Successful knowledge translation intervention in long-term care: final results from the vitamin D and osteoporosis study (ViDOS) pilot cluster randomized controlled trial

Courtney C Kennedy, George Ioannidis, Lehana Thabane, Jonathan D Adachi, Sharon Marr, Lora M Giangregorio, Suzanne N Morin, Richard G Crilly, Robert G Josse, Lynne Lohfeld, Laura E Pickard, Mary-Lou van der Horst, Glenda Campbell, Jackie Stroud, Lisa Dolovich, Anna M Sawka, Ravi Jain, Lynn Nash, Alexandra Papaioannou, Courtney C Kennedy, George Ioannidis, Lehana Thabane, Jonathan D Adachi, Sharon Marr, Lora M Giangregorio, Suzanne N Morin, Richard G Crilly, Robert G Josse, Lynne Lohfeld, Laura E Pickard, Mary-Lou van der Horst, Glenda Campbell, Jackie Stroud, Lisa Dolovich, Anna M Sawka, Ravi Jain, Lynn Nash, Alexandra Papaioannou

Abstract

Background: Few studies have systematically examined whether knowledge translation (KT) strategies can be successfully implemented within the long-term care (LTC) setting. In this study, we examined the effectiveness of a multifaceted, interdisciplinary KT intervention for improving the prescribing of vitamin D, calcium and osteoporosis medications over 12-months.

Methods: We conducted a pilot, cluster randomized controlled trial in 40 LTC homes (21 control; 19 intervention) in Ontario, Canada. LTC homes were eligible if they had more than one prescribing physician and received services from a large pharmacy provider. Participants were interdisciplinary care teams (physicians, nurses, consultant pharmacists, and other staff) who met quarterly. Intervention homes participated in three educational meetings over 12 months, including a standardized presentation led by expert opinion leaders, action planning for quality improvement, and audit and feedback review. Control homes did not receive any additional intervention. Resident-level prescribing and clinical outcomes were collected from the pharmacy database; data collectors and analysts were blinded. In addition to feasibility measures, study outcomes were the proportion of residents taking vitamin D (≥800 IU/daily; primary), calcium ≥500 mg/day and osteoporosis medications (high-risk residents) over 12 months. Data were analyzed using the generalized estimating equations technique accounting for clustering within the LTC homes.

Results: At baseline, 5,478 residents, mean age 84.4 (standard deviation (SD) 10.9), 71% female, resided in 40 LTC homes, mean size = 137 beds (SD 76.7). In the intention-to-treat analysis (21 control; 19 intervention clusters), the intervention resulted in a significantly greater increase in prescribing from baseline to 12 months between intervention versus control arms for vitamin D (odds ratio (OR) 1.82, 95% confidence interval (CI): 1.12, 2.96) and calcium (OR 1.33, 95% CI: 1.01, 1.74), but not for osteoporosis medications (OR 1.17, 95% CI: 0.91, 1.51). In secondary analyses, excluding seven nonparticipating intervention homes, ORs were 3.06 (95% CI: 2.18, 4.29), 1.57 (95% CI: 1.12, 2.21), 1.20 (95% CI: 0.90, 1.60) for vitamin D, calcium and osteoporosis medications, respectively.

Conclusions: Our KT intervention significantly improved the prescribing of vitamin D and calcium and is a model that could potentially be applied to other areas requiring quality improvement.

Trial registration: ClinicalTrials.gov: NCT01398527 . Registered: 19 July 2011.

Figures

Figure 1
Figure 1
Flow-chart of randomization, allocation, follow-up and analysis.
Figure 2
Figure 2
ViDOS multifaceted intervention.

