Implementation and Evaluation of a Complex Intervention to Reduce Avoidable Transitions Between Nursing Home and Hospital

Hospital admissions can have a negative impact on the physical and emotional health of nursing home residents. Although evidence-based interventions have been developed to reduce hospitalisations, the evidence regarding their effectiveness is inconclusive and challenges have been reported in implementing these interventions within the nursing home context. Hence, this study aimed to implement and evaluate a complex intervention to reduce avoidable transitions between nursing home and hospital (RATHER-NH).

Inclusion criteria for nursing homes: * A capacity of at least 60 beds * Active engagement for the study from nursing home management, head nurses and the coordinating \& advisory physician, meaning: 1. The nursing home manager, head nurses and the coordinating \& advisory physician agree that the implementation of the RATHER-NH intervention is a priority for their facility. 2. The nursing home manager agrees to provide time for the nursing home staff members to participate in activities related to the implementation of RATHER-NH such as attending information sessions, training workshops, and feedback moments. 3. The nursing home manager is willing to allocate time to at least two nursing home staff members (each approximately 0.1 FTE for the study duration) to act as local project champions and to at least four other staff members (type of staff to be decided with the nursing home manager) to form a local action team to support the implementation and evaluation of RATHER-NH. Exclusion criteria for nursing homes: * Already participated in another project designed to reduce potentially avoidable hospitalisations. * Already taking part in another major quality improvement initiative or study. * A large reorganisation or change in staff is taking place or is planned during the study period.