| Implementation Science | |
| An interdisciplinary knowledge translation intervention in long-term care: Study protocol for the vitamin D and osteoporosis study (ViDOS) pilot cluster randomized controlled trial | |
| Alexandra Papaioannou1  Lynn Nash7  Ravi Jain2  Anna M Sawka9  Lisa Dolovich7  Jackie Stroud1,10  Glenda Campbell1,10  Mary-Lou van der Horst1  Susanne King1  Laura E Pickard1  Lynne Lohfeld3  Robert G Josse1,11  Sharon Marr1  Richard G Crilly8  Suzanne N Morin4  Lehana Thabane3  Jonathan D Adachi6  Lora M Giangregorio5  George Ioannidis6  Courtney C Kennedy3  | |
| [1] Hamilton Health Sciences - St. Peter's Hospital, Juravinski Research Centre, 88 Maplewood Avenue, Hamilton, Ontario L8M 1W9, Canada;Ontario Osteoporosis Strategy, Osteoporosis Canada, 1090 Don Mills Road, Suite 301, Toronto, Ontario, M3C 3R6, Canada;Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4K1, Canada;Department of Medicine, Division of General Internal Medicine, MUHC-Montreal General Hospital, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada;Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, 200 University Ave West, Waterloo, Ontario, N2L 3G1, Canada;Charlton Medical Centre, 25 Charlton Ave East, Hamilton, Ontario, L8N 1Y2, Canada;Department of Family Medicine, McMaster Innovation Park, 175 Longwood Road South, Hamilton, Ontario, L8P 0A1, Canada;Schulich School of Medicine & Dentistry, The University of Western Ontario, Parkwood Hospital, 801 Commissioners Rd. East, London, Ontario, N6C 5J1, Canada;Department of Medicine, Division of Endocrinology and Metabolism, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada;Medical Pharmacies Group Limited, 590 Granite Court, Pickering, Ontario, L1W 3X6, Canada;Department of Medicine, Division of Endocrinology and Metabolism, University of Toronto, St. Michael's Hospital, Toronto, Ontario, Canada | |
| 关键词: Opinion leader; Educational meeting; Interactive; Reminders; Audit and feedback; Feasibility; Interdisciplinary; Multifaceted; Vitamin D; Fractures; Osteoporosis; Nursing home; Long-term care; Knowledge translation; | |
| Others : 815389 DOI : 10.1186/1748-5908-7-48 |
|
| received in 2012-03-14, accepted in 2012-05-24, 发布年份 2012 | |
PDF
|
|
【 摘 要 】
Background
Knowledge translation (KT) research in long-term care (LTC) is still in its early stages. This protocol describes the evaluation of a multifaceted, interdisciplinary KT intervention aimed at integrating evidence-based osteoporosis and fracture prevention strategies into LTC care processes.
Methods and design
The Vitamin D and Osteoporosis Study (ViDOS) is underway in 40 LTC homes (n = 19 intervention, n = 21 control) across Ontario, Canada. The primary objectives of this study are to assess the feasibility of delivering the KT intervention, and clinically, to increase the percent of LTC residents prescribed ≥800 IU of vitamin D daily. Eligibility criteria are LTC homes that are serviced by our partner pharmacy provider and have more than one prescribing physician. The target audience within each LTC home is the Professional Advisory Committee (PAC), an interdisciplinary team who meets quarterly. The key elements of the intervention are three interactive educational sessions led by an expert opinion leader, action planning using a quality improvement cycle, audit and feedback reports, nominated internal champions, and reminders/point-of-care tools. Control homes do not receive any intervention, however both intervention and control homes received educational materials as part of the Ontario Osteoporosis Strategy. Primary outcomes are feasibility measures (recruitment, retention, attendance at educational sessions, action plan items identified and initiated, internal champions identified, performance reports provided and reviewed), and vitamin D (≥800 IU/daily) prescribing at 6 and 12 months. Secondary outcomes include the proportion of residents prescribed calcium supplements and osteoporosis medications, and falls and fractures. Qualitative methods will examine the experience of the LTC team with the KT intervention. Homes are centrally randomized to intervention and control groups in blocks of variable size using a computer generated allocation sequence. Randomization is stratified by home size and profit/nonprofit status. Prescribing data retrieval and analysis are performed by blinded personnel.
