scholarly journals Understanding implementation fidelity in a pragmatic randomized clinical trial in the nursing home setting:a mixed-methods examination

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Jennifer A. Palmer ◽  
Victoria A. Parker ◽  
Lacey R. Barre ◽  
Vincent Mor ◽  
Angelo E. Volandes ◽  
...  
Keyword(s):  
Nursing Home ◽  
Mixed Methods ◽  
Nursing Homes ◽  
Randomized Clinical Trials ◽  
Pragmatic Trial ◽  
Implementation Fidelity ◽  
Status Report ◽  
Program Participant ◽  
Participant Responsiveness ◽  
Core Elements

Abstract Background The Pragmatic Trial of Video Education in Nursing Homes (PROVEN) is one of the first large pragmatic randomized clinical trials (pRCTs) to be conducted in U.S. nursing homes (N = 119 intervention and N = 241 control across two health-care systems). The trial aims to evaluate the effectiveness of a suite of videos to improve advance care planning (ACP) for nursing home patients. This report uses mixed methods to explore the optimal and suboptimal conditions necessary for implementation fidelity within pRCTs in nursing homes. Methods PROVEN’s protocol required designated facility champions to offer an ACP video to long-stay patients every 6 months during the 18-month implementation period. Champions completed a video status report, stored within electronic medical records, each time a video was offered. Data from the report were used to derive each facility’s adherence rate (i.e., cumulative video offer). Qualitative interviews held after 15 months with champions were purposively sampled from facilities within the highest and lowest adherence rates (i.e., those in the top and bottom quintiles). Two researchers analyzed interview data thematically using a deductive approach based upon six domains of the revised Conceptual Framework for Implementation Fidelity (CFIF). Matrices were developed to compare coded narratives by domain across facility adherence status. Results In total, 28 interviews involving 33 champions were analyzed. Different patterns were observed across high- versus low-adherence facilities for five CFIF domains. In low-adherence nursing homes, (1) there were limited implementation resources (Context), (2) there was often a perceived negative patient or family responsiveness to the program (Participant Responsiveness), and (3) champions were reticent in offering the videos (Recruitment). In high-adherence nursing homes, (1) there was more perceived patient and family willingness to engage in the program (Participant Responsiveness), (2) champions supplemented the video with ACP conversations (Quality of Delivery), (3) there were strategic approaches to recruitment (Recruitment), and (4) champions appreciated external facilitation (Strategies to Facilitate Implementation). Conclusions Critical lessons for implementing pRCTs in nursing homes emerged from this report: (1) flexible fidelity is important (i.e., delivering core elements of an intervention while permitting the adaptation of non-core elements), (2) reciprocal facilitation is vital (i.e., early and ongoing stakeholder engagement in research design and, reciprocally, researchers’ and organizational leaders’ ongoing support of the implementation), and (3) organizational and champion readiness should be formally assessed early and throughout implementation to facilitate remediation. Trial registration ClinicalTrials.gov, NCT02612688. Registered on 19 November 2015.

scholarly journals PRagmatic trial Of Video Education in Nursing homes: The design and rationale for a pragmatic cluster randomized trial in the nursing home setting

2017 ◽  
Vol 14 (2) ◽  
pp. 140-151 ◽  
Author(s):  
Vincent Mor ◽  
Angelo E Volandes ◽  
Roee Gutman ◽  
Constantine Gatsonis ◽  
Susan L Mitchell
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Advance Care Planning ◽  
Pragmatic Trial ◽  
Healthcare Systems ◽  
Care Planning ◽  
Home Setting ◽  
Randomized Controlled ◽  
Advance Care ◽  
Video Education

