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

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          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.


          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, 4641 care aides and 1693 nurses cared for 8766 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.


          Baseline and follow-up data were available for 20 homes (57 care units, 751 care aides, 2428 residents) in the control group, 19 homes (61 care units, 836 care aides, 2387 residents) in the basic group, and 14 homes (45 care units, 615 care aides, 1584 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.


          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

 ( NCT02695836), registered on March 1, 2016

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          Most cited references 26

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          Consort 2010 statement: extension to cluster randomised trials.

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            Assessment of nursing home residents in Europe: the Services and Health for Elderly in Long TERm care (SHELTER) study

            Background Aims of the present study are the following: 1. to describe the rationale and methodology of the Services and Health for Elderly in Long TERm care (SHELTER) study, a project funded by the European Union, aimed at implementing the interRAI instrument for Long Term Care Facilities (interRAI LTCF) as a tool to assess and gather uniform information about nursing home (NH) residents across different health systems in European countries; 2. to present the results about the test-retest and inter-rater reliability of the interRAI LTCF instrument translated into the languages of participating countries; 3 to illustrate the characteristics of NH residents at study entry. Methods A 12 months prospective cohort study was conducted in 57 NH in 7 EU countries (Czech Republic, England, Finland, France, Germany, Italy, The Netherlands) and 1 non EU country (Israel). Weighted kappa coefficients were used to evaluate the reliability of interRAI LTCF items. Results Mean age of 4156 residents entering the study was 83.4 ± 9.4 years, 73% were female. ADL disability and cognitive impairment was observed in 81.3% and 68.0% of residents, respectively. Clinical complexity of residents was confirmed by a high prevalence of behavioral symptoms (27.5% of residents), falls (18.6%), pressure ulcers (10.4%), pain (36.0%) and urinary incontinence (73.5%). Overall, 197 of the 198 the items tested met or exceeded standard cut-offs for acceptable test-retest and inter-rater reliability after translation into the target languages. Conclusion The interRAI LTCF appears to be a reliable instrument. It enables the creation of databases that can be used to govern the provision of long-term care across different health systems in Europe, to answer relevant research and policy questions and to compare characteristics of NH residents across countries, languages and cultures.
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              Study protocol for the translating research in elder care (TREC): building context – an organizational monitoring program in long-term care project (project one)

              Background While there is a growing awareness of the importance of organizational context (or the work environment/setting) to successful knowledge translation, and successful knowledge translation to better patient, provider (staff), and system outcomes, little empirical evidence supports these assumptions. Further, little is known about the factors that enhance knowledge translation and better outcomes in residential long-term care facilities, where care has been shown to be suboptimal. The project described in this protocol is one of the two main projects of the larger five-year Translating Research in Elder Care (TREC) program. Aims The purpose of this project is to establish the magnitude of the effect of organizational context on knowledge translation, and subsequently on resident, staff (unregulated, regulated, and managerial) and system outcomes in long-term care facilities in the three Canadian Prairie Provinces (Alberta, Saskatchewan, Manitoba). Methods/Design This study protocol describes the details of a multi-level – including provinces, regions, facilities, units within facilities, and individuals who receive care (residents) or work (staff) in facilities – and longitudinal (five-year) research project. A stratified random sample of 36 residential long-term care facilities (30 urban and 6 rural) from the Canadian Prairie Provinces will comprise the sample. Caregivers and care managers within these facilities will be asked to complete the TREC survey – a suite of survey instruments designed to assess organizational context and related factors hypothesized to be important to successful knowledge translation and to achieving better resident, staff, and system outcomes. Facility and unit level data will be collected using standardized data collection forms, and resident outcomes using the Resident Assessment Instrument-Minimum Data Set version 2.0 instrument. A variety of analytic techniques will be employed including descriptive analyses, psychometric analyses, multi-level modeling, and mixed-method analyses. Discussion Three key challenging areas associated with conducting this project are discussed: sampling, participant recruitment, and sample retention; survey administration (with unregulated caregivers); and the provision of a stable set of study definitions to guide the project.

                Author and article information

                Implement Sci
                Implement Sci
                Implementation Science : IS
                BioMed Central (London )
                10 September 2020
                10 September 2020
                : 15
                [1 ]GRID grid.17089.37, Faculty of Nursing, , University of Alberta, ; 11405 87 Avenue, Edmonton, Alberta T6G 1C9 Canada
                [2 ]GRID grid.21100.32, ISNI 0000 0004 1936 9430, School of Health Policy & Management, Faculty of Health, , York University, ; Toronto, Ontario M3J 1P3 Canada
                [3 ]GRID grid.22072.35, ISNI 0000 0004 1936 7697, Cumming School of Medicine, , University of Calgary, ; Calgary, Alberta T2N 4 N1 Canada
                [4 ]GRID grid.410711.2, ISNI 0000 0001 1034 1720, School of Nursing, , University of North Carolina, ; Chapel Hill, NC 27599-7460 USA
                [5 ]GRID grid.265014.4, ISNI 0000 0000 9945 2031, School of Nursing, , Thompson Rivers University, ; Kamloops, British Columbia V2C 0C8 Canada
                [6 ]GRID grid.4714.6, ISNI 0000 0004 1937 0626, Division of Nursing, Department of Neurobiology, Care Sciences and Society, , Karolinska Institutet, ; Huddinge, SE-104 35 Stockholm, Sweden
                [7 ]GRID grid.17063.33, ISNI 0000 0001 2157 2938, Lawrence S Bloomberg Faculty of Nursing, , University of Toronto, ; Toronto, Ontario M5T 1P8 Canada
                [8 ]GRID grid.215352.2, ISNI 0000000121845633, University of Texas Health Science Center San Antonio, , University of Texas, ; San Antonio, TX 78229 USA
                [9 ]GRID grid.55602.34, ISNI 0000 0004 1936 8200, School of Nursing, Faculty of Health, , Dalhousie University, ; Halifax, Nova Scotia B3H 4R2 Canada
                [10 ]GRID grid.28046.38, ISNI 0000 0001 2182 2255, School of Nursing, Faculty of Health Sciences, , University of Ottawa, ; Ottawa, Ontario K1H 8 M5 Canada
                [11 ]GRID grid.17089.37, Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine & Dentistry, , University of Alberta, ; Edmonton, Alberta T6G 2P4 Canada
                © The Author(s) 2020

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                Funded by: Canadian Institute of Health Research
                Award ID: Operating Grant (#341532)
                Award ID: Tier 1 Canada Research Chair in Knowledge Translation (no award number available)
                Award Recipient :
                Funded by: Alberta Innovates
                Award ID: Postdoctoral Fellowship, File No: 201300543, CA #: 3723
                Award Recipient :
                Funded by: University of Alberta Faculty of Nursing
                Award ID: Professorship in Continuing Care Policy Research (no award number available)
                Award ID: Establishment Grant (no award number available)
                Award Recipient :
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