From pilot to a multi-site trial: refining the Early Detection of Deterioration in Elderly Residents (EDDIE +) intervention.

Autor: Allen MJ; Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia. M27.allen@qut.edu.au., Carter HE; Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia., Cyarto E; School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia., Meyer C; Bolton Clarke Research Institute, Forest Hill, Victoria, Australia.; Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Melbourne, Australia.; Centre for Health Communication and Participation, La Trobe University, Bundoora, Australia., Dwyer T; Central Queensland University, Norman Gardens, Australia., Oprescu F; School of Health, University of the Sunshine Coast, Sippy Downs, QLD, Australia., Aitken C; Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia., Farrington A; Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia., Shield C; Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia., Rowland J; Faculty of Medicine, University of Queensland, Herston, Australia.; Faculty of Health, School of Nursing, Queensland University of Technology, Kelvin Grove, Australia.; Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Herston, Australia., Lee XJ; Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia., Graves N; Duke-NUS Medical School, Singapore, Singapore., Parkinson L; School of Medicine and Public Health, University of Newcastle, Callaghan, Australia., Harvey G; Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia.; Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.
Jazyk: angličtina
Zdroj: BMC geriatrics [BMC Geriatr] 2023 Dec 06; Vol. 23 (1), pp. 811. Date of Electronic Publication: 2023 Dec 06.
DOI: 10.1186/s12877-023-04491-z
Abstrakt: Background: Early Detection of Deterioration in Elderly Residents (EDDIE +) is a multi-modal intervention focused on empowering nursing and personal care workers to identify and proactively manage deterioration of residents living in residential aged care (RAC) homes. Building on successful pilot trials conducted between 2014 and 2017, the intervention was refined for implementation in a stepped-wedge cluster randomised trial in 12 RAC homes from March 2021 to May 2022. We report the process used to transition from a small-scale pilot intervention to a multi-site intervention, detailing the intervention to enable future replication.
Methods: The EDDIE + intervention used the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to guide the intervention development and refinement process. We conducted an environmental scan; multi-level context assessments; convened an intervention working group (IWG) to develop the program logic, conducted a sustainability assessment and deconstructed the intervention components into fixed and adaptable elements; and subsequently refined the intervention for trial.
Results: The original EDDIE pilot intervention included four components: nurse and personal care worker education; decision support tools; diagnostic equipment; and facilitation and clinical support. Deconstructing the intervention into core components and what could be flexibly tailored to context was essential for refining the intervention and informing future implementation across multiple sites. Intervention elements considered unsustainable were updated and refined to enable their scalability. Refinements included: an enhanced educational component with a greater focus on personal care workers and interactive learning; decision support tools that were based on updated evidence; equipment that aligned with recipient needs and available organisational support; and updated facilitation model with local and external facilitation.
Conclusion: By using the i-PARIHS framework in the scale-up process, the EDDIE + intervention was tailored to fit the needs of intended recipients and contexts, enabling flexibility for local adaptation. The process of transitioning from a pilot to larger scale implementation in practice is vastly underreported yet vital for better development and implementation of multi-component interventions across multiple sites. We provide an example using an implementation framework and show it can be advantageous to researchers and health practitioners from pilot stage to refinement, through to larger scale implementation.
Trial Registration: The trial was prospectively registered with the Australia New Zealand Clinical Trial Registry (ACTRN12620000507987, registered 23/04/2020).
(© 2023. The Author(s).)
Databáze: MEDLINE
Externí odkaz: