Life In The Slower Lane

Here is the structured PICO analysis for the forty-first article you uploaded:

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Full Title (verbatim and exact):

“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”

Sampson EL, Feast A, Blighe A, et al.

BMJ Open (2019); 9:e026510

DOI: https://doi.org/10.1136/bmjopen-2018-026510

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Type of Article:

Protocol for a pilot cluster-randomised controlled trial

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PICO Analysis:

Population:

• Residents of 14 UK nursing homes (8 in West Yorkshire, 6 in London)
• All participants aged ≥65 years
• Included residents with multimorbidity and frailty at risk of avoidable admissions
• Individual-level data collected from residents, staff, and care partners 

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Intervention:

The BHiRCH intervention is a multicomponent evidence-based strategy targeting ambulatory care sensitive conditions (ACSCs), with three core tools:

1. Stop and Watch Early Warning Tool – detects changes in resident condition by all staff/care partners
2. Care Pathway – decision support for four conditions (UTI, dehydration, respiratory infection, CHF)
3. SBAR communication tool – structured clinical handover to primary care

• Led by Practice Development Champions (PDCs) in each intervention home
• Supported by practice development support groups, monthly coaching, and resource handbooks 

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Comparator:

• Usual care in control homes, including local protocols and standard care procedures
• Control homes did not receive training or tools from the intervention 

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Outcome:

1. Person-centred outcomes:

• Resident-reported and proxy-rated quality of life using EQ-5D-5L
• Care partner engagement and role preference
• Barthel Index for functional status
• Measures collected pre-intervention, 6 months, and post-intervention 

2. Process outcomes:

• Primary outcome of the pilot study: feasibility and acceptability of intervention
• Metrics included:
  • Recruitment and consent rates
  • Intervention fidelity (number of Stop and Watch and Care Pathway uses)
  • Staff knowledge, confidence, and perceived support
  • Interviews with staff, care partners, and managers to assess implementation acceptability 

3. Health system outcomes:

• System-level outcomes included:
  • GP visits, ambulance calls, A&E attendance, and hospital admissions (especially for ACSCs)
  • Staff turnover and bed availability
  • Analysis of hospitalisation avoidability via Structured Implicit Record Review (SIRR)
  • Economic evaluation planned: QALYs, NHS/social care costs, and incremental cost per QALY gained 

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Summary Conclusion:

The BHiRCH pilot trial tests the feasibility and acceptability of a UK-adapted, multicomponent intervention designed to reduce avoidable hospital admissions in nursing home residents. Adapted from INTERACT and co-designed with stakeholders, the intervention targets early detection of deterioration (Stop and Watch), clinical escalation (Care Pathway), and structured GP communication (SBAR). It is delivered by in-house PDCs with external coaching. While not powered to detect clinical efficacy, this trial will inform a definitive RCT and generate key implementation and economic insights into care home hospital avoidance strategies.

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