Testing the evidence integration triangle for implementation of interventions to manage behavioral and psychological symptoms associated with dementia: Protocol for a pragmatic trial

Kolanowski, Ann; Haitsma, Kimberly Van; Galik, Elizabeth; Boltz, Marie; Ellis, Jeanette; Behrens, Liza; Flanagan, Nina; Eshraghi, Karen; Zhu, Shijun

doi:10.1002/nur.21866

Cited by 38 publications

(39 citation statements)

References 81 publications

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“…Briefly, this trial focuses on person-centered management of the BPSD in nursing homes through the implementation of the evidence-based intervention known as EIT-4-BPSD, Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia. 27,28 Details of the intervention have been previously published. 28…”

Section: Methodsmentioning

confidence: 99%

The Quality of Interactions Between Staff and Residents With Cognitive Impairment in Nursing Homes

Paudel

Resnick

Galik

2019

Am J Alzheimers Dis Other Demen

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Background: Positive and effective staff–resident interactions are imperative to adequately assess and meet the needs of cognitively impaired residents in nursing homes and optimize their quality of life. Aim: The purpose of this study was to quantify, describe, and analyze the interaction between staff and cognitively impaired residents in nursing homes, using the Quality of Interaction Schedule (QuIS). Method: This descriptive analysis utilized baseline data from the first 2 cohorts in a randomized clinical trial including 341 residents from 35 nursing homes. Results: Five hundred fifty-six staff–resident interactions were evaluated; majority were positive (n = 466, 83.8%) and the remaining were either neutral (n = 60, 10.8%) or negative (n = 30, 5.4%). The quality of interactions varied by interaction location, interpersonal distance, and resident participation. Conclusion: Future research should focus on decreasing the negative/neutral interactions and explore staff characteristics (eg, gender, level of experience) and facility factors (eg, size, ownership) that might influence the quality of interactions.

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Section: Methodsmentioning

confidence: 99%

The Quality of Interactions Between Staff and Residents With Cognitive Impairment in Nursing Homes

Paudel

Resnick

Galik

2019

Am J Alzheimers Dis Other Demen

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“…The study was approved by a University based Institutional Review Board. Details of the protocol for this study have been published elsewhere (Resnick et al, 2018). Briefly, this was a pragmatic trial focused on testing the use of the EIT (Glasgow, Green, Taylor, & Stange, 2012) to support implementation of person-centered behavioral approaches to manage BPSD among nursing home residents.…”

Section: Methodsmentioning

confidence: 99%

Current Psychotropic Medication Use and Contributing Factors Among Nursing Home Residents With Cognitive Impairment

et al. 2019

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This study described current use and predictors of psychotropics among residents with moderate to severe cognitive impairment. This was a secondary data analysis using baseline data from the first 341 residents in an ongoing trial. Predictive measures included age, gender, race, depressive symptoms, agitation, resistiveness to care, depression, cognition, pain, comorbidities, facility factors, and state. Overall 63% ( n = 211) received at least one psychotropic medication, 16% ( n = 52) an anti-seizure medication, 23% ( n = 77) an anxiolytic, 30% ( n = 99) an antidepressant, 2% ( n = 8) a sedative hypnotic, 28% ( n = 93) an antipsychotic medication, and 9% ( n = 29) an opioid. Testing of models explained 9% to 15% of psychotropic medication use. There were high rates of psychotropic medication use and a limited association between demographic factors, behavioral symptoms, and psychotropic medication use. Continued research is needed to explore the impact of deprescribing, person-centered behavioral interventions, and beliefs of providers on psychotropic medication use.

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“…Carrieri et al [28] for example, are undertaking a realist review of interventions to tackle doctors' mental health, using the EIT to convene a stakeholder group with experts in which research can inform practical decision-making and dissemination of messages. Also Resnik et al [29] are testing the EIT for implementation of interventions to manage behavioural and psychological symptoms associated with dementia, incorporating a pragmatic trial.…”

Section: Discussion: Addressing the Challengesmentioning

confidence: 99%

Advancing integrated care evaluation in shifting contexts: Blending implementation research with case study design in Project SUSTAIN.

Billings

Bruin

Baan

et al. 2020

Preprint

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BackgroundDespite many studies evaluating the effectiveness of integrated care, evidence remains inconsistent. There is increasing commentary pointing out the mismatch between the ability to capture the somewhat ‘illusive’ impact of integrated care initiatives and programmes, and the most appropriate way to do this. Focusing on methodology, this paper describes and critically reviews the experiences of SUSTAIN, a Horizon 2020 funded project (2015-2019) with the purpose of advancing knowledge and understanding of cross-European integrated care evaluation. SUSTAIN sought to improve integrated care initiatives for older people in seven countries, and to maximise the potential for knowledge transfer and application across Europe. The methods approach drew from implementation research, employing the participative Evidence Integration Triangle (EIT) and incorporating a mixed method, multiple embedded case study design. A core set of qualitative and quantitative indicators, alongside context and process data, were created and tested within four key project domains (person-centredness, prevention-orientation, safety and efficiency). The paper critically discusses the overall approach, highlighting the value of the EIT and case study design, and signalling the challenges of data collection with frail older people and stakeholder involvement at the sites, as well as difficulties developing the core set of indicators.ConclusionsLessons learned and recommendations for advancing integrated care evaluation are put forward that focus on the status of integrated care as a complex intervention and a process. The use of implementation research methods and case study design are recommended as an additional evaluation approach for researchers to consider, alongside suggested ways of improving methods of data collection with frail populations and cost analysis.

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Testing the evidence integration triangle for implementation of interventions to manage behavioral and psychological symptoms associated with dementia: Protocol for a pragmatic trial

Cited by 38 publications

References 81 publications

The Quality of Interactions Between Staff and Residents With Cognitive Impairment in Nursing Homes

The Quality of Interactions Between Staff and Residents With Cognitive Impairment in Nursing Homes

Current Psychotropic Medication Use and Contributing Factors Among Nursing Home Residents With Cognitive Impairment

Advancing integrated care evaluation in shifting contexts: Blending implementation research with case study design in Project SUSTAIN.

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