Strengthening Geriatric Expertise in Swiss Nursing Homes: INTERCARE Implementation Study Protocol.

Area of Science:

• Geriatric Care
• Nursing Home Quality Improvement
• Healthcare Delivery Models

Background:

• Nursing home residents often have complex needs requiring close monitoring and in-house decision-making.
• Limited access to geriatric expertise in nursing homes can lead to avoidable hospitalizations.
• There is a need for innovative, contextually adapted nurse-led care models to improve nursing home quality and reduce hospitalizations.

Purpose of the Study:

• To develop, implement, and evaluate an innovative, contextually adapted nurse-led care model in nursing homes.
• To assess the clinical outcomes and implementation effectiveness of the nurse-led care model.
• To improve the quality of care and reduce hospitalizations for nursing home residents with complex needs.

Main Methods:

• An effectiveness-implementation hybrid type 2 design was employed.
• A mixed-method approach was used to evaluate implementation outcomes, guided by the Consolidated Framework for Implementation Research (CFIR).
• The intervention involved a multilevel, context-adapted approach with trained INTERCARE nurses and evidence-based tools (e.g., ISBAR), supported by leadership training.

Main Results:

• The primary outcome measured was unplanned hospitalizations per 1000 resident days.
• Secondary outcomes included emergency department visits, quality indicators (e.g., physical restraint use), and costs.
• Implementation outcomes focused on fidelity to the model's core elements.

Conclusions:

• The INTERCARE study provides evidence on the effectiveness of a nurse-led care model in real-world nursing home settings.
• The study demonstrates the value of accompanying implementation strategies in supporting the adoption of the care model.
• The findings support the potential of nurse-led interventions to enhance geriatric care quality and reduce hospitalizations.