Statistical methods
REGRESSION, SECONDARY, ADVERSE EVENT
Descriptive statistics for episodes of care occurring in ED ACE hours (Monday to Friday, 8am to 4 pm) are presented as count and percentages for categorical data. Mean and standard deviation (SD) and median (with minima and maxima) for continuous data are presented. The measures presented are the proportions of episodes of care by type of contact.This was an intention to treat analysis. Intention to treat in this context means that all calls which occurred after the implementation of the intervention were deemed to be VTC calls regardless of whether they were a phone call or VTC.The number of ED (physical) presentations were aggregated at the RACF level for each study month. Months were classified as pre or post-implementation, based on the month that the intervention was first implemented. There was an RACF “settling in period” of two weeks that allowed close surveillance of barriers and enablers that didn’t affect the VTC count. The month that the intervention was first implemented in an RACF, and all following months, were classified as post-implementation; regardless of on which day the implementation occurred. The rate of ED presentations per 100 RACF beds was modelled using a mixed effects negative binomial regression model with the number of ED presentations per month for each RACF as the outcome and the log number of beds per 100 RACF beds as the offset. The analysis included terms for study month (as categorical) and implementation status (pre or post-implementation) as fixed effects. The categorical study month variable was used to adjust for potential effects of underlying secular trends at each discrete time point which was assumed to be common among all sites. Random intercepts for cluster and RACF nested within cluster were included in the model. The difference in rates of ED presentations between pre and post-implementation periods within ED ACE hours was examined and reported as incidence rate ratios (IRR) with 95% CI. The difference in rates of ED presentations between pre and post-implementation periods during ED ACE hours combined with non-ED ACE hours was also reported.The secondary outcome was presentations to ED within 48 h and not the same-day as the episode of care for RACF residents who had not presented to ED after a VTC. This outcome was assessed by auditing the results of the 24-h phone call and comparing to the reason for the ED presentation to decide if an adverse event had occurred.A disadvantage of modelling the rate of ED presentations per month per RACF is that it does not consider the actual number of episodes of care. Episodes of care where an ED ACE/VTC was conducted, and the resident did not attend ED are not explicitly included as data when modelling the rate of ED presentations. Therefore, in a post-hoc analysis, a logistic regression was conducted on all episodes of care with ED presentation (yes/no) as the outcome, variables for pre and post-implementation and study month fitted as fixed effects and adjusting for resident gender and age. This analysis defined the pre/post-implementation status based on the actual date of the implementation, not the month of implementation, and estimated the odds of an episode of care resulting in an ED presentation post-implementation relative to pre-implementation. Random intercepts for cluster and RACF nested within cluster were included in the model.To assess uptake of VTC, the proportion of ED ACE calls conducted pre-implementation and the proportion of ED ACE/VTCs post-implementation are presented.