Sustained effects of the INFORM cluster randomized trial: an observational post-intervention study

Abstract

Background Numerous studies have examined the efficacy and effectiveness of health services interventions. However, much less research is available on the sustainability of study outcomes. The purpose of this study was to assess the lasting benefits of INFORM (Improving Nursing Home Care Through Feedback On perfoRMance data) and associated factors 2.5 years after removal of study supports. INFORM was a complex, theory-based, three-arm, parallel cluster-randomized trial. In 2015–2016, we successfully implemented two theory-based feedback strategies (compared to a simple feedback approach) to increase nursing home (NH) care aides’ involvement in formal communications about resident care. Methods Sustainability analyses included 51 Western Canadian NHs that had been randomly allocated to a simple and two assisted feedback interventions in INFORM. We measured care aide involvement in formal interactions (e.g., resident rounds, family conferences) and other study outcomes at baseline (T1, 09/2014-05/2015), post-intervention (T2, 01/2017-12/2017), and long-term follow-up (T3, 06/2019–03/2020). Using repeated measures, hierarchical mixed models, adjusted for care aide, care unit, and facility variables, we assess sustainability and associated factors: organizational context (leadership, culture, evaluation) and fidelity of the original INFORM intervention. Results We analyzed data from 18 NHs (46 units, 529 care aides) in simple feedback, 19 NHs (60 units, 731 care aides) in basic assisted feedback, and 14 homes (41 units, 537 care aides) in enhanced assisted feedback. T2 (post-intervention) scores remained stable at T3 in the two enhanced feedback arms, indicating sustainability. In the simple feedback group, where scores were had remained lower than in the enhanced groups during the intervention, T3 scores rose to the level of the two enhanced feedback groups. Better culture (β = 0.099, 95% confidence interval [CI] 0.005; 0.192), evaluation (β = 0.273, 95% CI 0.196; 0.351), and fidelity enactment (β = 0.290, 95% CI 0.196; 0.384) increased care aide involvement in formal interactions at T3. Conclusions Theory-informed feedback provides long-lasting improvement in care aides’ involvement in formal communications about resident care. Greater intervention intensity neither implies greater effectiveness nor sustainability. Modifiable context elements and fidelity enactment during the intervention period may facilitate sustained improvement, warranting further study—as does possible post-intervention spread of our intervention to simple feedback homes.

The Association of Nursing Homes’ Organizational Context With Care Aide Empowerment: A Cross-Sectional Study

“…We found that care aides’ engagement in formal interactions was negatively associated with the meaning derived from their work. An earlier clinical trial, Improving Nursing Home Care Through Feedback on Performance Data (INFORM), within the TREC program demonstrated that including care aides in resident care decisions (formal interactions) was only successful when a supportive work culture was present ( Hoben et al, 2021 ). Involving care aides in formal communication and decision making about residents must be initiated by the managerial team and encouraged with appropriate information and feedback mechanisms ( Hoben et al, 2020 ), as it can lead to low turnover, higher retention rates, higher aggregate social engagement scores, and lower incidence of pressure ulcers for residents in nursing homes ( Barry et al, 2005 ).…”

Cluster randomised trial of a complex interprofessional intervention (interprofACT) to reduce hospital admission of nursing home residents

“…Nurse empowerment and leadership were identified as likely elements for a better management of acute changes in NHRs’ conditions [ 21 ]. Hoben and colleagues [ 36 ] confirmed the effectiveness and sustainability [ 37 ] of nursing staff’s involvement in improving the interprofessional exchange about NHRs’ health. Change agents in all three trials were trained, received implementation material and were supervised regularly.…”

Safer Care for Older Persons in (residential) Environments (SCOPE): a pragmatic controlled trial of a care aide-led quality improvement intervention

“…Using descriptive statistics, baseline characteristics of LTC homes, care units, care aides, and residents were compared between study arms. To assess intervention effectiveness, mixed effects regression models were used [ 99 , 100 ]. All models were adjusted for sampling strata, baseline differences of the outcome variables, care aide characteristics (sex, age, English as first language [yes/no]), and care unit staffing (total care hours per resident day and percentage of total hours per resident day provided by care aides).…”