Older people in residential aged care are a vulnerable group with a high risk of emergency acute admission to hospital. We expect that many hospitalisations could be avoided by improved management or by providing treatment within the facility, with better outcomes. In 2008 a census-type study of all facilities and residents across greater Auckland (6828 subjects; 91% of residents) repeated identical studies in 1988, 1993 and 1998. In 2008 we found increasing dependency in residents over the 20-year period, and high levels of medical instability. This proposal uses the 2008 study to prospectively identify factors (relating to individuals and to facilities) predicting avoidable acute hospitalisation - and so allows identification/selection of facilities with high acute hospitalisation rates for a randomised controlled trial. The intervention will use multidisciplinary teams to support those facilities and up-skill staff using known quality improvement interventions, to test whether acute admissions are reduced and primary care improved.