背景:美国的疗养院被COVID-19摧毁,到2021年10月,全国共有71万例病例和138,000例死亡。尽管设施需要有感染控制人员,在COVID-19大流行之前,只有3%的指定感染预防医师参加了基本的感染控制课程.大多数研究集中在急性护理环境中的感染控制。然而,对疗养院实施感染控制措施和有效干预措施知之甚少。本研究利用ECHO项目(社区健康成果扩展),基于证据的远程模型,将宾夕法尼亚州立大学主题专家与疗养院工作人员和管理人员联系起来,以积极支持循证感染控制指南的实施。
目的:我们的研究旨在回答如何在疗养院有效实施循证感染控制指南这一研究问题。包括比较两种ECHO提供的培训干预措施对以患者为中心的关键结局的有效性,例如减少诊断为COVID-19的居民人数。
方法:采用分层整群随机设计。使用1:1的比例,我们随机分配给ECHO或ECHOPlus的136家疗养院。随机化按地理位置分层,基线COVID-19感染率,设施能力。该研究分为两个阶段。在第一阶段,在2021年7月完成,这两个研究组的疗养院通过实时接受了为期16周的传染病和质量改进培训干预,交互式视频会议和ECHO学习模型。第一阶段会议持续时间长达90分钟。在第二阶段,在2021年11月完成后,ECHO小组获得了可选的60分钟办公时间,为期9周,ECHOPlus小组获得了9周的60分钟新兴主题课程和额外的8期感染控制复习系列课程。
结果:总共对290个疗养院设施进行了资格评估,招募了136家疗养院,并随机分配到ECHO或ECHOPlus。在到达的指引下,有效性,收养,实施,和维护(RE-AIM)框架,我们将在基线(干预开始日期)同时评估研究的有效性和实施结果,在4、6、12和18个月。主要结果是疗养院的COVID-19感染率。次要结果包括COVID-19住院和死亡,流感样疾病,和生活质量。对参与者的调查和访谈也将提供有关采用的数据,实施,以及在整个ECHO会议期间教授的最佳实践的维护。
结论:多管齐下改善疗养院感染控制和应急准备非常重要,考虑到COVID-19大流行给居民和工作人员造成的损失。与传统训练相比,ECHO模型具有显著的优势,因为它允许由多学科专家团队提供远程学习,并利用与疗养院的背景和能力相匹配的案例讨论。
背景:ClinicalTrials.govNCT04499391;https://clinicaltrials.gov/ct2/show/NCT04499391。
BACKGROUND: Nursing homes in the United States were devastated by COVID-19, with 710,000 cases and 138,000 deaths nationally through October 2021. Although facilities are required to have infection control staff, only 3% of designated infection preventionists have taken a basic infection control course prior to the COVID-19 pandemic. Most research has focused on infection control in the acute care setting. However, little is known about the implementation of infection control practices and effective interventions in nursing homes. This
study utilizes Project ECHO (Extension for Community Health Outcomes), an evidence-based telementoring model, to connect Penn State University subject matter experts with nursing home staff and administrators to proactively support evidence-based infection control guideline implementation.
OBJECTIVE: Our
study seeks to answer the research question of how evidence-based infection control guidelines can be implemented effectively in nursing homes, including comparing the effectiveness of two ECHO-delivered training interventions on key patient-centered outcomes such as reducing the number of residents with a COVID-19 diagnosis.
METHODS: A stratified cluster randomized design was utilized. Using a 1:1 ratio, we randomly assigned 136 nursing homes to ECHO or ECHO Plus arms. Randomization was stratified by geographic location, baseline COVID-19 infection rate, and facility capacity. The
study had two phases. In phase one, completed in July 2021, nursing homes in both
study arms received a 16-week infectious disease and quality improvement training intervention via real-time, interactive videoconferencing and the ECHO learning model. Phase one sessions were up to 90 minutes in duration. In phase two, completed in November 2021, the ECHO group was offered optional 60-minute office hours for 9 weeks and the ECHO Plus group received 9 weeks of 60-minute sessions on emerging topics and an additional 8-session refresher series on infection control.
RESULTS: A total of 290 nursing home facilities were assessed for eligibility, with 136 nursing homes recruited and randomly assigned to ECHO or ECHO Plus. Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, we will simultaneously evaluate the
study\'s effectiveness and implementation outcomes at baseline (intervention start date), and at 4, 6, 12, and 18 months. The primary outcome is the COVID-19 infection rate in nursing homes. Secondary outcomes include COVID-19 hospitalizations and deaths, flu-like illness, and quality of life. Surveys and interviews with participants will also provide data as to the adoption, implementation, and maintenance of best practices taught throughout ECHO sessions.
CONCLUSIONS: A multipronged approach to improving infection control and emergency preparedness in nursing homes is important, given the toll that the COVID-19 pandemic has taken on residents and staff. The ECHO model has significant strengths when compared to traditional training, as it allows for remote learning delivered by a multidisciplinary team of experts, and utilizes case discussions that match the context and capacity of nursing homes.
BACKGROUND: ClinicalTrials.gov NCT04499391; https://clinicaltrials.gov/ct2/show/NCT04499391.