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Improving Nursing Home Care Through Feedback On PerfoRMance Data (INFORM)

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ClinicalTrials.gov Identifier: NCT02695836
Recruitment Status : Active, not recruiting
First Posted : March 1, 2016
Last Update Posted : October 11, 2018
Sponsor:
Information provided by (Responsible Party):
Carole Estabrooks, University of Alberta

Brief Summary:
This project will evaluate three different strategies to get research findings back to managers of care units in nursing homes. Feedback will be provided in a timely and effective way so that it results in improvements in organizational context (modifiable features of the care unit work environment, such as Formal Interactions, Informal Interactions, Social Capital or Slack Time), quality of care providers' work life (e.g., burnout, job satisfaction, general health) and quality of care. Three feedback packages will be tested to determine the strategy that is most effective at fostering improvements and is also cost-effective. The project will be carried out in nursing homes in Alberta and British Columbia. The information developed will contribute to better care for Canadian seniors who spend their final years in a nursing home.

Condition or disease Intervention/treatment Phase
Organizational Context Other: Initial face-to-face dissemination workshop Other: Face-to-face goal setting workshop Other: Virtual support workshops Other: Face-to-face support workshops Other: On-demand email and telephone support Not Applicable

  Show Detailed Description

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 119 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Masking Description: Participants and outcome assessors are blinded to study arm assignment
Primary Purpose: Health Services Research
Official Title: Improving Nursing Home Care Through Feedback On PerfoRMance Data (INFORM)
Actual Study Start Date : March 1, 2016
Actual Primary Completion Date : December 31, 2017
Estimated Study Completion Date : December 31, 2019

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Nursing Homes

Arm Intervention/treatment
Active Comparator: Standard feedback
Facilities in this arm will receive an initial face-to-face dissemination workshop that includes feedback of research data on modifiable aspects of their microsystem context but no goal setting.
Other: Initial face-to-face dissemination workshop
Managers and directors of care will receive a printed report (tailored to their facility) on their facility's performance and performance of each unit (microsystem) within that facility. The workshop will include a presentation of the feedback reports with a particular focus on the core set of actionable context targets (Formal Interactions, Evaluation, Social Capital, Organizational Slack (OS) - Time) in the face-to-face workshops. Following the presentation, participants will discuss their reports in facilitated, round-table group discussions to a) help with interpretation of the results overall, b) draw attention to elements of context that are modifiable, c) encourage microsystem teams to work on improving the more modifiable areas

Experimental: Basic assisted feedback
In addition to the face-to-face dissemination workshop, facilities in this arm will receive a face-to-face goal setting workshop focused on modifiable areas of their microsystem context and two virtual support workshops at six month intervals.
Other: Initial face-to-face dissemination workshop
Managers and directors of care will receive a printed report (tailored to their facility) on their facility's performance and performance of each unit (microsystem) within that facility. The workshop will include a presentation of the feedback reports with a particular focus on the core set of actionable context targets (Formal Interactions, Evaluation, Social Capital, Organizational Slack (OS) - Time) in the face-to-face workshops. Following the presentation, participants will discuss their reports in facilitated, round-table group discussions to a) help with interpretation of the results overall, b) draw attention to elements of context that are modifiable, c) encourage microsystem teams to work on improving the more modifiable areas

Other: Face-to-face goal setting workshop
Sessions will build on the dissemination workshops and will be held three months after. Feedback reports on Formal Interactions, Evaluation, Social Capital, and Organizational Slack (OS) - Time will be discussed. Small group activities will take place including: a) reflecting on context data, b) performance goal setting using the 'tell and sell' method, which capitalizes on the workshop leaders' perceived expertise about what goals are achievable, c) establishing a series of proximal learning goals that will provide teams with explicit strategies for attaining performance goals set in (b). An action plan and instructions for reporting back at the Virtual Support Workshop will be provided.

Other: Virtual support workshops
On virtual support workshop will be held six months after the feedback and goal setting workshop, and a second one another six months later. Groups will a) report on their progress in the proximal learning goals and strategies used toward their performance goals, b) discuss challenges they may be encountering, and c) receive support from the research team in addressing these challenges.

