Shih-Yin Lin1, Catherine E Schneider1, Alycia A Bristol2, Maureen Clancy3, Sara A Sprague4, Melissa Aldridge5,6, Tara Cortes1, Keith S Goldfeld7, Jean S Kutner8, Susan L Mitchell9,10, Joseph W Shega11,12, Bei Wu1, Carolyn W Zhu5,6, Abraham A Brody1. 1. Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, New York, New York, USA. 2. College of Nursing, University of Utah, Salt Lake City, Utah, USA. 3. MJHS Hospice and Palliative Care, New York, New York, USA. 4. Providence TrinityCare Hospice, Torrance, California, USA. 5. Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA. 6. James J. Peters VA Medical Center, Bronx, New York, USA. 7. Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA. 8. Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA. 9. Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA. 10. Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. 11. Vitas Healthcare, Miami, Florida, USA. 12. College of Medicine, University of Central Florida, Orlando, Florida, USA.
Abstract
BACKGROUND AND OBJECTIVES: Many investigators of Alzheimer's disease and related dementias (AD/ADRD) are unfamiliar with the embedded pragmatic clinical trials (ePCTs) and the indispensable pilot phase preceding ePCTs. This paper provides a much-needed example for such a pilot phase and discusses implementation barriers and additional infrastructure and implementation strategies developed in preparation for a nationwide AD/ADRD ePCT. RESEARCH DESIGN AND METHODS: Two pilot trials were conducted in 2 hospices sequentially to refine and test Aliviado Dementia Care-Hospice Edition, a complex quality improvement intervention for advanced dementia symptom management. Readiness for the subsequent full-scale ePCT was assessed by three milestones: ≥80% training completion rate ("feasibility"), ≥80% posttraining survey respondents indicating intention for practice changes ("applicability"), and at least 1 Aliviado care plan/assessment instrument administered in ≥75% of dementia patients admitted to home hospice within 1-month posttraining ("fidelity"). RESULTS: Participants included 72 interdisciplinary team members and 11 patients with AD/ADRD across the pilots. Feasibility, applicability, and fidelity outcomes (92%, 93%, and 100%, respectively) all surpassed the preestablished milestones (80%, 80%, and 75%). Main implementation challenges were related to hospice staff turnover, integration of the Aliviado toolbox materials within the electronic health records, and hospices' limited research experience and infrastructure. DISCUSSION AND IMPLICATIONS: This pilot phase demonstrated feasibility, applicability, and fidelity required to proceed to the full-scale ePCT. Our study findings and discussions of additional infrastructure and implementation strategies developed following the pilot phase can inform researchers and clinicians interested in conducting AD/ADRD-related pilot studies for ePTCs or quality improvement initiatives. CLINICAL TRIALS REGISTRATION NUMBER: NCT03681119.
BACKGROUND AND OBJECTIVES: Many investigators of Alzheimer's disease and related dementias (AD/ADRD) are unfamiliar with the embedded pragmatic clinical trials (ePCTs) and the indispensable pilot phase preceding ePCTs. This paper provides a much-needed example for such a pilot phase and discusses implementation barriers and additional infrastructure and implementation strategies developed in preparation for a nationwide AD/ADRD ePCT. RESEARCH DESIGN AND METHODS: Two pilot trials were conducted in 2 hospices sequentially to refine and test Aliviado Dementia Care-Hospice Edition, a complex quality improvement intervention for advanced dementia symptom management. Readiness for the subsequent full-scale ePCT was assessed by three milestones: ≥80% training completion rate ("feasibility"), ≥80% posttraining survey respondents indicating intention for practice changes ("applicability"), and at least 1 Aliviado care plan/assessment instrument administered in ≥75% of dementia patients admitted to home hospice within 1-month posttraining ("fidelity"). RESULTS: Participants included 72 interdisciplinary team members and 11 patients with AD/ADRD across the pilots. Feasibility, applicability, and fidelity outcomes (92%, 93%, and 100%, respectively) all surpassed the preestablished milestones (80%, 80%, and 75%). Main implementation challenges were related to hospice staff turnover, integration of the Aliviado toolbox materials within the electronic health records, and hospices' limited research experience and infrastructure. DISCUSSION AND IMPLICATIONS: This pilot phase demonstrated feasibility, applicability, and fidelity required to proceed to the full-scale ePCT. Our study findings and discussions of additional infrastructure and implementation strategies developed following the pilot phase can inform researchers and clinicians interested in conducting AD/ADRD-related pilot studies for ePTCs or quality improvement initiatives. CLINICAL TRIALS REGISTRATION NUMBER: NCT03681119.
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