DOI: 10.3886/icpsr38769.v1
title: COVID-19 Project ECHO for Nursing Homes: A Patient-centered, Randomized-controlled Trial to Implement Infection Control, United States, 2021
title: Version 1

description: Nationally, nursing homes have been devastated with 2,726,897 COVID-19 cases and 162,874 COVID-19 deaths as of November 28, 2022. Nursing homes were ill-equipped for the pandemic; though facilities are required to have infection control staff, only 3% have taken a basic infection control course. Significant research has focused on infection control in the acute care setting; however, little is known about the implementation of practices and effective interventions in nursing homes. The researchers proposed an intervention utilizing Project ECHO (Extension for Community Health Outcomes), an evidence-based tele-mentoring model, to connect Penn State University experts with remote nursing home staff and administrators to proactively support evidence-based infection control guideline implementation. This study sought to answer the critical research question of how evidence-based infection control guidelines can be implemented effectively in nursing homes.
description: The purpose of this study was to compare the effectiveness of a 16-week Agency for Healthcare Research and Quality (AHRQ) phase 1 COVID-19 Project ECHO (Extension for Community Health Outcomes) intervention followed by nine weekly, optional 60-minute office hour sessions (AHRQ phase 2) to ECHO and an additional 17 sessions, 60-minutes in length, including an 8-week flu-focused refresher series for fall 2021, focused on infection control (ECHO+) in reducing the number of nursing home residents with COVID-19. Secondary aims of this study include: <b>1)</b> To compare the effectiveness of ECHO versus ECHO+ on other patient-centered outcomes, including quality of life (QoL), flu-like symptoms, hospitalizations, and deaths. <b>2)</b> To evaluate the impact of the COVID-19 ECHO on key implementation outcomes in nursing home settings using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework.
description: A stratified cluster randomized design was used, using a 1:1 ratio to randomly assign nursing homes from the Northeast and Midwest, including Connecticut, New Jersey, New York, Wisconsin, New Hampshire, Illinois, Vermont, Indiana, Virginia, Maryland, Pennsylvania, and Ohio to either: <b>1)</b> AHRQ-funded COVID-19 ECHO that included 16 weekly tele-mentoring sessions addressing COVID-19 guidelines and best practices plus 9 optional, weekly 60-minute office hour sessions, or <b>2)</b> AHRQ-funded COVID-19 ECHO+, which included 16 weekly tele-mentoring sessions addressing COVID-19 guidelines and best practices, plus 17 weekly 60-minute sessions with a focus on stakeholder-identified needs and Centers for Disease Control and Prevention (CDC) infection control training. Patient-centered outcomes were assessed at baseline (intervention start date), 4, 6, 12, and 18 months. The study was guided by the RE-AIM framework to critically evaluate both the effectiveness and implementation outcomes of the proposed intervention. The research team surveyed nursing home administrators (NHAs) and nursing staff at baseline and 6-month follow-up using validated items from the CDC.
description: The variables in this study include measures of COVID infections, participation and attitudes regarding the ECHO program, and overall operation of the nursing homes.
description: Response Rates: 136 nursing homes were enrolled based on the 290 nursing homes assessed. A total of 197 participants from 126 nursing homes responded to the implementation surveys.
description: National nursing home lists were obtained using Centers for Medicare and Medicaid Services' (CMS) data, state agency and nursing home association contact websites, and engaged stakeholders. Inclusion criteria included being a CMS-eligible facility and no prior participation in a prior ECHO-delivered COVID-19 intervention.
description: Datasets: DS0: Study-Level Files DS1: Baseline Data DS2: COVID-19 and Resident Mood Interview Data DS3: Baseline and 6 Month Comparison for Facility Administrators Data DS4: Baseline and 6 Month Comparison for Facility Administrators and Staff Data DS5: Miscellaneous Nursing Home Administrators Data DS6: Miscellaneous Staff Data
description: Nursing homes in the Northeast and Midwest United States. Smallest Geographic Unit: None.
description: face-to-face interview; web-based survey