Project

Back to overview

Nurse-led care models in Swiss nursing homes: improving interdisciplinary care for better resident outcomes (INTERCARE)

Applicant Simon Michael
Number 167458
Funding scheme NRP 74 Smarter Health Care
Research institution Pflegewissenschaft - Nursing Science (INS) Department Public Health Universität Basel
Institution of higher education University of Basel - BS
Main discipline Geriatrics
Start/End 01.02.2017 - 31.12.2021
Approved amount 837'600.00
Show all

Keywords (7)

nursing homes; advanced practice nurse; avoidable hospitalizations; quality of care; older people; chronic disease management; new models of care

Lay Summary (German)

Lead
Pflegewissenschaftler und Ärzte entwickeln und erproben gemeinsam ein Versorgungsmodell für Menschen in Pflegeheimen, um die Anzahl unnötiger Hospitalisierungen zu reduzieren. Das neue Modell soll mit spezifisch trainierten Pflegefachpersonen die medizinische und pflegerische Betreuung verbessern.
Lay summary

Alte Menschen in Pflegeheimen leiden zunehmend an mehreren und komplexen Krankheiten. Die Zusammenarbeit aller beteiligten Fachpersonen ist deshalb besonders wichtig. In einem pflegegeleiteten Modell übernehmen Pflegefachpersonen mit vertieften geriatrischen Kenntnissen die klinische Führung und koordinieren die Zusammenarbeit mit Hausärzten und Spitälern. Internationale Studien zeigen, dass pflegegeleitete Modelle die Zahl der unnötigen Spitalaufenthalte reduzieren können.

Das Ziel der Studie ist die Entwicklung und Erprobung eines pflegegeleiteten Versorgungmodells für chronisch kranke Bewohnerinnen und Bewohner in Schweizer Pflegeheimen zur Reduktion unnötiger Hospitalisationen. Das Modell soll so entwickelt werden, dass es in Pflegeheimen mit unterschiedlicher Grösse und Ausstattung in der Praxis angewendet werden kann.

In der ersten Phase wird ein Prototyp eines pflegegeleiteten Versorgungsmodells auf Grundlage der internationalen Literatur und von Interviews mit Bewohnern und Angehörigen, Pflegenden und Hausärzten entwickelt und mit Stakeholdern konkretisiert. In der zweiten Phase werden die Behandlungsteams  von zwölf Pflegeheimen in der Deutschschweiz und Romandie vor Ort vorbereitet und die Pflegefachpersonen gezielt geschult. Abschliessend wird überprüft, wie sich der Einsatz des Modells auf die Koordination und Qualität der Versorgung, die Zufriedenheit der Fachpersonen, die Lebensqualität der Bewohner/-innen, die Zahl von Spitalaufenthalten sowie auf die Kosten auswirkt. 

Das Modell wird das erste erprobte, pflegegeleitete Versorgungsmodell in Schweizer Pflegeheimen sein, welches Pflegefachpersonen mit vertieftem geriatrischem Fachwissen in zentraler Stellung einsetzt. Es verbessert den Zugang zu geriatrischer Expertise und dient der der interprofessionellen Zusammenarbeit und Koordination. Die Ergebnisse werden den Verantwortlichen von Pflegeheimen sowie der Gesundheitspolitik wertvolle Informationen zur Entscheidungsfindung liefern.

