COVID-19 Project ECHO for Nursing Homes: A Patient-centered, Randomized-controlled Trial to Implement Infection Control, United States, 2021 (ICPSR 38769)
Version Date: Aug 7, 2023 View help for published
Principal Investigator(s): View help for Principal Investigator(s)
Jennifer L. Kraschnewski, Pennsylvania State University. College of Medicine
https://doi.org/10.3886/ICPSR38769.v1
Version V1
Summary View help for Summary
Nationally, nursing homes have been devastated with 2,726,897 COVID-19 cases and 162,874 COVID-19 deaths as of November 28, 2022. Nursing homes were ill-equipped for the pandemic; though facilities are required to have infection control staff, only 3% have taken a basic infection control course. Significant research has focused on infection control in the acute care setting; however, little is known about the implementation of practices and effective interventions in nursing homes. The researchers proposed an intervention utilizing Project ECHO (Extension for Community Health Outcomes), an evidence-based tele-mentoring model, to connect Penn State University experts with remote nursing home staff and administrators to proactively support evidence-based infection control guideline implementation. This study sought to answer the critical research question of how evidence-based infection control guidelines can be implemented effectively in nursing homes.
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Geographic Coverage View help for Geographic Coverage
Smallest Geographic Unit View help for Smallest Geographic Unit
None.
Restrictions View help for Restrictions
Access to the data in this collection is restricted. Users interested in obtaining these data must complete a Restricted Data Use Agreement, specify the reason for the request, and obtain IRB approval or notice of exemption for their research.
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Date of Collection View help for Date of Collection
Study Purpose View help for Study Purpose
The purpose of this study was to compare the effectiveness of a 16-week Agency for Healthcare Research and Quality (AHRQ) phase 1 COVID-19 Project ECHO (Extension for Community Health Outcomes) intervention followed by nine weekly, optional 60-minute office hour sessions (AHRQ phase 2) to ECHO and an additional 17 sessions, 60-minutes in length, including an 8-week flu-focused refresher series for fall 2021, focused on infection control (ECHO+) in reducing the number of nursing home residents with COVID-19.
Secondary aims of this study include:
1) To compare the effectiveness of ECHO versus ECHO+ on other patient-centered outcomes, including quality of life (QoL), flu-like symptoms, hospitalizations, and deaths.
2) To evaluate the impact of the COVID-19 ECHO on key implementation outcomes in nursing home settings using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework.
Study Design View help for Study Design
A stratified cluster randomized design was used, using a 1:1 ratio to randomly assign nursing homes from the Northeast and Midwest, including Connecticut, New Jersey, New York, Wisconsin, New Hampshire, Illinois, Vermont, Indiana, Virginia, Maryland, Pennsylvania, and Ohio to either:
1) AHRQ-funded COVID-19 ECHO that included 16 weekly tele-mentoring sessions addressing COVID-19 guidelines and best practices plus 9 optional, weekly 60-minute office hour sessions, or
2) AHRQ-funded COVID-19 ECHO+, which included 16 weekly tele-mentoring sessions addressing COVID-19 guidelines and best practices, plus 17 weekly 60-minute sessions with a focus on stakeholder-identified needs and Centers for Disease Control and Prevention (CDC) infection control training.
Patient-centered outcomes were assessed at baseline (intervention start date), 4, 6, 12, and 18 months. The study was guided by the RE-AIM framework to critically evaluate both the effectiveness and implementation outcomes of the proposed intervention. The research team surveyed nursing home administrators (NHAs) and nursing staff at baseline and 6-month follow-up using validated items from the CDC.
Sample View help for Sample
National nursing home lists were obtained using Centers for Medicare and Medicaid Services' (CMS) data, state agency and nursing home association contact websites, and engaged stakeholders. Inclusion criteria included being a CMS-eligible facility and no prior participation in a prior ECHO-delivered COVID-19 intervention.
Time Method View help for Time Method
Universe View help for Universe
Nursing homes in the Northeast and Midwest United States.
Unit(s) of Observation View help for Unit(s) of Observation
Data Type(s) View help for Data Type(s)
Mode of Data Collection View help for Mode of Data Collection
Description of Variables View help for Description of Variables
The variables in this study include measures of COVID infections, participation and attitudes regarding the ECHO program, and overall operation of the nursing homes.
Response Rates View help for Response Rates
136 nursing homes were enrolled based on the 290 nursing homes assessed. A total of 197 participants from 126 nursing homes responded to the implementation surveys.
HideOriginal Release Date View help for Original Release Date
2023-08-07
Version History View help for Version History
2023-08-07 ICPSR data undergo a confidentiality review and are altered when necessary to limit the risk of disclosure. ICPSR also routinely creates ready-to-go data files along with setups in the major statistical software formats as well as standard codebooks to accompany the data. In addition to these procedures, ICPSR performed the following processing steps for this data collection:
- Checked for undocumented or out-of-range codes.
Notes
The public-use data files in this collection are available for access by the general public. Access does not require affiliation with an ICPSR member institution.
One or more files in this data collection have special restrictions. Restricted data files are not available for direct download from the website; click on the Restricted Data button to learn more.
This study is maintained and distributed by the Patient-Centered Outcomes Data Repository (PCODR). PCODR is the official data repository of the Patient-Centered Outcomes Research Initiative (PCORI).