Testing the Implementation of Function-focused Care in Assisted Living Settings |
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| Affiliation: | 1. University of Maryland School of Nursing, Baltimore, MD, USA;2. College of Nursing, Pennsylvania State University, University Park, PA, USA;3. Lamy Center, University of Maryland, Baltimore, MD, USA;1. Division of Geriatric Medicine, Tours University Medical Center, Tours, France;2. INSERM 1246-SPHERE, Tours and Nantes Universities, Tours, France;3. Education, Ethics, Health (EA 7505), Tours University, Tours, France;1. Internal Medicine, Geriatry and Therapeutic Department, Timone and Sainte Marguerite Hospital, AP-HM, Aix-Marseille University, Marseille, France;2. Pharmaceutical Expertise and Clinical Research Unit, Pharmacy Department, Timone Hospital, AP-HM, Aix-Marseille University, Marseille, France;3. School of Medicine–La Timone Medical Campus, EA 3279: CEReSS Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France;4. Korian Nursing Homes Group, Marseille, France;5. MEDEOS Nursing Homes, Marseille, France;1. Center of Innovation in Long Term Services and Supports, Providence VA Medical Center, Providence, RI, USA;2. Brown School of Public Health, Providence, RI, USA;3. Warren Alpert Medical School of Brown University, Providence, RI, USA;1. Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA;2. Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA;3. Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA;4. Department of Internal Medicine and Geriatrics, Community Care, Cleveland Clinic, Cleveland, OH, USA;1. Division of Health Care Policy & Research, University of Colorado–Anschutz Medical Campus, Aurora, CO, USA;2. Hospice and Palliative Care, VA Eastern Colorado Healthcare System, Department of Veterans Affairs, Aurora, CO, USA;3. Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA;4. VA Puget Sound Health Care System Health Services Research and Development, Seattle, WA, USA;5. College of Nursing, University of Colorado–Anschutz Medical Campus, Aurora, CO, USA |
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| Abstract: | ObjectivesThe purpose of this study was to evaluate the Function-Focused Care for Assisted Living Using the Evidence Integration Triangle (FFC-AL-EIT) intervention.DesignFFC-AL-EIT was a randomized controlled pragmatic trial including 85 sites and 794 residents.InterventionFFC-AL-EIT was implemented by a Research Nurse Facilitator working with a facility champion and stakeholder team for 12 months to increase function and physical activity among residents. FFC-AL-EIT included (Step I) Environment and Policy Assessments; (Step II) Education; (Step III) Establishing Resident Function-Focused Care Service Plans; and (Step IV) Mentoring and Motivating.Setting and ParticipantsThe age of participants was 89.48 years [standard deviation (SD) = 7.43], and the majority were female (n = 561; 71%) and white (n = 771; 97%).MethodsResident measures, obtained at baseline, 4, and 12 months, included function, physical activity, and performance of function-focused care. Setting outcomes, obtained at baseline and 12 months, included environment and policy assessments and service plans.ResultsReach was based on 85 of 90 sites that volunteered (94%) participating. Effectiveness was based on less decline in function (P < .001), more function-focused care (P = .012) and better environment (P = .032) and policy (P = .003) support for function-focused care in treatment sites. Adoption was supported with 10.00 (SD = 2.00) monthly meetings held, 77% of settings engaged in study activities as or more than expected, and direct care workers providing function-focused care (63% to 68% at 4 months and 90% at 12 months). The intervention was implemented as intended, and education was received based on a mean knowledge test score of 88% correct. Evidence of maintenance from 12 to 18 months was noted in treatment site environments (P = .35) and policies continuing to support function-focused care (P = .28)].Conclusions and ImplicationsThe Evidence Integration Triangle is an effective implementation approach for assisted living. Future work should continue to consider innovative approaches for measuring RE-AIM outcomes. |
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| Keywords: | Function physical activity implementation assisted living |
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