Nurse-led Care Models in Swiss Nursing Homes: Improving Interprofessional Care for Better Resident Outcomes (INTERCARE)

NCT03590470 | Completed

• 1 other identifier: EKNZ2018-00501
• Study Type: interventional
• Target: 944
• Locations: 1 country
• Sites: 7

Brief Summary

This implementation science project aims to implement a nurse-led model of care in 11 nursing homes in the German speaking part of Switzerland, to reduce avoidable hospitalisations. The model will be introduced using a non-randomized stepped-wedge design. First, training will be delivered to leadership teams and to geriatric nurse experts, secondly after a baseline measurement period, including distribution of questionnaires and collection of resident data mainly national quality indicators and data regarding hospitalisations, the nurse led model will be implemented and thereafter 2 measurement periods will follow (6 months after the beginning of the intervention and at the end). Quantitative resident data will be retrieved from the RAI-NH three-monthly, and hospitalization data with the help of a data platform, reflection tools and hospital discharge reports continuously from the baseline period until the end of the data collection in 02.2020. The hypotheses of the project are:

• To assess the effectiveness of the nurse-led care model on unplanned hospitalizations (primary outcome) and additional resident and staff outcomes, hypothesizing that nursing homes with a nurse-led care model have lower rates of unplanned hospitalizations and show improvements in additional resident and staff outcomes
• To assess the effect of the degree of adoption on client outcomes, hypothesizing that a higher degree of adoption is related to better client outcomes
• To describe the implementation costs the Swiss nurse-led interprofessional NH care model on the NH level and to assess the economic impact of INTERCARE with a cost-effectiveness analysis adopting a health care system perspective (comparing the increase in staff costs with the decrease of days of avoidable hospitalizations)
• To explore resident/family and staff perceptions of service outcomes (e.g., timeliness) and the acceptability of the nurse-led care model;
• To describe the degree to which the model was adopted, its feasibility, the fidelity with which it was applied, and the barriers and facilitators met by NH leadership and nurse experts.

Conditions

Hospitalisations

Keywords

avoidable hospitalisations; quality of care; nursing homes; implementation science; quality improvement

Outcome Measures

Primary Outcomes (1)

• Number of all unplanned hospitalizations /1000 resident care days

  Due to the complexity involved in the measurement of avoidable hospitalizations, we will follow experts' recommendation \[24\], tracking all unplanned hospital admissions as a primary endpoint. The primary endpoint will be calculated as number of unplanned hospitalisations per 1000 resident care days.

  21 months

Secondary Outcomes (6)

• Avoidable hospitalizations

  21 months

• Avoidable emergency department (ED) visits

  21 months

• Resident quality indicators: Pain

  21 months

• Resident quality indicators: physical restraints

  21 months

• Resident quality indicators: Polypharmacy

  21 months

Study Arms (2)

Experimental_INTERCARE intervention

EXPERIMENTAL

Implementation of a nurse-led model of care adapted to the Swiss context, comprising a geriatric nurse expert with specific training in multidimensional clinical assessment and quality improvement tools.

Other: Implementation of a nurse-led model of care

Control

NO INTERVENTION

The design used for the INTERCARE intervention is a non-randomized stepped wedge design, therefore all nursing homes will receive the intervention but at different time points. All nursing homes will be in a control phase before receiving the intervention, and switch to the intervention phase, once the intervention is implemented.

Interventions

Implementation of a nurse-led model of care OTHER

A nurse-model of care consisting of a specifically trained geriatric nurse expert, communication and quality improvement tools will be implemented in 11 nursing homes in the German speaking part of Switzerland

Experimental_INTERCARE intervention

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Nursing homes
• German-speaking
• Size: ≥80 long-term care beds (NHs with \>60 beds will be considered if they have a high hospitalisation rate)
• Hospitalisation rates: ≥0.8/1000 resident days
• Residents
• \- All long-term care residents
• Geriatric nurse experts:
• Registered nurse
• At least three years' experience in long-term care
• Nursing home staff
• Care workers of all educational levels, including students
• Other health professionals employed by the NH (such as therapists, dieticians) with direct resident contact
• Employed by the NH and working in the NH for a minimum of 3 months

