Here is the PICO analysis for the thirtieth uploaded article:
✅ PICO Analysis
Full Article Title:
Predicting Nursing Home Adherence to a Clinical Trial Intervention: Lessons for the Conduct of Cluster Randomized Trials
Type of Study:
Post hoc methodological analysis of a cluster randomized trial (CRT)
Journal and Year:
Journal of the American Geriatrics Society (JAGS), 2011; 59(12):2332–2336
DOI: 10.1111/j.1532-5415.2011.03697.x
P – Population
- Setting:
- 26 nursing homes (NHs) in Connecticut, USA
- Participants:
- All eligible licensed nursing staff and nursing home administrators
- Trial Context:
- Cluster randomized trial evaluating a structured communication intervention (SBAR: Situation-Background-Assessment-Recommendation) for improving nurse–physician telephone communication regarding warfarin management
I – Intervention
- Nature of Intervention:
- SBAR-based structured communication tool for nurses calling physicians about residents on warfarin
- Train-the-trainer delivery model: facility nurse leaders trained centrally then delivered training in their home facilities
- Intervention components:
- Staff education on warfarin safety and SBAR communication
- Monthly submission of structured communication checklists as a fidelity measure
- Monthly implementation check-ins with nurse leaders
- Adherence measured as submitting ≥1 completed communication checklist per resident for at least 3 months of the 12-month study
C – Comparison
- Comparator:
- Facilities in the same trial randomized to the control group (no intervention)
- Within the intervention group, comparisons were made between adherent and non-adherent facilities
O – Outcomes
Primary Outcome (This Study):
- Identification of facility-level factors predictive of adherence to the intervention within a CRT framework
Key Findings:
Among the 13 intervention NHs:
- 7 adhered, 6 did not adhere to the intervention
Predictors of Non-Adherence:
- Director of Nursing turnover:
- 0% in adherent NHs vs. 50% in non-adherent NHs (p = 0.03)
- Lower CMS nurse staffing rating:
- Adherent: 4.3 ± 0.5 vs. Non-adherent: 3.7 ± 0.5 (p = 0.048)
- Lower pre-intervention survey response rate:
- Adherent: 34.2% vs. Non-adherent: 15.6% (p = 0.02)
Non-significant factors:
- Profit status, number of beds, number of deficiencies on state survey
Outcome Classification
- Person-centred outcomes:
- Not assessed in this methodological study
- Process outcomes:
- Adherence to structured communication intervention within a clinical trial
- Implementation fidelity assessed via checklist return rates and leadership engagement
- Health system outcomes:
- Indirect implications for improving communication safety, particularly for anticoagulant management in long-term care
Summary Conclusion
This study identifies predictive factors of adherence to clinical trial interventions in nursing homes, crucial for designing effective cluster randomized trials (CRTs). Nursing homes with higher nurse staffing ratings, stable leadership, and higher engagement in pre-intervention activities (e.g., questionnaire response rates) were more likely to adhere. These findings can help researchers select trial sites more likely to implement interventions effectively, improving resource efficiency and internal validity in future nursing home-based studies .
Life In The Slower Lane 
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