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Research
Malcolm Doupe
University of Manitoba
Corresponding Author
ORCiD: https://orcid.org/0000-0002-6889-9097
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Nursing home residents require daily support. While care aides provide most of this support they are rarely empowered to lead quality improvement (QI) initiatives. A previous proof of principle study, called Safer Care for Older Persons in Residential Care Environments (SCOPE), demonstrated that care aide-led teams can successfully participate in QI interventions. In preparation for a large-scale study, this one-year pilot evaluated how well the bundle of SCOPE coaching strategies helped care-aide led teams to enact these interventions. A secondary aim was to determine if improvements in resident quality of care occurred.
Methods: Using a modified IHI Breakthrough Collaborative Series model in a prospective single-arm study design, we randomly sampled 7 nursing homes in Winnipeg, Manitoba from the longitudinal Translating Research in Elder Care (TREC) cohort. Each SCOPE team had 5-7 front-line staff led by care aides. Teams received coaching to enact the intervention (i.e., to create actionable aim statements, implement QI interventions using plan-do-study-act [PDSA] cycles, use measurement to guide decision making) during three learning congresses, networked and shared learning experiences during these sessions, and received additional support from quality advisors between congresses. We used self-report data to code intervention enactment (‘poor’, ‘adequate’, ‘excellent’), and also measured improvement in team cohesion and communication. Secondarily, we observed changes in unit-level quality indicators using RAI-MDS 2.0 data.
Results: Most teams successfully enacted SCOPE. Five of 7 teams created adequate-to-excellent aim statements throughout the pilot (e.g., statements were specific, measurable, time-bound). While 6 of 7 teams successfully implemented PDSAs, only 2 reported spreading their idea to involve more than a few residents and/or staff on their unit. Three of 7 teams explicitly stated how measurement was used to guide decisions. Team cohesion and communication scored high at baseline, and hence improved minimally. Resident quality indicators improved in 4 of the 7 nursing home units.
Conclusions: Our bundled coaching strategies helped most care aide-led teams to enact SCOPE. Coaching modifications are needed in follow-up studies to help teams more effectively use measurement, and to spread successful interventions within the unit. More detailed and robust approaches are also needed to monitor treatment enactment.
Keywords
Nursing Homes, Quality Improvement, Pilot Study, Care aide-led intervention, Facilitated Coaching, SCOPE
Figure 1
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This is a list of supplementary files associated with this preprint. Click to download.
- Appendix1.docx
Additional File 1 (word file .docx). Title: Appendix 1. This file provides the daily agendas for each SCOPE Learning Congress.
- Appendix2.docx
Additional File 2 (word file .docx). Title: Appendix 2. This file shows the SCOPE Quality Improvement Team Assessment Form, completed bi-monthly during pilot. Responses to this form were used to score team enactment.
- CONSORTextensionAbstractsChecklist.doc
- CONSORTextensionforPilotandFeasibilityTrialsChecklist.doc
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This preprint is under consideration at Pilot and Feasibility Studies. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Malcolm Doupe
University of Manitoba
Corresponding Author
ORCiD: https://orcid.org/0000-0002-6889-9097
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 19 Mar, 2021
No community comments so far
Reviewers invited
Invitations sent on 21 Mar, 2021
Editor assigned
On 16 Mar, 2021
Submission checks complete
On 16 Mar, 2021
Editor invited
On 16 Mar, 2021
First submitted
On 15 Mar, 2021
Subject Areas
Internal Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Nursing home residents require daily support. While care aides provide most of this support they are rarely empowered to lead quality improvement (QI) initiatives. A previous proof of principle study, called Safer Care for Older Persons in Residential Care Environments (SCOPE), demonstrated that care aide-led teams can successfully participate in QI interventions. In preparation for a large-scale study, this one-year pilot evaluated how well the bundle of SCOPE coaching strategies helped care-aide led teams to enact these interventions. A secondary aim was to determine if improvements in resident quality of care occurred.
Methods: Using a modified IHI Breakthrough Collaborative Series model in a prospective single-arm study design, we randomly sampled 7 nursing homes in Winnipeg, Manitoba from the longitudinal Translating Research in Elder Care (TREC) cohort. Each SCOPE team had 5-7 front-line staff led by care aides. Teams received coaching to enact the intervention (i.e., to create actionable aim statements, implement QI interventions using plan-do-study-act [PDSA] cycles, use measurement to guide decision making) during three learning congresses, networked and shared learning experiences during these sessions, and received additional support from quality advisors between congresses. We used self-report data to code intervention enactment (‘poor’, ‘adequate’, ‘excellent’), and also measured improvement in team cohesion and communication. Secondarily, we observed changes in unit-level quality indicators using RAI-MDS 2.0 data.
Results: Most teams successfully enacted SCOPE. Five of 7 teams created adequate-to-excellent aim statements throughout the pilot (e.g., statements were specific, measurable, time-bound). While 6 of 7 teams successfully implemented PDSAs, only 2 reported spreading their idea to involve more than a few residents and/or staff on their unit. Three of 7 teams explicitly stated how measurement was used to guide decisions. Team cohesion and communication scored high at baseline, and hence improved minimally. Resident quality indicators improved in 4 of the 7 nursing home units.
Conclusions: Our bundled coaching strategies helped most care aide-led teams to enact SCOPE. Coaching modifications are needed in follow-up studies to help teams more effectively use measurement, and to spread successful interventions within the unit. More detailed and robust approaches are also needed to monitor treatment enactment.
Figure 1
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