BHiRCH: Better Health in Residents in Care Homes

Funded by a National Institute for Health Research programme grant, this study aims to develop and test a complex intervention to reduce rates of avoidable hospital admissions from nursing homes.

Project summary 

Many older people go to hospital for conditions that could have been treated in the care home. Avoidable hospital admissions are often for:

  • acute exacerbation of congestive heart failure
  • respiratory infections
  • urinary tract infection
  • dehydration

Hospitalisation is distressing to the person, their family and nursing home staff and costly to the NHS and can be. Early identification of changes in residents' health is essential to ensure active health care in nursing homes. The 39 month-long study is based in London and in West Yorkshire and started in June 2015.

Plan of work

In year one: We developed the components of this complex intervention by reviewing the pre-existing literature and engaging with clinicians, care home staff, family members. This involves providing education for nurses and care assistants, implementing care protocols and pathways, promoting and understanding family involvement, and support for making change happen. Alongside training days, a study manual and handbooks have been developed for care home staff to achieve these aims.

In years two and three:

  • Feasibility Study

Our aim was to refine study procedures in two care homes in preparation for the pilot cluster randomised study. We tested the intervention in two care homes in Yorkshire over a 4-month period recruiting resident, family members and care home staff.

We have refined our understanding of how best to bring about change in care homes. Intervention resources have been simplified and there will be a greater focus on implementation support. The feasibility results signal that this could be a worthwhile intervention and taken to pilot stage.

  • Pilot Cluster Randomised Trial

This will indicate whether a further definitive study is warranted. We have recruited 14 care homes, 6 in Greater London and 8 in West Yorkshire who are interested in participating in this trial. Half of the homes will receive the intervention and half will receive usual care. Individual, process, system and economic data will be collected across a 16-month period.

For more information, please visit the BHiRCH web site:

BHiRCH website