Results Summary

What was the research about?

Nursing home residents are at high risk for severe COVID-19 infection. To help prevent the spread of COVID-19, nursing homes can follow national guidance on infection control. But only 3 percent of nursing home staff have had training on this topic.

In this study, the research team compared two ways to train nursing home staff and administrators in COVID-19 infection control measures:

  • Project ECHO was a 16-week training. Topics included how to screen for COVID-19 symptoms and how to use personal protective equipment. After the training, staff could take optional sessions over nine weeks where they could ask experts questions about related topics.
  • Project ECHO+ offered the same 16-week training as Project ECHO. Then, staff took a nine-week required training course on topics identified by nursing home staff, like how to manage in a crisis and maintain best practices. Finally, staff took an eight-week refresher course focused on topics chosen by nursing home staff and leaders.

What were the results?

At 4, 6, 12, and 18 months, residents in nursing homes where staff received the ECHO training and residents in nursing homes where staff received the ECHO+ training didn’t differ in:

  • Rates of COVID-19 infection or flu-like illnesses
  • Reported quality of life
  • Hospital admissions

At 18 months, nursing homes in the ECHO+ training reported a higher number of deaths in the previous four weeks than nursing homes in the ECHO training. But nursing homes in the ECHO and ECHO+ trainings didn’t differ in the number of deaths at any other point in time.

Also, staff in nursing homes that took the ECHO and ECHO+ trainings didn’t differ in how well they applied what they learned, like communicating with residents and their families.

Who was in the study?

The study included 16,700 nursing home residents who were receiving care in one of 136 nursing homes.

What did the research team do?

The research team assigned nursing homes by chance to receive either the ECHO or ECHO+ training. At 4, 6, 12, and 18 months after the training, the team reviewed data reported by nursing homes. They looked at rates of COVID-19 infections, flu-like illnesses, hospitalizations, and deaths, and quality of life. The team also surveyed nursing home administrators and staff before and six months after the training. The survey asked about staff use of infection control best practices from the training.

Nursing home residents, families, staff, and policy makers helped design the study.

What were the limits of the study?

The study occurred when COVID-19 infection rates, strains, and vaccine availability were changing, so seeing the impact of the trainings on infection rates was hard. Also, the rate of COVID-19 infections was low in all nursing homes across the country, which limited the ability to detect differences between trainings.

Future research could continue to look at ways to train staff to reduce the spread of infections in nursing homes.

How can people use the results?

Nursing home administrators can use these results when looking at ways to train their staff in how to control the spread of infections.

PCORI identified COVID-19 as an important research topic. Patients, clinicians, and others wanted to learn: What are effective ways to prevent or reduce the impact of COVID-19, especially on vulnerable populations and the healthcare workforce? To help answer this question, PCORI launched an initiative in 2020 to Strengthen Understanding of COVID-19 Impact and Inform Healthcare Responses. The initiative funded this research project and others.

Final Research Report

This project's final research report is expected to be available by August 2024.

Peer-Review Summary

The Peer-Review Summary for this project will be posted here soon.

Conflict of Interest Disclosures

Project Information

Jennifer L. Kraschnewski, MD, MPH
Pennsylvania State University Hershey Medical Center
COVID-19 Project ECHO for Nursing Homes: A Patient-Centered, Randomized-Controlled Trial to Implement Infection Control and Quality-of-Life Best Practices

Key Dates

December 2023


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Last updated: December 21, 2023