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J Am Geriatr Soc. 2011 Dec;59(12):2332-6. doi: 10.1111/j.1532-5415.2011.03697.x. Epub 2011 Oct 31.

Predicting nursing home adherence to a clinical trial intervention: lessons for the conduct of cluster randomized trials.

Author information

  • 1Division of Geriatric Medicine, Medical School, University of Massachusetts, Worcester, Massachusetts 01605, USA. jennifer.tjia@umassmed.edu

Abstract

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.

© 2011, Copyright the Authors Journal compilation © 2011, The American Geriatrics Society.

PMID:
22091689
[PubMed - indexed for MEDLINE]
PMCID:
PMC4164958
Free PMC Article
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