Direct link to Lay Summary Last update: 09.01.2017

Responsible applicant and co-applicants

Employees

Publications

Publication
Residents’ and Relatives’ Experiences of Acute Situations: A Qualitative Study to Inform a Care Model
Basinska Kornelia, Künzler-Heule Patrizia, Guerbaai Raphaëlle Ashley, Zúñiga Franziska, Simon Michael, Wellens Nathalie I H, Serdaly Christine, Nicca Dunja (2021), Residents’ and Relatives’ Experiences of Acute Situations: A Qualitative Study to Inform a Care Model, in The Gerontologist, 61(7), 1041-1052.
Registered nurses in expanded roles improve care in nursing homes: Swiss perspective based on the modified Delphi method
Basinska Kornelia, Wellens Nathalie I. H., Simon Michael, Zeller Andreas, Kressig Reto W., Zúñiga Franziska (2021), Registered nurses in expanded roles improve care in nursing homes: Swiss perspective based on the modified Delphi method, in Journal of Advanced Nursing, 77(2), 742-754.
Preventable hospitalizations from ambulatory care sensitive conditions in nursing homes: evidence from Switzerland
Muench Ulrike, Simon Michael, Guerbaai Raphaëlle-Ashley, De Pietro Carlo, Zeller Andreas, Kressig Reto W., Zúñiga Franziska (2019), Preventable hospitalizations from ambulatory care sensitive conditions in nursing homes: evidence from Switzerland, in International Journal of Public Health, 64(9), 1273-1281.
Strengthening Geriatric Expertise in Swiss Nursing Homes: INTERCARE Implementation Study Protocol
Zúñiga Franziska, De Geest Sabina, Guerbaai Raphaëlle Ashley, Basinska Kornelia, Nicca Dunja, Kressig Reto W., Zeller Andreas, Wellens Nathalie I.H., De Pietro Carlo, Vlaeyen Ellen, Desmedt Mario, Serdaly Christine, Simon Michael (2019), Strengthening Geriatric Expertise in Swiss Nursing Homes: INTERCARE Implementation Study Protocol, in Journal of the American Geriatrics Society, 67(10), 2145-2150.
Identifying Appropriate Nursing Home Resources to Reduce Fall-Related Emergency Department Transfers
Guerbaai Raphaëlle-Ashley, Kressig Reto W, Andreas Zeller, Wellens Nathalie I H, Benkert Brigitte, Monika Tröger, Osińska Magdalena, Nickel Christian H, Simon Michael, Zúñiga Franziska, Identifying Appropriate Nursing Home Resources to Reduce Fall-Related Emergency Department Transfers, in Journal of the American Medical Directors Association, JAMDA-D-21.
Positive effect of the INTERCARE nurse‐led model on reducing nursing home transfers: A nonrandomized stepped‐wedge design
Zúñiga Franziska, Guerbaai Raphaëlle-Ashley, de Geest Sabina, Popejoy Lori L., Bartakova Jana, Denhaerynck Kris, Trutschel Diana, Basinska Kornelia, Nicca Dunja, Kressig Reto W., Zeller Andrea, Wellens Nathalie I H, de Pietro Carlo, Desmedt Mario, Serdaly Christine, Simon Michael, Positive effect of the INTERCARE nurse‐led model on reducing nursing home transfers: A nonrandomized stepped‐wedge design, in Journal of the American Geriatrics Society , JGS17677.

Collaboration

Group / person Country
Types of collaboration
Fatima Häussler, Kompetenzzentrum für Sehbehinderung im Alter (KSiA), Zurich Switzerland (Europe)
- Industry/business/other use-inspired collaboration
Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Germany (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Lori Popejoy, Missouri Quality Initiative for Nursing Homes (MOQI), University of Missouri United States of America (North America)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Miriam Engelhard, Engelhard Training, Gottenheim Germany (Europe)
- Industry/business/other use-inspired collaboration
Joe Ouslander, INTERACT, Florida Atlantic University United States of America (North America)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Christine Serdaly, Serdaly & Ankers, Conches Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Industry/business/other use-inspired collaboration
Catherine Offermann, Berner Bildungszentrum Pflege Switzerland (Europe)
- Industry/business/other use-inspired collaboration
Clinical Trial Unit, Basel Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Research Infrastructure

