marshall, Fiona Montgomery, Alan Tan, Wei Sach, Tracey Logan, Pip Kendrick, Denise Watson, Alison Walker, Maria Waring, Justin Objective: To compare the clinical and cost-effectiveness of a Community In-reach Rehabilitation and Care Transition (CIRACT) service with the traditional hospital-based rehabilitation (THB-Rehab) service. Design: Pragmatic randomised controlled trial with an integral health economic study. Settings: Large UK teaching hospital, with community follow-up. Subjects: Frail older people aged 70 years and older admitted to hospital as an acute medical emergency. Measurements: Primary outcome: hospital length of stay; secondary outcomes: readmission, day 91-super spell bed days, functional ability, co-morbidity and health-related quality of life; cost-effectiveness analysis. Results: A total of 250 participants were randomised. There was no significant difference in length of stay between the CIRACT and THB-Rehab service (median 8 versus 9 days; geometric mean 7.8 versus 8.7 days, mean ratio 0.90, 95% confidence interval (CI) 0.74–1.10). Of the participants who were discharged from hospital, 17% and 13% were readmitted within 28 days from the CIRACT and THB-Rehab services, respectively (risk difference 3.8%, 95% CI −5.8% to 13.4%). There were no other significant differences in any of the other secondary outcomes between the two groups. The mean costs (including NHS and personal social service) of the CIRACT and THB-Rehab service were £3,744 and £3,603, respectively (mean cost difference £144; 95% CI −1,645 to 1,934). Conclusion: The CIRACT service does not reduce major hospital length of stay nor reduce short-term readmission rates, compared to the standard THB-Rehab service; however, a modest (<2.3 days) effect cannot be excluded. Further studies are necessary powered with larger sample sizes and cluster randomisation. Trial registration: ISRCTN 94393315, 25th April 2013 Oxford University Press 2016-10-06 Article PeerReviewed Sahota, Opinder, Pulikottil-Jacob, Ruth, Marshall, Fiona, Montgomery, Alan, Tan, Wei, Sach, Tracey, Logan, Pip, Kendrick, Denise, Watson, Alison, Walker, Maria and Waring, Justin (2016) The Community In-reach Rehabilitation and Care Transition (CIRACT) clinical and cost-effectiveness randomisation controlled trial in older people admitted to hospital as an acute medical emergency. Age and Ageing, 46 (1). pp. 26-32. ISSN 1468-2834 older people; care transition; transition coach; community rehabilitation; in-reach; readmission; hospital length of stay; cost-effectiveness https://academic.oup.com/ageing/article/46/1/26/2605712/The-Community-In-reach-Rehabilitation-and-Care doi:10.1093/ageing/afw149 doi:10.1093/ageing/afw149 |
| spellingShingle | older people; care transition; transition coach; community rehabilitation; in-reach; readmission; hospital length of stay; cost-effectiveness Sahota, Opinder Pulikottil-Jacob, Ruth Marshall, Fiona Montgomery, Alan Tan, Wei Sach, Tracey Logan, Pip Kendrick, Denise Watson, Alison Walker, Maria Waring, Justin The Community In-reach Rehabilitation and Care Transition (CIRACT) clinical and cost-effectiveness randomisation controlled trial in older people admitted to hospital as an acute medical emergency |
| title | The Community In-reach Rehabilitation and Care Transition (CIRACT) clinical and cost-effectiveness randomisation controlled trial in older people admitted to hospital as an acute medical emergency |
| title_full | The Community In-reach Rehabilitation and Care Transition (CIRACT) clinical and cost-effectiveness randomisation controlled trial in older people admitted to hospital as an acute medical emergency |
| title_fullStr | The Community In-reach Rehabilitation and Care Transition (CIRACT) clinical and cost-effectiveness randomisation controlled trial in older people admitted to hospital as an acute medical emergency |
| title_full_unstemmed | The Community In-reach Rehabilitation and Care Transition (CIRACT) clinical and cost-effectiveness randomisation controlled trial in older people admitted to hospital as an acute medical emergency |
| title_short | The Community In-reach Rehabilitation and Care Transition (CIRACT) clinical and cost-effectiveness randomisation controlled trial in older people admitted to hospital as an acute medical emergency |
| title_sort | community in-reach rehabilitation and care transition (ciract) clinical and cost-effectiveness randomisation controlled trial in older people admitted to hospital as an acute medical emergency |
| topic | older people; care transition; transition coach; community rehabilitation; in-reach; readmission; hospital length of stay; cost-effectiveness |
| url | https://eprints.nottingham.ac.uk/37617/ https://eprints.nottingham.ac.uk/37617/ https://eprints.nottingham.ac.uk/37617/ |