Madrigal Caroline, Mills Whitney L, Keleher Virginia C, Pimentel Camilla B, Hartmann Christine W, Snow A Lynn, Camp Cameron, Hilgeman Michelle M
Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA.
Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA.
Gerontologist. 2023 Mar 21;63(3):589-603. doi: 10.1093/geront/gnac133.
Effectively adapting evidence-based interventions for nursing home (NH) implementation is a critical, yet underexamined, component of improving care quality. Montessori-based activity programming (MAP) is an evidence-based intervention that promotes person-centered care, engages persons living with dementia, and mitigates distress behaviors. Currently, there is sparse evidence of MAP in Department of Veterans Affairs NHs (i.e., community living centers [CLCs]). CLCs differ significantly from community NHs and require adaptations to support MAP use and sustainability. This study uses the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) to track changes made to MAP as an exemplar for clinicians and implementation scientists. This work fills a gap in adapting interventions through a detailed examination of the adaptation process in NHs.
Qualitative and quantitative data were collected across 8 CLCs (e.g., advisory panel, staff interviews, training evaluations, field notes, and fidelity assessments). We used an iterative, rapid content analytic approach to triangulate findings and identify needed adaptations for the CLC setting.
Thirty-six adaptations were made. Most adaptions occurred during the preimplementation phase, were reactive, focused on training/evaluation, and involved researchers, intervention developers, and practitioners. All were fidelity-consistent with MAP. The most common goal across adaptations was increased reach/engagement of the intervention.
CLCs and community NHs can use findings to support intervention adaptation, and adapt and implement MAP to improve meaningful engagement for persons living with dementia and other residents. Future research should further evaluate and standardize FRAME for diverse users of complex interventions.
有效调整基于证据的干预措施以在养老院（NH）实施，是提高护理质量的关键但未得到充分研究的组成部分。基于蒙台梭利方法的活动规划（MAP）是一种基于证据的干预措施，可促进以患者为中心的护理，让痴呆症患者参与其中，并减轻困扰行为。目前，在退伍军人事务部的养老院（即社区生活中心[CLC]）中，关于MAP的证据很少。社区生活中心与社区养老院有很大不同，需要进行调整以支持MAP的使用和可持续性。本研究使用增强版的适应与修改报告框架（FRAME）来跟踪对MAP所做的更改，为临床医生和实施科学家提供一个范例。这项工作通过详细检查养老院的适应过程，填补了干预措施调整方面的空白。
在8个社区生活中心收集了定性和定量数据（例如，咨询小组、员工访谈、培训评估、实地记录和保真度评估）。我们采用迭代、快速的内容分析方法来验证研究结果，并确定社区生活中心环境所需的调整。
共进行了36项调整。大多数调整发生在实施前阶段，是被动反应式的，侧重于培训/评估，涉及研究人员、干预措施开发者和从业者。所有调整都与MAP的保真度一致。调整中最常见的目标是扩大干预措施的覆盖范围/参与度。
社区生活中心和社区养老院可以利用研究结果来支持干预措施的调整，并调整和实施MAP，以提高痴呆症患者和其他居民的有意义参与度。未来的研究应进一步评估并为复杂干预措施的不同使用者规范FRAME。
