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.

Sandra L Spoelstra, Monica Schueller, Viktoria Basso, Alla Sikorskii
{"title":"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.","authors":"Sandra L Spoelstra,&nbsp;Monica Schueller,&nbsp;Viktoria Basso,&nbsp;Alla Sikorskii","doi":"10.1186/s13012-022-01232-5","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov , NCT03634033 ; date registered August 16, 2018.</p>","PeriodicalId":417097,"journal":{"name":"Implementation Science : IS","volume":" ","pages":"57"},"PeriodicalIF":0.0000,"publicationDate":"2022-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9419328/pdf/","citationCount":"3","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Implementation Science : IS","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s13012-022-01232-5","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 3

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Trial registration: ClinicalTrials.gov , NCT03634033 ; date registered August 16, 2018.

Abstract Image

Abstract Image

一项多地点实用混合3型随机试验的结果,比较了在医疗补助豁免的社区居住残疾人和老年人中实施干预时的促进水平。
背景:基于证据的干预措施可以优化生活在社区中有日常生活困难的残疾人和老年人的身体功能。然而,吸收有限,特别是在资源受限(医疗补助)的设置。促进可能是一种有效的实施策略。本研究的目的是比较内部促进(IF)与外部促进(EF)对医疗补助家庭和社区豁免干预的采用和可持续性的影响。方法:在混合3型试验中,随机分配豁免点(N = 18),使用干扰素或干扰素加干扰素的一系列策略实施干预。通过每个站点的实施完成阶段(SIC)来评估采用率和可持续性。对539名注册护士、社工和职业治疗师的临床态度和自我效能感进行了评估。医疗补助受益人的日常生活活动、抑郁、疼痛、跌倒、急诊科就诊和住院治疗结果在N = 7030的样本中进行评估,反映在医疗补助豁免计划的电子健康记录数据中。在考虑聚类随机设计的情况下,使用线性混合效应模型来比较试验组之间的结果。结果:IF组(9个部位)的平均SIC评分为72.22分(标准差[SD] = 16.98), IF + EF组(9个部位)的平均SIC评分为61.33分(SD = 19.29)。差异无统计学意义,但符合中等临床重要效应大小Cohen’s d = 0.60。临床医生的态度和自我效能的执行结果在不同的试验组之间没有差异。与IF组相比,IF + EF组的受益抑郁显著减少(p = 0.04, 95%可信区间为差异[0.01,0.24])。试验组之间在其他受益结果方面没有发现差异。结论:促进水平并没有提高在医疗补助环境中对残疾人和老年人进行循证干预的采用能力和可持续性。与单独使用IF相比,改善受益者抑郁倾向于使用IF和EF,其他结果没有发现差异。这些发现还表明,便利程度可能不会影响受益人的结果。试验注册:ClinicalTrials.gov, NCT03634033;注册日期2018年8月16日。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信