Background/Aims Nursing homes are complex healthcare systems serving an increasingly sick population. Nursing homes must engage patients in advance care planning, but do so inconsistently. Video decision support tools improved advance care planning in small randomized controlled trials. Pragmatic trials are increasingly employed in health services research, although not commonly in the nursing home setting to which they are well-suited. This report presents the design and rationale for a pragmatic cluster randomized controlled trial that evaluated the “real world” application of an Advance Care Planning Video Program in two large US nursing home healthcare systems. Methods PRagmatic trial Of Video Education in Nursing homes was conducted in 360 nursing homes (N = 119 intervention/N = 241 control) owned by two healthcare systems. Over an 18-month implementation period, intervention facilities were instructed to offer the Advance Care Planning Video Program to all patients. Control facilities employed usual advance care planning practices. Patient characteristics and outcomes were ascertained from Medicare Claims, Minimum Data Set assessments, and facility electronic medical record data. Intervention adherence was measured using a Video Status Report embedded into electronic medical record systems. The primary outcome was the number of hospitalizations/person-day alive among long-stay patients with advanced dementia or cardiopulmonary disease. The rationale for the approaches to facility randomization and recruitment, intervention implementation, population selection, data acquisition, regulatory issues, and statistical analyses are discussed. Results The large number of well-characterized candidate facilities enabled several unique design features including stratification on historical hospitalization rates, randomization prior to recruitment, and 2:1 control to intervention facilities ratio. Strong endorsement from corporate leadership made randomization prior to recruitment feasible with 100% participation of facilities randomized to the intervention arm. Critical regulatory issues included minimal risk determination, waiver of informed consent, and determination that nursing home providers were not engaged in human subjects research. Intervention training and implementation were initiated on 5 January 2016 using corporate infrastructures for new program roll-out guided by standardized training elements designed by the research team. Video Status Reports in facilities’ electronic medical records permitted “real-time” adherence monitoring and corrective actions. The Centers for Medicare and Medicaid Services Virtual Research Data Center allowed for rapid outcomes ascertainment. Conclusion We must rigorously evaluate interventions to deliver more patient-focused care to an increasingly frail nursing home population. Video decision support is a practical approach to improve advance care planning. PRagmatic trial Of Video Education in Nursing homes has the potential to promote goal-directed care among millions of older Americans in nursing homes and establish a methodology for future pragmatic randomized controlled trials in this complex healthcare setting.

scholarly journals Needs-based provision of medical care to nursing home residents: protocol for a mixed-methods study

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e025614 ◽  
Author(s):  
Jonas Czwikla ◽  
Maike Schulz ◽  
Franziska Heinze ◽  
Thomas Kalwitzki ◽  
Daniel Gand ◽  
...  
Keyword(s):  
Nursing Home ◽  
Mixed Methods ◽  
Nursing Homes ◽  
Medical Care ◽  
Delphi Study ◽  
Nursing Home Residents ◽  
Community Dwelling ◽  
Mixed Methods Study ◽  
Care Needs ◽  
Term Care

IntroductionNursing home residents typically have greater needs for medical care than community-dwelling elderly. However, restricted cognitive abilities and limited mobility may impede their access to general practitioners and medical specialists. The provision of medical care in nursing homes may therefore be inappropriate in some areas of medical care. The purpose of this mixed-methods study is to systematically assess, evaluate and explain met and unmet medical care needs in German nursing homes and to develop solutions where medical care is found to be inappropriate.Methods and analysisFirst, statutory health insurance claims data are analysed to identify differences in the utilisation of medical care between nursing home residents and community-dwelling elderly with and without need for long-term care. Second, the health status and medical care of 500 nursing home residents are assessed and evaluated to quantify met and unmet medical care needs. Third, qualitative expert interviews and case conferences and, fourth, quantitative analyses of linked data are used to provide structural, case-specific and generalisable explanations of inappropriate medical care among nursing home residents. Fifth, a modified Delphi study is employed to develop pilot projects aiming to improve medical care in nursing homes.Ethics and disseminationThis study was approved by the Ethics Committee of the University of Bremen on 23 November 2017. Research findings are disseminated through presentations at national and international conferences and publications in peer-reviewed scientific journals.Trial registration numberDRKS00012383.

