Evaluating the Further Enabling Care at Home (FECH) post-discharge program as a way to support carers of older hospital patients

INTERVENTION: The Further Enabling Care at Home (FECH) program is a post‐discharge telephone caregiving support program for carers of older medical patients discharged home from hospital. There are three manuals used in the support of this program: a FECH training manual for preparing those who will deliver the intervention (FECH nurses), a FECH implementation manual to support the FECH Nurses in their role, and a resource manual (tailored to each of the two states involved) that documents resources available to provide support for carers, including resources that can help them learn more about the care recipient's health condition (eg, Carers WA, Alzheimers WA, Motor Neurone Disease Association). Training is to be delivered to FECH Nurses over three days and will include: (a) determining the extent and type of discharge information provided to the carer, any clarification needed or additional information required (delivered by a nurse with an acute care background); (b) using the Carer Support Needs Assessment Tool (CSNAT) approach(1) (delivered by a nurse with expertise in carer support plus a palliative care researcher who has trialled this tool in palliative home care); (c) embedding a problem‐solving approach for carers so that it can be used in the longer term, after the program has ended (delivered by a psychologist with special expertise in this area); and (d) types of resources that may be helpful to carers (delivered by a nurse with a background in carer support). Attendance lists will be kept to document FECH Nurse training attendance and FECH Nurses will be required to attest to their having completed the required on‐line training prior to the face‐to‐face training. The CSNAT approach is used as part of the FECH program, to help ca CONDITION: Ageing; ; Ageing Public Health ‐ Health service research PRIMARY OUTCOME: Change in carers' self‐reported Health Related Quality of Life (HRQoL) expressed in terms of AQol‐8D scores*; ; *Richardson J., Iezzi A., Khan M.A., A. M. Validity and reliability of the Assessment of Quality of Life (AQoL‐8D) multi attribute utility instrument Patient. 2014;7(1):85‐96.[Time 1 (T1, baseline, within 4 days of discharge of the care recipient), T2 (3 months post‐discharge), T3 (6 months post discharge ‐ primary timepoint), T4 (12 months post‐discharge).] Costs will be determined using linked health service administrative data (carers and care recipients), PBS and MBS data (carers and care recipients), and information collected from carers about use of residential aged care for care recipients (using costs available from government reports), We will use the AQOL‐8D questionaire. Cost‐effectiveness for carers, defined as having an incremental cost‐effectiveness ratio of less than AUD$50,000/QALY gained.[Discharge date for the patient's index admission until at least 12 months after this date. ] SECONDARY OUTCOME: Change in carers' caregiving distress expressed as a change in the distress scores from the Family Appraisal of Caregiving Questinnaire ‐ Palliative Care (FACQ).* ; ; *Cooper B, Kinsella GJ, Picton C. Development and initial validation of a family appraisal of caregiving questionnaire for palliative care. Psychooncology. 2006;15(7):613‐22.[T2 (3 months post‐discharge), T3 (6 months post discharge), T4 (12 months post‐discharge).] Change in carers' caregiving self‐efficacy scores expressed as a change scores from the Caregiver Inventory* ; ; ; ; ; ; ; ; From T1 to T4 (12 months post‐discharge).] Difference in time to permanent admission into residential aged care for the patient, from carer reports.[From T1 to T4 (12 months post‐discharge).] INCLUSION CRITERIA: Included dyads will comprise: (b) that older person (the care recipient). ; Merluzzi T, Philip E, Vachon D, Heitzmann C. Assessment of self‐efficacy for caregiving: The critical role of self‐care in caregiver stress and burden. Palliat Support Care. 2011;9(1):15‐24.[T3 (6 months post discharge), T4 (12 months post‐discharge).] Change in carers' caregiving strain expressed as a change in the strain scores from the Family Appraisal of Caregiving Questinnaire ‐ Palliative Care (FACQ).* ; *Cooper B, Kinsella GJ, Picton C. Development and initial validation of a family appraisal of caregiving questionnaire for palliative care. Psychooncology. 2006;15(7):613‐22.[T2 (3 months post‐discharge), T3 (6 months post discharge), T4 (12 months post‐discharge).] Change in carers' emergency presentations to hospital (from routinely collected [linked] administrative data). [From the 12 months before until the 12 months after the patient's index separation, ] Change in carers' preparedness for caregiving expressed as a change in the Preparedness for Caregiving (PCS) score* ; *Archbold PG, Stewart BJ, Greenlick MR, Harvath T. Mutuality and preparedness as predictors of caregiver role strain. Res Nurs Health. 1990;13(6):375‐84.[T2 (3 months post‐discharge), T3 (6 months post discharge), T4 (12 months post‐discharge). ; *Yeo D, Faleiro R, Lincoln NB. Barthel ADL index: A comparison of administration methods. Clin Rehabil. 1995;9(1):34‐9.[T2 (3 months post‐discharge), T3 (6 months post discharge), T4 (12 months post‐discharge).] Changes in patient symptom distress scores expressed using the Symptom Assessment Scale* (patient reports or carer proxy reports if patient reports cannot be accessed). ; *Aoun S, Monterosso L, Kristjanson L, McConigley R. Measuring symptom distress in palliative care: Psychometric properties of the Symptom Assessment Scale. J Palliat Med. 2011;14(3):315‐21.[T2 (3 months post‐discharge), T3 (6 months post discharge), T4 (12 months post‐discharge).] Difference in service use (home care services or residential respite care) for the patient, from carer reports.[ (a) one adult (aged 18+) carer who provides regular , ongoing , home‐based physical and/or emotional care to a person aged 70 or older, when this person is returning home (discharged) from an included ward after a medical (as opposed to surgical) admission and ; ] Change in patients' emergency presentations to hospital (from routinely collected [linked] administrative data).[From the 12 months before until the 12 months after the patient's (ie, the care recipient's) index separation. ] Change in the number of ambulance trips for the carer (from routinely collected [linked] administrative data). [From the 12 months before until the 12 months after the patient's index separation.] Change in the number of ambulance trips for the patient (from routinely collected [linked] administrative data). [From the 12 months before until the 12 months after the patient's index separation.] Change in the number of days spent in hospital for carers (from routinely collected [linked] administrative data). [From the 12 months before until the 12 months after the patient's index separation.] Change in the number of days spent in hospital for patients (ie, care recipients) (from routinely collected [linked] administrative data). .[From the 12 months before until the 12 months after the patient's index separation.] Change in the use of medications for the carer (from routinely collected [linked] administrative data, Pharmaceutical Benefits Scheme).[From the 12 months before until the 12 months after the patient's index separation.] Change in the use of medications for the patient (from routinely collected [linked] administrative data, Pharmaceutical Benefits Scheme).[From the 12 months before until the 12 months after the patient's index separation.] Change in the use of primary health services for the carer (from routinely collected [linked] administrative data, Medicare Benefits Schedule) .[From the 12 months before until the 12 months after the patient's index separation.] Change in the use of primary health services for the patient (from routinely collected [linked] administrative data, Medicare Benefits Schedule).[From the 12 months before until the 12 months after the patient's index separation.] Changes in patient independence expressed using the Barthel Activities of Daily Living Index* (carer reports).