Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: Outcomes of Nursing Management Practice in Nursing Homes
Brief Summary: Clinical trials have identified interventions that reduce adverse outcomes such as falls in nursing home (NH) residents but attempts to translate these into practice quality improvement (QI) techniques have not been successful. Using a complexity science framework, our previous study showed that low connection, information flow, and cognitive diversity among NH staff explains quality of care for complex problems such as falls. Our pilot of "Connect," a multi-component intervention that encourages staff to engage in network-building and use simple strategies to make new connections with others, enhance information flow, and use cognitive diversity, suggests that staff can improve the density and quality of their interactions. This 5-year study uses a prospective, cluster-randomized, outcome assessment blinded design, with NHs (n=16) randomized to either Connect and a falls QI program (Connect + Falls) or QI alone (Falls). About 800 residents and 576 staff will participate. Specific aims are to, in nursing homes: 1) Compare the impact of the Connect intervention plus a falls reduction QI intervention (Connect+Falls) to a falls reduction QI intervention (Falls) on fall risk reduction indicators (orthostatic blood pressure, sensory impairment, footwear appropriateness, gait; assistive device; toileting needs, environment, and psychotropic medication); 2) Compare the impact of Connect+Falls to Falls alone on fall rates and injurious falls, and determine whether these are mediated by the change in fall risk reduction indicators; 3) Compare the impact of Connect+Falls to Falls alone on complexity science measures (communication, participation in decision making, local interactions, safety climate, staff perceptions of quality) and determine whether these mediate the impact on fall risk reduction indicators and fall rates and injurious falls. Cross-sectional observations of complexity science measures are taken at baseline, at 3 months, at 6 months, and at 9 months. Resident fall risk reduction indicators, fall rates, and injurious falls are measured for the 6 months prior to the first intervention and the 6 months after the final intervention is completed. Analysis will use a 3-level mixed model to account for the complex nesting of patients and staff within nursing homes, and to control for covariates associated with fall risk, including baseline facility fall rates and staff turnover rates.


Options:
A: Arm Label: Mulitfaceted podiatry Intervention; Type: EXPERIMENTAL; Interventions: Other: Foot and ankle exercises, foot orthoses, footwear provision | Arm Label: Usual podiatry care; Type: PLACEBO_COMPARATOR; Interventions: Other: Usual Care | Intervention Type: OTHER; Name: Foot and ankle exercises, foot orthoses, footwear provision; Assigned to Arm(s): Mulitfaceted podiatry Intervention | Intervention Type: OTHER; Name: Usual Care; Assigned to Arm(s): Usual podiatry care
B: Arm Label: Fall QI; Type: EXPERIMENTAL; Interventions: Behavioral: Falls QI | Arm Label: Connect & Falls QI; Type: EXPERIMENTAL; Interventions: Behavioral: Connect | Intervention Type: BEHAVIORAL; Name: Falls QI; Assigned to Arm(s): Fall QI | Intervention Type: BEHAVIORAL; Name: Connect; Assigned to Arm(s): Connect & Falls QI
C: Arm Label: Functional training group; Type: EXPERIMENTAL; Interventions: Other: Functional training program | Arm Label: Control group; Type: NO_INTERVENTION; Interventions: N/A | Intervention Type: OTHER; Name: Functional training program; Assigned to Arm(s): Functional training group
D: Intervention Type: DEVICE; Name: BedEx Patient Occupancy Monitoring System; Assigned to Arm(s): N/A

Answer: B