Experimental: Enhanced assisted feedback
In addition to the face-to-face dissemination workshop, facilities in this arm will receive an additional face-to-face goal setting workshop focused on modifiable areas of their microsystem context, two additional face-to-face support workshops at six month intervals plus on-demand email and telephone support.
Other: Initial face-to-face dissemination workshop
Managers and directors of care will receive a printed report (tailored to their facility) on their facility's performance and performance of each unit (microsystem) within that facility. The workshop will include a presentation of the feedback reports with a particular focus on the core set of actionable context targets (Formal Interactions, Evaluation, Social Capital, Organizational Slack (OS) - Time) in the face-to-face workshops. Following the presentation, participants will discuss their reports in facilitated, round-table group discussions to a) help with interpretation of the results overall, b) draw attention to elements of context that are modifiable, c) encourage microsystem teams to work on improving the more modifiable areas

Other: Face-to-face goal setting workshop
Sessions will build on the dissemination workshops and will be held three months after. Feedback reports on Formal Interactions, Evaluation, Social Capital, and Organizational Slack (OS) - Time will be discussed. Small group activities will take place including: a) reflecting on context data, b) performance goal setting using the 'tell and sell' method, which capitalizes on the workshop leaders' perceived expertise about what goals are achievable, c) establishing a series of proximal learning goals that will provide teams with explicit strategies for attaining performance goals set in (b). An action plan and instructions for reporting back at the Virtual Support Workshop will be provided.

Other: Face-to-face support workshops
On face-to-face support workshop will be held six months after the feedback and goal setting workshop, and a second one another six months later. Groups will a) report on their progress in the proximal learning goals and strategies used toward their performance goals, b) discuss challenges they may be encountering, and c) receive support from the research team in addressing these challenges. Workshops will be attended by all participating teams from a region, to maximize opportunities for teams to learn from one another and trouble-shoot together with the support of workshop leaders.

Other: On-demand email and telephone support
Participants can contact the research team if needed with requests for support in defining or implementing improvement strategies or dealing with barriers towards improvement.




Primary Outcome Measures :
  1. Formal Interactions (FI) [ Time Frame: Post-intervention assessment, up to 6 months (July-December 2017) ]
    FI is one of ten concepts included in the Alberta Context Tool (ACT). It is defined as "formal exchanges that occur between individuals working within an organization (unit) through scheduled activities that can promote the transfer of knowledge." FI includes four items asking care aides how often, in the last typical month, they participated in (a) team meetings about residents, (b) family conferences, (c) change-of-shift report, and (d) continuing education (conferences, courses) outside the nursing home (rated from 1=never to 5=almost always). To score FI, scores of each item are recoded (1 and 2 => 0; 3 => .5; 4 and 5 => 1) and summed up. FI therefore is scored with values ranging from 0 to 4, and averaged.

  2. Formal Interactions (FI) [ Time Frame: Long-term follow up, up to 6 months (January-June 2019) ]
    FI is one of ten concepts included in the Alberta Context Tool (ACT). It is defined as "formal exchanges that occur between individuals working within an organization (unit) through scheduled activities that can promote the transfer of knowledge." FI includes four items asking care aides how often, in the last typical month, they participated in (a) team meetings about residents, (b) family conferences, (c) change-of-shift report, and (d) continuing education (conferences, courses) outside the nursing home (rated from 1=never to 5=almost always). To score FI, scores of each item are recoded (1 and 2 => 0; 3 => .5; 4 and 5 => 1) and summed up. FI therefore is scored with values ranging from 0 to 4, and averaged.


Secondary Outcome Measures :
  1. Evaluation (Unit Feedback) [ Time Frame: Post-intervention assessment, up to 6 months (July-December 2017) ]
    Evaluation is one of ten concepts included in the Alberta Context Tool (ACT). It is defined as "the process of using data to assess group/team performance and to achieve outcomes in organizations or units (i.e., evaluation)". Evaluation includes six items asking care aides to rate regular feedback activities on their care unit (e.g., if their team routinely monitors their performance with respect to previously generated action plans). The six items are rated on a 5-point Likert scale from 1 = strongly disagree to 5 = strongly agree. To obtain the Evaluation score, the six items are averaged.