scholarly journals An integrative counselling program to promote active ageing for older people in Thai nursing homes: an intervention mixed methods design

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Jantana Juthavantana ◽  
Nanchatsan Sakunpong ◽  
Ujsara Prasertsin ◽  
Monthira Charupheng ◽  
Sheibon Hassakama Lau
Keyword(s):  
Nursing Home ◽  
Mixed Methods ◽  
Nursing Homes ◽  
Older People ◽  
Phase 1 ◽  
The Elderly ◽  
Active Ageing ◽  
Phase 2 ◽  
Mixed Methods Design ◽  
Counselling Program

Abstract Background Active ageing has been a rapidly developing field of study in light of the growing population of older people. Acknowledgement of the lack of a counselling program to promote active ageing for the older people in nursing homes led to the development of this study which aims to investigate active ageing of the Thai elderly in a nursing home in addition to promoting active ageing for them through integrative counselling. Methods The study was conducted in a nursing home in Samut Prakan province, Thailand. The integrative counselling program referred to appropriate literature along with implementation of the Satir Model and Motivational Interviewing techniques. An intervention mixed methods design was applied in the study, which consisted of two phases. Phase 1 involved an investigation of the concept of active ageing, based on the context of older people in nursing homes by way of in-depth interviews, involving 5 participants. Phase 2 comprised of an investigation of the effects of an integrative counselling program to promote active ageing for older people in the same nursing home. There was a total of 16 participants in phase 2 which were divided equally into experimental and control groups respectively. Results Phase 1 of the study showcased qualitative results of the progress of active ageing development in older people that resulted in 4 sub-themes (Health development, spiritual development, active engagement and psychosocial support). Two parameters were used to analyze the results in phase 2. The quantitative results showed that the active ageing score of participants in the experimental arm increased significantly after enrollment (p < 0.05). Furthermore, the experimental group had a higher overall active ageing score in comparison to the control group. Qualitative results of phase 2 elicited factors promoting active ageing in the elderly which included activities, group facilitator and group atmosphere. Both quantitative and qualitative results of phase 2 proved to be significant, showing that the program managed to develop active ageing in participants. Conclusion Psychologists and multidisciplinary teams looking after older people in nursing homes are able to use this integrative counselling program for development of active ageing in the elderly population.

Implementation of core elements of antibiotic stewardship in nursing homes—National Healthcare Safety Network, 2016–2018

2021 ◽  
pp. 1-5
Author(s):  
Katryna A. Gouin ◽  
Sarah Kabbani ◽  
Angela Anttila ◽  
Josephine Mak ◽  
Elisabeth Mungai ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Antibiotic Stewardship ◽  
Antibiotic Use ◽  
Infection Prevention And Control ◽  
Term Care ◽  
National Healthcare ◽  
The Core ◽  
National Healthcare Safety Network ◽  
Core Elements

Abstract Objective: To assess the national uptake of the Centers for Disease Control and Prevention’s (CDC) core elements of antibiotic stewardship in nursing homes from 2016 to 2018 and the effect of infection prevention and control (IPC) hours on the implementation of the core elements. Design: Retrospective, repeated cross-sectional analysis. Setting: US nursing homes. Methods: We used the National Healthcare Safety Network (NHSN) Long-Term Care Facility Component annual surveys from 2016 to 2018 to assess nursing home characteristics and percent implementation of the core elements. We used log-binomial regression models to estimate the association between weekly IPC hours and the implementation of all 7 core elements while controlling for confounding by facility characteristics. Results: We included 7,506 surveys from 2016 to 2018. In 2018, 71% of nursing homes reported implementation of all 7 core elements, a 28% increase from 2016. The greatest increases in implementation from 2016 to 2018 were in education (19%), reporting (18%), and drug expertise (15%). In 2018, 71% of nursing homes reported pharmacist involvement in improving antibiotic use, an increase of 27% since 2016. Nursing homes that reported at least 20 hours of IPC activity per week were 14% (95% confidence interval, 7%–20%) more likely to implement all 7 core elements when controlling for facility ownership and affiliation. Conclusions: Nursing homes reported substantial progress in antibiotic stewardship implementation from 2016 to 2018. Improvements in access to drug expertise, education, and reporting antibiotic use may reflect increased stewardship awareness and resource use among nursing home providers under new regulatory requirements. Nursing home stewardship programs may benefit from increased IPC staff hours.

