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

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Principal Investigator(s):
Jennifer L. Kraschnewski, Pennsylvania State University. College of Medicine

https://doi.org/10.3886/ICPSR38769.v1

Version V1

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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.

Citation

Kraschnewski, Jennifer L. COVID-19 Project ECHO for Nursing Homes: A Patient-centered, Randomized-controlled Trial to Implement Infection Control, United States, 2021. Inter-university Consortium for Political and Social Research [distributor], 2023-08-07. https://doi.org/10.3886/ICPSR38769.v1

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Subject Terms

Geographic Coverage

Smallest Geographic Unit

None.

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.

Distributor(s)

Inter-university Consortium for Political and Social Research
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Time Period(s)

2021

Date of Collection

2021-07 (Phase 1), 2021-11 (Phase 2)
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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

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

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

Longitudinal

Universe

Nursing homes in the Northeast and Midwest United States.

Unit(s) of Observation

Organization

Data Type(s)

Mode of Data Collection

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

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.

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Original Release Date

2023-08-07

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.

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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.