DIVERT-Collaboration Action Research and Evaluation (CARE) Trial Protocol: a multiprovincial pragmatic cluster randomised trial of cardiorespiratory management in home care

Andrew P Costa, Connie Schumacher, Aaron Jones, Darly Dash, Graham Campbell, Mats Junek, Gina Agarwal, Chaim M Bell, Veronique Boscart, Susan E Bronskill, David Feeny, Paul C Hébert, George A Heckman, John P Hirdes, Linda Lee, Robert S McKelvie, Lori Mitchell, Samir K Sinha, Joy Davis, Tammy Priddle, Joanne Rose, Roslyn Gillan, Deborah Mills, Dilys Haughton, Andrew P Costa, Connie Schumacher, Aaron Jones, Darly Dash, Graham Campbell, Mats Junek, Gina Agarwal, Chaim M Bell, Veronique Boscart, Susan E Bronskill, David Feeny, Paul C Hébert, George A Heckman, John P Hirdes, Linda Lee, Robert S McKelvie, Lori Mitchell, Samir K Sinha, Joy Davis, Tammy Priddle, Joanne Rose, Roslyn Gillan, Deborah Mills, Dilys Haughton

Abstract

Introduction: Home care clients are increasingly medically complex, have limited access to effective chronic disease management and have very high emergency department (ED) visitation rates. There is a need for more appropriate and targeted supportive chronic disease management for home care clients. We aim to evaluate the effectiveness and preliminary cost effectiveness of a targeted, person-centred cardiorespiratory management model.

Methods and analysis: The Detection of Indicators and Vulnerabilities of Emergency Room Trips (DIVERT) - Collaboration Action Research and Evaluation (CARE) trial is a pragmatic, cluster-randomised, multicentre superiority trial of a flexible multicomponent cardiorespiratory management model based on the best practice guidelines. The trial will be conducted in partnership with three regional, public-sector, home care providers across Canada. The primary outcome of the trial is the difference in time to first unplanned ED visit (hazard rate) within 6 months. Additional secondary outcomes are to identify changes in patient activation, changes in cardiorespiratory symptom frequencies and cost effectiveness over 6 months. We will also investigate the difference in the number of unplanned ED visits, number of inpatient hospitalisations and changes in health-related quality of life. Multilevel proportional hazard and generalised linear models will be used to test the primary and secondary hypotheses. Sample size simulations indicate that enrolling 1100 home care clients across 36 clusters (home care caseloads) will yield a power of 81% given an HR of 0.75.

Ethics and dissemination: Ethics approval was obtained from the Hamilton Integrated Research Ethics Board as well as each participating site's ethics board. Results will be submitted for publication in peer-reviewed journals and for presentation at relevant conferences. Home care service partners will also be informed of the study's results. The results will be used to inform future support strategies for older adults receiving home care services.

Trial registration number: NCT03012256.

Keywords: DIVERT scale; cardio-respiratory; chronic disease management; cluster-randomised; disease management; home care.

Conflict of interest statement

Competing interests: It should be noted that DHF has a proprietary interest in Health Utilities Incorporated, Dundas, Ontario, Canada. HUInc distributes copyrighted Health Utilities Index materials and provides methodological advice on the use of the HUI.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Caseload randomisation schematic. HNHB LHIN, Hamilton-Niagara-Haldimand-Brant Local Health Integration Network.
Figure 2
Figure 2
Detection of Indicators and Vulnerabilities of Emergency Room Trips scale target groups. ED, emergency department; UTI, Urinary Tract Infection

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