Discussion
Our study will contribute to an improved understanding of the feasibility and acceptability of a multifaceted intervention aimed at translating knowledge to LTC practitioners. Lessons learned from this study will be valuable in guiding future research and understanding the complexities of translating knowledge in LTC.
Trial registration
ClinicalTrials.gov NCT01398527.
【 授权许可】
2012 Kennedy et al.; licensee BioMed Central Ltd.
【 预 览 】
| Files | Size | Format | View |
|---|---|---|---|
| 20140710071317832.pdf | 571KB | ||
| Figure 2. | 52KB | Image | |
| Figure 1. | 30KB | Image |
【 图 表 】
Figure 1.
Figure 2.
【 参考文献 】
- [1]Canadian Institutes of Health Researchhttp://www.cihr-irsc.gc.ca.libaccess.lib.mcmaster.ca/e/29418.html webcite
- [2]Grimshaw J, Eccles M, Tetroe J: Implementing clinical guidelines: current evidence and future implications. J Contin Educ Health Prof 2004, 24(Suppl 1):S31-S37.
- [3]Grimshaw JM, Eccles MP, Walker AE, Thomas RE: Changing physicians' behavior: what works and thoughts on getting more things to work. J Contin Educ Health Prof 2002, 22:237-243.
- [4]Zwarenstein M, Reeves S: Knowledge translation and interprofessional collaboration: Where the rubber of evidence‐based care hits the road of teamwork. J Contin Educ Health Prof 2006, 26:46-54.
- [5]Bostrom AM, Slaughter SE, Chojecki D, Estabrooks CA: What Do We Know About Knowledge Translation in the Care of Older Adults? A Scoping Review. J Am Med Dir Assoc 2011, 13:210-219.
- [6]Berta W, Teare GF, Gilbart E, Ginsburg LS, Lemieux-Charles L, Davis D, Rappolt S: Spanning the know-do gap: Understanding knowledge application and capacity in long-term care homes. Soc Sci Med 2010, 70:1326-1334.
- [7]Rycroft-Malone J, Dopson S, Degner L, Hutchinson AM, Morgan D, Stewart N, Estabrooks CA: Study protocol for the translating research in elder care (TREC): building context through case studies in long-term care project (project two). Implement Sci 2009, 4:53. BioMed Central Full Text
- [8]Estabrooks CA, Hutchinson AM, Squires JE, Birdsell J, Cummings GG, Degner L, Morgan D, Norton PG: Translating research in elder care: an introduction to a study protocol series. Implement Sci 2009, 4:51. BioMed Central Full Text
- [9]Estabrooks CA, Squires JE, Cummings GG, Teare GF, Norton PG: Study protocol for the translating research in elder care (TREC): building context - an organizational monitoring program in long-term care project (project one). Implement Sci 2009, 4:52. BioMed Central Full Text
- [10]Grimshaw JM, Shirran L, Thomas R, Mowatt G, Fraser C, Bero L, Grilli R, Harvey E, Oxman A, O'Brien MA: Changing Provider Behavior: An Overview of Systematic Reviews of Interventions. Med Care 2001, 39(8, Supplement II: Implementing Evidence-Based Recommendations for Health Care: Papers from the Leeds Castle Conference):II2-II45.
- [11]Bero LA, Grilli R, Grimshaw JM, Harvey E, Oxman AD, Thomson MA: Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. The Cochrane Effective Practice and Organization of Care Review Group. BMJ 1998, 317:465-468.
