Implementation in Nursing Homes: Describing Early and Late Adopters of an Evidence-Based Dementia Care Program

Despite national efforts to improve nursing home (NH) quality, care remains variable. Health system efforts to drive improvement often begin with a sub-group of NHs before scaling up across the organization. Yet, there is limited evidence on who to target for the first group. This study addressed this gap by examining facility characteristics of early and late adopters within a multi-site pragmatic clinical trial. Data were obtained from the Organizational Readiness to Change Assessment (ORCA), which was completed by expert trainers, and Nursing Home Compare. Early and late adoption was operationalized according to Roger’s Diffusion of Innovations. Sixty-percent of NHs (n=12) were late adopters and 40% (n=8) were early adopters. Between group differences (p<.01) were found in number of health inspection citations and context domain within the ORCA. These findings equip health systems with evidence on how to strategically target partners for initial quality improvement efforts prior to system-wide implementation.

AGI Grade-guided Chaiqin Chengqi Decoction Treatment For Predicted Moderately Severe And Severe Acute Pancreatitis (CAP Trial): Study Protocol of a Randomised, Double-blind, Placebo-controlled, Parallel-group, Pragmatic Clinical Trial

Background: Acute pancreatitis (AP) is the common digestive disease with a potentially high risk of mortality. Traditional Chinese medicinal formula chaiqin chengqi decoction (CQCQD) has been used for the management of AP in West China Hospital for decades. CQCQD for AP (CAP) trial tests whether the administration of CQCQD will improve the efficacy of the present comprehensive treatments for predicted moderately severe and severe AP.Methods: This is a single-centre, randomised, controlled, double-blind, two-arm pragmatic clinical trial. Eligible patients with a clinical diagnosis of AP will be randomly allocated on a 1:1 basis to CQCQD or placebo control administration based on conventional standard therapy for AP. The administration of CQCQD and placebo are guided by Acute Gastrointestinal Injury (AGI) grade-based algorithm. The primary outcome measure will be the duration of respiratory failure within 28 days after onset. Secondary outcome measures include occurrence of new-onset organ failure and new-onset persistent organ failure, receipt of new organ support therapy, duration of gastrointestinal decompression, requirement of prokinetic agents, duration of fasting, incidence of local complications, requirement for drainage or necrosectomy, hospital length of stay, intensive care unit (ICU) length of stay, cumulative levels of C-reaction protein (CRP) on day 1, 2, 3, 5, 7, 14, 21, 28 after admission, in-hospital cost, all-cause mortality, five-level EuroQol five-dimensional (EQ-5D-5L) questionnaire and so on. Follow-up will be scheduled on 6, 12, and 26 weeks after enrolment.Discussion: The results of this study may provide high-quality evidence of the efficacy of CQCQD in the management of AP. Trial registration: Chictr.org.cn Registry (ChiCTR2000034325). Registered on 2 July, 2020. https://www.chictr.org.cn/showproj.aspx?proj=55591

Active and healthy lifestyle in Brazilian Primary Health Care user’s: A pragmatic clinical trial about "VAMOS" behavior change program

This study aimed to investigate the effectiveness and maintenance of the behavior change program "VAMOS", version 2.0, on behavioral and health outcomes in Brazilian users (≥ 18 years) of Primary Health Care (PHC) in Florianópolis, state of Santa Catarina, southern Brazil. A pragmatic clinical trial was carried out between 2016 and 2019 in Basic Health Units, with 265 users allocated in the intervention group (n = 125) and the control group (n = 140). The intervention group participated for three months in the VAMOS to promote physical activity (PA) and a healthy diet. The control group received in a single meeting counseling about the importance of an active and healthy lifestyle. Variables of PA (daily minutes in light PA, moderate-to-vigorous PA, total PA, and sedentary behavior), eating behavior (weekly consumption of fruits, vegetables, and soda drinks), anthropometry (body mass, waist circumference (WC), and body mass index), and quality of life (QOL) (positive or negative perception), were evaluated, through interviews and objective measures, in the pre-intervention, post-intervention, and 12 months after the end of the intervention. The intervention group increased moderate-to-vigorous PA bouts, consumed of vegetables and, QOL, and decreased the consumption of soda drinks and WC (p<0.05). The intervention was sufficient to maintain the achieved benefits of moderate-to-vigorous PA bouts, soda drink consumption, and WC. VAMOS effectively promote an active and healthy lifestyle in PHC users and, its strategies proved to be adequate to maintain the gains acquired. VAMOS is a pioneer and a health innovation.