The effect of using telehealth to train residential aged care facility staff in delivery of palliative care to residents on the rate of unplanned hospitalisation admissions and quality of end-of-life care

INTERVENTION: The IMPART intervention is actively implemented over a 6‐month period. There are 10 residential aged care facilities (RACFs) completing the stepped‐wedge trial. At the start of the trial all facilities will be randomised to receive the intervention at one of 5 steps with two RACFs actively implementing the intervention during each step. Therefore the trial will occur over 2.5 years (5 X 6‐month steps). The 6‐month intervention involves five components described in a manual to support facility staff to implement the intervention. If the intervention is successful, the manual will be made publicly available on the NARI website so that other facilities can implement the intervention and access the templates required. After each RACF completes their active 6‐month part of the intervention, the RACF will be able to use the knowledge, strategies and specialist connections and apply them for the subsequent 6‐month steps of the trial and into the future. For each active 6 ‐month intervention period, the specialist in‐reach support will be funded 0.1 EFT to support engagement with the facility. We will aim to hold meetings and workshops in person at the facility, however, we also aim to enable video‐conferencing to facilitate external staff involvement. COMPONENT 1: ESTABLISH PLANNING AHEAD TEAMS (Month 1) The research team will work collaboratively with the RACF to establish the facility ‘Planning Ahead Team’. The RACF will identify staff to be involved, which could include nurses with a portfolio of palliative care, clinical care coordinators, or staff who have an interest in end‐of‐life care. We will engage senior nurses as care champions who will be able to support other staff in palliative care discussions and processes. The lead of the Planning Ahead Team will suppo CONDITION: Palliative care;End of life care; ; Palliative care ; End of life care Public Health ‐ Health service research PRIMARY OUTCOME: Rate of unplanned hospitalisations per 1000 bed days of aged care residents extracted from the Victorian Admitted Episodes Dataset[6 months prior to the active intervention (pre‐trial), and every 6 months until 6 months after the final cluster has been randomised] INCLUSION CRITERIA: Residents: All residents living permanently in the participating RACFs will be eligible to take part in this research. Family members or friends of eligible residents, including families of residents who die during the study and wish to take part in the post‐death survey. GPs, RACF senior nurses and clinical care coordinators liaising with or working within the participating RACFs will be eligible to participate. SECONDARY OUTCOME: Length of stay in days of unplanned hospital admissions per 1000 bed days of aged care residents extracted from Victorian Admitted Episodes Dataset[6 months prior to the active intervention (pre‐trial), and every 6 months until 6 months after the final cluster has been randomised] ICECAP‐Supportive Care Measure completed by resident or proxy (family or staff)[At baseline (pre‐trial), and every 6 months until 6 months after the final cluster has been randomised] Comfort Assessment in Dying (CAD) survey with family members of residents who die during the trial period (both in the intervention and the control/waiting arm)[2‐4 months after the resident's death] Satisfaction with Care at End of Life survey with family members of residents who die during the trial period (both in the intervention and the control/waiting arm)[2‐4 months after the resident's death] Cost‐effectiveness (Costs of implementing trial ‐ staffing, resources etc recorded through activity logs; Medicare and Pharmaceutical Benefits Scheme data for health care costs; hospitalisation and emergency presentation costs[Every 6 months until 6 months after the final cluster has been randomised] ICECAP‐ Close Person Measure with family members of residents who die during the trial period (both in the intervention and the control/waiting arm)[2‐4 months after the resident's death] Rate of emergency department presentations per 1000 bed days of aged care residents extracted from the Victorian Emergency Minimum Dataset[6 months prior to the active intervention (pre‐trial), and every 6 months until 6 months after the final cluster has been randomised]