Understanding a Complex Intervention to Reduce Unplanned Hospitalizations From Nursing Homes: Process Evaluation of...

Area of Science:

• Geriatric care
• Healthcare intervention research
• Process evaluation

Background:

• The INTERCARE study implemented a complex nurse-led model in Swiss nursing homes to decrease unplanned hospitalizations.
• A process evaluation was conducted to understand intervention elements, barriers, facilitators, and mechanisms of change for scale-up.

Purpose of the Study:

• To describe the practical application of INTERCARE intervention elements.
• To explore barriers and facilitators influencing the intervention's implementation.
• To identify mechanisms of change driving the reduction of unplanned hospitalizations.

Main Methods:

• A process evaluation using qualitative data from interviews and focus groups with care workers, INTERCARE nurses, and physicians.
• Inclusion of structured notes from nursing home leadership team meetings.
• Inductive coding of compiled intervention data and consolidation into a conceptual model.

Main Results:

• Intervention mechanisms were categorized into those altering care worker reasoning (e.g., structured task performance) and those enabling resources (e.g., INTERCARE nurse availability).
• Observed behavior changes in care workers included quicker responses to resident changes, more thorough assessments, and better communication.
• These changes directly contributed to a reduction in hospitalizations.

Conclusions:

• Interprofessional collaboration, evidence-based instruments, and the INTERCARE nurse are crucial for reducing unplanned hospitalizations.
• Findings inform optimization of intervention elements for scale-up and refinement of alternative care models.
• The study highlights the importance of understanding intervention mechanisms for effective implementation in nursing home settings.