scholarly journals Implementing Changing Talk Online Training: A Pragmatic Trial to Improve Dementia Care Communication in NHs

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 495-495
Author(s):  
Carissa Coleman ◽  
Kristine Williams ◽  
Yelena Perkhounkova ◽  
Maria Hein ◽  
Tim Beachy ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Culture Change ◽  
Pragmatic Trial ◽  
Implementation Strategies ◽  
Direct Care ◽  
Care Staff ◽  
Knowledge Gain ◽  
Staff Members ◽  
Post Test

Abstract The Changing Talk (CHAT) training effectively reduces elderspeak and subsequent behavioral challenges in residents with dementia in nursing homes. The Changing Talk: Online (CHATO) training was developed to increase staff access to education using a new online format. A pilot test was conducted to confirm the feasibility and effects of CHATO on training outcomes. In the initial nursing home, twenty-three direct care staff members in a small Midwestern nursing home enrolled in the course including 12 CNAs, 4 RNs, 2 LPNs, 2 CMAs, 1 Dietary Aide, 1 Social Worker, and 1 in Transportation. Two forms of a 13-item scenario-based test to measure knowledge gain were developed and tested. Of the 23 staff, 18 (78%) completed the post-test and 83% of completers achieved a post-test score of 70% or greater. Scores on the test improved from M=69% correct (SD=11.7) at pretest to 86% correct (SD=10.6) on posttest demonstrating knowledge gain (p=.024). Participants improved their recognition of elderspeak (21%) and person-centered communication (24%) in a video vignette and 86% self-reported improvement in their abilities to recognize ineffective communication and to apply more effective communication strategies in practice. A randomized control trial enrolled staff (N=187) in eight additional nursing homes. Preliminary results confirm improvements in test scores from M=70.6% correct (SD=15.8) at pretest to 77.2% correct (SD=14.1) on posttest and increased elderspeak recognition (p=.004). Relationships between nursing home characteristics, implementation strategies, and culture change measured by the Artifacts of Culture Change Tool and their relationship to communication outcomes will be presented.

scholarly journals Improving quality in clinical placement studies in nursing homes (QUALinCLINstud): the study protocol of a participatory mixed-methods multiple case study design

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e040491
Author(s):  
Kristin Alstveit Laugaland ◽  
Marianne Thorsen Gonzalez ◽  
Brendan McCormack ◽  
Kirsti-Iren Skovdahl ◽  
Åshild Slettebø ◽  
...  
Keyword(s):  
Nursing Home ◽  
Mixed Methods ◽  
Nursing Homes ◽  
Clinical Supervision ◽  
Student Nurses ◽  
Assessment Practices ◽  
Learning Tools ◽  
Web Based ◽  
Clinical Placements ◽  
E Learning

