Covid19
Conditions
Keywords
Project ECHO, telehealth
Brief summary
Nursing homes are ground zero for the COVID-19 pandemic. Nursing homes are 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 long-term care facilities.The investigators propose an intervention utilizing Project ECHO, an evidence-based telehealth model, to connect Penn State University experts with remote nursing home staff and administrators to proactively support evidence-based infection control guideline implementation. Our study seeks to answer the critical research question of how evidence-based infection control guidelines can be implemented effectively in nursing homes
Detailed description
The investigators will recruit 200 nursing homes with approximately 24,560 residents from across the United States through collaborations with our stakeholders. Nursing homes will be randomized to one of two arms: 1) AHRQ-funded COVID-19 ECHO that includes 16 weekly telehealth sessions addressing COVID-19 guidelines and best practices or 2) AHRQ-funded COVID-19 ECHO plus an additional 9 sessions with a focus on CDC infection control training. Randomization will be stratified by characteristics of nursing homes to ensure balance among the two trial groups, including size (number of beds),geographic location, and current COVID-19 infection rate. Patient-centered outcomes (nursing home residents with COVID-19 infections, hospitalizations, deaths, and QOL) will be assessed at baseline, 4, 6, 12, and 18 months. Our study is guided by the RE-AIM framework to critically evaluate both effectiveness and implementation outcomes of the proposed intervention. The RE-AIM framework is frequently utilized to improve sustainable adoption and implementation of effective, generalizable, evidence-based interventions like Project ECHO.
Interventions
OTHERProject ECHO
Project ECHO utilizes case-based, collaborative learning to support discussion of learners' challenges and barriers to guideline implementation. This differentiates ECHO from traditional learning and facilitates rapid dissemination of medical knowledge and increased capacity to deliver best-practice care.studying innovative approaches.
Sponsors
Milton S. Hershey Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
stratified cluster randomized design
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
for Facilities Skilled Nursing Facility in United States Access to computer or electronic device
Exclusion criteria
for Facilities Previously participated in Project ECHO COVID-19 series either through Penn State or another institution
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Infection Rate | Baseline, 4, 6, 12, 18 months | Rate of COVID-19 infection in enrolled nursing homes, as measured by the cumulative 4-week incidence at study points for Confirmed COVID-19 cases per 1,000 residents |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Hospitalization | Baseline, 4, 6, 12, 18 months | Number of COVID-19 hospitalizations from enrolled nursing homes, as measured by Cumulative 4-week incidence at study points for Total COVID-19 admissions |
| Death | Baseline, 4, 6, 12, 18 months | Number of COVID-19 deaths from enrolled nursing homes, as measured by Cumulative 4-week incidence at study points for Total COVID-19 deaths |
| Flu-like Illness | Baseline, 4, 6, 12, 18 months | Number of flu-like illnesses reported from enrolled nursing homes, as measured by Cumulative 4-week incidence at study points for Total confirmed new influenza per 1,000 residents in 4 weeks |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| ECHO Plus Nursing homes in this arm will receive the intervention via real-time, interactive videoconferencing using Zoom at no cost to participants. Sessions will be 90 minutes in duration and held weekly for 6 months (25 sessions total) at regularly scheduled times. Participants in this arm will receive a 2 month (8 sessions total) refresher course in Fall 2021. Project ECHO utilizes case-based, collaborative learning to support discussion of learners' challenges and barriers to guideline implementation
Project ECHO: Project ECHO utilizes case-based, collaborative learning to support discussion of learners' challenges and barriers to guideline implementation. This differentiates ECHO from traditional learning and facilitates rapid dissemination of medical knowledge and increased capacity to deliver best-practice care.studying innovative approaches. | 0 |
| ECHO Plus Nursing homes in this arm will receive the intervention via real-time, interactive videoconferencing using Zoom at no cost to participants. Sessions will be 90 minutes in duration and held weekly for 6 months (25 sessions total) at regularly scheduled times. Participants in this arm will receive a 2 month (8 sessions total) refresher course in Fall 2021. Project ECHO utilizes case-based, collaborative learning to support discussion of learners' challenges and barriers to guideline implementation
