Sustainable Improvement of INTERprofessional Care for Better Resident Outcomes: SCAling up an Evidence-based Care Model for Nursing Homes (INTERSCALE)
试验速览
- 阶段
- 不适用
- 状态
- 进行中（未招募）
- 入组人数
- 40
- 试验地点
- 1
- 主要终点
- LTCF Leadership level: Degree of overall fidelity to the core elements of the INTERCARE model
研究概览
简要总结
INTERCARE is an interprofessional nurse-led care model developed specifically for long-term care facilities (LTCFs) in Switzerland that has been shown to successfully reduce unplanned transfers for residents. INTERCARE proved both effective in reducing unplanned transfers to the hospital but also more costly than the usual care. To sustainably implement evidence-base practices or programs such as INTERCARE on a large scale, implementation research studies are needed to assess fitting implementation strategies. Given that the INTERCARE study demonstrated replicability of the INTERCARE model in eleven LTCFs, showing clinical effectiveness, high acceptability, feasibility and LTCF' fidelity to the core components, the INTERSCALE study is the next step to reach scalability in a broader context of a cost-effective solution when supporting the implementation.
详细描述
Background and rationale
Over the last two decades, a number of nurse-led care models have been developed and proven to be effective in reducing unplanned hospital transfers of residents in LTCFs with a range between 6.1% to 11.7% reduction in unplanned transfers and 30% reduction in overall transfers.
Particularly, nurse-led care models include nurses in expanded roles who take the lead in handling resident situations, coaching and empowering care teams and fostering interprofessional collaboration to support decision-making concerning transfers to the hospital. Most models have in common a multidisciplinary team including skilled medical providers such as geriatricians, specialist nurses, or registered nurses (RNs) with additional training, comprehensive geriatric assessment, root-cause analysis or benchmarking of hospitalizations, and individualized care planning (i.e., advance care planning).
In Switzerland, our research group recently developed and tested a nurse-led care model in Swiss nursing homes: improving INTERprofessional CARE for better resident outcomes (i.e. the INTERCARE study), which presented a pilot effort to develop evidenced-based knowledge regarding the effect of this model of care in Swiss LTCFs on avoidable hospitalizations. The INTERCARE model included six core components to be implemented by participating LTCFs: 1) strengthening interprofessional collaboration, 2) introducing an INTERCARE nurse, a registered nurse trained in geriatric knowledge and skills to take up an expanded role, 3) promoting comprehensive geriatric assessment, 4) introducing evidence-based tools to strengthen the communication within the care team (the STOP&WATCH tool) and with general practitioners (the ISBAR tool), 5) introducing advance care planning, and 6) applying data-driven quality improvement. Introduction of the INTERCARE model within a facility is aimed to drive organizational change in LTCFs by skilling-up key staff like the INTERCARE nurse and introducing new processes and tools.
The INTERCARE study was evaluated using a hybrid-type II implementation effectiveness design, which simultaneously evaluated the effectiveness of the intervention by determining the clinical effectiveness of the model on unplanned transfers as well as to collect information about the effectiveness of implementation strategies. Overall findings demonstrated that the model was effective in reducing unplanned hospital transfers from LTCFs with high acceptability and sustainability amongst facilities but also with high-cost demands for both the LTCFs and the research team in view of the time invested to implement the model. More general information about the INTERCARE model can be found via the following website: https://intercare.nursing.unibas.ch.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Study inclusion/
排除标准
- •are based on level of participant:
- •Inclusion criteria:
- •- Located within German-speaking part of Switzerland
- •- ≥ 20 long-term care beds on the cantonal list of LTCFs (or a cooperation of smaller LTCFs with a total of at least 20 long-term care beds, working with the same INTERCARE nurse(s))
- •- Willingness to introduce the core components of INTERCARE (formal commitment)
- •- Willingness to provide routine resident assessment data (Resident Assessment Instrument-nursing home version (RAI-NH) or BESA system)
- •Exclusion criteria:
- •- LTCFs located in the Italian- or French-speaking part of Switzerland.