References

    1. Wensing M, Bosch M, Grol R. Developing and selecting interventions for translating knowledge to action. CMAJ. 2010;182:E85–8. doi: 10.1503/cmaj.081233.
    1. Bostrom AM, Slaughter SE, Chojecki D, Estabrooks CA. What do we know about knowledge translation in the care of older adults? A scoping review. J Am Med Dir Assoc. 2012;13:210–9. doi: 10.1016/j.jamda.2010.12.004.
    1. Kaasalainen S, Brazil K, Akhtar-Danesh N, Coker E, Ploeg J, Donald F, et al. The evaluation of an interdisciplinary pain protocol in long term care. J Am Med Dir Assoc. 2012;13:664–e1-8. doi: 10.1016/j.jamda.2012.05.013.
    1. Berlowitz DR, Young GJ, Hickey EC, Joseph J, Anderson JJ, Ash AS, et al. Clinical practice guidelines in the nursing home. Am J Med Qual. 2001;16:189–95. doi: 10.1177/106286060101600602.
    1. Thabane L, Ma J, Chu R, Cheng J, Ismaila A, Rios LP, et al. A tutorial on pilot studies: the what, why and how. BMC Med Res Methodol. 2010;10:1. doi: 10.1186/1471-2288-10-1.
    1. Morley J. Osteoporosis and fragility fractures. J Am Med Dir Assoc. 2011;12:389–92. doi: 10.1016/j.jamda.2011.04.023.
    1. Crilly RG, Tanner DA, Kloseck M, Chesworth BM. Hip fractures in long-term care: is the excess explained by the age and gender distribution of the residents? J Aging Res. 2010. doi: 10.4061/2010/291258.
    1. Cameron ID, Gillespie LD, Robertson MC, Murray GR, Hill KD, Cumming RG, et al. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev. 2012;12:CD005465.
    1. Avenell A, Gillespie WJ, Gillespie LD, O’Connell D. Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis. Cochrane Database Syst Rev. 2009;2:CD000227.
    1. Sawka AM, Ismaila N, Raina P, Thabane L, Straus S, Adachi JD, et al. Hip fracture prevention strategies in long-term care: a survey of Canadian physicians’ opinions. Can Fam Physician. 2010;56:e392–7.
    1. Giangregorio LM, Jantzi M, Papaioannou A, Morin S, Cheung AM. Osteoporosis management among residents living in long-term care. Osteoporos Int. 2009;20:1471–8. doi: 10.1007/s00198-009-0837-x.
    1. Ioannidis G, Kennedy CC, Dykeman J, Dudziak S, Papaioannou A. Association between vitamin D3 supplementation and serum 25-hydroxyvitamin D levels in older individuals residing in long-term care in Ontario, Canada. J Am Geriatr Soc. 2012;60:985–7. doi: 10.1111/j.1532-5415.2012.03914.x.
    1. Lau AN, Ioannidis G, Potts Y, Giangregorio LM, Van der Horst ML, Adachi JD, et al. What are the beliefs, attitudes and practices of front-line staff in long-term care (LTC) facilities related to osteoporosis awareness, management and fracture prevention? BMC Geriatr. 2010;10:73. doi: 10.1186/1471-2318-10-73.
    1. Wall M, Lohfeld L, Giangregorio L, Ioannidis G, Kennedy CC, Moser A, et al. Fracture risk assessment in long-term care: a survey of long-term care physicians. BMC Geriatr. 2013;13:109. doi: 10.1186/1471-2318-13-109.
    1. Colon-Emeric CS, Casebeer L, Saag K, Allison J, Levine D, Suh TT, et al. Barriers to providing osteoporosis care in skilled nursing facilities: perceptions of medical directors and directors of nursing. J Am Med Dir Assoc. 2004;5:361–6. doi: 10.1016/S1525-8610(04)70002-X.
    1. Grimshaw J, Eccles M, Tetroe J. Implementing clinical guidelines: current evidence and future implications. J Contin Educ Health Prof. 2004;24(Suppl 1):S31–7. doi: 10.1002/chp.1340240506.
    1. Kitson AL, Rycroft-Malone J, Harvey G, McCormack B, Seers K, Titchen A. Evaluating the successful implementation of evidence into practice using the PARiHS framework: theoretical and practical challenges. Implemen Sci. 2008;3:1. doi: 10.1186/1748-5908-3-1.
    1. Kennedy CC, Thabane L, Ioannidis G, Adachi JD, Papaioannou A. Implementing a knowledge translation intervention in long-term care: feasibility results from the Vitamin D and Osteoporosis Study (ViDOS) J Am Med Dir Assoc. 2014;15:943–5. doi: 10.1016/j.jamda.2014.05.007.
