Champions for improved adherence to guidelines in long-term care homes: a systematic review
Autor: | Gerd Flodgren, Amanda M. Hall, Andrea Sherriff, Helen Richmond, Sheila Welsh, Jacqueline Thompson, Bradley Furlong |
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Rok vydání: | 2021 |
Předmět: |
Medicine (General)
medicine.medical_specialty Guidelines Health administration law.invention Long-term care 03 medical and health sciences R5-920 0302 clinical medicine Quality of life (healthcare) Randomized controlled trial law Medicine 030212 general & internal medicine business.industry 030503 health policy & services Champion Health services research Evidence-based care Guideline Evidence-based medicine Implementation Family medicine Systematic Review 0305 other medical science business |
Zdroj: | Implementation Science Communications, Vol 2, Iss 1, Pp 1-15 (2021) Implementation Science Communications |
ISSN: | 2662-2211 |
DOI: | 10.1186/s43058-021-00185-y |
Popis: | Background The champion model is increasingly being adopted to improve uptake of guideline-based care in long-term care (LTC). Studies suggest that an on-site champion may improve the quality of care residents’ health outcomes. This review assessed the effectiveness of the champion on staff adherence to guidelines and subsequent resident outcomes in LTC homes. Method This was a systematic review and meta-analyses of randomised controlled trials. Eligible studies included residents aged 65 or over and nursing staff in LTC homes where there was a stand-alone or multi-component intervention that used a champion to improve staff adherence to guidelines and resident outcomes. The measured outcomes included staff adherence to guidelines, resident health outcomes, quality of life, adverse events, satisfaction with care, or resource use. Study quality was assessed with the Cochrane Risk of Bias tool; evidence certainty was assessed using the GRADE approach. Results After screening 4367 citations, we identified 12 articles that included the results of 1 RCT and 11 cluster-RCTs. All included papers evaluated the effects of a champion as part of a multicomponent intervention. We found low certainty evidence that champions as part of multicomponent interventions may improve staff adherence to guidelines. Effect sizes varied in magnitude across studies including unadjusted risk differences (RD) of 4.1% [95% CI: − 3%, 9%] to 44.8% [95% CI: 32%, 61%] for improving pressure ulcer prevention in a bed and a chair, respectively, RD of 44% [95% CI: 17%, 71%] for improving depression identification and RD of 21% [95% CI: 12%, 30%] for improving function-focused care to residents. Conclusion Champions may improve staff adherence to evidence-based guidelines in LTC homes. However, methodological issues and poor reporting creates uncertainty around these findings. It is premature to recommend the widespread use of champions to improve uptake of guideline-based care in LTC without further study of the champion role and its impact on cost. Trial registration PROSPERO CRD42019145579. Registered on 20 August 2019. |
Databáze: | OpenAIRE |
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