scholarly journals 1683. Hospital Admission Patterns in Adult Patients with Complicated Urinary Tract Infections (cUTIs): Identification of Potentially Avoidable Hospital Admissions Across United States (US) Hospitals

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S825-S826
Author(s):  
Thomas Lodise ◽  
Teena Chopra ◽  
Brian Nathanson ◽  
Katherine Sulham
Keyword(s):  
Hospital Admission ◽  
Hospital Admissions ◽  
Panel Member ◽  
Inclusion Criteria ◽  
Independent Contractor ◽  
Healthcare Database ◽  
Admission Rates ◽  
Comorbidity Index ◽  
Multi Center Study ◽  
Tract Infections

Abstract Background There is an increase in hospital admissions for cUTI in the US despite apparent reductions in the severity of admissions. However, there are scant data on cUTI hospital admission rates from the emergency department (ED) stratified by age, infection severity, and presence of comorbidities. This study described US hospitalization patterns among adults who present to the ED with a cUTI. We sought to quantify the proportion of admissions that were potentially avoidable based on presence of sepsis and associated symtpoms as well as Charlston Comorbidity Index (CCI) scores. Methods A retrospective multi-center study using data from the Premier Healthcare Database (2013-18) was performed. Inclusion criteria: (1) age ≥ 18 years, (2) primary cUTI ED/inpatient discharge diagnosis, (3) positive blood or urine culture between index ED service days -5 to +2. Transfers from acute care facilities were excluded. Based on ICD-9/10 diagnosis codes present on admission, incidence of hospital admissions were stratified by age (≥ 65 years vs. < 65 years), presence of sepsis (S), sepsis symptoms but no sepsis codes (SS) (e.g., fever, tachycardia, tachypnea, leukocytosis, etc.), and CCI. Results 187,789 patients met inclusion criteria. The mean (SD) age was 59.7 (21.9), 40.4% were male, 29.4% had sepsis, 16.7% had at least 1 SS symptom (but no S), and 53.9% had no evidence of S or SS. The median [IQR] CCI was 1 [0, 3]. 119,668 out of 187,789 (63.7%) were admitted to hospital. Among inpatients, median [IQR] length of stay (LOS) and total costs were 5 [3, 7] days and $7,956 [$4,834, $13,960] USD. Incidence of hospital admissions by age, presence of S/SS, and CCI score are shown in the Table. 18.9% of admissions (22,644/119,668) occurred in patients with no S/SS and a CCI ≤ 2. Their median [IQR] LOS and total costs were 3 [2, 5] days and $5,575 [$3,607, $9,133]. Incidence of Hospital Admission by Age, Charlson comorbidity index (CCI), Presence of Sepsis (S), and Presence of Sepsis Symptoms (SS) Conclusion Nearly 1 in 5 cUTI hospital admissions may be avoidable. Given the resources associated with the management of inpatients with cUTIs, these findings highlight the critical need for healthcare systems to develop well-defined criteria for hospital admission based on presence of comorbid conditions and infection severity. Preventing avoidable hospital admissions has the potential to save the healthcare system substantial costs. Disclosures Thomas Lodise, PharmD, PhD, Paratek Pharmaceuticals, Inc. (Consultant) Teena Chopra, MD, MPH, Spero Therapeutics (Consultant, Advisor or Review Panel member) Brian Nathanson, PhD, Spero Therapeutics (Independent Contractor) Katherine Sulham, MPH, Spero Therapeutics (Independent Contractor)

scholarly journals Associations between gestational age at birth and infection-related hospital admission rates during childhood in England: Population-based record linkage study

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257341
Author(s):  
Victoria Coathup ◽  
Claire Carson ◽  
Jennifer J. Kurinczuk ◽  
Alison J. Macfarlane ◽  
Elaine Boyle ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Gestational Age ◽  
Respiratory Tract Infections ◽  
Hospital Admissions ◽  
Population Based ◽  
Admission Rates ◽  
Tract Infections ◽  
Gestational Age At Birth ◽  
The Relationship ◽  
Age At Birth

