Sustained effects of the INFORM cluster randomized trial: an observational post-intervention study

Area of Science:

• Health Services Research
• Nursing Home Quality Improvement
• Organizational Behavior in Healthcare

Background:

• Limited research exists on the long-term sustainability of health services intervention outcomes.
• The INFORM study previously implemented feedback strategies to enhance nursing home care aide involvement in resident care communications.

Purpose of the Study:

• To assess the lasting benefits of the INFORM intervention 2.5 years after study support removal.
• To identify factors associated with the sustainability of improved care aide involvement in formal communication.

Main Methods:

• A cluster-randomized trial involving 51 Western Canadian nursing homes with simple and assisted feedback interventions.
• Repeated measures (baseline, post-intervention, long-term follow-up) analyzed using hierarchical mixed models.
• Assessment of organizational context (leadership, culture, evaluation) and intervention fidelity as factors influencing sustainability.

Main Results:

• Outcomes remained stable at long-term follow-up in the enhanced feedback arms.
• The simple feedback group's performance improved to match enhanced groups by long-term follow-up.
• Positive organizational culture, evaluation practices, and intervention fidelity enactment were associated with sustained care aide involvement.

Conclusions:

• Theory-informed feedback can yield long-lasting improvements in care aide communication involvement.
• Higher intervention intensity does not necessarily correlate with greater effectiveness or sustainability.
• Modifiable organizational factors and fidelity are key to sustained improvements in nursing home care.