Table 4.
Association between TRAIN-ADa providers and facilities (N = 380 providers) characteristics with overall adherence.
| Characteristicsd | Providers Participation No. (%) |
Odds Ratioc for Greater Overall Adherence (95% CI) |
|||
|---|---|---|---|---|---|
| Neither a seminar or Online course (n = 27) | Either a seminar or Online course (n = 104) | Both a seminar or Online course (n = 249) | Unadjusted | Adjusted | |
| Provider | |||||
| Nurse (vs prescribing provider) | 13 (48.1) | 88 (84.6) | 197 (79.1) | 1.36 (0.58–3.18) | |
| Prevalent group (vs incident)e | 26 (96.3) | 75 (72.1) | 228 (91.6) | 2.38 (1.37–4.13)f | 2.01 (1.02–3.96) |
| Facility | |||||
| Allocation to wave 1 | 5 (18.5) | 16 (15.4) | 43 (17.3) | 1.07 (0.44–2.63) | |
| Enrolled providers >24 (median) | 21 (77.8) | 71 (68.3) | 169 (67.9) | 0.87 (0.39–1.92) | |
| No champion turnover (vs any) | 16 (59.3) | 64 (61.5) | 178 (71.5) | 1.59 (0.74–3.39) | |
| Enrolled residents >12 (median) | 10 (37.0) | 42 (40.4) | 122 (49.0) | 1.46 (0.75–2.86) | |
| Beds >133 (median) | 20 (74.1) | 58 (55.8) | 131 (52.6) | 0.71 (0.35–1.47) | |
| For profit status (vs non- profit) | 18 (66.7) | 58 (55.8) | 123 (49.4) | 0.69 (0.33–1.42) | |
| Licensed and registered nurse/hour/resident/day >1.4 (median) | 4 (14.8) | 50 (48.1) | 81 (32.5) | 0.79 (0.42–1.48) | |
| Five-star rating score of 5 versus <5(median)g | 13 (48.1) | 41 (39.4) | 165 (66.3) | 2.63 (1.43–4.82)f | 2.44 (1.27–4.66) |
| Infectious disease practice score of 4 (median)h | 13 (48.1) | 69 (66.3) | 146 (58.6) | 0.91 (0.42–1.94) | |
| Palliative care practice > score of 3 (median)i | 6 (22.2) | 55 (52.9) | 119 (47.8) | 1.16 (0.59–2.27) | |
b Attendance ascertained within 3 months of enrollment; among the 380 providers, 7.1% (N = 27) completed neither a seminar (mini or full) nor the online course, 27.4% (N = 104) completed either a seminar or the online course, and 65.5% (N = 249) completed both.
Trial to Reduce Antimicrobial Use in Nursing Home Residents with Alzheimer's Disease and other Dementias.
Analyses done at the provider level. Participation in neither a seminar nor course is referent category. Odds ratio adjusted for facility clustering using generalized estimating equations.
Characteristics abstracted at baseline and medians calculated at the facility level.
Providers enrolled at time of facility start-up versus follow-up period.
Variables significant at P < .10 in bivariable analyses and entered into the multivariable model.
Nursing Home Compare Five-star rating; range 0–5, higher scores indicate better care quality [24].
Infectious disease practice score is calculated using senior administrator survey responses about whether the facility had any of the following: infection preventionist, antimicrobial stewardship program, and standardized protocols or initiatives for the diagnosis and treatment of suspected UTI and LRI infections. One point is given for each practice with total score; range 0–4, higher scores indicate greater intensity of infection disease practices.
Palliative Care practice score based on senior administrator survey responses about whether the facility had the following: access to hospice, access to palliative care consultations, and proxy discussions about infection management on admission, during regular care plan meeting, when a resident develops signs and symptoms of an infection, and following an event such as an aspiration. One point is given for each practice with total score; range 0–6, higher scores indicate greater intensity of infection disease practices.