Background Children born preterm (<37 completed weeks’ gestation) have a higher risk of infection-related morbidity than those born at term. However, few large, population-based studies have investigated the risk of infection in childhood across the full spectrum of gestational age. The objectives of this study were to explore the association between gestational age at birth and infection-related hospital admissions up to the age of 10 years, how infection-related hospital admission rates change throughout childhood, and whether being born small for gestational age (SGA) modifies this relationship. Methods and findings Using a population-based, record-linkage cohort study design, birth registrations, birth notifications and hospital admissions were linked using a deterministic algorithm. The study population included all live, singleton births occurring in NHS hospitals in England from January 2005 to December 2006 (n = 1,018,136). The primary outcome was all infection-related inpatient hospital admissions from birth to 10 years of age, death or study end (March 2015). The secondary outcome was the type of infection-related hospital admission, grouped into broad categories. Generalised estimating equations were used to estimate adjusted rate ratios (aRRs) with 95% confidence intervals (CIs) for each gestational age category (<28, 28–29, 30–31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41 and 42 weeks) and the models were repeated by age at admission (<1, 1–2, 3–4, 5–6, and 7–10 years). An interaction term was included in the model to test whether SGA status modified the relationship between gestational age and infection-related hospital admissions. Gestational age was strongly associated with rates of infection-related hospital admissions throughout childhood. Whilst the relationship attenuated over time, at 7–10 years of age those born before 40 weeks gestation were still significantly higher in comparison to those born at 40 weeks. Children born <28 weeks had an aRR of 6.53 (5.91–7.22) during infancy, declining to 3.16 (2.50–3.99) at ages 7–10 years, in comparison to those born at 40 weeks; whilst in children born at 38 weeks, the aRRs were 1·24 (1.21–1.27) and 1·18 (1.13–1.23), during infancy and aged 7–10 years, respectively. SGA status modified the effect of gestational age (interaction P<0.0001), with the highest rate among the children born at <28 weeks and SGA. Finally, study findings indicated that the associations with gestational age varied by subgroup of infection. Whilst upper respiratory tract infections were the most common type of infection experienced by children in this cohort, lower respiratory tract infections (LRTIs) (<28 weeks, aRR = 10.61(9.55–11.79)) and invasive bacterial infections (<28 weeks, aRR = 6.02 (4.56–7.95)) were the most strongly associated with gestational age at birth. Of LRTIs experienced, bronchiolitis (<28 weeks, aRR = 11.86 (10.20–13.80)), and pneumonia (<28 weeks, aRR = 9.49 (7.95–11.32)) were the most common causes. Conclusions Gestational age at birth was strongly associated with rates of infection-related hospital admissions during childhood and even children born a few weeks early remained at higher risk at 7–10 years of age. There was variation between clinical subgroups in the strength of relationships with gestational age. Effective infection prevention strategies should include focus on reducing the number and severity of LRTIs during early childhood.

scholarly journals Challenges of using asthma admission rates as a measure of primary care quality in children: An international comparison

2021 ◽  
pp. 135581962110127
Author(s):  
Irina Lut ◽  
Kate Lewis ◽  
Linda Wijlaars ◽  
Ruth Gilbert ◽  
Tiffany Fitzpatrick ◽  
...  
Keyword(s):  
Primary Care ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Underlying Disease ◽  
Primary Diagnosis ◽  
Care Quality ◽  
Attendance Rates ◽  
Admission Rates ◽  
Primary Care Quality ◽  
Hospital Administrative

Objectives To demonstrate the challenges of interpreting cross-country comparisons of paediatric asthma hospital admission rates as an indicator of primary care quality. Methods We used hospital administrative data from >10 million children aged 6–15 years, resident in Austria, England, Finland, Iceland, Ontario (Canada), Sweden or Victoria (Australia) between 2008 and 2015. Asthma hospital admission and emergency department (ED) attendance rates were compared between countries using Poisson regression models, adjusted for age and sex. Results Hospital admission rates for asthma per 1000 child-years varied eight-fold across jurisdictions. Admission rates were 3.5 times higher when admissions with asthma recorded as any diagnosis were considered, compared with admissions with asthma as the primary diagnosis. Iceland had the lowest asthma admission rates; however, when ED attendance rates were considered, Sweden had the lowest rate of asthma hospital contacts. Conclusions The large variations in childhood hospital admission rates for asthma based on the whole child population reflect differing definitions, admission thresholds and underlying disease prevalence rather than primary care quality. Asthma hospital admissions among children diagnosed with asthma is a more meaningful indicator for inter-country comparisons of primary care quality.