Project ECHO: Project ECHO utilizes case-based, collaborative learning to support discussion of learners' challenges and barriers to guideline implementation. This differentiates ECHO from traditional learning and facilitates rapid dissemination of medical knowledge and increased capacity to deliver best-practice care.studying innovative approaches. | 64 |
| ECHO Nursing homes in this arm will receive the intervention via real-time, interactive videoconferencing using Zoom at no cost to participants. Sessions will be 90 minutes in duration and held weekly for 6 months (25 sessions total) at regularly scheduled times. Project ECHO utilizes case-based, collaborative learning to support discussion of learners' challenges and barriers to guideline implementation
Project ECHO: Project ECHO utilizes case-based, collaborative learning to support discussion of learners' challenges and barriers to guideline implementation. This differentiates ECHO from traditional learning and facilitates rapid dissemination of medical knowledge and increased capacity to deliver best-practice care.studying innovative approaches. | 0 |
| ECHO Nursing homes in this arm will receive the intervention via real-time, interactive videoconferencing using Zoom at no cost to participants. Sessions will be 90 minutes in duration and held weekly for 6 months (25 sessions total) at regularly scheduled times. Project ECHO utilizes case-based, collaborative learning to support discussion of learners' challenges and barriers to guideline implementation
Project ECHO: Project ECHO utilizes case-based, collaborative learning to support discussion of learners' challenges and barriers to guideline implementation. This differentiates ECHO from traditional learning and facilitates rapid dissemination of medical knowledge and increased capacity to deliver best-practice care.studying innovative approaches. | 62 |
| Total | 126 |
Baseline characteristics
| Characteristic | ECHO Plus | ECHO | Total |
|---|---|---|---|
| Age, Categorical <=18 years | NA Nursing home | NA Nursing home | NA Nursing home |
| Age, Categorical >=65 years | NA Nursing home | NA Nursing home | NA Nursing home |
| Age, Categorical Between 18 and 65 years | NA Nursing home | NA Nursing home | NA Nursing home |
| Baseline Infection Rate None | 11 Nursing home | 7 Nursing home | 18 Nursing home |
| Baseline Infection Rate Some | 53 Nursing home | 55 Nursing home | 108 Nursing home |
| Facility Payment Model For-profit | 41 Nursing home | 33 Nursing home | 74 Nursing home |
| Facility Payment Model Not-for-profit | 23 Nursing home | 29 Nursing home | 52 Nursing home |
| Facility Size >=60 beds | 47 Nursing home | 43 Nursing home | 90 Nursing home |
| Facility Size <60 Beds | 17 Nursing home | 19 Nursing home | 36 Nursing home |
| Facility Type Independent | 27 Nursing home | 32 Nursing home | 59 Nursing home |
| Facility Type Networked | 37 Nursing home | 30 Nursing home | 67 Nursing home |
| Location Rural | 26 Nursing home | 27 Nursing home | 53 Nursing home |
| Location Urban | 38 Nursing home | 35 Nursing home | 73 Nursing home |
| Memory Care Status No | 47 Nursing home | 52 Nursing home | 99 Nursing home |
| Memory Care Status Yes | 17 Nursing home | 10 Nursing home | 27 Nursing home |
| Race (NIH/OMB) American Indian or Alaska Native | NA Nursing home | NA Nursing home | NA Nursing home |
| Race (NIH/OMB) Asian | NA Nursing home | NA Nursing home | NA Nursing home |
| Race (NIH/OMB) Black or African American | NA Nursing home | NA Nursing home | NA Nursing home |
| Race (NIH/OMB) More than one race | NA Nursing home | NA Nursing home | NA Nursing home |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | NA Nursing home | NA Nursing home | NA Nursing home |
| Race (NIH/OMB) Unknown or Not Reported | NA Nursing home | NA Nursing home | NA Nursing home |
| Race (NIH/OMB) White | NA Nursing home | NA Nursing home | NA Nursing home |
| Sex: Female, Male Female | NA Nursing home | NA Nursing home | NA Nursing home |
| Sex: Female, Male Male | NA Nursing home | NA Nursing home | NA Nursing home |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 0 | 0 / 0 |
| other Total, other adverse events | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 |
Outcome results
Primary
Infection Rate
Rate of COVID-19 infection in enrolled nursing homes, as measured by the cumulative 4-week incidence at study points for Confirmed COVID-19 cases per 1,000 residents
Time frame: Baseline, 4, 6, 12, 18 months
Population: Nursing homes were assigned to Arms/Groups, participant level data is not available
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| ECHO Plus | Infection Rate | 18m | 33.07 infections per 1,000 residents in 4 week | Standard Deviation 66.81 |
| ECHO Plus | Infection Rate | Baseline | 141.91 infections per 1,000 residents in 4 week | Standard Deviation 266.23 |
