Results of a multi-site pragmatic hybrid type 3 cluster randomized trial comparing level of facilitation while implementing an intervention in community-dwelling disabled and older adults in a Medicaid waiver.
Results of a multi-site pragmatic hybrid type 3 cluster randomized trial comparing level of facilitation while implementing an intervention in community-dwelling disabled and older adults in a Medicaid waiver.
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DOI：
10.1186/s13012-022-01232-5
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发表时间：
2022-08-26
影响因子：
7.2
通讯作者：
Sikorskii, Alla
中科院分区：
文献类型：
--
作者：
Spoelstra, Sandra L.;Schueller, Monica;Basso, Viktoria;Sikorskii, Alla
关键词：
有循证干预措施，可优化生活在社区中的残疾人和老年人的身体功能，这些人在日常生活任务方面有困难。然而，采用一直有限，特别是在资源有限（医疗补助）的设置。便利化可能是一种有效的执行战略。本研究的目的是比较内部促进（IF）与IF和外部促进（EF）的采用和可持续性的干预医疗补助家庭和社区为基础的豁免。在一项混合3型试验中，随机分配豁免研究中心（N = 18），使用IF或IF和EF的一系列策略实施干预。通过实施完成阶段（SIC）对每个站点的采用和可持续性进行评估。临床医生对循证实践和自我效能的态度进行了评估，539名注册护士，社会工作者和职业治疗师。医疗补助受益人的日常生活活动，抑郁，疼痛，福尔斯，急诊科就诊和住院治疗的结果进行了评估，在一个样本N = 7030，反映了医疗补助豁免计划的电子健康记录数据。使用线性混合效应模型比较试验组之间的结局，同时考虑到随机分组设计。IF组（9家临床试验机构）的平均SIC评分为72.22（标准差[SD] = 16.98），IF + EF组（9家临床试验机构）为61.33（SD = 19.29）。该差异无统计学显著性，但对应于中等临床重要效应量Cohen d = 0.60。临床医生的态度和自我效能的实施结果在试验组之间没有差异。与IF组相比，IF + EF组的有益抑郁显著减少（p = 0.04，差异的95%置信区间[0.01，0.24]）。在其他受益结局方面，未发现试验组之间存在差异。促进水平并没有提高能力，采用和可持续性的循证干预医疗补助设置，照顾残疾人和老年人。改善受益人抑郁倾向于使用IF和EF相比，IF单独，没有发现其他结果的差异。这些研究结果还表明，便利程度可能不会影响受益人的成果。ClinicalTrials.gov，NCT 03634033;注册日期2018年8月16日。在线版本包含补充材料，可通过10.1186/s13012-022-01232-5获得。
Evidence-based interventions that optimize physical function for disabled and older adults living in the community who have difficulty with daily living tasks are available. However, uptake has been limited, particularly in resource-constrained (Medicaid) settings. Facilitation may be an effective implementation strategy. This study’s aim was to compare internal facilitation (IF) versus IF and external facilitation (EF) on adoption and sustainability of an intervention in a Medicaid home and community-based waiver. In a hybrid type 3 trial, waiver sites (N = 18) were randomly assigned to implement the intervention using a bundle of strategies with either IF or IF and EF. Adoption and sustainability were assessed via Stages of Implementation Completion (SIC) for each site. Clinician attitudes toward evidence-based practice and self-efficacy were evaluated among 539 registered nurses, social workers, and occupational therapists. Medicaid beneficiary outcomes of activities of daily living, depression, pain, falls, emergency department visits, and hospitalizations were evaluated in a sample of N = 7030 as reflected by electronic health records data of the Medicaid waiver program. Linear mixed-effects models were used to compare outcomes between trial arms while accounting for cluster-randomized design. The mean SIC scores were 72.22 (standard deviation [SD] = 16.98) in the IF arm (9 sites) and 61.33 (SD = 19.29) in the IF + EF arm (9 sites). The difference was not statistically significant but corresponded to the medium clinically important effect size Cohen’s d = 0.60. Clinician implementation outcomes of attitudes and self-efficacy did not differ by trial arm. Beneficiary depression was reduced significantly in the IF + EF arm compared to the IF arm (p = .04, 95% confidence interval for the difference [0.01, 0.24]). No differences between trial arms were found for other beneficiary outcomes. Level of facilitation did not enhance capacity for adoption and sustainability of an evidence-based intervention in a Medicaid setting that cares for disabled and older adults. Improved beneficiary depression favored use of IF and EF compared to IF alone, and no differences were found for other outcomes. These findings also suggest level of facilitation may not have impacted beneficiary outcomes. ClinicalTrials.gov, NCT03634033; date registered August 16, 2018. The online version contains supplementary material available at 10.1186/s13012-022-01232-5.
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DOI：
10.1007/s10488-014-0552-6
发表时间：
2015-09
影响因子：
2.6
作者：
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DOI：
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发表时间：
2014-10-14
期刊：
Implementation science : IS
影响因子：
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