scholarly journals Association between home insulation and hospital admission rates: retrospective cohort study using linked data from a national intervention programme

BMJ ◽  
2020 ◽  
pp. m4571 ◽  
Author(s):  
Caroline Fyfe ◽  
Lucy Telfar ◽  
Barnard ◽  
Philippa Howden-Chapman ◽  
Jeroen Douwes
Keyword(s):  
Cohort Study ◽  
Heart Disease ◽  
Confidence Interval ◽  
Hospital Admission ◽  
Retrospective Cohort ◽  
Rate Ratio ◽  
Hospital Admissions ◽  
Relative Rate ◽  
Intervention Programme ◽  
Admission Rates

Abstract Objectives To investigate whether retrofitting insulation into homes can reduce cold associated hospital admission rates among residents and to identify whether the effect varies between different groups within the population and by type of insulation. Design A quasi-experimental retrospective cohort study using linked datasets to evaluate a national intervention programme. Participants 994 317 residents of 204 405 houses who received an insulation subsidy through the Energy Efficiency and Conservation Authority Warm-up New Zealand: Heat Smart retrofit programme between July 2009 and June 2014. Main outcome measure A difference-in-difference approach was used to compare the change in hospital admissions of the study population post-insulation with the change in hospital admissions of the control population that did not receive the intervention over the same two timeframes. Relative rate ratios were used to compare the two groups. Results 234 873 hospital admissions occurred during the study period. Hospital admission rates after the intervention increased in the intervention and control groups for all population categories and conditions with the exception of acute hospital admissions among Pacific Peoples (rate ratio 0.94, 95% confidence interval 0.90 to 0.98), asthma (0.92, 0.86 to 0.99), cardiovascular disease (0.90, 0.88 to 0.93), and ischaemic heart disease for adults older than 65 years (0.79, 0.74 to 0.84). Post-intervention increases were, however, significantly lower (11%) in the intervention group compared with the control group (relative rate ratio 0.89, 95% confidence interval 0.88 to 0.90), representing 9.26 (95% confidence interval 9.05 to 9.47) fewer hospital admissions per 1000 in the intervention population. Effects were more pronounced for respiratory disease (0.85, 0.81 to 0.90), asthma in all age groups (0.80, 0.70 to 0.90), and ischaemic heart disease in those older than 65 years (0.75, 0.66 to 0.83). Conclusion This study showed that a national home insulation intervention was associated with reduced hospital admissions, supporting previous research, which found an improvement in self-reported health.

scholarly journals Trends in admissions for acute respiratory infections in children: an inter-country comparison between Western Australia and England

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Hannah Moore ◽  
Tasmin Abdalla ◽  
Christopher Blyth ◽  
Ruth Gilbert ◽  
Pia Hardelid
Keyword(s):  
Western Australia ◽  
Hospital Admissions ◽  
Respiratory Infections ◽  
Laboratory Data ◽  
Primary Diagnosis ◽  
Respiratory Pathogens ◽  
Vaccination Programs ◽  
Admission Rates ◽  
Tract Infections ◽  
The Impact

ABSTRACTObjectiveAcute respiratory infections (ARI) including bronchiolitis, pneumonia and influenza are a major cause of hospital admissions in children worldwide. Linkage of administrative health datasets provides a platform to investigate temporal and seasonal trends in large populations over many years. We examined the similarities and differences in ARI admissions using linked datasets in Western Australia and England. ApproachThrough the availability of common data items in each jurisdiction, identical coding and data cleaning principles were applied to both datasets. Hospital admissions for ARI in children aged <5 years between 2000 and 2012 were identified using International Classification of Diseases diagnosis codes. Admission rates per 1000 child-years by age, gender and admission year were calculated in each jurisdiction. A total population birth cohort was available in Western Australia and the denominator was person time at risk whereas for England, all hospitalisations were used with the mid-year population as the denominator. ResultsThe overall incidence of ARI was 18.3/1000 child-years in Western Australia and 14.4/1000 in England. In both countries, the highest incidence of ARI was observed in infants (47.9/1000 child-years in Western Australia and 42.1/1000 child-years in England). Bronchiolitis was the most common primary diagnosis in infants in both countries, accounting for 79.7% of ARI admissions in Western Australia and 78.3% in England. The most common primary diagnosis in 1-4 year olds was unspecified lower respiratory tract infections in England (48.8% of ARI admissions in this age group) and pneumonia in Western Australia (43.9% of ARI admissions in 1-4-year-olds). The annual incidence rate for ARI hospitalisations declined in Western Australia from 2000 to 2006 and since remained steady. ARI admission rates increased in England throughout the study period. Admission rates across all age groups were 1.1-1.5 times higher in boys than girls in both countries. ConclusionThe availability of similar datasets in two economically similar countries in different hemispheres has afforded the opportunity to characterise and compare the epidemiology of paediatric respiratory infections over a 13 year period. Future analyses will allow us to assess differences in coding practices, seasonality and risk factors such as socio-economic deprivation and prematurity. Furthermore the availability of linked laboratory data for respiratory pathogens in each jurisdiction will allow for comparisons of pathogen-specific epidemiology and the impact of universal vaccination programs.