- •- LTCFs who have previously worked with a nurse-led model similar to the INTERCARE/INTERSCALE research intervention
- •INTERCARE nurse
- •Inclusion criteria:
- •- Working contract or affiliation with the LTCF
- •- Educational background as an RN with ≥ 3 years' experience working with older persons
- •- Assigned role of INTERCARE nurse
- •Exclusion criteria:
- •- No contract with the LTCF
- •Other care staff
- •Inclusion criteria:
- •All care staff who work directly with residents (e.g., care workers, physiotherapists and activity staff) of different educational backgrounds (e.g., RNs, LPNs, nurse aides) working in the LTCF at least 8h/week for ≥ 3 months
- •Other therapeutic personnel involved in 8h/week or more in treatments/direct contact with residents
- •Exclusion criteria:
- •- Non-health care professionals (e.g., administration)
- •General Practitioners (GPs)
- •Inclusion criteria:
- •All GP's who treat at least 5 residents in the LTCF at the time of data collection
- •Exclusion criteria:
- •- Temporary substitute GPs
- •Inclusion criteria:
- •- All residents present at the LTCF during the study duration with long-term care and billed according to the health insurance law
- •Exclusion criteria:
- •- Residents who opt out of participating in the study
研究组 & 干预措施
Original Set (Set O)
Implementation strategies applied are:
- preparatory workshops
- implementation handbook
- Training and coaching of INTERCARE nurses (geriatric nurse experts)
- continuous support for participating facilities: meetings, ticket system
- benchmarking reports
Coaching of INTERCARE nurse and meetings with facilities are at INDIVIDUAL level
干预措施: Original set (Other)
Adapted Set (Set A)
same as set O, except
Coaching of INTERCARE nurse and meetings with facilities are at GROUP level
干预措施: Adapted set (Other)
结局指标
主要结局
LTCF Leadership level: Degree of overall fidelity to the core elements of the INTERCARE model
时间窗: Quarterly, from baseline (month 0) through end of intervention phase (month 12)
Overall fidelity score (percentage of minimal requirements of the INTERCARE model fulfilled) from the side of the LTCF Leadership will be measured using semi-structured interviews (degree of fulfillment: yes, partialy, no).
次要结局
- General practitioner level: Degree of fidelity to the core elements "interprofessional collaboration" and "evidence-based instruments" (focus on use of ISBAR) of the INTERCARE model will be measured(Two times: 1) in the middle of the implementation phase (month 6) and 2) at the end of intervention period (month 12))
- LTCF level: Staff turnover(Quarterly exports, from baseline (month 0) through study completion period (month 24))
- Other care staff level: Acceptability of the INTERCARE model(Three times: 1) at the get-in period (month 0); 2) in the middle of the implementation phase (month 6) and 3) at the end of intervention period (month 12))
- INTERCARE Nurse level: Feasibility of the INTERCARE model(Three times: 1) at the get-in period (month 0); 2) in the middle of the implementation phase (month 6) and 3) at the end of intervention period (month 12))
- Other care staff level: Feasibility of the INTERCARE model(Three times: 1) at the get-in period (month 0); 2) in the middle of the implementation phase (month 6) and 3) at the end of intervention period (month 12))
- Resident level: fidelity to core element Advanced Care Planning(Quarterly, from baseline (month 0) through study completion period (24 months))
- LTCF level: Sustainability(Quarterly, from end of intervention phase (month 12) through end of sustainment phase (month 24))
- INTERCARE Nurse level: Acceptability of the INTERCARE model(Three times: 1) at the get-in period (month 0); 2) in the middle of the implementation phase (month 6) and 3) at the end of intervention period (month 12))
- Research group level: Costs of implementation strategies in Swiss Francs(Continuous tracking, from baseline (month 0) through study completion period (24 months))
- INTERCARE Nurse level: Intention to leave(Three times: 1) at the get-in period (month 0); 2) in the middle of the implementation phase (month 6) and 3) at the end of intervention period (month 12))
- INTERCARE Nurse level: Intention to stay(Three time points: 1) at the get-in period (month 0); 2) in the middle of the implementation phase (month 6) and 3) at the end of intervention period (month 12))
- Resident level: Unplanned transfers(Quarterly, from baseline (month 0) through study completion period (24 months))
- LTCF level: Staff absenteeism(Quarterly exports, from baseline (month 0) through study completion period (month 24))
- Other care staff level: Intention to leave(Three times: 1) at the get-in period (month 0); 2) in the middle of the implementation phase (month 6) and 3) at the end of intervention period (month 12))
- LTCF Leadership level: Facility costs and expenditures related to implementation strategies in Swiss Francs(Monthly reporting, from baseline (month 0) through study completion period (month 24))
- Other care staff level: Intention to stay(Three times: 1) at the get-in period (month 0); 2) in the middle of the implementation phase (month 6) and 3) at the end of intervention period (month 12))
研究者
Franziska Zúñiga
Prof. Dr. Franziska Zúñiga
University of Basel