| ECHO Plus | Infection Rate | 4m | 1.54 infections per 1,000 residents in 4 week | Standard Deviation 6.62 |
| ECHO Plus | Infection Rate | 6m | 2.08 infections per 1,000 residents in 4 week | Standard Deviation 16.67 |
| ECHO Plus | Infection Rate | 12m | 28.01 infections per 1,000 residents in 4 week | Standard Deviation 54.48 |
| ECHO | Infection Rate | 12m | 26.56 infections per 1,000 residents in 4 week | Standard Deviation 50.17 |
| ECHO | Infection Rate | 6m | 0.83 infections per 1,000 residents in 4 week | Standard Deviation 5.04 |
| ECHO | Infection Rate | Baseline | 106.57 infections per 1,000 residents in 4 week | Standard Deviation 192.49 |
| ECHO | Infection Rate | 18m | 30.5 infections per 1,000 residents in 4 week | Standard Deviation 74.18 |
| ECHO | Infection Rate | 4m | 2.86 infections per 1,000 residents in 4 week | Standard Deviation 14.11 |
Secondary
Death
Number of COVID-19 deaths from enrolled nursing homes, as measured by Cumulative 4-week incidence at study points for Total COVID-19 deaths
Time frame: Baseline, 4, 6, 12, 18 months
Population: Nursing homes were assigned to Arms/Groups, participant level data is not available
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| ECHO Plus | Death | 6m | 0.46 per 1,000 residents in 4 weeks | Standard Deviation 2.61 |
| ECHO Plus | Death | 4m | 0.82 per 1,000 residents in 4 weeks | Standard Deviation 4.39 |
| ECHO Plus | Death | 12m | 3.60 per 1,000 residents in 4 weeks | Standard Deviation 12.51 |
| ECHO Plus | Death | Baseline | 30.22 per 1,000 residents in 4 weeks | Standard Deviation 61.59 |
| ECHO Plus | Death | 18m | 2.00 per 1,000 residents in 4 weeks | Standard Deviation 7.28 |
| ECHO | Death | Baseline | 31.98 per 1,000 residents in 4 weeks | Standard Deviation 66.2 |
| ECHO | Death | 6m | 0.30 per 1,000 residents in 4 weeks | Standard Deviation 2.35 |
| ECHO | Death | 18m | 0.19 per 1,000 residents in 4 weeks | Standard Deviation 1.49 |
| ECHO | Death | 4m | 0.00 per 1,000 residents in 4 weeks | Standard Deviation 0 |
| ECHO | Death | 12m | 3.71 per 1,000 residents in 4 weeks | Standard Deviation 11.37 |
Secondary
Flu-like Illness
Number of flu-like illnesses reported from enrolled nursing homes, as measured by Cumulative 4-week incidence at study points for Total confirmed new influenza per 1,000 residents in 4 weeks
Time frame: Baseline, 4, 6, 12, 18 months
Population: Nursing homes were assigned to Arms/Groups, participant level data is not available
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| ECHO Plus | Flu-like Illness | 12m | 0.35 per 1,000 residents in 4 weeks | Standard Deviation 2.78 |
| ECHO Plus | Flu-like Illness | Baseline | 0.65 per 1,000 residents in 4 weeks | Standard Deviation 5.21 |
| ECHO Plus | Flu-like Illness | 6m | 0.00 per 1,000 residents in 4 weeks | Standard Deviation 0 |
| ECHO Plus | Flu-like Illness | 4m | 0.00 per 1,000 residents in 4 weeks | Standard Deviation 0 |
| ECHO Plus | Flu-like Illness | 18m | 0.00 per 1,000 residents in 4 weeks | Standard Deviation 0 |
| ECHO | Flu-like Illness | 4m | 0.00 per 1,000 residents in 4 weeks | Standard Deviation 0 |
| ECHO | Flu-like Illness | 6m | 0.62 per 1,000 residents in 4 weeks | Standard Deviation 4.88 |
| ECHO | Flu-like Illness | 12m | 1.36 per 1,000 residents in 4 weeks | Standard Deviation 8.01 |
| ECHO | Flu-like Illness | 18m | 0.00 per 1,000 residents in 4 weeks | Standard Deviation 0 |
| ECHO | Flu-like Illness | Baseline | 0.00 per 1,000 residents in 4 weeks | Standard Deviation 0 |
Secondary
Hospitalization
Number of COVID-19 hospitalizations from enrolled nursing homes, as measured by Cumulative 4-week incidence at study points for Total COVID-19 admissions
Time frame: Baseline, 4, 6, 12, 18 months
Population: Nursing homes were assigned to Arms/Groups, participant level data is not available
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| ECHO Plus | Hospitalization | 6m | 5.55 per 1,000 residents in 4 weeks | Standard Deviation 30.4 |
| ECHO Plus | Hospitalization | 12m | 24.57 per 1,000 residents in 4 weeks | Standard Deviation 113.55 |
| ECHO Plus | Hospitalization | 4m | 3.09 per 1,000 residents in 4 weeks | Standard Deviation 14.01 |
| ECHO Plus | Hospitalization | 18m | 7.27 per 1,000 residents in 4 weeks | Standard Deviation 21.31 |
| ECHO Plus | Hospitalization | Baseline | 40.05 per 1,000 residents in 4 weeks | Standard Deviation 83.13 |
| ECHO | Hospitalization | 18m | 13.58 per 1,000 residents in 4 weeks | Standard Deviation 55.54 |
| ECHO | Hospitalization | 4m | 4.72 per 1,000 residents in 4 weeks | Standard Deviation 21.33 |
| ECHO | Hospitalization | Baseline | 39.12 per 1,000 residents in 4 weeks | Standard Deviation 83.88 |
| ECHO | Hospitalization | 6m | 5.18 per 1,000 residents in 4 weeks | Standard Deviation 37.47 |
| ECHO | Hospitalization | 12m | 7.87 per 1,000 residents in 4 weeks | Standard Deviation 24.71 |