To compare the effectiveness of two training programs on COVID-19 infection control practices for nursing home staff and administrators in reducing the number of COVID-19 infections, and improving other patient-centered outcomes among nursing home residents
|Randomized controlled trial
|136 nursing homes with approximately 16,700 residents from the Northeast and Midwest in the United States
- Project ECHO training program: 16-week remote mentoring session with 9 optional weekly office hour sessions
- Project ECHO+ training program: 16-week remote mentoring session plus 9 weeks of training on emerging needs and an 8-week refresher session
Primary: COVID-19 infection rate per 1,000 nursing home residents
Secondary: quality of life; flu-like illnesses; hospitalizations; deaths; and measures of implementation effectiveness, like changes in visitation policies, of the ECHO and ECHO+ interventions
|18-month follow-up for primary outcome
This stratified, cluster randomized controlled trial compared the effectiveness of two training programs that provided evidence-based remote mentoring to nursing home staff and administrators in reducing COVID-19 infection rates and improving quality of life, flu-like illnesses, hospitalizations, and deaths among nursing home residents.
Researchers randomly assigned nursing homes to the Project Extension for Community Health Outcomes (ECHO) training program or the Project ECHO+ training program. Both staff training programs began with a 16-week live, virtual conference series discussing COVID-19 infection control and quality improvement in daily care practices. The ECHO program then provided nine optional, weekly office hour sessions; each session lasted 60 minutes. The ECHO+ program provided nine more weeks of video conference sessions focused on emerging needs identified by nursing home staff and subject matter experts, such as crisis management and ways to sustain best practices. An eight-week refresher course followed these sessions and covered further topics of interest identified by nursing home staff and administrators.
The study included approximately 16,700 nursing home residents who were receiving care in one of 136 nursing homes during the study period.
At 4, 6, 12, and 18 months post-intervention, researchers analyzed facility-reported data on COVID-19 infections in the Nursing Home COVID-19 Public File. At baseline and six months post-intervention, researchers also surveyed nursing home administrators and staff on their use of infection control best practices.
Nursing home residents, families, staff, administrators, and state agency representatives helped design the study.
The ECHO and ECHO+ training groups did not differ significantly in COVID-19 infection rates among nursing home residents, resident-reported quality of life, or rates of flu-like illnesses or hospitalizations at any time point in time. At 18 months, total COVID-19 deaths per 1,000 residents in the previous four-week observation period were higher in the ECHO+ study arm (p=0.05). However, the two training groups did not differ significantly in total deaths at any other point in time or in the study overall
Measures of implementation effectiveness, like improvement in communication with families and residents, did not differ significantly between nursing home staff in the ECHO and ECHO+ groups.
This study occurred when COVID-19 infection rates, variants, and vaccinations were experiencing major shifts, thus, observing if either training resulted in lower infection rates compared with baseline was difficult. Also, the rate of COVID-19 infections was low in all nursing homes across the country during the study period, limiting the ability to detect differences between interventions. Results may differ at other time points.
Conclusions and Relevance
Overall, the ECHO or ECHO+ training groups did not differ significantly in rates of resident COVID-19 infections, hospitalizations, deaths, or flu-like illness, or in quality of life.
Future Research Needs
Future research could further examine ways to train staff to reduce the spread of infectious disease in nursing homes.
|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.