Here is the structured PICO analysis for the twelfth article you uploaded:
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Full Title (verbatim and exact):
“Building a Program Theory of Implementation Using Process Evaluation of a Complex Quality Improvement Trial in Nursing Homes”
Ginsburg LR, Easterbrook A, Massie A, et al.
The Gerontologist (2024); 64:1–14
DOI: https://doi.org/10.1093/geront/gnad064
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Type of Article:
Concurrent process evaluation of a complex quality improvement (QI) intervention trial
(SCOPE: Safer Care for Older Persons in residential Environments)
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PICO Analysis:
Population:
- Residents and staff in 31 long-term care (LTC) homes across four regions in Western Canada
- Focus on care aides (nursing assistants), who provide ~90% of direct care
- SCOPE teams were unit-based, led primarily by care aides, and supported by sponsors (internal leaders) and Quality Advisors (external facilitators)
Intervention:
- SCOPE intervention: A multicomponent, care-aide-led QI model adapted from the Institute for Healthcare Improvement’s Breakthrough Series
- Key components:
- Care-aide-led QI teams working on a specific clinical focus
- Quarterly in-person Learning Congresses
- Use of Plan-Do-Study-Act (PDSA) cycles and QI methods
- External coaching by Quality Advisors
- Internal leadership support from unit managers and administrators (Sponsors)
- Aimed to improve care processes and resident outcomes (e.g., pain, mobility, responsive behaviours)
Comparator:
- No active control group described in the process evaluation article
- The broader SCOPE trial was a pragmatic controlled trial—however, this article focuses on process evaluationof the intervention arm only
Outcome:
1. Person-centred outcomes:
- Indirect: Perceived improvements in resident care (e.g., mobility, behavioural symptoms), assessed via care aide ratings and qualitative examples (e.g., “we simply SCOPE them” to describe applying tailored interventions)
2. Process outcomes:
- Implementation fidelity measured by:
- Engagement with PDSA cycles
- Team sponsor support
- Quality Advisor support
- Acceptability and perceived effectiveness
- Leadership roles and internal team dynamics
- Fidelity enactment score increased modestly from LC3 to LC4 (mean 2.25 → 2.52 on a 0–4 scale)
- Strong sponsor support enabled high fidelity regardless of initial acceptability
3. Health system outcomes:
- Improved team cohesion, care aide empowerment, and sustainment of QI activities
- Reduction of hierarchical barriers and increased collaboration between care aides and registered staff
- Despite being a “negative trial” for its primary outcome, the process evaluation suggests that the intervention improved systems capacity for change and cultural shifts in leadership and practice
Summary Conclusion:
This article provides a rich, theory-informed process evaluation of the SCOPE trial. It concludes that care-aide-led quality improvement interventions can be implemented successfully in LTC settings if supported by strong internal leadership, context-sensitive facilitation, and structures that empower frontline staff. While resident outcome improvements were perceived rather than directly measured, the findings underscore the importance of implementation fidelity, cultural shifts, and care aide empowerment as key outcomes in themselves. The study offers a program theory that can inform future implementation strategies in residential aged care settings.
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