- [12]Registered Nurses Association of Ontario: Toolkit: Implementation of clinical practice guidelines. 2002. http://www.rnao.org/Storage/12/668_BPG_Toolkit.pdf webcite
- [13]Ontario Association of Non-Profit Homes and Services for Seniors (OANHSS): The Professional Care Team In Long Term Care: A Discussion Paper. 2010. http://www.oanhss.org/AM/AMTemplate.cfm?Section=Position_Papers_Submissions&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=7917 webcite
- [14]Thomas DC, Johnston B, Dunn K, Sullivan GM, Brett B, Matzko M, Levine SA: Continuing medical education, continuing professional development, and knowledge translation: improving care of older patients by practicing physicians. J Am Geriatr Soc 2006, 54:1610-1618.
- [15]Cameron ID, Murray GR, Gillespie LD, Robertson MC, Hill KD, Cumming RG, Kerse N: Interventions for preventing falls in older people in nursing care facilities and hospitals. Cochrane Database Syst Rev 2010, 1:CD005465.
- [16]Kitson AL, Rycroft-Malone J, Harvey G, McCormack B, Seers K, Titchen A: Evaluating the successful implementation of evidence into practice using the PARiHS framework: theoretical and practical challenges. Implement Sci 2008, 3:1. BioMed Central Full Text
- [17]Cummings GG, Estabrooks CA, Midodzi WK, Wallin L, Hayduk L: Influence of organizational characteristics and context on research utilization. Nurs Res 2007, 56(4 Suppl):S24-S39.
- [18]Wallin L, Bostrom AM, Wikblad K, Ewald U: Sustainability in changing clinical practice promotes evidence-based nursing care. J Adv Nurs 2003, 41:509-518.
- [19]Mentes JC, Tripp-Reimer T: Barriers and facilitators in nursing home intervention research. West J Nurs Res 2002, 24:918-936.
- [20]Colon-Emeric CS, Lekan D, Utley-Smith Q, Ammarell N, Bailey D, Corazzini K, Piven ML, Anderson RA: Barriers to and facilitators of clinical practice guideline use in nursing homes. J Am Geriatr Soc 2007, 55:1404-1409.
- [21]Papaioannou A, Morin S, Cheung AM, Atkinson S, Brown JP, Feldman S, Hanley DA, Hodsman A, Jamal SA, Kaiser SM, Kvern B, Siminoski K, Leslie WD, Scientific Advisory Council of Osteoporosis Canada: clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ 2010, 182:1864-1873.
- [22]Sawka AM, Ismaila N, Cranney A, Thabane L, Kastner M, Gafni A, Woodhouse LJ, Crilly R, Cheung AM, Adachi JD, Josse RG: Papaioannou A: A scoping review of strategies for the prevention of hip fracture in elderly nursing home residents. PLoS One 2010, 5(3):e9515.
- [23]Brown JP, Fortier M, Frame H, Lalonde A, Papaioannou A, Senikas V, Yuen CK: Canadian consensus conference on osteoporosis, 2006 update. J Obstet Gynaecol Can 2006, 28(2 Suppl 1):S95-S112.
- [24]Chapuy MC, Arlot ME, Duboeuf F, Brun J, Crouzet B, Arnaud S, Delmas PD, Meunier PJ: Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med 1992, 327:1637-1642.
- [25]Dawson-Hughes B: Serum 25-hydroxyvitamin D and functional outcomes in the elderly. Am J Clin Nutr 2008, 88:537S-540S.
- [26]Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, Staehelin HB, Bazemore MG, Zee RY, Wong JB: Effect of Vitamin D on falls: a meta-analysis. JAMA 2004, 291:1999-2006.
- [27]Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B: Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA 2005, 293:2257-2264.
- [28]Sawka AM, Ismaila N, Raina P, Thabane L, Straus S, Adachi JD, Gafni A, Papaioannou A: Hip fracture prevention strategies in long-term care: a survey of Canadian physicians' opinions. Can Fam Physician 2010, 56:e392-e397.
