Nurse-led Care Models in Swiss Nursing Homes: Improving Interprofessional Care for Better Resident Outcomes (INTERCARE)
NCT ID: NCT03590470
Last Updated: 2020-11-13
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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COMPLETED
NA
944 participants
INTERVENTIONAL
2018-06-20
2020-06-01
Brief Summary
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* To assess the effectiveness of the nurse-led care model on unplanned hospitalizations (primary outcome) and additional resident and staff outcomes, hypothesizing that nursing homes with a nurse-led care model have lower rates of unplanned hospitalizations and show improvements in additional resident and staff outcomes
* To assess the effect of the degree of adoption on client outcomes, hypothesizing that a higher degree of adoption is related to better client outcomes
* To describe the implementation costs the Swiss nurse-led interprofessional NH care model on the NH level and to assess the economic impact of INTERCARE with a cost-effectiveness analysis adopting a health care system perspective (comparing the increase in staff costs with the decrease of days of avoidable hospitalizations)
* To explore resident/family and staff perceptions of service outcomes (e.g., timeliness) and the acceptability of the nurse-led care model;
* To describe the degree to which the model was adopted, its feasibility, the fidelity with which it was applied, and the barriers and facilitators met by NH leadership and nurse experts.
Detailed Description
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The registered nurse which will take on the role of geriatric nurse expert will either be recruited within the pool of nurses in each respective NH or recruited from the outside. The nurse-led care model will be built with core components, such as interprofessional collaboration, presence of a geriatric nurse expert, comprehensive geriatric assessment, advance care planning, guidance and coaching, data driven quality and evidence-based tools. Each NH will have to implement these core components along with implementing the role of geriatric nurse expert.
The intervention will be implemented and evaluated by means of a non-randomized quasi experimental stepped-wedge design, over a period of 21 months. The stepped wedge design allows inclusion of all NHs, thus does not exclude NHs from receiving the INTERCARE \| Research plan Version 1.1/09.05. 2018 20/53 intervention. The "stepped" or "graded" unidirectional allocation to the intervention enables each NH to act as its own control. After a 3-month baseline phase, NHs will sequentially begin implementation of the nurse-led care model, which they will continue to use post-implementation. A get-in period of 1 month will be planned to address possible timing problems at the intervention start. Another advantage of the design is the graded start in the NHs facilitating delivery of the intervention, as each NH will discuss with the research team when they will receive the intervention. The first two NHs will start their baseline data collection in June 2018 and implement the intervention in September 2018, and every month thereafter, two other NHs will start with the intervention.
A non-randomized design was chosen to enable NHs to choose when they will start with the intervention, to allow for each NH to prepare accordingly for the implementation. Limitations of this study design might arise from its novelty. So far, no gold standard for data analysis has been established. In addition to this, non-randomization of the starting point of the intervention may imply that NHs were prepared for the intervention and this may be reflected in the results.
Conditions
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Keywords
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Study Design
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NON_RANDOMIZED
SEQUENTIAL
HEALTH_SERVICES_RESEARCH
NONE
Study Groups
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Experimental_INTERCARE intervention
Implementation of a nurse-led model of care adapted to the Swiss context, comprising a geriatric nurse expert with specific training in multidimensional clinical assessment and quality improvement tools.
Implementation of a nurse-led model of care
A nurse-model of care consisting of a specifically trained geriatric nurse expert, communication and quality improvement tools will be implemented in 11 nursing homes in the German speaking part of Switzerland
Control
The design used for the INTERCARE intervention is a non-randomized stepped wedge design, therefore all nursing homes will receive the intervention but at different time points. All nursing homes will be in a control phase before receiving the intervention, and switch to the intervention phase, once the intervention is implemented.
No interventions assigned to this group
Interventions
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Implementation of a nurse-led model of care
A nurse-model of care consisting of a specifically trained geriatric nurse expert, communication and quality improvement tools will be implemented in 11 nursing homes in the German speaking part of Switzerland
Eligibility Criteria
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Inclusion Criteria
* German-speaking
* Size: ≥80 long-term care beds (NHs with \>60 beds will be considered if they have a high hospitalisation rate)
* Hospitalisation rates: ≥0.8/1000 resident days
Residents
\- All long-term care residents
Geriatric nurse experts:
* Registered nurse
* At least three years' experience in long-term care
Nursing home staff
* Care workers of all educational levels, including students
* Other health professionals employed by the NH (such as therapists, dieticians) with direct resident contact
* Employed by the NH and working in the NH for a minimum of 3 months
Exclusion Criteria
* Italian-speaking
* French-speaking
Residents
\- Short term or day care residents, other residents with a discharge planned within two months after admittance
ALL
No
Sponsors
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Swiss National Science Foundation
OTHER
University Department of Geriatric Medicine FELIX PLATTER
OTHER
University of Applied Sciences and Arts of Southern Switzerland
OTHER
Insel Gruppe AG, University Hospital Bern
OTHER
Hôpital ophtalmique Jules-Gonin (HOJG)
UNKNOWN
Serdaly & Ankers, Switzerland
UNKNOWN
Vaud state public health department
UNKNOWN
stiftung pflegewissenchaft
UNKNOWN
KU Leuven
OTHER
University of Basel
OTHER
Responsible Party
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Michael Simon
Tenure Track Assistant Professor
Principal Investigators
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Michael Simon, PhD
Role: PRINCIPAL_INVESTIGATOR
Institut für Pflegewissenschaft Fakultät für Medizin, Universität Basel Bernoullistrasse 28, Raum 107 CH-4056 Basel
Locations
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Obesunne
Arlesheim, , Switzerland
St Christophorus
Basel, , Switzerland
Marienhaus
Basel, , Switzerland
Domicil schwabgut
Bern, , Switzerland
Zentrum Schlossmat
Burgdorf, , Switzerland
Viva Luzern
Lucerne, , Switzerland
Reusspark
Niederwil, , Switzerland
Countries
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References
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Guerbaai RA, DeGeest S, Popejoy LL, Simon M, Wellens NIH, Denhaerynck K, Zuniga F. Evaluating the implementation fidelity to a successful nurse-led model (INTERCARE) which reduced nursing home unplanned hospitalisations. BMC Health Serv Res. 2023 Feb 9;23(1):138. doi: 10.1186/s12913-023-09146-8.
Bartakova J, Zuniga F, Guerbaai RA, Basinska K, Brunkert T, Simon M, Denhaerynck K, De Geest S, Wellens NIH, Serdaly C, Kressig RW, Zeller A, Popejoy LL, Nicca D, Desmedt M, De Pietro C. Health economic evaluation of a nurse-led care model from the nursing home perspective focusing on residents' hospitalisations. BMC Geriatr. 2022 Jun 9;22(1):496. doi: 10.1186/s12877-022-03182-5.
Basinska K, Zuniga F, Simon M, De Geest S, Guerbaai RA, Wellens NIH, Nicca D, Brunkert T. Implementation of a complex intervention to reduce hospitalizations from nursing homes: a mixed-method evaluation of implementation processes and outcomes. BMC Geriatr. 2022 Mar 12;22(1):196. doi: 10.1186/s12877-022-02878-y.
Other Identifiers
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EKNZ2018-00501
Identifier Type: -
Identifier Source: org_study_id