TABLE 3.
Measures used to assess RE-AIM outcomes: Constructs, measurement level, source, and timing
| Construct | Measurement level | Source | Time | Measures |
|---|---|---|---|---|
| Descriptives/covariates | ||||
| Demographics | Community (All) | Nursing home compare website | Baseline | State; size; profit status; urban or rural; nursing staff ratio and mix; nursing home compare quality measure ratings (falls, pain, depressive symptoms, worsening of activities of daily living, antipsychotic medication use) |
| Demographics | Resident | RA from medical record | Baseline | Age, gender, race, ethnicity, marital status, education, length of stay |
| Cognitive status | Resident | RA from resident | Baseline , 4, 12 | Brief interview of mental status (BIMS) (Mansbacha) Macea,& Clarka,2014) |
| Health status and medications | Resident | RA from medical record | Baseline , 4, 12 | Cumulative illness rating scale (Linn et al., 1968; Parmelee, Thuras, Katz, & Lawton, 1995) total score; number, dosing, and frequency of medications prescribed |
| Reach | ||||
| Participation (defined as attending at least the first Stakeholder meeting in EIT-4-BPSD communities) | Community: All for volunteering; EIT-4-BPSD for stakeholder meeting participation | Research facilitator | Baseline; over 12 months | All communities: Percentage of communities that volunteer to participate (#volunteers/591 communities in both states). First 50 will be enrolled. Comparison of participating communities versus non-participating communities will be done. EIT communities: Percent of NHs that participate in the first Stakeholder meeting (#completed/25 EIT-4-BPSD) |
| Exposure of residents to person-centered interventions for BPSD | All residents in EIT-4-BPSD communities | RA from medical record | 12 months post implementation | Checklist for evidence of use of person-centered care Approaches to manage BPSD in care plans: Percentage of all residents living in the EIT-4-BPSD communities that have care plans reflecting at least 1 person-centered intervention to address BPSD (based on de-identified care plans for all residents in the EIT-4-BPSD communities) |
| Nurses exposed to educational session | Community (All) | Research facilitator | Following educational sessions | Percentage of nursing staff in all communities exposed to the educational sessions provided (#exposed/all nursing staff in the community). We will compare exposure between EIT-4-BPSD and EO communities |
| Effectiveness | ||||
| Environmental modifications | Community (All) | RA | Baseline, 12 | Environment assessment total score |
| Policy modifications | Community (All) | RA | Baseline, 12 | Policy assessment total score |
| BPSD: depression | Resident | RA from Staff | Baseline, 4,12 | Cornell Scale for Depression in Dementia (CSDD) (Alexopoulos et al., 1988a, b) |
| BPSD: resistance to care | Resident | RA from Staff | Baseline, 4,12 | Resistiveness to Care Scale (Mahoney et al., 1999) |
| BPSD: agitation | Resident | RA from Staff | Baseline, 4, 12 | Cohen-Mansfield Agitation Inventory (CMAI) (Cohen-Mansfield, 2014; Finkel et al., 1992) |
| Function | Resident | RA from Staff | Baseline, 4, 12 | Barthel Index (BI) (Mahoney & Barthel, 1965) |
| Quality of life | Resident | RA from Staff | Baseline, 4, 12 | Quality of Life-AD (QoL-AD) (Logsdon et al., 2002) |
| Adverse events | Resident | RA from Medical Record | Baseline, 4, 12 | Number of falls; Number transferred to hospitals or emergency room, number of residents restrained |
| Medications: psychotropics | Resident | RA from Record | Baseline, 4, 12 | Medications (including PRN dosing) given in the 7 days prior to the Day of evaluation. |
| Adoption | ||||
| Participation in initial and monthly stakeholder team meetings | Community (EIT-4-BPSD only) | Research Facilitator | Over the 12 month study period | Number of communities completing the initial and the monthly meetings; number of champions/stakeholders attending monthly meetings; Differences in communities that participate versus don’t participate. |
| Environment and policy changes; care plan changes | Community(all | RA | Baseline, 12 | Environment/Policy Assessments; Checklist for Evidence of Use of Person Centered Care Approaches to Manage BPSD in Care plans: :Number of communities that complete Environment and Policy assessments, demonstrated change in environments, policies and care plans. Differences in communities that did or did not complete assessments or make changes (change in at least one item for each measure). |
| Rate of adoption | ||||
| • Early | Community (EIT-4-BPSD only) | RA | Baseline to 4 months | Environment, policy, and care plan Assessments: evidence of policy, environment and/or care plan changes in first four months |
| • Late | Community (EIT-4-BPSD only) | RA | Between 5–12 months | Environment, policy, and care plan assessments: evidence of policy, environment and/or care plan changes in months 5–12 |
| • No-adopters | Community (EIT-4-BPSD only) | RA | By 12 months | Environment, policy, and care plan assessments: no evidence of changes in policy, environment and/or care plan by 12 months |
| Implementation/fidelity | ||||
| Delivery of first EIT meeting with team | Community (EIT-4-BPSD only) | Research Facilitator | First month | Number of communities out of total 25 EIT-4-BPSD communities completing the initial Stakeholder training meeting |
| Delivery of four steps of EIT-4-BPSD Step 1: Environment/policy assessments; Step 2 Education of staff; Step 3: Development of care plans for BPSD; Step 4: Mentoring and motivating | Community (EIT-4-BPSD only) | Research facilitator | During 12 month period | Step 1: Completion of environment and policy assessments. Step 2: Percentage of staff participating in educational sessions; Step 3: Development of care plans with person centered interventions for BPSD based on checklist (Step 4: Evidence from the internal champion of use of information from weekly Tidbits; participation in contests; verbal encouragement of staff; completion of the observations using the Behavioral Interventions for BPSD measure at 0–2, 4–6, and 10–12 months post implementation of EIT-4-BPSD |
| Delivery: education for EO communities | EO community (all) | 0–2 months | Percentage of staff participating in educational sessions | |
| Receipt of education: step 2 in EIT-4-BPSD; EO | Community (all) | Internal champion; research facilitator | 0–2 months | Knowledge of behavioral interventions for BPSD: Evidence of receipt will be based on percentage of staff obtaining 80% or better total score on knowledge of behavioral interventions for BPSD |
| Enactment of behavioral approaches to BPSD (staff) | Community (EIT-4-BPSD only) | Internal champion; research facilitator | 0–2; 4–6; and 10–12 months | Observation tool: use of behavioral interventions for BPSD: increase in number of behavioral interventions provided during routine care interactions (based on Use of behavioral interventions for BPSD) |
| Maintenance | ||||
| Long term attrition | Community (All) | RA | 12 | Percentage of communities that withdraw by 12 months |
| Person centered care plans for BPSD | Community (All) | RA | 12, 18, 24 | Checklist for evidence of use of person centered care approaches to manage bpsd in care plans: evidence of person centered approaches for BPSD in care plans of recruited residents based on checklist for evidence of use of person centered care approaches to manage BPSD in care plan |
| Environment and policy | Community (EIT-4-BPSD) | RA | 12, 18, 24 | Environment/policy assessments: positive change in environment/policy assessments |
RE-AIM, Reach, Effectiveness, Adoption, Implementation, and Maintenance; EIT-4-BPSD, Evidence Integration Triangle for management of behavioral and psychological symptoms of dementia; EO, education only; RA, research assistant.