scholarly journals COVID-19 and delivery of difficult asthma services

2021 ◽  
pp. archdischild-2021-322335
Author(s):  
Anna-Louise Nichols ◽  
Mayank Sonnappa-Naik ◽  
Laura Gardner ◽  
Charlotte Richardson ◽  
Natalie Orr ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Multidisciplinary Team ◽  
Hospital Admissions ◽  
Forced Expiratory Volume ◽  
Acute Hospital ◽  
Attendance Rates ◽  
Face To Face ◽  
Admission Rates ◽  
Oral Corticosteroids ◽  
Difficult Asthma

The COVID-19 pandemic necessitated an urgent reconfiguration of our difficult asthma (DA) service. We rapidly switched to virtual clinics and rolled out home spirometry based on clinical need. From March to August 2020, 110 patients with DA (68% virtually) were seen in clinic, compared with March–August 2019 when 88 patients were seen face-to-face. There was DA clinic cancellation/non-attendance (16% vs 43%; p<0.0003). In patients with home spirometers, acute hospital admissions (6 vs 26; p<0.01) from March to August 2020 were significantly lower compared with the same period in 2019. There was no difference in the number of courses of oral corticosteroids or antibiotics prescribed (47 vs 53; p=0.81). From April to August 2020, 50 patients with DA performed 253 home spirometry measurements, of which 39 demonstrated >20% decrease in forced expiratory volume in 1 s, resulting in new action plans in 87% of these episodes. In our DA cohort, we demonstrate better attendance rates at virtual multidisciplinary team consultations and reduced hospital admission rates when augmented with home spirometry monitoring.

scholarly journals Variation in hospital admission in febrile children evaluated at the Emergency Department (ED) in Europe: PERFORM, a multicentre prospective observational study

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0244810
Author(s):  
Dorine M. Borensztajn ◽  
Nienke N. Hagedoorn ◽  
Irene Rivero Calle ◽  
Ian K. Maconochie ◽  
Ulrich von Both ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Admission ◽  
Disease Severity ◽  
Severe Disease ◽  
Patient Characteristics ◽  
Care Utilization ◽  
Upper Respiratory Tract ◽  
Admission Rates ◽  
Patient Groups ◽  
Tract Infections

Objectives Hospitalisation is frequently used as a marker of disease severity in observational Emergency Department (ED) studies. The comparison of ED admission rates is complex in potentially being influenced by the characteristics of the region, ED, physician and patient. We aimed to study variation in ED admission rates of febrile children, to assess whether variation could be explained by disease severity and to identify patient groups with large variation, in order to use this to reduce unnecessary health care utilization that is often due to practice variation. Design MOFICHE (Management and Outcome of Fever in children in Europe, part of the PERFORM study, www.perform2020.org), is a prospective cohort study using routinely collected data on febrile children regarding patient characteristics (age, referral, vital signs and clinical alarming signs), diagnostic tests, therapy, diagnosis and hospital admission. Setting and participants Data were collected on febrile children aged 0–18 years presenting to 12 European EDs (2017–2018). Main outcome measures We compared admission rates between EDs by using standardised admission rates after adjusting for patient characteristics and initiated tests at the ED, where standardised rates >1 demonstrate higher admission rates than expected and rates <1 indicate lower rates than expected based on the ED patient population. Results We included 38,120 children. Of those, 9.695 (25.4%) were admitted to a general ward (range EDs 5.1–54.5%). Adjusted standardised admission rates ranged between 0.6 and 1.5. The largest variation was seen in short admission rates (0.1–5.0), PICU admission rates (0.2–2.2), upper respiratory tract infections (0.4–1.7) and fever without focus (0.5–2.7). Variation was small in sepsis/meningitis (0.9–1.1). Conclusions Large variation exists in admission rates of febrile children evaluated at European EDs, however, this variation is largely reduced after correcting for patient characteristics and therefore overall admission rates seem to adequately reflect disease severity or a potential for a severe disease course. However, for certain patient groups variation remains high even after adjusting for patient characteristics.

