Strengthening Geriatric Expertise in Swiss Nursing Homes: INTERCARE Implementation Study Protocol

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 67; no. 10; pp. 2145 - 2150
• Main Authors: Zúñiga, Franziska, De Geest, Sabina, Guerbaai, Raphaëlle Ashley, Basinska, Kornelia, Nicca, Dunja, Kressig, Reto W., Zeller, Andreas, Wellens, Nathalie I.H., De Pietro, Carlo, Vlaeyen, Ellen, Desmedt, Mario, Serdaly, Christine, Simon, Michael
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.10.2019; Wiley Subscription Services, Inc
• Subjects: Aged; Clinical Competence - standards; Clinical decision making; clinical leadership; Cross-Over Studies; Decision making; Geriatrics; Geriatrics - education; Homes for the Aged - standards; Hospitalization; Humans; implementation science; interprofessional models of care; Leadership; Models, Nursing; Non-Randomized Controlled Trials as Topic; nurse expert; nursing home; Nursing homes; Nursing Homes - standards; Practice Patterns, Nurses' - organization & administration; Quality of care; Quality of Health Care; Switzerland; Switzerland; hospitalization; interprofessional models of care; nurse expert; nursing home; quality of care; clinical leadership; implementation science
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.16074

OBJECTIVES Nursing home (NH) residents with complex care needs ask for attentive monitoring of changes and appropriate in‐house decision making. However, access to geriatric expertise is often limited with a lack of geriatricians, general practitioners, and/or nurses with advanced clinical skills, leading to potentially avoidable hospitalizations. This situation calls for the development, implementation, and evaluation of innovative, contextually adapted nurse‐led care models that support NHs in improving their quality of care and reducing hospitalizations by investing in effective clinical leadership, geriatric expertise, and care coordination. DESIGN An effectiveness‐implementation hybrid type 2 design to assess clinical outcomes of a nurse‐led care model and a mixed‐method approach to evaluate implementation outcomes will be applied. The model development, tailoring, and implementation are based on the Consolidated Framework for Implementation Research (CFIR). SETTING NHs in the German‐speaking region of Switzerland. PARTICIPANTS Eleven NHs were recruited. The sample size was estimated assuming an average of .8 unplanned hospitalizations/1000 resident days and a reduction of 25% in NHs with the nurse‐led care model. INTERVENTION The multilevel complex context‐adapted intervention consists of six core elements (eg, specifically trained INTERCARE nurses or evidence‐based tools like Identify, Situation, Background, Assessment and Recommendation [ISBAR]). Multilevel implementation strategies include leadership and INTERCARE nurse training and support. MEASUREMENTS The primary outcomes are unplanned hospitalizations/1000 care days. Secondary outcomes include unplanned emergency department visits, quality indicators (eg, physical restraint use), and costs. Implementation outcomes included, for example, fidelity to the model's core elements. CONCLUSION The INTERCARE study will provide evidence about the effectiveness of a nurse‐led care model in the real‐world setting and accompanying implementation strategies. J Am Geriatr Soc 67:2145–2150, 2019