A randomised control trial of a Quick response team for older people : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing at Massey University

Abstract

A Randomised Controlled Trial of a Quick Response Team for Older People Who Have Experienced a Health Crisis This research investigated the impact of Quick Response Team (QRT) care on levels of independence in older people at three months, as measured by changes in living accommodation and home support packages. It was part of a large collaborative project, a randomised clinical controlled trial that tested efficacy, safety, and cost sayings of a crisis intervention programme for older people in Central Auckland. The QRT, an intensive short-term multidisciplinary scheme developed in Canada, was evaluated as being very effective in preventing hospital admissions and enabling early discharges. This study explored the effectiveness of QRT care within the context of health care in New Zealand. The study population included people over 55 years of age who lived at home and, mainly due to increased social needs, would normally be cared for in hospital. QRT nurses and geriatricians at Auckland Hospital identified and screened patients, in the Emergency Department for the Admission Prevention arm of the study, and on in-patient wards for the Early Discharge arm of the study. Data on age, gender, demographics, problems, and reasons for seeking hospital care were obtained from patient records and through personal and telephone interviews with patients, family, hospital staff, GPs, and community health providers. QRT nurses completed comprehensive assessments at study entry including details about: living accommodation and the use of formal supports, such as District Nursing, rehabilitation therapy, meal services, home help, day programmes, and respite care. Consenting patients (Ṉ = 285) were randomly assigned either to control groups receiving the usual in-patient hospital care or to experimental groups receiving QRT care. Visiting nurses, rehabilitation therapists, and social workers provided care and coordinated home supports for the QRT intervention groups, which included live-in home help if required. Medical supervision was provided by hospital geriatricians in a shared role with GPs. Interviews were completed again three months after study entry. Subjects in all groups after three months showed an increase in dependency as evidenced by changes in living accommodation and care support packages, however there were no significant differences in the changes between the experimental and control groups (p < 0.05). Therefore, regarding levels of independence, care at home by the QRT was judged to be as effective as hospital care for older people experiencing a health crisis. The results obtained in this study need to be considered along with the results of the larger tial.