You may not qualify if:

• Nursing homes
• Italian-speaking
• French-speaking
• Residents
• \- Short term or day care residents, other residents with a discharge planned within two months after admittance

Sponsors & Collaborators

• University of Basel: lead
• Swiss National Science Foundation: collaborator
• University Department of Geriatric Medicine FELIX PLATTER: collaborator
• University of Applied Sciences and Arts of Southern Switzerland: collaborator
• Insel Gruppe AG, University Hospital Bern: collaborator
• Hôpital ophtalmique Jules-Gonin (HOJG): collaborator
• Serdaly & Ankers, Switzerland: collaborator
• Vaud state public health department: collaborator
• stiftung pflegewissenchaft: collaborator
• KU Leuven: collaborator

Study Sites (7)

Obesunne

Arlesheim, 4144, Switzerland

Location

St Christophorus

Basel, 4057, Switzerland

Location

Marienhaus

Basel, Switzerland

Location

Domicil schwabgut

Bern, 3018, Switzerland

Location

Zentrum Schlossmat

Burgdorf, 3400, Switzerland

Location

Viva Luzern

Lucerne, 6003, Switzerland

Location

Reusspark

Niederwil, 5524, Switzerland

Location

Related Publications (4)

• Zuniga F, Kotkowski K, Guerbaai RA, Simon M, Serdaly C, Geest S, Zeller A, Kressig RW, Wellens NIH, Brunkert T. Understanding a Complex Intervention to Reduce Unplanned Hospitalizations From Nursing Homes: Process Evaluation of INTERCARE. Health Sci Rep. 2026 Jan 11;9(1):e71748. doi: 10.1002/hsr2.71748. eCollection 2026 Jan.

  PMID: 41527584 DERIVED

• Guerbaai RA, DeGeest S, Popejoy LL, Simon M, Wellens NIH, Denhaerynck K, Zuniga F. Evaluating the implementation fidelity to a successful nurse-led model (INTERCARE) which reduced nursing home unplanned hospitalisations. BMC Health Serv Res. 2023 Feb 9;23(1):138. doi: 10.1186/s12913-023-09146-8.

  PMID: 36759902 DERIVED

• Bartakova J, Zuniga F, Guerbaai RA, Basinska K, Brunkert T, Simon M, Denhaerynck K, De Geest S, Wellens NIH, Serdaly C, Kressig RW, Zeller A, Popejoy LL, Nicca D, Desmedt M, De Pietro C. Health economic evaluation of a nurse-led care model from the nursing home perspective focusing on residents' hospitalisations. BMC Geriatr. 2022 Jun 9;22(1):496. doi: 10.1186/s12877-022-03182-5.

  PMID: 35681157 DERIVED

• Basinska K, Zuniga F, Simon M, De Geest S, Guerbaai RA, Wellens NIH, Nicca D, Brunkert T. Implementation of a complex intervention to reduce hospitalizations from nursing homes: a mixed-method evaluation of implementation processes and outcomes. BMC Geriatr. 2022 Mar 12;22(1):196. doi: 10.1186/s12877-022-02878-y.

  PMID: 35279088 DERIVED

Study Officials

• Michael Simon, PhD

  Institut für Pflegewissenschaft Fakultät für Medizin, Universität Basel Bernoullistrasse 28, Raum 107 CH-4056 Basel

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: SEQUENTIAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Tenure Track Assistant Professor

Model Details: Non-randomized stepped-wedge design

Study Record Dates

• First Submitted: June 10, 2018
• First Posted: July 18, 2018
• Study Start: June 20, 2018
• Primary Completion: February 28, 2020
• Study Completion: June 1, 2020
• Last Updated: November 13, 2020

Record last verified: 2020-11

Data Sharing

• IPD Sharing: Will not share

Locations

CH (7)