Positive effect of the INTERCARE nurse-led model on reducing nursing home transfers: A nonrandomized stepped-wedge design

Zúñiga, Franziska and Guerbaai, Raphaëlle-Ashley and de Geest, Sabina and Popejoy, Lori L. and Bartakova, Jana and Denhaerynck, Kris and Trutschel, Diana and Basinska, Kornelia and Nicca, Dunja and Kressig, Reto W. and Zeller, Andreas and Wellens, Nathalie I. H. and de Pietro, Carlo and Desmedt, Mario and Serdaly, Christine and Simon, Michael. (2022) Positive effect of the INTERCARE nurse-led model on reducing nursing home transfers: A nonrandomized stepped-wedge design. Journal of the American Geriatrics Society, 70 (5). pp. 1546-1557.

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Unplanned nursing home (NH) transfers are burdensome for residents and costly for health systems. Innovative nurse-led models of care focusing on improving in-house geriatric expertise are needed to decrease unplanned transfers. The aim was to test the clinical effectiveness of a comprehensive, contextually adapted geriatric nurse-led model of care (INTERCARE) in reducing unplanned transfers from NHs to hospitals.; A multicenter nonrandomized stepped-wedge design within a hybrid type-2 effectiveness-implementation study was implemented in 11 NHs in German-speaking Switzerland. The first NH enrolled in June 2018 and the last in November 2019. The study lasted 18 months, with a baseline period of 3 months for each NH. Inclusion criteria were 60 or more long-term care beds and 0.8 or more hospitalizations per 1'000 resident care days. Nine hundred and forty two long-term NH residents were included between June 2018 and January 2020 with informed consent. Short-term residents were excluded. The primary outcome was unplanned hospitalizations. A fully anonymized dataset of overall transfers of all NH residents served as validation. Analysis was performed with segmented mixed regression modeling.; Three hundred and three unplanned and 64 planned hospitalizations occurred. During the baseline period, unplanned transfers increased over time (β; 1; = 0.52), after which the trend significantly changed by a similar but opposite amount (β; 2; = -0.52; p = 0.0001), resulting in a flattening of the average transfer rate throughout the postimplementation period (β; 1; + β; 2; ≈ 0). Controlling for age, gender, and cognitive performance did not affect these trends. The validation set showed a similar flattening trend.; A complex intervention with six evidence-based components demonstrated effectiveness in significantly reducing unplanned transfers of NH residents to hospitals. INTERCARE's success was driven by registered nurses in expanded roles and the use of tools for clinical decision-making.
Faculties and Departments:03 Faculty of Medicine > Departement Public Health > Institut für Pflegewissenschaft
UniBasel Contributors:Zuniga, Franziska and Guerbaai, Raphaelle-Ashley and De Geest, Sabina M. and Bartakova, Jana and Denhaerynck, Kris and Simon, Michael and Nicca, Dunja
Item Type:Article, refereed
Article Subtype:Research Article
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:17 May 2022 10:13
Deposited On:17 May 2022 10:13

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