Here is the standardised PICO analysis for the forty-third uploaded article:
Full Title
Champions for improved adherence to guidelines in long-term care homes: a systematic review
Authors: Amanda M. Hall, Gerd M. Flodgren, Helen L. Richmond, et al.
Journal: Implementation Science Communications, 2021; 2:85
DOI: 10.1186/s43058-021-00185-y
Type of Study
Systematic Review and Meta-Analysis of Randomised Controlled Trials (RCTs and cluster RCTs)
PICO Summary
Population (P)
- Residents aged 65+ in long-term care (LTC) homes, and nursing home staff including:
- Registered nurses, licensed practical nurses, personal support workers, aides
- Settings across Europe, North America, and Australia
Intervention (I)
- Implementation of guideline-based care via a ‘champion’ staff member
- The champion was a peer (not external expert) given additional training and responsibilities, including:
- Education delivery
- Mentorship
- Monitoring and feedback
- Acting as a liaison between staff and researchers
- All 12 included studies embedded the champion in multicomponent interventions, such as training, reminders, audit, tools
Comparison (C)
- No intervention, or
- Same intervention without a champion
- No studies used champions as a stand-alone strategy
Outcomes (O)
Primary outcome:
- Staff adherence to evidence-based guidelines
- Low-certainty evidence that champions in multicomponent interventions may improve adherence, with:
- Risk differences ranging from 4.1% to 44.8% depending on target (e.g. pressure ulcers, depression detection, function-focused care)
- Low-certainty evidence that champions in multicomponent interventions may improve adherence, with:
Secondary outcomes:
- Resident clinical outcomes:
- Oral hygiene: moderate-certainty evidence of reduced plaque (e.g., MD = –0.34 denture plaque)
- Agitation: low-certainty evidence of little or no effect
- Other outcomes (malnutrition, delirium, pressure ulcers, physical function): very low-certainty, small or unclear effects
- Resident quality of life:
- Very low-certainty evidence of no significant benefit (MD = 0.03 [95% CI: –0.01, 0.07])
- Satisfaction with care:
- Very low-certainty, one study (MD = 1.72; not statistically significant)
- Adverse events (falls, injuries):
- Very low-certainty evidence of no significant differences
- Resource use (hospital admissions):
- Very low-certainty evidence suggesting a possible reduction (e.g., RD = –22% in one study), but wide CIs and heterogeneity precluded meta-analysis
Findings Summary
- Champions may contribute to improved staff adherence to clinical guidelines in LTC homes, particularly in oral care, depression detection, and function-focused care
- Most champions played a major role, including educating staff, facilitating feedback, and modelling behaviour
- Resident outcomes showed mixed or weak effects, likely due to inconsistent implementation and unmeasured staff adherence in many studies
- Methodological concerns (e.g. unclear allocation, lack of adjustment for clustering, poor fidelity reporting) led to mostly low or very low certainty evidence
Conclusion
The champion model shows potential as an implementation strategy to support guideline adoption in long-term care, but further high-quality research is required. Specifically:
- Studies must isolate the champion’s contribution
- Standardised reporting on cost, training, duties, and fidelity is needed
- Future trials should be designed to capture both staff adherence and resident impact
Life In The Slower Lane 
Leave a comment