Improving Nursing Home Care through Feedback On PerfoRMance Data (INFORM): Protocol for a cluster-randomized trial

et al. 2020

Preprint

Self Cite

Background: Effective communication among interdisciplinary healthcare teams is essential for quality healthcare, especially in nursing homes (NHs). Care aides provide most direct care in NHs, yet are rarely included in formal communications about resident care (e.g., change of shift reports, family conferences). Audit and feedback is a potentially effective improvement intervention. This study compares the effect of simple and two higher intensity levels of feedback based on Goal Setting Theory on improving formal staff communication in NHs.Methods: This pragmatic three-arm parallel cluster-randomized controlled trial included NHs participating in TREC (Translating Research in Elder Care) across the Canadian provinces of Alberta and British Columbia. Facilities with at least one care unit with 10 or more care aide responses on the TREC baseline survey were eligible. At baseline, 4,641 care aides and 1,693 nurses cared for 8,766 residents in 67 eligible NHs. NHs were randomly allocated to a simple (control) group (22 homes, 60 care units) or one of two higher intensity feedback intervention groups (based on Goal Setting Theory): basic assisted feedback (22 homes, 69 care units) and enhanced assisted feedback 2 (23 homes, 72 care units). Our primary outcome was the amount of formal communication about resident care that involved care aides, measured by the Alberta Context Tool and presented as adjusted mean differences [95% confidence interval] between study arms at 12-month follow-up.Results: Baseline and follow-up data were available for 20 homes (57 care units, 751 care aides, 2,428 residents) in the control group, 19 homes (61 care units, 836 care aides, 2,387 residents) in the basic group, and 14 homes (45 care units, 615 care aides, 1,584 residents) in the enhanced group. Compared to simple feedback, care aide involvement in formal communications at follow-up was 0.17 points higher in both the basic ([0.03; 0.32], p=0.021) and enhanced groups ([0.01; 0.33], p=0.035). We found no difference in this outcome between the two higher intensity groups.Conclusions: Theoretically informed feedback was superior to simple feedback in improving care aides’ involvement in formal communications about resident care. This underlines that prior estimates for efficacy of audit and feedback may be constrained by the type of feedback intervention tested.Trial registration: ClinicalTrials.gov (NCT02695836), https://clinicaltrials.gov/ct2/show/NCT02695836, registered on March 1, 2016

“…INFORM was registered (ClinicalTrials.gov Identi er: NCT02695836) and the trial protocol published [26].…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 90%

See 1 more Smart Citation

Comparing effects of two higher intensity feedback interventions with simple feedback on improving staff communication in nursing homes – The INFORM cluster-randomized controlled trial

et al. 2020

Preprint

Self Cite

“…INFORM was registered (ClinicalTrials.gov Identifier: NCT02695836) and the trial protocol published [30]. We followed CONSORT reporting guidelines for cluster-randomized trials [31].…”

Section: Methodsmentioning

confidence: 99%

Comparing effects of two higher intensity feedback interventions with simple feedback on improving staff communication in nursing homes – The INFORM cluster-randomized controlled trial

et al. 2020

Preprint

Self Cite

BackgroundEffective communication among interdisciplinary healthcare teams is essential for quality healthcare, especially in nursing homes (NHs). Care aides provide most direct care in NHs, yet are rarely included in formal communications about resident care (e.g., change of shift reports, family conferences). Audit and feedback is a potentially effective improvement intervention. This study compares the effect on improving formal staff communication in NHs of simple and two higher intensity levels of feedback based on Goal Setting Theory.MethodsThis pragmatic three-arm parallel cluster-randomized controlled trial included NHs participating TREC (Translating Research in Elder Care) across the Canadian provinces of Alberta and British Columbia. Facilities with at least one care unit with 10 or more care aide responses on the TREC baseline survey were eligible. At baseline, 4,641 care aides and 1,693 nurses cared for 8,766 residents in 67 eligible NHs. NHs were randomly allocated to a simple (control) group (22 homes, 60 care units) or one of two higher intensity feedback intervention groups (based on Goal Setting Theory): basic assisted feedback (22 homes, 69 care units) and enhanced assisted feedback 2 (23 homes, 72 care units). Our primary outcome was the amount of formal communication about resident care that involved care aides, measured by the Alberta Context Tool and presented as adjusted mean differences [95% confidence interval] between study arms at 12-month follow-up.ResultsBaseline and follow-up data were available for 20 homes (57 care units, 751 care aides, 2,428 residents) in the control group, 19 homes (61 care units, 836 care aides, 2,387 residents) in the basic group, and 14 homes (45 care units, 615 care aides, 1,584 residents) in the enhanced group. Compared to simple feedback, care aide involvement in formal communications at follow-up was 0.17 points higher in both the basic ([0.03; 0.32], p=0.021) and enhanced groups ([0.01; 0.33], p=0.035). We found no difference in this outcome between the two higher intensity groups.ConclusionsTheoretically informed feedback was superior to simple feedback. This underlines that prior estimates for efficacy of audit and feedback may be constrained by the type of feedback intervention tested.Trial registrationClinicalTrials.gov (NCT02695836), https://clinicaltrials.gov/ct2/show/NCT02695836, registered on March 1, 2016

“…There is, however, little in the published literature regarding delity in complex behavioural interventions. [6] The INFORM study [11] (Improving Nursing Home Care Through Feedback On perfoRMance data) is a complex three-arm behavioural trial designed to increase involvement of unregulated care aides in formal team communications about resident care in nursing homes [trial paper is currently under review with Implementation Science as a companion paper to this one -and is at the minor revision stage]. This paper reports on a mixed-methods study that examines trial delity in INFORM and explores the relationship between delity, study arm, and the trial's primary outcome -care aide involvement in formal team communications about resident care.…”

Section: Introductionmentioning

confidence: 99%

Examining fidelity in the INFORM trial, a complex team-based behavioural intervention

et al. 2020

Preprint

Self Cite

Background. Fidelity in complex behavioural interventions is underexplored. This study examines fidelity of the INFORM trial and explores the relationship between fidelity, study arm and the trial’s primary outcome – care aide involvement in formal team communications about resident care. Methods. A concurrent process evaluation of implementation fidelity was conducted in 33 nursing homes in Western Canada (Alberta and British Columbia). Study participants were from 106 clinical care units clustered in 33 nursing homes randomized to the Basic and Enhanced Assisted Feedback arms of the INFORM trial.Results. Fidelity of the INFORM intervention was moderate to high, with fidelity delivery and receipt higher than fidelity enactment for both study arms. Higher enactment teams experienced a significantly larger improvement in formal team communications between baseline and follow-up than lower enactment teams (F(1, 70) = 4.27, p = .042).Conclusions. Overall fidelity enactment was associated with improvements in formal team communications, but study arm was not. This suggests that the intensity with which an intervention is offered and delivered may be less important than the intensity with which intervention participants enact the core components of an intervention. Greater attention to fidelity assessment and publication of fidelity results through studies such as this one is critical to improving the utility of published trials.