    1. Kennedy CC, Ioannidis G, Giangregorio LM, Adachi JD, Thabane L, Morin SN, et al. An interdisciplinary knowledge translation intervention in long-term care: study protocol for the vitamin D and osteoporosis study (ViDOS) pilot cluster randomized controlled trial. Implemen Sci. 2012;7:48. doi: 10.1186/1748-5908-7-48.
    1. Ontario Ministry Health & Long-term Care. Reports on long-term care homes. 2010. . Accessed 30 December 30 2013.
    1. Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, et al. Lost in knowledge translation: time for a map? J Contin Educ Health Prof. 2006;26(1):13–24. doi: 10.1002/chp.47.
    1. Locock L, Dopson S, Chambers D, Gabbay J. Understanding the role of opinion leaders in improving clinical effectiveness. Soc Sci Med. 2001;53(6):745–57. doi: 10.1016/S0277-9536(00)00387-7.
    1. Agency for Healthcare Research and Quality. QualityTool: Plan-do-study-act (PDSA) cycle 2008. . Accessed 30 Dec 2013.
    1. Jaglal SB, Hawker G, Cameron C, Canavan J, Beaton D, Bogoch E, et al. The Ontario Osteoporosis Strategy: implementation of a population-based osteoporosis action plan in Canada. Osteoporos Int. 2010;21:903–8. doi: 10.1007/s00198-010-1206-5.
    1. Forsetlund L, Bjorndal A, Rashidian A, Jamtvedt G, O’Brien MA, Wolf F, et al. Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2009;2:CD003030.
    1. Hardin JW, Hilbe JM. Generalized estimating equations. 1. New York: Chapman & Hall/CRC; 2003.
    1. Donner A, Klar N. Confidence interval construction for effect measures arising from cluster randomization trials. J Clin Epidemiol. 1993;46:123–31. doi: 10.1016/0895-4356(93)90050-B.
    1. Ivers NM, Halperin IJ, Barnsley J, Grimshaw JM, Shah BR, Tu K, et al. Allocation techniques for balance at baseline in cluster randomized trials: a methodological review. Trials. 2012;13:120. doi: 10.1186/1745-6215-13-120.
    1. Papaioannou A, Morin S, Cheung AM, Atkinson S, Brown JP, Feldman S, et al. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ. 2010;182:1864–73. doi: 10.1503/cmaj.100771.
    1. Ciaschini PM, Straus SE, Dolovich LR, Goeree RA, Leung KM, Woods CR, et al. Community based intervention to optimize osteoporosis management: randomized controlled trial. BMC Geriatr. 2010;10:60. doi: 10.1186/1471-2318-10-60.
    1. Cox H, Puffer S, Morton V, Cooper C, Hodson J, Masud T, et al. Educating nursing home staff on fracture prevention: a cluster randomised trial. Age Ageing. 2008;37:167–72. doi: 10.1093/ageing/afm168.
    1. Colon-Emeric CS, Lyles KW, House P, Levine DA, Schenck AP, Allison J, et al. Randomized trial to improve fracture prevention in nursing home residents. Am J Med. 2007;120:886–92. doi: 10.1016/j.amjmed.2007.04.020.
    1. Davis D, O’Brien MA, Freemantle N, Wolf FM, Mazmanian P, Taylor-Vaisey A. Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes? JAMA. 1999;282:867–74. doi: 10.1001/jama.282.9.867.
    1. Berta W, Teare GF, Gilbart E, Ginsburg LS, Lemieux-Charles L, Davis D, et al. Spanning the know-do gap: understanding knowledge application and capacity in long-term care homes. Soc Sci Med. 2010;70:1326–34. doi: 10.1016/j.socscimed.2009.11.028.
    1. Resnick B, Quinn C, Baxter S. Testing the feasibility of implementation of clinical practice guidelines in long-term care facilities. J Am Med Dir Assoc. 2004;5:1–8. doi: 10.1016/S1525-8610(04)70037-7.
    1. Levine DA, Saag KG, Casebeer LL, Colon-Emeric C, Lyles KW, Shewchuk RM. Using a modified nominal group technique to elicit director of nursing input for an osteoporosis intervention. J Am Med Dir Assoc. 2006;7:420–5. doi: 10.1016/j.jamda.2006.05.004.