  2. Evaluation (Unit Feedback) [ Time Frame: Long-term follow up, up to 6 months (January-June 2019) ]
    Evaluation is one of ten concepts included in the Alberta Context Tool (ACT). It is defined as "the process of using data to assess group/team performance and to achieve outcomes in organizations or units (i.e., evaluation)". Evaluation includes six items asking care aides to rate regular feedback activities on their care unit (e.g., if their team routinely monitors their performance with respect to previously generated action plans). The six items are rated on a 5-point Likert scale from 1 = strongly disagree to 5 = strongly agree. To obtain the Evaluation score, the six items are averaged.

  3. Social Capital [ Time Frame: Post-intervention assessment, up to 6 months (July-December 2017) ]
    Social Capital is one of ten concepts included in the Alberta Context Tool (ACT). It is defined as "the stock of active connections among people. These connections are of three types: bonding, bridging, and linking". Social Capital includes six items asking care aides to rate characteristics of their care team (e.g., if they are "comfortable talking about resident care issues with those in positions of authority"). The six items are rated on a 5-point Likert scale from 1 = strongly disagree to 5 = strongly agree. To obtain the Evaluation score, the six items are averaged.

  4. Social Capital [ Time Frame: Long-term follow up, up to 6 months (January-June 2019) ]
    Social Capital is one of ten concepts included in the Alberta Context Tool (ACT). It is defined as "the stock of active connections among people. These connections are of three types: bonding, bridging, and linking". Social Capital includes six items asking care aides to rate characteristics of their care team (e.g., if they are "comfortable talking about resident care issues with those in positions of authority"). The six items are rated on a 5-point Likert scale from 1 = strongly disagree to 5 = strongly agree. To obtain the Evaluation score, the six items are averaged.

  5. Organizational Slack (OS) Time [ Time Frame: Post-intervention assessment, up to 6 months (July-December 2017) ]
    OS Time is one of ten concepts included in the Alberta Context Tool (ACT). It is defined as "the cushion of actual or potential time resources which allows a care unit to adapt successfully to internal pressures for adjustments or to external pressures for changes". OS Time includes four items asking care aides to rate how often they have time to do certain things during resident care (e.g., "do something extra for residents"). The Items are rated on a 5-point Likert scale 1 = never to 5 = almost always. To obtain the OS Time score, the four items are averaged.

  6. Organizational Slack (OS) Time [ Time Frame: Long-term follow up, up to 6 months (January-June 2019) ]
    OS Time is one of ten concepts included in the Alberta Context Tool (ACT). It is defined as "the cushion of actual or potential time resources which allows a care unit to adapt successfully to internal pressures for adjustments or to external pressures for changes". OS Time includes four items asking care aides to rate how often they have time to do certain things during resident care (e.g., "do something extra for residents"). The Items are rated on a 5-point Likert scale 1 = never to 5 = almost always. To obtain the OS Time score, the four items are averaged.

  7. Instrumental Research Use (IRU) [ Time Frame: Post-intervention assessment, up to 6 months (July-December 2017) ]
    IRU is defined as "the use of observable research-based practices when caring for residents. Practice may be guided by guidelines, protocols, routines, care plans or procedures that are based on research". IRU includes one item asking care aides to rate how often on their last typical work day they used this type of research (best practices). The Item is rated on a 5-point Likert scale 1 = never to 5 = almost always.

  8. Instrumental Research Use (IRU) [ Time Frame: Long-term follow up, up to 6 months (January-June 2019) ]
    IRU is defined as "the use of observable research-based practices when caring for residents. Practice may be guided by guidelines, protocols, routines, care plans or procedures that are based on research". IRU includes one item asking care aides to rate how often on their last typical work day they used this type of research (best practices). The Item is rated on a 5-point Likert scale 1 = never to 5 = almost always.

  9. Conceptual Research Use (CRU) [ Time Frame: Post-intervention assessment, up to 6 months (July-December 2017) ]
    CRU is defined as "the cognitive, reflective use of research (best practices) where the best practice knowledge may change one's opinion or mind set about a specific practice area but not necessarily one's direct actions. It is an indirect application of research findings". CRU includes five items asking care aides to rate how often on their last typical work day research (best practice knowledge) did, for example, raise their awareness about new ways to care for residents. The Items are rated on a 5-point Likert scale 1 = never to 5 = almost always. To obtain the CRU score, the five items are averaged.

