A randomised controlled trial evaluating the impact of the Supported Transfer & Accelerated Rehabilitation Team (START) for Accident Compensation Corporation (ACC) clients and how this compares to the usual ACC pathway of care for people over 65 years of age who have sustained an injury. The trial outcomes will focus on on hospital length of stay, subsequent hospitalisations, and cost for patients being discharged from hospital in the Waikato region who have recently sustained an injury.

In 2010 Waikato DHB commenced a pilot supported discharge service (Supported Transfer and Accelerated Rehabilitation Team, or START). A randomised controlled trial was carried out and completed, which compared this service to usual care in terms of client satisfaction, rehabilitation outcomes, hospital length of stay, subsequent hospitalisations, entry to residential care and cost. This trial did not include Accident Compensation Corporation (ACC) clients. This current study focusses on recruitment of ACC clients using a Randomised Control Trial methodology to investigate the benefits and costs of long-term funding of early supported discharge services for our clients and the usual care ACC pathway for people over the age of 65years. The service provides the following: 1. Facilitate timely and coordinated discharge home for medically stable adults who require ongoing support at home 2. Provide an immediate or rapid response to older people presenting in the emergency department who could be discharged directly home if appropriate home support services were established on discharge. The START team consists of Health Care Assistants (HCA) trained to Level III on the NZQA framework, Registered Nurses working at an advanced level of practice and Allied health (Physiotherapy and Occupational Therapy). In addition, Consultant Geriatricians provide weekly input through case conferencing. Within the START intervention, the initial visit to the client following discharge will involve the RN and HCA completing the following with the patient: 1. Assessment of need and determination of goals for the patient 2. Development of service plan to support goal attainment 3. Determination of the number of visits required to deliver the service plan Health Care Assistants will provide up to four visits a day, seven days a week and will utilise functional rehabilitation principles to maximise recovery through incorporating exercises within ADL tasks. For instance, progressively increasing walking distance, sit to stands, lying in bed to standing, carrying groceries home from shops and putting away in cupboards. The model focuses on maximising independence rather than fostering dependence and aligns with developing research in New Zealand and significantly, such exercise programmes can be successfully implemented by non-health professionals rather than Physiotherapists. Such a staffing compliment within START will maximise patient recovery and responsiveness and reduce fragmentation. There will be a minimum of weekly reviews / reassessment of the patient by RN and OT/ PT with changes made as required to the service plan. Once patients have returned home, direct clinical care responsibility returns to the General Practitioner (GP). The team will work in close collaboration with GPs and Practice Nurses as well as the specialist community teams and hospital services. The team will work with Patients until their return to independence or until stable but requiring continuing input from community nursing or home care support. Patients will be likely limited to six weeks maximum attendance, though the team on an exception basis may choose to extend this to maximise potential recovery. Patients will be supported to develop meaningful distal goals, which will be interpreted into a therapy ladder to support development of a care plan utilising functional rehabilitation principles.