- [29]Lau AN, Ioannidis G, Potts Y, Giangregorio LM, Van der Horst ML, Adachi JD, Papaioannou A: What are the beliefs, attitudes and practices of front-line staff in long-term care (LTC) facilities related to osteoporosis awareness, management and fracture prevention? BMC Geriatr 2010, 10:73. BioMed Central Full Text
- [30]Colon-Emeric CS, Casebeer L, Saag K, Allison J, Levine D, Suh TT, Lyles KW: Barriers to providing osteoporosis care in skilled nursing facilities: perceptions of medical directors and directors of nursing. J Am Med Dir Assoc 2004, 5:361-366.
- [31]Bischoff-Ferrari HA, Willett WC, Wong JB, Stuck AE, Staehelin HB, Orav EJ, Thoma A, Kiel DP, Henschkowski J: Prevention of nonvertebral fractures with oral vitamin D and dose dependency: a meta-analysis of randomized controlled trials. Arch Intern Med 2009, 169:551-561.
- [32]Papaioannou A, Kennedy C, Campbell G, Giangregorio L, Ma J, Adachi J: Treating Osteoporosis in the Elderly: An Environmental Scan of Nursing Home Prescribing in Ontario, Canada. [abstract]. ASBMR 30th Annual Meeting, Volume Su 404 edition. 2008.
- [33]Giangregorio LM, Jantzi M, Papaioannou A, Hirdes J, Maxwell CJ, Poss JW: Osteoporosis management among residents living in long-term care. Osteoporos Int 2009, 20:1471-1478.
- [34]Poss JW, Jutan NM, Hirdes JP, Fries BE, Morris JN, Teare GF, Reidel K: A review of evidence on the reliability and validity of Minimum Data Set data. Healthc Manage Forum 2008, 21:33-39.
- [35]Hirdes JP, Fries BE, Morris JN, Steel K, Mor V, Frijters D, LaBine S, Schalm C, Stones MJ, Teare G, Smith T, Marhaba M, Perez E, Jonsson P: Integrated health information systems based on the RAI/MDS series of instruments. Healthc Manage Forum 1999, 12:30-40.
- [36]Health Canada; What is Long-Term Facilities-Based Care?. http://www.hc-sc.gc.ca/hcs-sss/home-domicile/longdur/index-eng.php webcite
- [37]Kerry SM, Bland JM: The intracluster correlation coefficient in cluster randomisation. BMJ 1998, 316:1455.
- [38]Loeb M, Carusone SC, Goeree R, Walter SD, Brazil K, Krueger P, Simor A, Moss L, Marrie T: Effect of a clinical pathway to reduce hospitalizations in nursing home residents with pneumonia: a randomized controlled trial. JAMA 2006, 295:2503-2510.
- [39]Loeb M, Brazil K, Lohfeld L, McGeer A, Simor A, Stevenson K, Zoutman D, Smith S, Liu X, Walter SD: Effect of a multifaceted intervention on number of antimicrobial prescriptions for suspected urinary tract infections in residents of nursing homes: cluster randomised controlled trial. BMJ 2005, 331:669.
- [40]Roberts MS, Stokes JA, King MA, Lynne TA, Purdie DM, Glasziou PP, Wilson DA, McCarthy ST, Brooks GE, de Looze FJ, Del Mar CB: Outcomes of a randomized controlled trial of a clinical pharmacy intervention in 52 nursing homes. Br J Clin Pharmacol 2001, 51:257-265.
- [41]Campbell MK, Elbourne DR, Altman DG, CONSORT group: CONSORT statement: extension to cluster randomised trials. BMJ 2004, 328:702-708.
- [42]Thabane L, Ma J, Chu R, Cheng J, Ismaila A, Rios LP, Robson R, Thabane M, Giangregorio L, Goldsmith CH: A tutorial on pilot studies: the what, why and how. BMC Med Res Methodol 2010, 10:1. BioMed Central Full Text
- [43]Comondore VR, Devereaux PJ, Zhou Q, Stone SB, Busse JW, Ravindran NC, Burns KE, Haines T, Stringer B, Cook DJ, Walter SD, Sullivan T, Berwanger O, Bhandari M, Banglawala S, Lavis JN, Petrisor B, Schunemann H, Walsh K, Bhatnagar N, Guyatt GH: Quality of care in for-profit and not-for-profit nursing homes: systematic review and meta-analysis. BMJ 2009, 339:b2732.