  10. Conceptual Research Use (CRU) [ Time Frame: Long-term follow up, up to 6 months (January-June 2019) ]
    CRU is defined as "the cognitive, reflective use of research (best practices) where the best practice knowledge may change one's opinion or mind set about a specific practice area but not necessarily one's direct actions. It is an indirect application of research findings". CRU includes five items asking care aides to rate how often on their last typical work day research (best practice knowledge) did, for example, raise their awareness about new ways to care for residents. The Items are rated on a 5-point Likert scale 1 = never to 5 = almost always. To obtain the CRU score, the five items are averaged.

  11. Psychological Empowerment Scale [ Time Frame: Post-intervention assessment, up to 6 months (July-December 2017) ]
    Psychological Empowerment reflects an active orientation in which an individual wishes and feels able to shape his or her work role and context. It is a state rather than a trait and is specific to the work domain (e.g. is not generalizable to one's life situations and roles). The Psychological Empowerment Scale includes twelve items that are scored on a 5-point Likert scale from 1 = strongly disagree to 5 = strongly agree. The twelve items reflect four different sub-scales - Meaning, Competence, Determination, and Impact - each of which is formed by three items. Each of the four sub-scale scores is obtained by averaging the respective three items.

  12. Psychological Empowerment Scale [ Time Frame: Long-term follow up, up to 6 months (January-June 2019) ]
    Psychological Empowerment reflects an active orientation in which an individual wishes and feels able to shape his or her work role and context. It is a state rather than a trait and is specific to the work domain (e.g. is not generalizable to one's life situations and roles). The Psychological Empowerment Scale includes twelve items that are scored on a 5-point Likert scale from 1 = strongly disagree to 5 = strongly agree. The twelve items reflect four different sub-scales - Meaning, Competence, Determination, and Impact - each of which is formed by three items. Each of the four sub-scale scores is obtained by averaging the respective three items.

  13. Job Satisfaction (Michigan Organizational Assessment Questionnaire Job Satisfaction Subscale - MOAQ-JSS-3) [ Time Frame: Post-intervention assessment, up to 6 months (July-December 2017) ]
    The MOAQ-JSS-3 is a global job satisfaction measure that reflects affective components (i.e. ones feelings about his/her job). It includes three items that are scored on a 5-point Likert scale from 1 = strongly disagree to 5 = strongly agree. To obtain the Job Satisfaction score, the three items are averaged.

  14. Job Satisfaction (Michigan Organizational Assessment Questionnaire Job Satisfaction Subscale - MOAQ-JSS-3) [ Time Frame: Long-term follow up, up to 6 months (January-June 2019) ]
    The MOAQ-JSS-3 is a global job satisfaction measure that reflects affective components (i.e. ones feelings about his/her job). It includes three items that are scored on a 5-point Likert scale from 1 = strongly disagree to 5 = strongly agree. To obtain the Job Satisfaction score, the three items are averaged.

  15. Prevalence of Worsening Pain [ Time Frame: Post-intervention assessment, up to 6 months (July-December 2017) ]
    This is one of 35 quality indicators that can be derived from the Resident Assessment Instrument - Minimum Data Set (RAI-MDS) 2.0, which is collected in quarterly assessments for all residents. Prevalence of Worsening Pain is one of 13 practice sensitive RAI-MDS 2.0 quality indicators (i.e., modifiable by care staff). It is based on the items J2a - Frequency of pain and J2b - Intensity of pain and reflects the percentage of residents with greater pain at target assessment relative to prior assessment.

  16. Prevalence of Worsening Pain [ Time Frame: Long-term follow up, up to 6 months (January-June 2019) ]
    This is one of 35 quality indicators that can be derived from the Resident Assessment Instrument - Minimum Data Set (RAI-MDS) 2.0, which is collected in quarterly assessments for all residents. Prevalence of Worsening Pain is one of 13 practice sensitive RAI-MDS 2.0 quality indicators (i.e., modifiable by care staff). It is based on the items J2a - Frequency of pain and J2b - Intensity of pain and reflects the percentage of residents with greater pain at target assessment relative to prior assessment.