    1. Beer C, Horner B, Flicker L, Scherer S, Lautenschlager NT, Bretland N, et al. A cluster-randomised trial of staff education to improve the quality of life of people with dementia living in residential care: the DIRECT study. PLoS One. 2011;6:e28155. doi: 10.1371/journal.pone.0028155.
    1. Tjia J, Mazor KM, Field T, Doherty P, Spenard A, Gurwitz JH. Predicting nursing home adherence to a clinical trial intervention: lessons for the conduct of cluster randomized trials. J Am Geriatr Soc. 2011;59:2332–6. doi: 10.1111/j.1532-5415.2011.03697.x.
    1. Kennedy CC, Lohfeld L, Adachi JD, Morin SM, Marr S, Crilly RG et al. Is a multifaceted knowledge translation intervention feasible and acceptable in long-term care? A qualitative study with ViDOS participants. Can Ger J. 2013;16
    1. Grimshaw JM, Eccles MP, Lavis JN, Hill SJ, Squires JE. Knowledge translation of research findings. Implemen Sci. 2012;7:50. doi: 10.1186/1748-5908-7-50.
    1. O’Brien MA, Rogers S, Jamtvedt G, Oxman AD, Odgaard-Jensen J, Kristoffersen DT, et al. Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2007;4:CD000409.
    1. Flodgren G, Parmelli E, Doumit G, Gattellari M, O’Brien MA, Grimshaw J, et al. Local opinion leaders: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2011;8:CD000125.
    1. Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, et al. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012;6:CD000259.
    1. Shojania KG, Jennings A, Mayhew A, Ramsay CR, Eccles MP, Grimshaw J. The effects of on-screen, point of care computer reminders on processes and outcomes of care. Cochrane Database Syst Rev. 2009;3:CD001096.
    1. Wensing M, Wollersheim H, Grol R. Organizational interventions to implement improvements in patient care: a structured review of reviews. Implemen Sci. 2006;1:2. doi: 10.1186/1748-5908-1-2.
    1. Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M. Interprofessional education: effects on professional practice and healthcare outcomes (update) Cochrane Database Syst Rev. 2013;3:CD002213.
    1. Campbell MK, Grimshaw JM. BMJ. 1998;317:1171–2. doi: 10.1136/bmj.317.7167.1171.
    1. Berta W, Laporte A, Valdmanis V. Observations on institutional long-term care in Ontario: 1996–2002. Can J Aging. 2005;24:70–84. doi: 10.1353/cja.2005.0002.
    1. Comondore VR, Devereaux PJ, Zhou Q, Stone SB, Busse JW, Ravindran NC, et al. Quality of care in for-profit and not-for-profit nursing homes: systematic review and meta-analysis. BMJ. 2009;339:b2732. doi: 10.1136/bmj.b2732.
    1. Ersek M, Polissar N, Pen AD, Jablonski A, Herr K, Neradilek MB. Addressing methodological challenges in implementing the nursing home pain management algorithm randomized controlled trial. Clin Trials. 2012;9:634–44. doi: 10.1177/1740774512454243.
    1. Gallagher EM, Scott VJ. Final report: Canada health agency, population health fund stepping in: Long-term care collaborative falls prevention project. 2005. . Accessed 19 Jan 2014.
    1. Sawka AM, Ismaila N, Cranney A, Thabane L, Kastner M, Gafni A, et al. A scoping review of strategies for the prevention of hip fracture in elderly nursing home residents. PLoS One. 2010;53:e9515. doi: 10.1371/journal.pone.0009515.
    1. Wensing M, van der Weijden T, Grol R. Implementing guidelines and innovations in general practice: which interventions are effective? Br J Gen Pract. 1998;48:991–7.
    1. Cummings GG, Estabrooks CA, Midodzi WK, Wallin L, Hayduk L. Influence of organizational characteristics and context on research utilization. Nurs Res. 2007;56(4 Suppl):S24–39. doi: 10.1097/01.NNR.0000280629.63654.95.
    1. Anderson RA, Corazzini K, Porter K, Daily K, McDaniel RR, Jr, Colon-Emeric C. CONNECT for quality: protocol of a cluster randomized controlled trial to improve fall prevention in nursing homes. Implemen Sci. 2012;7:11. doi: 10.1186/1748-5908-7-11.

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