PDF(Pubmed)
Abstract：
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.
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.
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.
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.
The trial was prospectively registered with the Australia New Zealand Clinical Trial Registry (ACTRN12620000507987, registered 23/04/2020).
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.
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.
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.
The trial was prospectively registered with the Australia New Zealand Clinical Trial Registry (ACTRN12620000507987, registered 23/04/2020).
摘要：
背景：老年居民恶化的早期发现（EDDIE）是一种多模式干预措施，旨在使护理和个人护理人员能够识别并主动管理居住在老年护理（RAC）家庭中的居民恶化。在2014年至2017年之间成功进行的试点试验的基础上，从2021年3月至2022年5月在12个RAC家庭中进行的阶梯式楔形集群随机试验中对干预措施进行了改进。我们报告了从小规模试点干预过渡到多地点干预的过程，详细说明干预措施，以实现未来的复制。
方法：EDDIE+干预措施使用了卫生服务研究实施综合促进行动（i-PARIHS）框架来指导干预措施的制定和完善过程。我们进行了环境扫描；多层次的背景评估；召集了一个干预工作组（IWG）来开发程序逻辑，进行了可持续性评估,并将干预成分解构为固定和适应性因素;随后完善了试验干预措施.
结果：最初的EDDIE试点干预包括四个组成部分：护士和个人护理人员教育；决策支持工具；诊断设备；以及促进和临床支持。将干预分解为核心组成部分，以及可以根据上下文灵活定制的内容，对于完善干预措施并为未来跨多个站点的实施提供信息至关重要。被认为不可持续的干预元素已被更新和完善，以实现其可扩展性。改进包括：增强的教育部分，更加注重个人护理人员和互动学习；基于最新证据的决策支持工具；符合接受者需求和可用组织支持的设备；以及具有本地和外部便利的更新便利模式。
结论：通过在扩大过程中使用i-PARIHS框架，EDDIE+干预是为满足预期接受者和环境的需求而量身定制的，为本地适应提供灵活性。在实践中从试点过渡到更大规模实施的过程被严重低估，但对于更好地在多个地点开发和实施多部分干预措施至关重要。我们提供了一个使用实施框架的例子，并表明它可以有利于研究人员和健康从业者从试点阶段到完善，通过更大规模的实施。
背景：该试验在澳大利亚新西兰临床试验注册中心进行了前瞻性注册（ACTRN12620000507987，注册23/04/2020）。
方法：EDDIE+干预措施使用了卫生服务研究实施综合促进行动（i-PARIHS）框架来指导干预措施的制定和完善过程。我们进行了环境扫描；多层次的背景评估；召集了一个干预工作组（IWG）来开发程序逻辑，进行了可持续性评估,并将干预成分解构为固定和适应性因素;随后完善了试验干预措施.
结果：最初的EDDIE试点干预包括四个组成部分：护士和个人护理人员教育；决策支持工具；诊断设备；以及促进和临床支持。将干预分解为核心组成部分，以及可以根据上下文灵活定制的内容，对于完善干预措施并为未来跨多个站点的实施提供信息至关重要。被认为不可持续的干预元素已被更新和完善，以实现其可扩展性。改进包括：增强的教育部分，更加注重个人护理人员和互动学习；基于最新证据的决策支持工具；符合接受者需求和可用组织支持的设备；以及具有本地和外部便利的更新便利模式。
结论：通过在扩大过程中使用i-PARIHS框架，EDDIE+干预是为满足预期接受者和环境的需求而量身定制的，为本地适应提供灵活性。在实践中从试点过渡到更大规模实施的过程被严重低估，但对于更好地在多个地点开发和实施多部分干预措施至关重要。我们提供了一个使用实施框架的例子，并表明它可以有利于研究人员和健康从业者从试点阶段到完善，通过更大规模的实施。
背景：该试验在澳大利亚新西兰临床试验注册中心进行了前瞻性注册（ACTRN12620000507987，注册23/04/2020）。
