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. 2019 Oct;67(10):2145-2150.
doi: 10.1111/jgs.16074. Epub 2019 Jul 18.

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

Franziska Zúñiga  1 , Sabina De Geest  1   2 , Raphaëlle Ashley Guerbaai  1 , Kornelia Basinska  1 , Dunja Nicca  1   3 , Reto W Kressig  4   5 , Andreas Zeller  5   6 , Nathalie I H Wellens  7 , Carlo De Pietro  8 , Ellen Vlaeyen  1   2 , Mario Desmedt  9 , Christine Serdaly  10 , Michael Simon  1   11
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Strengthening Geriatric Expertise in Swiss Nursing Homes: INTERCARE Implementation Study Protocol

Franziska Zúñiga et al. J Am Geriatr Soc. 2019 Oct.

Abstract

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.

Keywords: clinical leadership; hospitalization; implementation science; interprofessional models of care; nurse expert; nursing home; quality of care.

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References

REFERENCES

    1. Bundesamt für Statistik, Statistik der Sozialmedizinischen Institutionen 2017 - Definitive Standardtabellen. Neuchâtel, Switzerland: Bundesamt für Statistik; 2017.
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