Sustainable Improvement of INTERprofessional Care for Better Resident Outcomes
NCT Number: NCT06473051
Acronym: INTERSCALE
Status: RECRUITING
Study Type: INTERVENTIONAL
Phases: NA
Conditions: Unplanned Hospitalizations
Interventions: OTHER: Original set|OTHER: Adapted set
Sponsor: University of Basel
Sex: ALL
Age: CHILD, ADULT, OLDER_ADULT
Enrollment: 40
Study Design: Allocation: RANDOMIZED|Intervention Model: PARALLEL|Masking: NONE|Primary Purpose: HEALTH_SERVICES_RESEARCH
Start Date: 2024-07-01
Completion Date: 2027-10-31
Locations: Institute of Nursing Science, Basel, 4057, Switzerland

Summary:
INTERCARE is an interprofessional nurse-led care model developed specifically for long-term care facilities (LTCFs) in Switzerland that has been shown to successfully reduce unplanned transfers for residents. INTERCARE proved both effective in reducing unplanned transfers to the hospital but also more costly than the usual care. To sustainably implement evidence-base practices or programs such as INTERCARE on a large scale, implementation research studies are needed to assess fitting implementation strategies. Given that the INTERCARE study demonstrated replicability of the INTERCARE model in eleven LTCFs, showing clinical effectiveness, high acceptability, feasibility and LTCF' fidelity to the core components, the INTERSCALE study is the next step to reach scalability in a broader context of a cost-effective solution when supporting the implementation.

Primary Outcome Measures: LTCF Leadership level: Degree of overall fidelity to the core elements of the INTERCARE model, Overall fidelity score (percentage of minimal requirements of the INTERCARE model fulfilled) from the side of the LTCF Leadership will be measured using semi-structured interviews (degree of fulfillment: yes, partialy, no)., Quarterly, from baseline (month 0) through end of intervention phase (month 12)
Secondary Outcome Measures: Resident level: fidelity to core element Advanced Care Planning, Implementation of ACP with new residents: wishes concerning do-not-resuscitate orders, wishes concerning hospitalization, and antibiotic administration (yes/no) within three months of admission to the LTCF will be collected using structured data sheets., Quarterly, from baseline (month 0) through study completion period (24 months)|General practitioner level: Degree of fidelity to the core elements "interprofessional collaboration" and "evidence-based instruments" (focus on use of ISBAR) of the INTERCARE model will be measured, Fidelity to the two core elements will be measured using questionnaire surveys., Two times: 1) in the middle of the implementation phase (month 6) and 2) at the end of intervention period (month 12)|LTCF level: Sustainability, Sustainability of the INTERCARE model will be measured with an overall fidelity score (percentage of minimal requirements of the INTERCARE model fulfilled) from the side of the LTCF Leadership using semi-structured interviews (degree of fulfillment: yes, partialy, no). Sustainability is understood as the continued use of the INTERCARE model up to 12 months after the end of the intervention phase., Quarterly, from end of intervention phase (month 12) through end of sustainment phase (month 24)|INTERCARE Nurse level: Acceptability of the INTERCARE model, Acceptability of core components of the INTERCARE model will be measured using Acceptability of Intervention Measure (AIM), a 4-item instrument measuring the acceptability of an intervention., Three times: 1) at the get-in period (month 0); 2) in the middle of the implementation phase (month 6) and 3) at the end of intervention period (month 12)|Other care staff level: Acceptability of the INTERCARE model, Acceptability of core components of the INTERCARE model will be measured using Acceptability of Intervention Measure (AIM), a 4-item instrument measuring the acceptability of an intervention., Three times: 1) at the get-in period (month 0); 2) in the middle of the implementation phase (month 6) and 3) at the end of intervention period (month 12)|INTERCARE Nurse level: Feasibility of the INTERCARE model, Feasibility of core components of the INTERCARE model will be measured using Feasibility of Intervention Measure (FIM), a 4-item instrument measuring the feasibility of an intervention., Three times: 1) at the get-in period (month 0); 2) in the middle of the implementation phase (month 6) and 3) at the end of intervention period (month 12)|Other care staff level: Feasibility of the INTERCARE model, Feasibility of core components of the INTERCARE model will be measured using Feasibility of Intervention Measure (FIM), a 4-item instrument measuring the feasibility of an intervention., Three times: 1) at the get-in period (month 0); 2) in the middle of the implementation phase (month 6) and 3) at the end of intervention period (month 12)|LTCF Leadership level: Facility costs and expenditures related to implementation strategies in Swiss Francs, Facility costs and expenditures related to implementation strategies from the side of the LTCF will be measured using structured data reporting forms. Recordings of time required for the implementation strategies and the salary estimate of employees involved will be done using a time-driven activity-based costing sheet., Monthly reporting, from baseline (month 0) through study completion period (month 24)|Research group level: Costs of implementation strategies in Swiss Francs, A recording of activities as part of the implementation strategies, time required, and the salary estimate of employees involved in the application/participation of implementation strategies (e.g., coaching, training, information events) will be tracked by the involved members of the research team using a time-driven activity-based costing sheet., Continuous tracking, from baseline (month 0) through study completion period (24 months)|Resident level: Unplanned transfers, Number of all unplanned transfers/1000 resident care days will be collected using structured data sheets., Quarterly, from baseline (month 0) through study completion period (24 months)|LTCF level: Staff turnover, Percentage of employees with voluntary turnover per unit per month, calculated as number of employees leaving per month divided by average number of staff per month (number of staff at beginning of month + number of staff at end of month/2)

These routinely collected/administrative organizational data from the side of the LTCF on staff turnover will be tracked using structured data exports., Quarterly exports, from baseline (month 0) through study completion period (month 24)|LTCF level: Staff absenteeism, 1. Percentage of staff who show short (up to 3 days), medium (3-10 days) or long-term absences (more than 10 days) per unit per quarter (due to illness or accident)
2. Percentage of absence days per unit per quarter in relation to the total number of working days per unit per quarter

These routinely collected/administrative organizational data from the side of the LTCF on staff absenteeism will be tracked using structured data exports., Quarterly exports, from baseline (month 0) through study completion period (month 24)|INTERCARE Nurse level: Intention to leave, Intention to leave will be measured using a 3-item instrument measuring Care Workers' Intention to Leave Employment in Nursing Homes., Three times: 1) at the get-in period (month 0); 2) in the middle of the implementation phase (month 6) and 3) at the end of intervention period (month 12)|Other care staff level: Intention to leave, Intention to leave will be measured using a 3-item instrument measuring Care Workers' Intention to Leave Employment in Nursing Homes., Three times: 1) at the get-in period (month 0); 2) in the middle of the implementation phase (month 6) and 3) at the end of intervention period (month 12)|INTERCARE Nurse level: Intention to stay, Intention to leave will be measured using a single item instrument assessing the likelihood of an individual to continue working in the current workplace for the next 12 months., Three time points: 1) at the get-in period (month 0); 2) in the middle of the implementation phase (month 6) and 3) at the end of intervention period (month 12)|Other care staff level: Intention to stay, Intention to leave will be measured using a single item instrument assessing the likelihood of an individual to continue working in the current workplace for the next 12 months., Three times: 1) at the get-in period (month 0); 2) in the middle of the implementation phase (month 6) and 3) at the end of intervention period (month 12)