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
Programme Conference of NRP 74 Poster Nurse-led care model in Swiss nursing homes: Improving INTERprofessional CARE for better resident outcomes 15.11.2021 Zürich, Switzerland De Pietro Carlo; Kressig Reto Werner; Nicca Dunja; Zeller Andreas; Guerbaai Raphaëlle; Basinska Kornelia; Desmedt Mario Julien; Wellens Nathalie I.H.; De Geest Sabina; Zúñiga Franziska; Simon Michael;
ALASS conference Talk given at a conference Grado di fedeltà ad un modello di cura gestito da un/un’ infermiere/a e l’impatto sulla riduzione delle ospedalizzazioni non pianificate nelle case per anziani [Degree of fidelity to a nurse-led model of care and the impact on reducing unplanned transfers 15.11.2021 Locarno, Switzerland Wellens Nathalie I.H.; Guerbaai Raphaëlle; Zúñiga Franziska; De Geest Sabina; Simon Michael;
2021 Gerontological Society America Annual Scientific Meeting Talk given at a conference Defining Appropriate Resources For Nursing Homes to Reduce Potentially Avoidable Transfers After a Fall. 13.11.2021 Phoenix, United States of America Simon Michael; Zúñiga Franziska; Guerbaai Raphaëlle;
2021 Gerontological Society America Annual Scientific Meeting Talk given at a conference Positive Effect of a Successfully Implemented Model of Care on Unplanned Transfers to Hospital. 13.11.2021 Phoenix, United States of America Simon Michael; Guerbaai Raphaëlle; Zúñiga Franziska;
ALASS conference Talk given at a conference UN MODÈLE DE SOINS POUR RENFORCER L’EXPERTISE GÉRIATRIQUE AU SEIN DES ÉTABLISSEMENTS MÉDICO-SOCIAUX: ANALYSE CONTEXTUELLE 16.09.2021 Locarno, Switzerland Zúñiga Franziska; Basinska Kornelia; Guerbaai Raphaëlle; Wellens Nathalie I.H.; Simon Michael;
Symposium fur Gesundheitsberufe Bern Talk given at a conference How can falls be safely managed in nursing homes? 19.03.2021 Bern, Switzerland Simon Michael; Zúñiga Franziska; Guerbaai Raphaëlle; Kressig Reto Werner;
MedInfo Talk given at a conference International Perspectives on Information Management in E-Networks during Care of Older Adults 22.08.2019 Lyon, France Guerbaai Raphaëlle; Zúñiga Franziska; Simon Michael;
Formation 2019 QUAFIPA-HéViva : Benchmarking 2018 et « Ateliers de bonnes pratiques » en matière de management de la qualité dans les EMS Talk given at a conference Présentation du projet INTERCARE : « Rôle de l’infirmière-clinicienne dans la conduite de projets infirmiers et leur rôle dans l’amélioration et leur rôle dans l’amélioration de la qualité grâce aux données cliniques 13.06.2019 Fribourg, Switzerland Guerbaai Raphaëlle; Zúñiga Franziska;
Zentralschweizer Pflegesymposium Management & ANP Talk given at a conference Implementation of a nurse-led model of care – preparation of nursing home leadership 16.10.2018 Luzern, Switzerland Guerbaai Raphaëlle;
Zentralschweizer Pflegesymposium Management & ANP Talk given at a conference Stakeholderbeteiligung an der Entwicklung eines schweizerischen pflegegeleiteten Versorgungsmodells: modifizierte RAND/ UCLA Appropriateness Methode 16.10.2018 Luzern, Switzerland Simon Michael; Basinska Kornelia; Zúñiga Franziska;
Salon Planète Santé live Poster Improving INTERprofessional CARE for better resident outcomes: The INTERCARE study 05.10.2018 Geneva, Switzerland Simon Michael; Guerbaai Raphaëlle; Zúñiga Franziska;
ALASS conference Talk given at a conference Increasing geriatric nurse competences in nursing homes with the goal of reducing hospitalization 06.09.2018 Lyon, France De Pietro Carlo; Zúñiga Franziska;
5. Zürcher Forum für Versorgungsforschung Talk given at a conference Gestaltung von Übergängen zwischen Spital und Pflegeheim 05.07.2018 Zürich, Switzerland Zúñiga Franziska;
1st International Conference of German Society of Nursing Science Talk given at a conference Stakeholders rating nurse-led model components and outcomes: RAND/UCLA appropriateness method 04.05.2018 Berlin, Germany Basinska Kornelia; Simon Michael; Zúñiga Franziska;
1st International Conference of German Society of Nursing Science Talk given at a conference Reaching sustainability – how an implementation framework guides the introduction of a new care model. 04.05.2018 Berlin, Germany Simon Michael; Zúñiga Franziska;
Wennberg International Collaborative Spring Policy Meeting 2018 Talk given at a conference Development of geriatric nurse competencies in a nurse-led interprofessional care model in Swiss nursing homes: RAND/UCLA appropriateness method 12.04.2018 Zürich, Switzerland Basinska Kornelia; Zúñiga Franziska; Simon Michael;
Wennberg International Collaborative Spring Policy Meeting 2018 Talk given at a conference Preventable hospitalizations from Swiss nursing homes: Analysis of Swiss discharge data 12.04.2018 Zürich, Switzerland Zúñiga Franziska; Simon Michael; Guerbaai Raphaëlle;
Symposium für Gesundheitsberufe "Capacity Building – Weichen stellen für die Zukunft" Talk given at a conference Entwicklung eines Versorgungsmodells in der Langzeitpflege - welche Fähigkeiten braucht es in der Zukunft? 09.03.2018 Bern, Switzerland Basinska Kornelia; Zúñiga Franziska; Simon Michael;
Nursing Home Research International Working Group Talk given at a conference Potentially preventable hospitalizations from nursing homes to acute care hospitals: A retrospective analysis of 2013 Swiss national data 13.10.2017 St Louis, United States of America Simon Michael; Zúñiga Franziska;


