TL/DR –
Researchers from the Regenstrief Institute, Indiana University School of Medicine, and IU School of Nursing have found that leadership stability and peer engagement are crucial to successfully implementing patient care programs in nursing homes. Their study examined the implementation of the APPROACHES intervention, a program aimed at improving advance care planning (ACP) for nursing home residents with dementia. The study found that among the 44 intervention nursing homes, 41% achieved robust implementation, defined as documenting ACP conversations for more than 75% of eligible residents.
Implementing Real-World Interventions in Nursing Homes: Key Factors Revealed in New Study
A pragmatic clinical trial conducted by the Regenstrief Institute, Indiana University School of Medicine, and the IU School of Nursing has identified key elements for successfully implementing patient care programs in nursing home settings. The trial concluded that leadership stability and peer engagement played crucial roles in the successful implementation.
The team examined the implementation of the ‘Aligning Patient Preferences – Role Offering Alzheimer’s Patients, Caregivers, and Healthcare Providers Education and Support’ (APPROACHES) intervention. This program aimed to enhance advance care planning (ACP) for dementia patients in nursing homes by training existing staff to lead structured ACP discussions. These conversations ultimately prepare residents and caregivers for improved communication and decision-making.
Using Coincidence Analysis, a method examining how intervention components interact with the delivery setting, the team identified two key factors: 1) No executive director turnover during the intervention period combined with participation in monthly peer calls, and 2) Higher baseline hospitalization rates combined with smaller facility size. According to the trial, stable leadership and meaningful peer connections are essential in creating a receptive environment for successful intervention implementation.
The study also found that among the 44 nursing homes incorporated in the analysis, 41 percent achieved robust implementation. This was defined as documenting ACP conversations for over 75 percent of eligible residents. The importance of peer engagement was emphasized, with monthly calls led by corporate heads allowing ACP specialists to share strategies, success stories, and collaborative problem-solving.
Federal policy already encourages ACP in nursing homes. However, understanding how to successfully implement these programs in real-world nursing home environments, where consistent training and infrastructure are often lacking, is a crucial priority. The APPROACHES ACP training modules are now available through Pathway Health’s learning management system, extending the program’s reach beyond the original study sites.
The full study, titled “Difference-Makers for Robust Implementation of a Nursing Home Advance Care Planning Embedded Pragmatic Clinical Trial”, is published in the Journal of the American Geriatric Society. The work was supported by the National Institute on Aging (Grant number: R33AG057463, Clinicaltrials.gov number: NCT03323502).
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