IntroductionImproved quality in clinical supervision and assessment of student nurses in nursing home clinical placements is vitally important to effective recruitment and preparation for this healthcare sector. Knowledge regarding supervision and assessment practices within these settings is limited. Also, knowledge of evolving e-learning tools on the quality and effectiveness of these educational practices seems to be absent.Methods and analysisThe aim of the “Improving quality in clinical placement studies in nursing homes” (QUALinCLINstud) study is to develop and evaluate how a web-based programme can optimise supervision, assessment and learning during nursing home placements. The study applies a participatory, mixed-methods case study design, organised in four work packages (WPs). WP1 will explore how the nurse education institution address the quality of student nurses’ clinical placements in nursing homes. In WP2, clinical supervision and assessment practices will be explored, and described from multiple stakeholder perspectives. In WP3, based on the findings from WP1 and WP2, a web-based pedagogical supervision and assessment programme will be developed through a developmental co-productive process between nurse education institutions, practice settings and student nurses. In WP4, the web-based programme will be pilot-tested and evaluated through a mixed-methods approach. A range of data collection procedures will be used throughout the project, for example, questionnaires, interviews, observations and workshops.Ethics and disseminationThe ethical conduct of the study is approved by the Norwegian Centre for Research Data (2018/61309 and 489776). The results will be disseminated through scientific articles, three PhD theses, presentations at national and international conferences, and through publicly accessible trade journals and newspapers. The results will generate knowledge to inform supervision and assessment practices in nursing home placements. Moreover, the study will generate knowledge concerning the developmental process of a web-based supervision and assessment programme, and the value of e-learning tools applied in clinical nursing education.

scholarly journals 88. Review of nursing home antibiotic stewardship citation deficiencies to identify opportunities to improve antibiotic stewardship implementation, 2018-2019

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S55-S56
Author(s):  
Katryna A Gouin ◽  
Andrea J Cool ◽  
Nimalie D Stone ◽  
Lauri Hicks ◽  
Kara M Jacobs Slifka ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Antibiotic Stewardship ◽  
Core Element ◽  
Qualitative Review ◽  
For Profit ◽  
Core Elements ◽  
Barriers To Implementation ◽  
Facility Level ◽  
Level Training

Abstract Background Centers for Medicare & Medicaid Services (CMS) set standards for nursing homes (NH) and conduct inspections to assess adherence to regulatory requirements, including antibiotic stewardship implementation. NHs not meeting requirements are issued a citation. We reviewed text summaries for citations related to antibiotic stewardship to assess implementation in NHs. Methods We obtained publicly available antibiotic stewardship deficiency citations issued to NHs from 9/2018—7/2019 and NH characteristics data from CMS Nursing Home Compare. We used the χ2 test to compare characteristics of NHs with and without citations. We did a qualitative review of a randomly selected subset (318/635) of antibiotic stewardship citations and classified citations into one or more of four categories based on Centers for Disease Control and Prevention’s Core Elements of Antibiotic Stewardship: 1) Leadership & Accountability, 2) Action, 3) Tracking & Reporting, 4) Education (Fig 1). We developed subcategories based on our iterative review process to further describe the citations. Each citation was reviewed by two reviewers and yielded 95% agreement in categorization. Discordant citations were reviewed by a third reviewer, and core element categories with agreement by ≥2/3 reviewers were assigned, resulting in 99% agreement. Antibiotic Stewardship Citation Deficiency Category Common Themes and Examples from Citation Text from Qualitative Review of Antibiotic Stewardship Citation Deficiencies. Results There were 635 NH stewardship citation deficiencies across 44 states from 9/2018—7/2019. NHs with a citation were more likely to have &lt; 100 beds (60% vs. 50%) and for-profit ownership (75% vs. 70%) (Table 1). Of the 318 reviewed citations, Action was cited in 67% of NHs; 115/213 had missing or incomplete criteria documented for antibiotic initiation. Tracking & Reporting was cited in 40% of NHs; 117/126 had missing or incomplete antibiotic or infection tracking logs. Leadership & Accountability was cited in 23% of NHs; 41/72 NHs had no stewardship policy available. Education was cited in 13% of NHs (Fig 2). Table 1. Characteristics of US Nursing Homes With and Without an Antibiotic Stewardship Citation Deficiency from 9/2018-7/2019. Figure 2. Types of Antibiotic Stewardship Citation Deficiencies in US Nursing Homes, 2018-2019, N=318. Conclusion The most common opportunities for improvement fell under appropriate assessment and documentation of criteria for antibiotic initiation at the resident and facility-level. Training NH staff to use available resources for antibiotic stewardship activities may improve implementation. Further evaluation to identify barriers to implementation is needed. Disclosures David Gifford, MD, MPH, American Healthcare Association (Employee)

scholarly journals The expectations and acceptability of a smart nursing home model among Chinese elderly people: A mixed methods study protocol