scholarly journals The challenge of using routinely collected data to compare hospital admission rates by ethnic group: a demonstration project in Scotland

2019 ◽  
Vol 42 (4) ◽  
pp. 748-755 ◽  
Author(s):  
S Knox ◽  
R S Bhopal ◽  
C S Thomson ◽  
A Millard ◽  
A Fraser ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Ethnic Group ◽  
Ethnic Groups ◽  
Hospital Admissions ◽  
Heart Diseases ◽  
Equity In Health ◽  
Admission Rates ◽  
Group A ◽  
Rate Ratios ◽  
Equity In Health Care

Abstract Background Recording patients’ ethnic group supports efforts to achieve equity in health care provision. Before the Equality Act (2010), recording ethnic group at hospital admission was poor in Scotland but has improved subsequently. We describe the first analysis of the utility of such data nationally for monitoring ethnic variation. Methods We analysed all in-patient or day case hospital admissions in 2013. We imputed missing data using the most recent ethnic group recorded for a patient from 2009 to 2015. For episodes lacking an ethnic code, we attributed known ethnic codes proportionately. Using the 2011 Census population, we calculated rates and rate ratios for all-cause admissions and ischaemic heart diseases (IHDs) directly standardized for age. Results Imputation reduced missing ethnic group codes from 24 to 15% and proportionate redistribution to zero. While some rates for both all-cause and IHD admissions appeared plausible, unexpectedly low or high rates were observed for several ethnic groups particularly amongst White groups and newly coded groups. Conclusions Completeness of ethnicity recoding on hospital admission records has improved markedly since 2010. However the validity of admission rates based on these data is variable across ethnic groups and further improvements are required to support monitoring of inequality.

scholarly journals Death rate from ischaemic heart disease in Western Australian psychiatric patients 1980–1998

2003 ◽  
Vol 182 (1) ◽  
pp. 31-36 ◽  
Author(s):  
David M. Lawrence ◽  
Cashel D'Arcy ◽  
J. Holman ◽  
Assen V. Jablensky ◽  
Michael S. T. Hobbs
Keyword(s):  
Mental Illness ◽  
Heart Disease ◽  
General Population ◽  
Hospital Admission ◽  
Ischaemic Heart Disease ◽  
Excess Mortality ◽  
Hospital Admissions ◽  
Psychiatric Patients ◽  
Admission Rates ◽  
People With Mental Illness

BackgroundPeople with mental illness suffer excess mortality due to physical illnesses.AimsTo investigate the association between mental illness and ischaemic heart disease (IHD) hospital admissions, revascularisation procedures and deaths.MethodA population-based record-linkage study of 210 129 users of mental health services in Western Australia during 1980–1998. IHD mortality rates, hospital admission rates and rates of revascularisation procedures were compared with those of the general population.ResultsIHD (not suicide) was the major cause of excess mortality in psychiatric patients. In contrast to the rate in the general population, the IHS mortality rate in psychiatric patients did not diminish over time. There was little difference in hospital admission rates for IHD between psychiatric patients and the general community, but much lower rates of revascularisation procedures with psychiatric patients, particularly in people with psychoses.ConclusionsPeople with mental illness do not receive an equitable level of intervention for IHD. More attention to their general medical care is needed.