- [44]Shapiro E, Tate R: Monitoring the Outcomes of Quality of Care in Nursing Homes Using Administrative Data. Can J Aging 1995, 14:755.
- [45]McGregor MJ, Cohen M, McGrail K, Broemeling AM, Adler RN, Schulzer M, Ronald L, Cvitkovich Y, Beck M: Staffing levels in not-for-profit and for-profit long-term care facilities: does type of ownership matter? CMAJ 2005, 172:645-649.
- [46]Grimshaw JM, Shirran L, Thomas R, Mowatt G, Fraser C, Bero L, Grilli R, Harvey E, Oxman A, O'Brien MA: Changing provider behavior: an overview of systematic reviews of interventions. Med Care 2001, 39(8 Suppl 2):II2-II45.
- [47]Grimshaw JM, Shirran L, Thomas R, Mowatt G, Fraser C, Bero L, Grilli R, Harvey E, Oxman A, O'Brien MA: Changing provider behavior: an overview of systematic reviews of interventions. Med Care 2001, 39(8 Suppl 2):II2-45.
- [48]Ioannidis G, Papaioannou A, Thabane L, Gafni A, Hodsman A, Kvern B, Walsh A, Jiwa F, Adachi JD: The utilization of appropriate osteoporosis medications improves following a multifaceted educational intervention: the Canadian quality circle project (CQC). BMC Med Educ 2009, 9:54. BioMed Central Full Text
- [49]Ioannidis G, Thabane L, Gafni A, Hodsman A, Kvern B, Johnstone D, Plumley N, Salach L, Jiwa F, Adachi JD, Papaioannou A: Optimizing care in osteoporosis: the Canadian quality circle project. BMC Musculoskel Disord 2008, 9:130. BioMed Central Full Text
- [50]Bywood PT, Lunnay B, Roche AM: Strategies for facilitating change in alcohol and other drugs (AOD) professional practice: a systematic review of the effectiveness of reminders and feedback. Drug Alcohol Rev 2008, 27:548-558.
- [51]Jamtvedt G, Young JM, Kristoffersen DT, O'Brien MA, Oxman AD: Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2006, 2:CD000259.
- [52]Flodgren G, Parmelli E, Doumit G, Gattellari M, O'Brien MA, Grimshaw J, Eccles MP: Local opinion leaders: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2011, 8:CD000125.
- [53]Enhancing Interdisciplinary Collaboration in Primary Health Care: Enhancing Interdisciplinary Collaboration in Primary Health Care in Canada. 2005.
- [54]Ontario Osteoporosis Strategy in Long-Term Care. http://www.osteoporosislongtermcare.ca webcite
- [55]Locock L, Dopson S, Chambers D, Gabbay J: Understanding the role of opinion leaders in improving clinical effectiveness. Soc Sci Med 2001, 53:745-757.
- [56]Jain M: Plan-do-study-act cycle rejuvenates a marriage. Ann Intern Med 2008, 149:209-210.
- [57]Agency for Healthcare Research and Quality. http://www.innovations.ahrq.gov/content.aspx?id=2398&tab=3 webcite
- [58]Kissam S, Gifford D, Parks P, Patry G, Palmer L, Wilkes L, Fitzgerald M, Petrulis AS, Barnette L: Approaches to quality improvement in nursing homes: lessons learned from the six-state pilot of CMS's Nursing Home Quality Initiative. BMC Geriatr 2003, 3:2. BioMed Central Full Text
- [59]Ministry of Health and Long-Term Care and Osteoporosis Canada: Osteoporosis Action Plan: An Osteoporosis Strategy for Ontario Report of the Osteoporosis Action Plan Committee to the Ministry of Health and Long-Term Care 2003. http://www.health.gov.on.ca/english/public/pub/ministry_reports/osteo/osteo_0205.pdf webcite
- [60]Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, Robinson N: Lost in knowledge translation: time for a map? J Contin Educ Health Prof 2006, 26:13-24.
