Predicting nursing home adherence to a clinical trial intervention: lessons for the conduct of cluster randomized trials
Authors
Tjia, JenniferMazor, Kathleen M.
Field, Terry S.
Doherty, Peter P
Spenard, Ann
Gurwitz, Jerry H.
UMass Chan Affiliations
Department of Medicine, Division of Geriatric MedicineMeyers Primary Care Institute
Document Type
Journal ArticlePublication Date
2011-12-01Keywords
Cluster AnalysisRandomized Controlled Trials as Topic
Nursing Homes
Geriatrics
Health Services Research
Primary Care
Metadata
Show full item recordAbstract
OBJECTIVES: To describe factors predictive of nursing home (NH) adherence to a clinical trial intervention. DESIGN: Post hoc analysis of a cluster randomized trial (CRT) evaluating a structured communication intervention to improve nurse-physician telephone communication in NHs. SETTING: NH. PARTICIPANTS: All eligible licensed nursing staff in all participating NHs. MEASUREMENTS: Adherence was defined as active participation for at least 3 months of the 12-month trial. NH characteristics hypothesized to affect trial outcomes (profit status, bed size, nursing staff time, NH quality, and leadership turnover) were measured a priori. The association between intervention adherence, NH characteristics and preintervention questionnaire response rate was examined. RESULTS: Of 13 intervention NHs, seven adhered to the intervention. Three factors differentiated adherent from nonadherent NHs: director of nursing turnover (nonadherent NHs 50% vs adherent NHs 0%, P = .03); Centers for Medicare and Medicaid Services (CMS) nurse staffing rating (range: 1-5) (nonadherent NHs mean 3.7 ± 0.5 vs adherent NHs mean 4.3 ± 0.5), P = .048); and questionnaire response rate (nonadherent NHs 15.6 ± 10.0% vs adherent NHs 34.2 ± 12.1%, P = .02). Profit status, bed size, and number of NH deficiencies on state surveys were not significantly associated with intervention adherence. CONCLUSION: CMS nurse staffing rating, leadership turnover, and questionnaire response rate are associated with adherence to a CRT intervention. Pretrial evaluation of NH staffing rating by CMS and of response to a questionnaire can help investigators improve trial efficiency by screening for NHs likely to adhere to a CRT intervention.Source
J Am Geriatr Soc. 2011 Dec;59(12):2332-6. doi: 10.1111/j.1532-5415.2011.03697.x. Epub 2011 Oct 31.DOI
10.1111/j.1532-5415.2011.03697.xPermanent Link to this Item
http://hdl.handle.net/20.500.14038/37113PubMed ID
22091689Related Resources
Link to article in PubMedae974a485f413a2113503eed53cd6c53
10.1111/j.1532-5415.2011.03697.x