Preschool respiratory hospital admissions following infant bronchiolitis: a birth cohort study

2019 ◽  
Vol 104 (7) ◽  
pp. 658-663 ◽  
Author(s):  
Helen Skirrow ◽  
Thomas Wincott ◽  
Elizabeth Cecil ◽  
Alex Bottle ◽  
Ceire Costelloe ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Admission ◽  
Birth Cohort ◽  
Hospital Admissions ◽  
Public Hospitals ◽  
Birth Cohort Study ◽  
Comorbid Condition ◽  
Upper Respiratory Tract ◽  
Tract Infections ◽  
Children Under 5

BackgroundBronchiolitis causes significant infant morbidity worldwide from hospital admissions. However, studies quantifying the subsequent respiratory burden in children under 5 years are lacking.ObjectiveTo estimate the risk of subsequent respiratory hospital admissions in children under 5 years in England following bronchiolitis admission in infancy.DesignRetrospective population-based birth cohort study.SettingPublic hospitals in England.PatientsWe constructed a birth cohort of 613 377 infants born between 1 April 2007 and 31 March 2008, followed up until aged 5 years by linking Hospital Episode Statistics admissions data.MethodsWe compared the risk of respiratory hospital admission due to asthma, wheezing and lower and upper respiratory tract infections (LRTI and URTI) in infants who had been admitted for bronchiolitis with those who had not, using Cox proportional hazard regression. We adjusted hazard ratios (HR) for known respiratory illness risk factors including living in deprived households, being born preterm or with a comorbid condition.ResultsWe identified 16 288/613 377 infants (2.7%) with at least one admission for bronchiolitis. Of these, 21.7% had a further respiratory hospital admission by age 5 years compared with 8% without a previous bronchiolitis admission (HR (adjusted) 2.82, 95% CI 2.72 to 2.92). The association was greatest for asthma (HR (adjusted) 4.35, 95% CI 4.00 to 4.73) and wheezing admissions (HR (adjusted) 5.02, 95% CI 4.64 to 5.44), but were also significant for URTI and LRTI admissions.ConclusionsHospital admission for bronchiolitis in infancy is associated with a threefold to fivefold risk of subsequent respiratory hospital admissions from asthma, wheezing and respiratory infections. One in five infants with bronchiolitis hospital admissions will have a subsequent respiratory hospital admission by age 5 years.

scholarly journals 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

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e026510 ◽  
Author(s):  
Elizabeth L Sampson ◽  
Alexandra Feast ◽  
Alan Blighe ◽  
Katherine Froggatt ◽  
Rachael Hunter ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Hospital Admissions ◽  
Care Home ◽  
Care Homes ◽  
System Level ◽  
Link Type ◽  
Cluster Randomised ◽  
Level Data ◽  
Tract Infections ◽  
Practice Development

IntroductionAcute hospital admission is distressing for care home residents. Ambulatory care sensitive conditions, such as respiratory and urinary tract infections, are conditions that can cause unplanned hospital admission but may have been avoidable with timely detection and intervention in the community. The Better Health in Residents in Care Homes (BHiRCH) programme has feasibility tested and will pilot a multicomponent intervention to reduce these avoidable hospital admissions. The BHiRCH intervention comprises an early warning tool for noting changes in resident health, a care pathway (clinical guidance and decision support system) and a structured method for communicating with primary care, adapted for use in the care home. We use practice development champions to support implementation and embed changes in care.Methods and analysisCluster randomised pilot trial to test study procedures and indicate whether a further definitive trial is warranted. Fourteen care homes with nursing (nursing homes) will be randomly allocated to intervention (delivered at nursing home level) or control groups. Two nurses from each home become Practice Development Champions trained to implement the intervention, supported by a practice development support group. Data will be collected for 3 months preintervention, monthly during the 12-month intervention and 1 month after. Individual-level data includes resident, care partner and staff demographics, resident functional status, service use and quality of life (for health economic analysis) and the extent to which staff perceive the organisation supports person centred care. System-level data includes primary and secondary health services contacts (ie, general practitioner and hospital admissions). Process evaluation assesses intervention acceptability, feasibility, fidelity, ease of implementation in practice and study procedures (ie, consent and recruitment rates).Ethics and disseminationApproved by Research Ethics Committee and the UK Health Research Authority. Findings will be disseminated via academic and policy conferences, peer-reviewed publications and social media (eg, Twitter).Trial registration numberISRCTN74109734; Pre-results.

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