Knowledge transfer events

Active participation

Title Type of contribution Date Place Persons involved
November 2020 - Nursing home meeting Workshop 26.11.2021 Online, Switzerland Zimmermann Natalie; Zúñiga Franziska; Simon Michael; Basinska Kornelia; Guerbaai Raphaëlle;
April 2021 - Stakeholder meeting Workshop 19.04.2021 Online, Switzerland Simon Michael; Zúñiga Franziska; Guerbaai Raphaëlle; Basinska Kornelia;
October 2020 - Stakeholder meeting Workshop 19.10.2020 Online, Switzerland Simon Michael; Guerbaai Raphaëlle; Zúñiga Franziska; Basinska Kornelia;
October 2019 - Stakeholder meeting Workshop 31.10.2019 Olten, Switzerland Basinska Kornelia; Simon Michael; Zimmermann Natalie; Zúñiga Franziska;
May 2018 - Stakeholder meeting INTERCARE Workshop 24.05.2018 Olten, Switzerland Zúñiga Franziska; Basinska Kornelia; Guerbaai Raphaëlle; Zimmermann Natalie; Simon Michael;
November 2017 - Stakeholder meeting INTERCARE Workshop 28.11.2017 Olten, Switzerland Zimmermann Natalie; Basinska Kornelia; Simon Michael; Guerbaai Raphaëlle; Zúñiga Franziska;
June 2017 - Stakeholder meeting INTERCARE Workshop 06.06.2017 Olten, Switzerland Guerbaai Raphaëlle; Zúñiga Franziska; Basinska Kornelia; Simon Michael;
April 2017 - Stakeholder meeting INTERCARE Workshop 06.04.2017 Olten, Switzerland Zúñiga Franziska; Guerbaai Raphaëlle; Simon Michael; Basinska Kornelia;


Communication with the public

Communication Title Media Place Year
Print (books, brochures, leaflets) Die Entwicklung und Inhalte des INTERCAREModells. Anhang 1 Western Switzerland German-speaking Switzerland 2021
Print (books, brochures, leaflets) Die Entwicklung und Inhalte des INTERCARE-Modells. Anhang 2 German-speaking Switzerland 2021
Print (books, brochures, leaflets) Ein pflegegeleitetes Versorgungsmodell zur Stärkung der geriatrischen Kompetenz in Pflegeinstitution German-speaking Switzerland 2021
Print (books, brochures, leaflets) The development and content of the INTERCARE model. Appendix 2 International 2021
New media (web, blogs, podcasts, news feeds etc.) The INTERCARE webpage: Pflegegeleitete Versorgungsmodelle in Schweizer Pflegeinstitutionen: Verbesse Western Switzerland International Italian-speaking Switzerland German-speaking Switzerland 2018
Media relations: print media, online media Das Projekt INTERCARE: pflegegeleitete Versorgungsmodelle in der Langzeitpflege Primary and hospital care German-speaking Switzerland 2017
Media relations: print media, online media Projekt INTERCARE: Pflegegeleitete Versorgung SBK-Zeitschrift Western Switzerland Rhaeto-Romanic Switzerland German-speaking Switzerland Italian-speaking Switzerland 2017
Media relations: print media, online media Senesuisse Newsletter Senesuisse Newsletter German-speaking Switzerland 2017

