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

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License: CC BY-NC-ND 4.0
Serval ID
serval:BIB_EC1710B0B1FF
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Positive effect of the INTERCARE nurse-led model on reducing nursing home transfers: A nonrandomized stepped-wedge design.
Journal
Journal of the American Geriatrics Society
Author(s)
Zúñiga F., Guerbaai R.A., de Geest S., Popejoy L.L., Bartakova J., Denhaerynck K., Trutschel D., Basinska K., Nicca D., Kressig R.W., Zeller A., Wellens NIH, de Pietro C., Desmedt M., Serdaly C., Simon M.
ISSN
1532-5415 (Electronic)
ISSN-L
0002-8614
Publication state
Published
Issued date
05/2022
Peer-reviewed
Oui
Volume
70
Number
5
Pages
1546-1557
Language
english
Notes
Publication types: Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
Unplanned nursing home (NH) transfers are burdensome for residents and costly for health systems. Innovative nurse-led models of care focusing on improving in-house geriatric expertise are needed to decrease unplanned transfers. The aim was to test the clinical effectiveness of a comprehensive, contextually adapted geriatric nurse-led model of care (INTERCARE) in reducing unplanned transfers from NHs to hospitals.
A multicenter nonrandomized stepped-wedge design within a hybrid type-2 effectiveness-implementation study was implemented in 11 NHs in German-speaking Switzerland. The first NH enrolled in June 2018 and the last in November 2019. The study lasted 18 months, with a baseline period of 3 months for each NH. Inclusion criteria were 60 or more long-term care beds and 0.8 or more hospitalizations per 1'000 resident care days. Nine hundred and forty two long-term NH residents were included between June 2018 and January 2020 with informed consent. Short-term residents were excluded. The primary outcome was unplanned hospitalizations. A fully anonymized dataset of overall transfers of all NH residents served as validation. Analysis was performed with segmented mixed regression modeling.
Three hundred and three unplanned and 64 planned hospitalizations occurred. During the baseline period, unplanned transfers increased over time (β <sub>1</sub> = 0.52), after which the trend significantly changed by a similar but opposite amount (β <sub>2</sub> = -0.52; p = 0.0001), resulting in a flattening of the average transfer rate throughout the postimplementation period (β <sub>1</sub> + β <sub>2</sub> ≈ 0). Controlling for age, gender, and cognitive performance did not affect these trends. The validation set showed a similar flattening trend.
A complex intervention with six evidence-based components demonstrated effectiveness in significantly reducing unplanned transfers of NH residents to hospitals. INTERCARE's success was driven by registered nurses in expanded roles and the use of tools for clinical decision-making.
Keywords
Aged, Hospitalization, Hospitals, Humans, Nurse's Role, Nursing Homes, Patient Transfer, implementation science, nurse-led models, nursing homes, stepped-wedge design, unplanned transfers
Pubmed
Web of science
Open Access
Yes
Create date
24/05/2022 9:39
Last modification date
25/01/2024 8:46
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