Positive effect of the <scp>INTERCARE</scp> nurse‐led model on reducing nursing home transfers: A nonrandomized stepped‐wedge design

Zúñiga, Franziska; Guerbaaï, Raphaëlle-Ashley; Geest, Sabina De; Popejoy, Lori L; Bartáková, Jana; Denhaerynck, Kris; Trutschel, Diana; Basinska, Kornelia; Nicca, Dunja; Kressig, Reto W.; Zeller, Andreas; Wellens, Nathalie; Pietro, Carlo De; Desmedt, Mario; Serdaly, Christine; Simon, Michaël

doi:10.1111/jgs.17677

Cited by 16 publications

(14 citation statements)

References 43 publications

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“…Eleven NHs were included in the INTERCARE study [11,14]. The NHs and resident characteristics can be found in a prior publication [14].…”

Section: Quantitative Resultsmentioning

confidence: 99%

“…Unplanned hospitalisations were measured as the main outcome of the INTERCARE study and described elsewhere [14]. Residents with informed consent hospitalisation data (Transfer date, type of transfer (planned/ unplanned), date of discharge and preliminary diagnosis) were collected throughout the study.…”

Section: Unplanned Hospitalisationsmentioning

confidence: 99%

“…The Improving INTERprofessionalCARE for better resident outcomes -the INTERCARE model, comprised six evidence-based core components and was developed within a theory-based implementation science study which relied on a thorough contextual analysis, continuous stakeholder involvement, evidence-based interventions and the development of implementation strategies targeting specific barriers and facilitators [11][12][13]. The INTERCARE model was successful in decreasing unplanned hospitalisations of NH residents [14] as well as cost-effective [15] and highly acceptable from the NH staff 's perspective [16].…”

Section: Introductionmentioning

confidence: 99%

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Evaluating the implementation fidelity to a successful nurse-led model (INTERCARE) which reduced nursing home unplanned hospitalisations

Guerbaaï

Geest

Popejoy

et al. 2023

BMC Health Serv Res

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Background Implementation fidelity assesses the degree to which an intervention is delivered as it should be. Fidelity helps to determine if the outcome(s) of an intervention are attributed to the intervention itself or to a failure of its implementation. Little is known about how fidelity impacts the intended outcome(s) and what elements or moderators can affect the fidelity trajectory over time. We exemplify the meaning of implementation fidelity with INTERCARE, a nurse-led care model that was implemented in eleven Swiss nursing homes (NHs) and showed effectiveness in reducing unplanned hospital transfers. INTERCARE comprises six core elements, including advance care planning and tools to support inter- and interprofessional communication, which were introduced with carefully developed implementation strategies. Methods A mixed-methods convergent/triangulation design was used to investigate the influence of implementation fidelity on unplanned transfers. A fidelity questionnaire measuring the degree of fidelity to INTERCARE’s core components was fielded at four time points in the participating NHs. Two-monthly meetings were conducted with NHs (September 2018-January 2020) and structured notes were used to determine moderators affecting fidelity (e.g., participant responsiveness). We used the fidelity scores and generalized linear mixed models to analyze the quantitative data. The Framework method was used for the qualitative analysis. The quantitative and qualitative findings were integrated using triangulation. Results A higher overall fidelity score showed a decreasing rate of unplanned hospital transfers post-intervention (OR: 0.65 (CI = 0.43–0.99), p = 0.047). A higher fidelity score to advance care planning was associated with lower unplanned transfers (OR = 0.24 (CI 0.13–0.44), p = < 0.001) and a lower fidelity score for communication tools (e.g., ISBAR) to higher rates in unplanned transfers (OR = 1.69 (CI 1.30–2.19), p = < 0.003). In-house physicians with a collaborative approach and staff’s perceived need for nurses working in extended roles, were important moderators to achieve and sustain high fidelity. Conclusion Implementation fidelity is challenging to measure and report, especially in complex interventions, yet is crucial to better understand how such interventions may be tailored for scale-up. This study provides both a detailed description of how fidelity can be measured and which ingredients highly contributed to reducing unplanned NH transfers. Trial registration The INTERCARE study was registered at clinicaltrials.gov Protocol Record NCT03590470.

