Institute for Social Medicine and Epidemiology, Nursing Research Group, University of Lübeck, Ratzeburger Allee 160, Haus 50, 23538, Lübeck, Germany.
Chair of Organization and Corporate Development, Faculty of Economic Sciences, Georg-August-University Göttingen, Platz der Göttinger Sieben 3, 37073, Göttingen, Germany.
Trials. 2022 Jul 8;23(1):561. doi: 10.1186/s13063-022-06476-6.
To improve interprofessional collaboration between registered nurses (RNs) and general practitioners (GPs) for nursing home residents (NHRs), the interprof ACT intervention package was developed. This complex intervention includes six components (e.g., shared goal setting, standardized procedures for GPs' nursing home visits) that can be locally adapted. The cluster-randomized interprof ACT trial evaluates the effects of this intervention on the cumulative incidence of hospital admissions (primary outcome) and secondary outcomes (e.g., length of hospital stays, utilization of emergency care services, and quality of life) within 12 months. It also includes a process evaluation which is subject of this protocol. The objectives of this evaluation are to assess the implementation of the interprof ACT intervention package and downstream effects on nurse-physician collaboration as well as preconditions and prospects for successive implementation into routine care.
This study uses a mixed methods triangulation design involving all 34 participating nursing homes (clusters). The quantitative part comprises paper-based surveys among RNs, GPs, NHRs, and nursing home directors at baseline and 12 months. In the intervention group (17 clusters), data on the implementation of preplanned implementation strategies (training and supervision of nominated IPAVs, interprofessional kick-off meetings) and local implementation activities will be recorded. Major outcome domains are the dose, reach and fidelity of the implementation of the intervention package, changes in interprofessional collaboration, and contextual factors. The qualitative part will be conducted in a subsample of 8 nursing homes (4 per study group) and includes repeated non-participating observations and semistructured interviews on the interaction between involved health professionals and their work processes. Quantitative and qualitative data will be descriptively analyzed and then triangulated by means of joint displays and mixed methods informed regression models.
By integrating a variety of qualitative and quantitative data sources, this process evaluation will allow comprehensive assessment of the implementation of the interprof ACT intervention package, the changes induced in interprofessional collaboration, and the influence of contextual factors. These data will reveal expected and unexpected changes in the procedures of interprofessional care delivery and thus facilitate accurate conclusions for the further design of routine care services for NHRs.
ClinicalTrials.gov NCT03426475 . Registered on 07/02/2018.
为了改善注册护士（RNs）和全科医生（GPs）之间在养老院居民（NHRs）方面的合作，开发了跨专业 ACT 干预包。这个复杂的干预措施包括六个组成部分（例如，共同设定目标，为全科医生的养老院访问制定标准化程序），可以在当地进行调整。这项基于群组的跨专业 ACT 试验评估了该干预措施对 12 个月内住院人数（主要结果）和次要结果（例如，住院时间，急诊服务的使用以及生活质量）的累积发生率的影响。它还包括一个过程评估，这是本方案的主题。该评估的目的是评估跨专业 ACT 干预包的实施情况以及对护士与医师合作的后续影响，以及为后续实施到常规护理中的前提条件和前景。
本研究采用混合方法三角测量设计，涉及所有 34 个参与的养老院（群组）。定量部分包括基线和 12 个月时对 RN、GP、NHR 和养老院主任进行的纸质问卷调查。在干预组（17 个群组）中，将记录计划实施策略（培训和监督指定的跨专业倡导者，跨专业启动会议）和当地实施活动的数据。主要结果领域是干预包的实施的剂量，范围和保真度，跨专业合作的变化以及背景因素。定性部分将在 8 个养老院（每组 4 个）的子样本中进行，包括对参与卫生专业人员及其工作流程之间相互作用的重复非参与观察和半结构化访谈。定量和定性数据将进行描述性分析，然后通过联合展示和混合方法知情回归模型进行三角测量。
通过整合各种定性和定量数据源，此过程评估将使我们能够全面评估跨专业 ACT 干预包的实施情况，跨专业合作所带来的变化以及背景因素的影响。这些数据将揭示在提供跨专业护理服务的程序中预期和意外的变化，从而为 NHR 的常规护理服务的进一步设计提供准确的结论。
ClinicalTrials.gov NCT03426475。注册于 2018 年 7 月 2 日。
