Here is the standardised PICO analysis for the nineteenth uploaded article:
Full Title
Accelerating guideline dissemination in nursing homes during the COVID-19 pandemic: A patient-centered randomized controlled trial
Authors: Jennifer L. Kraschnewski et al.
Journal: Geriatric Nursing, 2023; 51:439–445
DOI: 10.1016/j.gerinurse.2023.04.013
Type of Study
Cluster randomised controlled trial
PICO Summary
Population (P)
- 136 nursing homes across the United States
- Total ~16,700 residents
- Included a mix of rural/urban locations, different ownership models (for-profit, non-profit), independent and networked facilities
- All facilities were CMS-eligible skilled nursing facilities
Intervention (I)
- Project ECHO (Extension for Community Healthcare Outcomes):
- A 16-week infection control training and quality improvement series (Phase 1)
- Delivered via interactive, virtual sessions (didactic presentations, case discussions, expert Q&A)
- ECHO+ group additionally received:
- 9 extra weekly live sessions (Phase 2)
- An 8-week “fall refresher” series focusing on flu and emerging COVID-19 topics
Comparison (C)
- ECHO group received:
- The same 16-week core training as ECHO+
- Only 9 optional office hour sessions (Phase 2)
- Comparator was thus ECHO vs. ECHO+ interventions
Outcomes (O)
Health system outcomes:
- Primary outcome:
- Reduction in COVID-19 infection rates per 1,000 residents over 18 months
- Secondary outcomes:
- COVID-19 hospitalisations, deaths, and influenza cases
- Resident quality of life (measured through structured survey, not fully reported in this publication)
Findings Summary
- No significant difference was observed between ECHO and ECHO+ groups in:
- COVID-19 infections
- Hospitalisations
- Deaths
- Influenza incidence
- Infection and death rates declined initially but rebounded at 12 and 18 months (likely due to Omicron wave and waning vaccine protection)
- High participation early in the study, but reduced attendance over time, especially in Phase 2
- Qualitative feedback suggested the ECHO format was perceived positively by participants:
- Improved clarity of information
- Enhanced feelings of connection, support, and validation
- Provided a counter to inconsistent or conflicting state/federal guidance
- Limitations:
- Interventions in both arms were similar in Phase 1 (diluting differences)
- External factors (e.g. vaccine rollout, variant surges, information overload) influenced outcomes
- Participation burden and staff burnout affected engagement
Conclusion
The ECHO model provided a valuable educational and emotional support mechanism for nursing home staff, but did not demonstrate a measurable effect on COVID-19-related outcomes when comparing standard ECHO vs. ECHO+. It remains a promising approach for building capacity, bridging translational gaps, and improving confidence and knowledge, particularly when paired with consistent engagement and institutional support .
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