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255865
Author(s):  
Yuanyuan Zhao ◽  
Shariff-Ghazali Sazlina ◽  
Fakhrul Zaman Rokhani ◽  
Jing Su ◽  
Boon-How Chew
Keyword(s):  
Nursing Home ◽  
Mixed Methods ◽  
Nursing Homes ◽  
Qualitative Study ◽  
Phase I ◽  
Elderly People ◽  
Family Members ◽  
Sociodemographic Factors ◽  
Mixed Methods Study ◽  
Chinese Elderly

Nursing homes integrated with smart information such as the Internet of Things, cloud computing, artificial intelligence, and digital health could improve not only the quality of care but also benefit the residents and health professionals by providing effective care and efficient medical services. However, a clear concept of a smart nursing home, the expectations and acceptability from the perspectives of the elderly people and their family members are still unclear. In addition, instruments to measure the expectations and acceptability of a smart nursing home are also lacking. The study aims to explore and determine the levels of these expectations, acceptability and the associated sociodemographic factors. This exploratory sequential mixed methods study comprises a qualitative study which will be conducted through a semi-structured interview to explore the expectations and acceptability of a smart nursing home among Chinese elderly people and their family members (Phase I). Next, a questionnaire will be developed and validated based on the results of a qualitative study in Phase I and a preceding scoping review on smart nursing homes by the same authors (Phase II). Lastly, a nationwide survey will be carried out to examine the levels of expectations and acceptability, and the associated sociodemographic factors with the different categories of expectations and acceptability (Phase III). With a better understanding of the Chinese elderly people’s expectations and acceptability of smart technologies in nursing homes, a feasible smart nursing home model that incorporates appropriate technologies, integrates needed medical services and business concepts could be formulated and tested as a solution for the rapidly ageing societies in many developed and developing countries.

Uitbraak COVID-19 in de verpleeghuiszorg

2020 ◽  
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Nursing Homes ◽  
Long Term Care ◽  
Informal Caregivers ◽  
Rapid Review ◽  
Daily Routine ◽  
Term Care ◽  
Care Facilities

Long-term care for older adults is highly affect by the COVID-19 outbreak. The objective of this rapid review is to understand what we can learn from previous crises or disasters worldwide to optimize the care for older adults in long term care facilities during the outbreak of COVID-19. We searched five electronic databases to identify potentially relevant articles. In total, 23 articles were included in this study. Based on the articles, it appeared that nursing homes benefit from preparing for the situation as best as they can. For instance, by having proper protocols and clear division of tasks and collaboration within the organization. In addition, it is helpful for nursing homes to collaborate closely with other healthcare organizations, general practitioners, informal caregivers and local authorities. It is recommended that nursing homes pay attention to capacity and employability of staff and that they support or relieve staff where possible. With regard to care for the older adults, it is important that staff tries to find a new daily routine in the care for residents as soon as possible. Some practical tips were found on how to communicate with people who have dementia. Furthermore, behavior of people with dementia may change during a crisis. We found tips for staff how to respond and act upon behavior change. After the COVID-19 outbreak, aftercare for staff, residents, and informal caregivers is essential to timely detect psychosocial problems. The consideration between, on the one hand, acute safety and risk reduction (e.g. by closing residential care facilities and isolating residents), and on the other hand, the psychosocial consequences for residents and staff, were discussed in case of other disasters. Furthermore, the search of how to provide good (palliative) care and to maintain quality of life for older adults who suffer from COVID-19 is also of concern to nursing home organizations. In the included articles, the perspective of older adults, informal caregivers and staff is often lacking. Especially the experiences of older adults, informal caregivers, and nursing home staff with the care for older adults in the current situation, are important in formulating lessons about how to act before, during and after the coronacrisis. This may further enhance person-centered care, even in times of crisis. Therefore, we recommend to study these experiences in future research.

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