Background
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MAY
There has been a 31% increase in admissions in aged care services in the last decade, and today more than 200,000 Australians live in residential aged care (RAC) homes [Hospital avoidance initiatives have been developed to promote better resident and health service outcomes. ‘Early Detection of Deterioration In Elderly residents’ or ‘EDDIE’ is a model of care developed and piloted at a not-for-profit aged care organisation in regional Queensland, Australia [EDDIE + is an expanded and refined intervention that has been implemented and evaluated using a stepped-wedge cluster randomised trial in 11 RAC homes across Queensland, from March 2021 to May 2022 [Bridging the divide between pilot research and large-scale implementation is often fraught, resulting in many interventions with promising pilot study evidence, failing to be successfully adopted more broadly [The integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework [i-PARIHS was identified as a good fit for the project, as facilitation and clinical support is one of the key components of the EDDIE + intervention, and, given that implementation would be in multiple sites, context needed to be comprehensibly considered. Additional guidance was also sought from the 2008 Medical Research Council’s (MRC) guide ‘Developing and evaluating complex interventions’ [Of note, four years had passed between the pilot studies and development of the multi-site intervention trial. New evidence and policy changes in the aged care sector meant review and refinement were necessary. Further, the intervention was to be implemented in a stepped-wedge cluster randomised trial, across multiple sites, so a clear structured process for planning and evaluating the implementation was essential for the required rigour of this study design, and to inform the proposed process evaluation [A commonly cited criticism in health research is that the reporting of interventions lack sufficient detail to enable future replication [