- [61]Statistics Canada; From urban areas to population centres. http://www.statcan.gc.ca/subjects-sujets/standard-norme/sgc-cgt/urban-urbain-eng.htm webcite
- [62]Food and Drug Administration. http://www.fda.gov/cber/guidelines.htm webcite
- [63]Campbell MJ: Extending CONSORT to include cluster trials. BMJ 2004, 328:654-655.
- [64]CONSORT Grouphttp://www.consort-statement.org/ webcite
- [65]Hardin JW: Generalized Estimating Equations. New York: Chapman and Hall/CRC; 2001.
- [66]QSR International Pty Ltd: QSR Nvivo Version 8. http://www.qsrinternational.com/products.aspx webcite
- [67]Ajzen I: The theory of planned behavior. Organ Behav Hum Decis Process 1991, 50:179-211.
- [68]Armitage CJ, Talibudeen L: Test of a brief theory of planned behaviour-based intervention to promote adolescent safe sex intentions. Br J Psychol 2010, 101(Pt 1):155-172.
- [69]Webb TL, Sheeran P: Does changing behavioral intentions engender behavior change? A meta-analysis of the experimental evidence. Psychol Bull 2006, 132:249-268.
- [70]Rogers EM: Lessons for guidelines from the diffusion of innovations. Jt Comm J Qual Improv 1995, 21:324-328.
- [71]Rogers EM: Diffusion of preventive innovations. Addict Behav 2002, 27:989-993.
- [72]Simon SR, Gurwitz JH: Drug therapy in the elderly: improving quality and access. Clin Pharmacol Ther 2003, 73:387-393.
- [73]Rowe JW, Andres R, Tobin JD, Norris AH, Shock NW: The effect of age on creatinine clearance in men: a cross-sectional and longitudinal study. J Gerontol 1976, 31:155-163.
- [74]Avorn J, Gurwitz JH: Drug use in the nursing home. Ann Intern Med 1995, 123:195-204.
- [75]Mutasingwa DR, Ge H, Upshur RE: How applicable are clinical practice guidelines to elderly patients with comorbidities? Can Fam Physician 2011, 57:e253-e262.
- [76]Berta W, Teare GF, Gilbart E, Ginsburg LS, Lemieux-Charles L, Davis D, Rappolt S: The contingencies of organizational learning in long-term care: factors that affect innovation adoption. Health Care Manage Rev 2005, 30:282-292.
- [77]Finnick M, Crosby F, Ventura MR: Long-term care nurses identify educational needs regarding quality assessment and improvement. J Contin Educ Nurs 1992, 23:278-281.
- [78]Santos J: Uptake of Best Practice Guidelines in Ontario Long-Term Care Homes: An Analysis of the Provincial Survey. 2008. http://ricn.on.ca/photos/custom/CEICNfiles/LTC%20Provincial%20Survey%20Report%20on%20BPG%20Uptake%20in%20Ontario%20LTCHs%20-%20November%202008.pdf webcite
- [79]Kaasalainen S, Agarwal G, Dolovich L, Papaioannou A, Brazil K, Akhtar-Danesh N: Nurses' perceptions of and satisfaction with the medication administration system in long-term-care homes. Can J Nurs Res 2010, 42:58-79.
- [80]Bostrom AM, Kajermo KN, Nordstrom G, Wallin L: Barriers to research utilization and research use among registered nurses working in the care of older people: does the BARRIERS scale discriminate between research users and non-research users on perceptions of barriers? Implement Sci 2008, 3:24. BioMed Central Full Text
- [81]Kajermo KN, Bostrom AM, Thompson DS, Hutchinson AM, Estabrooks CA, Wallin L: The BARRIERS scale - the barriers to research utilization scale: A systematic review. Implement Sci 2010, 5:32. BioMed Central Full Text
PDF