Although efficacy trials have identified interventions that reduce adverse outcomes such as falls in nursing home (NH) residents, attempts to translate those interventions into practice using current standard of care quality improvement (QI) techniques have not been successful. Using a complexity science framework, our previous RO1 has shown that low connection, information flow, and cognitive diversity among NH staff explains much of the poor quality of care delivered for complex problems such as falls. Our pilot test of CONNECT, a multi-component intervention that encourages staff use simple strategies to make new connections with others, enhance information flow, and use cognitive diversity, demonstrated that staff can learn to improve the density and quality of their interactions, and that this change in behavior is associated with a trend to lower fall rates. We hypothesize that higher levels of connection, information flow and cognitive diversity fostered in the CONNECT Intervention are necessary before any QI intervention for a complex geriatric problem such as falls can be successful. This 5-year study will use a prospective, cluster-randomized, outcome assessment blinded design, with NHs (n=16) randomized to either CONNECT and a standard falls QI program (CONNECT + FALLS) or FALLS alone. We estimate that 800 residents and 576 staff members will participate.
Specific aims are to, in nursing homes: 1) Compare the impact of the CONNECT intervention plus a falls reduction QI intervention (CONNECT+FALLS) to a falls reduction QI intervention (FALLS) on fall risk reduction indicators (orthostatic blood pressure, sensory impairment, footwear appropriateness, gait; assistive device; toileting needs, environment, and psychotropic medication); 2) Compare the impact of CONNECT+FALLS to FALLS alone on fall rates and injurious falls, and determine whether these are mediated by the change in fall risk reduction indicators; 3) Compare the impact of CONNECT+FALLS to FALLS alone on complexity science measures (communication, participation in decision making, local interactions, safety climate, staff perceptions of quality) and determine whether these mediate the impact on fall risk reduction indicators and fall rates and injurious falls. Cross-sectional observations of complexity science measures are taken at baseline, at 3 months, at 6 months, and at 9 months. Resident fall risk reduction indicators, fall rates, and injurious falls are measured for the 6 months prior to the first intervention and the 6 months after the final intervention is completed. Fall risk reduction indicators are the primary outcome. Secondary outcome measures include fall rates, injurious falls, and complexity science measures (communication, participation in decision making, local interactions, safety climate, staff perceptions of quality). Analysis will use a 3-level mixed model to account for the complex nesting of patients and staff within nursing homes, and to control for covariates associated with fall risk, including baseline facility fall rates and staff turnover rates.
In order to promote the health of the frail NH population, it is essential to identify interventions to improve the translation of research advances into actual practice. The CONNECT intervention integrates behavioral and complexity science with principles of health services research, and has the potential to improve care in NHs for many complex medical and psycho-social problems among frail older adults.
| Colón-Emeric, Cathleen S; Corazzini, Kirsten N; McConnell, Eleanor S et al. (2018) Resident Vignettes for Assessing Care Quality in Nursing Homes. J Am Med Dir Assoc 19:405-410 |
| Cary Jr, Michael P; Hall, Rasheeda K; Anderson, Amber L et al. (2018) Management Team Perceptions of Risks and Strategies for Preventing Falls Among Short-Stay Patients in Nursing Homes. Health Care Manag (Frederick) 37:76-85 |
| Colón-Emeric, Cathleen S; Corazzini, Kirsten; McConnell, Eleanor S et al. (2017) Effect of Promoting High-Quality Staff Interactions on Fall Prevention in Nursing Homes: A Cluster-Randomized Trial. JAMA Intern Med 177:1634-1641 |
| Mewshaw, Jennifer; Bailey Jr, Donald E; Porter, Kristie A et al. (2017) A novel program for ABSN students to generate interest in geriatrics and geriatric nursing research. J Nurs Educ Pract 7:95-99 |
| Colón-Emeric, Cathleen S; Corazzini, Kirsten; McConnell, Eleanor et al. (2017) Study of Individualization and Bias in Nursing Home Fall Prevention Practices. J Am Geriatr Soc 65:815-821 |
| Colón-Emeric, Cathleen; Toles, Mark; Cary Jr, Michael P et al. (2016) Sustaining complex interventions in long-term care: a qualitative study of direct care staff and managers. Implement Sci 11:94 |
| Cary Jr, Michael P; Pan, Wei; Sloane, Richard et al. (2016) Self-Care and Mobility Following Postacute Rehabilitation for Older Adults With Hip Fracture: A Multilevel Analysis. Arch Phys Med Rehabil 97:760-71 |
| Marcum, Zachary A; Gurwitz, Jerry H; Colón-Emeric, Cathleen et al. (2015) Pills and ills: methodological problems in pharmacological research. J Am Geriatr Soc 63:829-30 |
| Hall, Rasheeda K; Landerman, Lawrence R; O'Hare, Ann M et al. (2015) Chronic kidney disease and recurrent falls in nursing home residents: a retrospective cohort study. Geriatr Nurs 36:136-41 |
| Anderson, Ruth A; Toles, Mark P; Corazzini, Kirsten et al. (2014) Local interaction strategies and capacity for better care in nursing homes: a multiple case study. BMC Health Serv Res 14:244 |
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