TY - JOUR
T1 - Comparing effects of two higher intensity feedback interventions with simple feedback on improving staff communication in nursing homes - The INFORM cluster-randomized controlled trial
AU - Hoben, Matthias
AU - Ginsburg, Liane R.
AU - Easterbrook, Adam
AU - Norton, Peter G.
AU - Anderson, Ruth A.
AU - Andersen, Elizabeth A.
AU - Boström, Anne Marie
AU - Cranley, Lisa A.
AU - Lanham, Holly J.
AU - Weeks, Lori E.
AU - Cummings, Greta G.
AU - Holroyd-Leduc, Jayna M.
AU - Squires, Janet E.
AU - Wagg, Adrian S.
AU - Estabrooks, Carole A.
N1 - Funding Information:
This study was funded by a Canadian Institute of Health Research (CIHR) Transitional Operating Grant (#341532). During the time of the study, Matthias Hoben was holding a Postdoctoral Fellowship from Alberta Innovates (formerly Alberta Innovates-Health Solutions; 2014-2017; File No: 201300543, CA #: 3723). He also received top-up funding from TREC and Estabrooks' Tier 1 Canada Research Chair and his last year of postdoctoral training (2017-2018) was funded by a TREC Postdoctoral Fellowship. Matthias Hoben currently holds a University of Alberta Faculty of Nursing Professorship in Continuing Care Policy Research and a University of Alberta Faculty of Nursing Establishment Grant, both of which were partially used to fund work related to this study. Carole Estabrooks holds a Tier 1 Canada Research Chair in Knowledge Translation.
Funding Information:
Tara Penner edited the manuscript and was funded by Matthias Hoben. We would like to thank the facilities, administrators, and their care teams who participated in this study. We acknowledge the contributions of Sube Banerjee and William Ghali who gave valuable input on the manuscript. We would also like to thank Don McLeod for facilitating the intervention workshops and contributing to the development of the intervention materials; the TREC regional project coordinators (Fiona MacKenzie, Kirstie McDermott, Julie Mellville, Michelle Smith) for recruiting facilities and participants, and keeping them engaged; Charlotte Berendonk for administrative support; the TREC data unit manager Joseph Akinlawon and the TREC analyst Moses Kim for carrying out the statistical analyses; and Malcolm Doupe for carrying out the randomization.
Publisher Copyright:
© 2020 The Author(s).
PY - 2020/9/10
Y1 - 2020/9/10
N2 - Background: 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. Methods: 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. Results: 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. Conclusions: 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: ClinicalTrials.gov
AB - Background: 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. Methods: 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. Results: 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. Conclusions: 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: ClinicalTrials.gov
KW - Audit and feedback
KW - Care aides
KW - Formal communication
KW - Nursing homes
KW - Quality improvement
KW - Randomized controlled trial
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U2 - 10.1186/s13012-020-01038-3
DO - 10.1186/s13012-020-01038-3
M3 - Article
C2 - 32912323
AN - SCOPUS:85090817047
SN - 1748-5908
VL - 15
JO - Implementation Science
JF - Implementation Science
IS - 1
M1 - 75
ER -