Predicting Nursing Home Adherence to a Clinical Trial Intervention:: Lessons for the Conduct of Cluster Randomized Trials

• Autores: Jennifer Tjia, Kathleen M. Mazor, Terry Field, Peter Doherty, Ann Spenard, Jerry H. Gurwitz
• Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 59, Nº. 12, 2011, págs. 2332-2336
• Idioma: inglés
• Texto completo no disponible (Saber más ...)
• Resumen

  • Objectives: To describe factors predictive of nursing home (NH) adherence to a clinical trial intervention.

    Design: Post hoc analysis of a cluster randomized trial (CRT) evaluating a structured communication intervention to improve nurse�physician telephone communication in NHs.

    Setting: NH.

    Participants: All eligible licensed nursing staff in all participating NHs.

    Measurements: Adherence was defined as active participation for at least 3 months of the 12-month trial. NH characteristics hypothesized to affect trial outcomes (profit status, bed size, nursing staff time, NH quality, and leadership turnover) were measured a priori. The association between intervention adherence, NH characteristics and preintervention questionnaire response rate was examined.

    Results: Of 13 intervention NHs, seven adhered to the intervention. Three factors differentiated adherent from nonadherent NHs: director of nursing turnover (nonadherent NHs 50% vs adherent NHs 0%, P = .03); Centers for Medicare and Medicaid Services (CMS) nurse staffing rating (range: 1�5) (nonadherent NHs mean 3.7 ± 0.5 vs adherent NHs mean 4.3 ± 0.5), P = .048); and questionnaire response rate (nonadherent NHs 15.6 ± 10.0% vs adherent NHs 34.2 ± 12.1%, P = .02). Profit status, bed size, and number of NH deficiencies on state surveys were not significantly associated with intervention adherence.

    Conclusion: CMS nurse staffing rating, leadership turnover, and questionnaire response rate are associated with adherence to a CRT intervention. Pretrial evaluation of NH staffing rating by CMS and of response to a questionnaire can help investigators improve trial efficiency by screening for NHs likely to adhere to a CRT intervention.