Positive effect of the INTERCARE nurse‐led model on reducing nursing home transfers: A nonrandomized stepped‐wedge design.
Background: 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 compreh...
| Publicado en: | Journal of the American Geriatrics Society Vol. 70; no. 5; pp. 1546 - 1558 |
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| Autores principales: | , , , , , , , , , , , , , , , |
| Formato: | Artículo |
| Publicado: |
Wiley-Blackwell
May2022
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| Materias: | |
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=156868699&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 156868699 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00028614 20Q jtl: Journal of the American Geriatrics Society issn: 00028614 maglogo: Y pubinfo: dt: May2022 vid: 70 iid: 5 pid: 480 pub: Wiley-Blackwell artinfo: ui: 156868699 10.1111/jgs.17677 ppf: 1546 ppct: 12 formats: tig: atl: Positive effect of the INTERCARE nurse‐led model on reducing nursing home transfers: A nonrandomized stepped‐wedge design. aug: au: Zúñiga, Franziska Guerbaai, Raphaëlle‐Ashley de Geest, Sabina Popejoy, Lori L. Bartakova, Jana Denhaerynck, Kris Trutschel, Diana Basinska, Kornelia Nicca, Dunja Kressig, Reto W. Zeller, Andreas Wellens, Nathalie I. H. de Pietro, Carlo Desmedt, Mario Serdaly, Christine Simon, Michael affil: Department of Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium University of Missouri, Sinclair School of Nursing, Columbia, USA Department of Computational Biology, Institut Pasteur, Paris, France Institut of Epidemiology, Biostatistics and Prevention, University of Zürich, Zürich, Switzerland University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland Faculty of Medicine, University of Basel, Basel, Switzerland Centre for Primary Health Care, University of Basel, Basel, Switzerland Directorate General of Health, Department of Public Health and Social Affairs of the Canton of Vaud, Lausanne, Switzerland La Source School of Nursing, HES‐SO University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland The department of Business economics, Health and Social Care at the University of Applied Sciences and Arts of Southern Switzerland, Lugano, Switzerland Foundation Asile des Aveugles, Lausanne, Switzerland Serdaly & Ankers snc, Chêne‐Bougeries, Switzerland Inselspital Bern University Hospital, Department of Nursing, Nursing & Midwifery Research Unit, Bern, Switzerland su: Nursing care facilities Hospital admission & discharge Nurses Hospital care Outpatient medical care Decision making in clinical medicine sug: subj: Nursing care facilities Hospital admission & discharge Nurses Hospital care Outpatient medical care Community health centres All other out-patient care centres All Other Outpatient Care Centers Nursing Care Facilities (Skilled Nursing Facilities) Community care facilities for the elderly Decision making in clinical medicine keyword: implementation science nurse‐led models nursing homes stepped‐wedge design unplanned transfers implementation science nurse‐led models nursing homes stepped‐wedge design unplanned transfers ab: Background: 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. Methods: 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. Results: Three hundred and three unplanned and 64 planned hospitalizations occurred. During the baseline period, unplanned transfers increased over time (β1 = 0.52), after which the trend significantly changed by a similar but opposite amount (β2 = −0.52; p = 0.0001), resulting in a flattening of the average transfer rate throughout the postimplementation period (β1 + β2 ≈ 0). Controlling for age, gender, and cognitive performance did not affect these trends. The validation set showed a similar flattening trend. Conclusion: 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. See related Editorial by Kaehr et al. in this issue. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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