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“…Eleven NHs were included in the INTERCARE study [11,14]. The NHs and resident characteristics can be found in a prior publication [14].…”

Section: Quantitative Resultsmentioning

confidence: 99%

Section: Unplanned Hospitalisationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluating the implementation fidelity to a successful nurse-led model (INTERCARE) which reduced nursing home unplanned hospitalisations

Guerbaaï

Geest

Popejoy

et al. 2023

BMC Health Serv Res

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“…1 The Swiss INTERCARE (INTERprofessionalCARE for better resident outcomes) model was built upon best practices to create and test a nurse-led model of care for nursing homes. In the current issue of JAGS, 2 Zuniga and colleagues describe the implementation and results of their stepped wedge clinical trial of the INTERCARE model in reducing unplanned nursing home hospital transfers. There are multiple implications of this work including emphasis on critical aspects of implementation of care models, choice of study design and outcome metrics, and challenges to scalability of multicomponent interventions.…”

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confidence: 99%

Complex problems need comprehensive solutions: The INTERCARE model provides evidence for nurse‐led nursing home care models

Kaehr

Unroe

2022

J American Geriatrics Society

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“…For example, the recent study by Zuniga et al (see Zúñiga et al Positive effect of the INTERCARE nurse-led model on reducing nursing home transfers: A nonrandomized stepped-wedge design. 1 ) demonstrates that with an introduction of a nurse-led care model to hospital admissions of nursing home residents can be significantly reduced. Similar positive approaches can be found, for example, on the recent scoping review by Schmüdderich et al (see Schmüdderich et al Core elements and potential of nurse-led care models in residential long-term care: A scoping review.…”

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confidence: 99%

Nursing home-sensitive conditions: analysis of routine health insurance data and modified Delphi analysis of potentially avoidable hospitalizations

et al. 2021

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Background: Hospitalizations of nursing home residents are associated with various health risks. Previous research indicates that, to some extent, hospitalizations of this vulnerable population may be inappropriate and even avoidable. This study aimed to develop a consensus list of hospital discharge diagnoses considered to be nursing home-sensitive, i.e., avoidable. Methods: The study combined analyses of routine data from six statutory health insurance companies in Germany and a two-stage Delphi panel, enhanced by expert workshop discussions, to identify and corroborate relevant diagnoses. Experts from four different disciplines estimated the proportion of hospitalizations that could potentially have been prevented under optimal conditions. Results: We analyzed frequencies and costs of data for hospital admissions from 242,236 nursing home residents provided by statutory health insurance companies. We identified 117 hospital discharge diagnoses, which had a frequency of at least 0.1%. We recruited experts (primary care physicians, hospital specialists, nursing home professionals and researchers) to estimate the proportion of potentially avoidable hospitalizations for the 117 diagnoses deemed avoidable in two Delphi rounds (n=107 in Delphi Round 1 and n=96 in Delphi Round 2, effective response rate=91%). A total of 35 diagnoses with high and consistent estimates of the proportion of potentially avoidable hospitalizations were identified as nursing home-sensitive. In an expert workshop (n=16), a further 25 diagnoses were discussed that had not reached the criteria, of which another 23 were consented to be nursing home-sensitive conditions. Extrapolating the frequency and mean costs of these 58 diagnoses to the national German context yielded total potentially avoidable care costs of €768,304,547, associated with 219,955 nursing home-sensitive hospital admissions. Conclusion: A total of 58 nursing home-relevant diagnoses (ICD-10-GM three-digit level) were classified as nursing home-sensitive using an adapted Delphi procedure. Interventions should be developed to avoid hospital admission from nursing homes for these diagnoses.

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Positive effect of the INTERCARE nurse‐led model on reducing nursing home transfers: A nonrandomized stepped‐wedge design

Cited by 16 publications

References 43 publications

Evaluating the implementation fidelity to a successful nurse-led model (INTERCARE) which reduced nursing home unplanned hospitalisations

Evaluating the implementation fidelity to a successful nurse-led model (INTERCARE) which reduced nursing home unplanned hospitalisations

Complex problems need comprehensive solutions: The INTERCARE model provides evidence for nurse‐led nursing home care models

Nursing home-sensitive conditions: analysis of routine health insurance data and modified Delphi analysis of potentially avoidable hospitalizations

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