Calo William A, Francis Erica, Kong Lan, Hogentogler Ruth, Heilbrunn Emily, Fisher Abbey, Hood Nancy, Kraschnewski Jennifer
Department of Public Health Sciences, Penn State College of Medicine, Penn State University, Hershey, PA, United States.
Department of Medicine, College of Medicine, Penn State University, Hershey, PA, United States.
JMIR Res Protoc. 2022 May 13;11(5):e34480. doi: 10.2196/34480.
Nursing homes in the United States were devastated by COVID-19, with 710,000 cases and 138,000 deaths nationally through October 2021. Although facilities are required to have infection control staff, only 3% of designated infection preventionists have taken a basic infection control course prior to the COVID-19 pandemic. Most research has focused on infection control in the acute care setting. However, little is known about the implementation of infection control practices and effective interventions in nursing homes. This study utilizes Project ECHO (Extension for Community Health Outcomes), an evidence-based telementoring model, to connect Penn State University subject matter experts with nursing home staff and administrators to proactively support evidence-based infection control guideline implementation.
Our study seeks to answer the research question of how evidence-based infection control guidelines can be implemented effectively in nursing homes, including comparing the effectiveness of two ECHO-delivered training interventions on key patient-centered outcomes such as reducing the number of residents with a COVID-19 diagnosis.
A stratified cluster randomized design was utilized. Using a 1:1 ratio, we randomly assigned 136 nursing homes to ECHO or ECHO Plus arms. Randomization was stratified by geographic location, baseline COVID-19 infection rate, and facility capacity. The study had two phases. In phase one, completed in July 2021, nursing homes in both study arms received a 16-week infectious disease and quality improvement training intervention via real-time, interactive videoconferencing and the ECHO learning model. Phase one sessions were up to 90 minutes in duration. In phase two, completed in November 2021, the ECHO group was offered optional 60-minute office hours for 9 weeks and the ECHO Plus group received 9 weeks of 60-minute sessions on emerging topics and an additional 8-session refresher series on infection control.
A total of 290 nursing home facilities were assessed for eligibility, with 136 nursing homes recruited and randomly assigned to ECHO or ECHO Plus. Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, we will simultaneously evaluate the study's effectiveness and implementation outcomes at baseline (intervention start date), and at 4, 6, 12, and 18 months. The primary outcome is the COVID-19 infection rate in nursing homes. Secondary outcomes include COVID-19 hospitalizations and deaths, flu-like illness, and quality of life. Surveys and interviews with participants will also provide data as to the adoption, implementation, and maintenance of best practices taught throughout ECHO sessions.
A multipronged approach to improving infection control and emergency preparedness in nursing homes is important, given the toll that the COVID-19 pandemic has taken on residents and staff. The ECHO model has significant strengths when compared to traditional training, as it allows for remote learning delivered by a multidisciplinary team of experts, and utilizes case discussions that match the context and capacity of nursing homes.
ClinicalTrials.gov NCT04499391; https://clinicaltrials.gov/ct2/show/NCT04499391.
美国的养老院受到新冠疫情的重创，截至2021年10月，全国有71万例病例，13.8万人死亡。尽管养老院被要求配备感染控制人员，但在新冠疫情大流行之前，只有3%的指定感染预防人员参加过基本的感染控制课程。大多数研究都集中在急性护理环境中的感染控制。然而，对于养老院感染控制措施的实施情况和有效干预措施知之甚少。本研究利用“社区健康成果扩展计划”（Project ECHO）这一循证远程指导模式，将宾夕法尼亚州立大学的主题专家与养老院工作人员及管理人员联系起来，以积极支持循证感染控制指南的实施。
我们的研究旨在回答如何在养老院有效实施循证感染控制指南这一研究问题，包括比较两种通过ECHO提供的培训干预措施对以患者为中心的关键结局（如减少新冠病毒确诊居民数量）的有效性。
采用分层整群随机设计。我们以1:1的比例将136家养老院随机分配到ECHO组或ECHO Plus组。随机分组按地理位置、基线新冠感染率和机构容量进行分层。该研究分为两个阶段。在2021年7月完成的第一阶段，两个研究组的养老院都通过实时互动视频会议和ECHO学习模式接受了为期16周的传染病和质量改进培训干预。第一阶段的课程时长可达90分钟。在2021年11月完成的第二阶段，ECHO组有9周的可选60分钟答疑时间，ECHO Plus组则接受了9周关于新出现主题的60分钟课程，以及另外8节感染控制复习课程。
共评估了290家养老院的资格，招募了136家养老院并随机分配到ECHO组或ECHO Plus组。在“覆盖、效果、采用、实施和维持”（RE-AIM）框架的指导下，我们将在基线（干预开始日期）以及4、6、12和18个月时同时评估研究的有效性和实施结果。主要结局是养老院的新冠感染率。次要结局包括新冠住院和死亡、流感样疾病以及生活质量。对参与者的调查和访谈也将提供关于在整个ECHO课程中教授的最佳实践的采用、实施和维持情况的数据。
鉴于新冠疫情对居民和工作人员造成的损失，采取多管齐下的方法来改善养老院的感染控制和应急准备非常重要。与传统培训相比，ECHO模式具有显著优势，因为它允许由多学科专家团队进行远程学习，并利用与养老院背景和能力相匹配的案例讨论。
ClinicalTrials.gov NCT04499391；https://clinicaltrials.gov/ct2/show/NCT04499391