  17. Prevalence of Declining Behavioral Symptoms [ Time Frame: Post-intervention assessment, up to 6 months (July-December 2017) ]
    This is one of 35 quality indicators that can be derived from the Resident Assessment Instrument - Minimum Data Set (RAI-MDS) 2.0, which is collected in quarterly assessments for all residents. Prevalence of Declining Behavioral Symptoms is one of 13 practice sensitive RAI-MDS 2.0 quality indicators (i.e., modifiable by care staff). It is based on the items E4a - Wandering, E4b - Verbally abusive, E4c - Physically abusive, E4d - Socially inappropriate behaviour, and reflects the percentage of residents who have declining behaviour symptoms. Where 1 or more of the indicators are greater at the target assessment than the prior assessment.

  18. Prevalence of Declining Behavioral Symptoms [ Time Frame: Long-term follow up, up to 6 months (January-June 2019) ]
    This is one of 35 quality indicators that can be derived from the Resident Assessment Instrument - Minimum Data Set (RAI-MDS) 2.0, which is collected in quarterly assessments for all residents. Prevalence of Declining Behavioral Symptoms is one of 13 practice sensitive RAI-MDS 2.0 quality indicators (i.e., modifiable by care staff). It is based on the items E4a - Wandering, E4b - Verbally abusive, E4c - Physically abusive, E4d - Socially inappropriate behaviour, and reflects the percentage of residents who have declining behaviour symptoms. Where 1 or more of the indicators are greater at the target assessment than the prior assessment.



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   Child, Adult, Older Adult
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Facilities:

Inclusion Criteria:

  • Participates in the Translating Research in Elder Care program
  • Located in on of the following health regions in Alberta and British Columbia: Alberta North, Alberta South, Fraser Health, Interior Health
  • At least one care unit in the facility with 10 or more care aide responses to our TREC survey
  • Care aide responses can be assigned to a care unit in the facility as defined by TREC (TREC microsystem)

Exclusion Criteria:

  • Does not participate in TREC
  • Not located in the above named health regions
  • No care unit in the facility with 10 or more care aide responses to our TREC survey
  • Care aide responses cannot be assigned to a TREC defined microsystem

Care Units:

Inclusion Criteria:

  • 10 or more care aide responses to our TREC survey
  • Clearly identifiable unit leader (can also lead other units)
  • Stable leadership over the last year

Exclusion Criteria:

  • Less than 10 care aide responses to our TREC survey
  • No clearly identifiable unit leader
  • No stable leadership over the last year

Care Professionals:

Inclusion Criteria:

  • Leader of one or more included care units (care managers, directors of care)
  • Assistant leader of one or more included care units
  • Quality improvement specialist or clinical educator/instructor of one or more included care units
  • Employed in the facility
  • Has been covering in this role on this unit for 1 year or more
  • Leaders can bring care providers with no formal leadership or expert position (e.g., care aide, nurses, allied health providers) to the workshops

Exclusion Criteria:

  • Not employed in the facility (e.g., casual)
  • Has been covering in this role on this unit for less than 1 year

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02695836


Sponsors and Collaborators
University of Alberta
Investigators
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Principal Investigator: Carole A Estabrooks, PhD University of Alberta

Additional Information:
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Carole Estabrooks, Professor & Canada Research Chair in Knowledge Translation, University of Alberta
ClinicalTrials.gov Identifier: NCT02695836     History of Changes
Other Study ID Numbers: RES0026204
Application Number: 341532 ( Other Identifier: Canadian Institute of Health Research - Open Operating Grant )
First Posted: March 1, 2016    Key Record Dates
Last Update Posted: October 11, 2018
Last Verified: October 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided
Keywords provided by Carole Estabrooks, University of Alberta:
Audit and Feedback
Nursing Homes
Organizational Context
Quality Improvement
Care Aides
Leadership
Resident Assessment Instrument (RAI)
Alberta Context Tool (ACT)