Abstract

The increasing complexity of medical care in nursing homes and the lack of coordination between settings jeopardize nursing home (NH) care quality. One particularly disturbing issue are avoidable hospitalizations, associated with potential negative clinical and psychosocial outcomes and excess cost. This calls for new models of care to support NH care quality by enhancing care coordination, improving care workers’ geriatric expertise (including the use of advanced practice nurses (ANP) and expert nurses), and investing in effective (clinical) leadership in NH. One promising solution, well-established in other countries, but still to be implemented and tested in Switzerland, are nurse-led interprofessional care NH models. These models have shown to improve resident satisfaction, to empower NH staff, as well as clinical outcomes including a reduction in avoidable hospitalizations. Moreover, they are typically led by APN or expert nurses and focus on residents’ needs assessment, care coordination (also in view of transitions between settings), provide geriatric clinical leadership and support data-driven quality improvement. The main goal of the INTERCARE study is therefore to develop and evaluate a Swiss nurse-led interprofessional care NH model to improve care coordination and quality of care in NHs with a special focus on the reduction of avoidable hospitalizations. This implementation science study will be guided by 2 frameworks: (1) the PEPPA+ framework developed to support the introduction and evaluation of care models including an APN, and (2) the Consolidated Framework for Implementation Research (CFIR) which provide a structured approach for the development and implementation of the nurse-led NH model. The project will have two stages: Stage A for the development, Stage B for the implementation and evaluation of the nurse-led care model. In Stage A, a ‘Swiss nurse-led interprofessional NH care model’ will be developed based on available international evidence, contextual information from existing local Swiss models and stakeholder involvement according to the principles of Public Patient Involvement. The ‘Swiss nurse-led interprofessional NH care model’, a multi-level complex intervention, will consist of core and peripheral components, the latter to be adaptable to the local context during the implementation phase (Stage B). Anticipated core components of the ‘Swiss nurse-led interprofessional NH care model’ are nurse experts with an expanded geriatric practice, advanced clinical leadership and competencies as well as administrative backing, which will be prepared with educational trainings and continuous coaching throughout the intervention period together with the NH leadership . The definitive content of the ‘Swiss nurse-led interprofessional NH care model’ at the end of stage A will be the resultant of the input of the different stakeholders and the contextual analysis guided by the 2 frameworks as well as the RAND/UCLA methodology. In Stage B, using a quasi experimental step wedged design (21 months) the ‘Swiss nurse-led interprofessional NH care model’ will be implemented and tested in a convenience sample of 12 NHs across Switzerland’s German- and French-speaking regions.We aim to assess the effectiveness of the nurse-led care model on unplanned hospitalizations (primary outcome) and additional resident and staff outcomes, hypothesizing that nursing homes with a nurse-led care model have lower rates of unplanned hospitalizations and show improvements in resident and staff outcomes. Furthermore, we assess the effect of the degree of the model’s adoption on client outcomes, hypothesizing that a higher degree of adoption is related to better client outcomes.Finally, we describe the implementation costs the Swiss nurse-led interprofessional NH care model on the NH level and assess the economic impact of INTERCARE with a cost-effectiveness analysis adopting a health care system perspective (comparing the increase in staff costs with the decrease of days of avoidable hospitalizations).The sample size calculation for this study (power 80%, alpha = 5%) resulting in a sample size of 12 nursing homes was estimated with a simulation of the proposed stepped wedge design assuming an average of 0.8 unplanned hospitalizations/1,000 resident days and a reduction of 25% unplanned hospitalizations based on literature data from 2 previous international studies. Outcomes will be measured using appropriate quantitative and qualitative measures/methods. Due to the complexity involved in the measurement of avoidable hospitalizations, we will follow experts’ recommendation, tracking all unplanned hospital admissions as primary outcome and then use a) a subset of specific diagnoses or conditions related to avoidable hospitalizations b) avoidable ED visits, and c) process measures as secondary outcomes. The primary outcome unplanned hospitalizations is operationalized as n of unplanned* hospitalizations /1000 care days (excluded are planned hospitalizations (e.g., non-emergency surgical procedure, blood transfusion, chemotherapy) and ED visits with discharge within 24h). In addition to the primary and secondary outcomes (see above), we will also assess service and implementation outcomes to evaluate the uptake and the degree to which the ‘Swiss nurse-led interprofessional NH care model’ will actually have been implemented during the course of the intervention period in the participating nursing homes. Data collection thus will include clinical outcome data, administrative data, questionnaire surveys, focus groups and individual interviews, and hospital discharge reports. Cost data collected will be staff costs (wages and other costs) as well as implementation costs.Data analysis: To test the main hypothesis in view of reduction of unplanned hospitalizations, a generalized linear mixed effects model with binomial error distribution and logistic link function will be applied, using nursing homes as random effect and intervention as fixed effect. A sensitivity analysis will be performed adding time as fixed factor to the model. We will perform intention-to-treat analyses and do sensitivity analyses based on whether the intervention was actually in place. The same approach will be taken for secondary outcomes (e.g., avoidable hospitalizations, ED visits). T As this is an implementation science project, qualitative data will be used to supplement the analyses of client outcomes by indicating the degree to which the nurse-led model was actually implemented, what barriers and facilitators were encountered and how the service offered was perceived by NH staff and residents. The study’s progress and results will be disseminated by newsletters, the INTERCARE website, two national reports on the model and the results, an INTERCARE congress and further project-specific events. The stakeholder group will regularly meet during the project and use their channels to support the dissemination. Expected impact: The ‘Swiss nurse-led interprofessional NH care model’ will help to address the current shortage of geriatric expertise in nursing homes and improve the allocation of health care resources. The results will support evidence-based decision making at the policy level and management level of individual nursing homes concerning the use of nurse-led care models. With the adaptation and integration of internationally established models of care to the Swiss setting, this project is well-placed to produce the first evidence of the use of contextually appropriate, sustainable nurse-led teams to foster interprofessional care coordination and collaboration in Swiss NHs. With its stepped-wedge design and strong theoretical foundations in the PEPPA+ and CFIR frameworks, the INTERCARE project provides a firm scientific basis for future implementation research regarding the care of older persons in Switzerland.
-