title: Predicting nursing home adherence to a clinical trial intervention: lessons for the conduct of cluster randomized trials.
abstract: OBJECTIVE
  To describe factors predictive of nursing home (NH) adherence to a clinical trial intervention.
  
  
  METHODS
  Post hoc analysis of a cluster randomized trial (CRT) evaluating a structured communication intervention to improve nurse-physician telephone communication in NHs.
  
  
  METHODS
  NH.
  
  
  METHODS
  All eligible licensed nursing staff in all participating NHs.
  
  
  METHODS
  Adherence was defined as active participation for at least 3 months of the 12-month trial. NH characteristics hypothesized to affect trial outcomes (profit status, bed size, nursing staff time, NH quality, and leadership turnover) were measured a priori. The association between intervention adherence, NH characteristics and preintervention questionnaire response rate was examined.
  
  
  RESULTS
  Of 13 intervention NHs, seven adhered to the intervention. Three factors differentiated adherent from nonadherent NHs: director of nursing turnover (nonadherent NHs 50% vs adherent NHs 0%, P = .03); Centers for Medicare and Medicaid Services (CMS) nurse staffing rating (range: 1-5) (nonadherent NHs mean 3.7 ± 0.5 vs adherent NHs mean 4.3 ± 0.5), P = .048); and questionnaire response rate (nonadherent NHs 15.6 ± 10.0% vs adherent NHs 34.2 ± 12.1%, P = .02). Profit status, bed size, and number of NH deficiencies on state surveys were not significantly associated with intervention adherence.
  
  
  CONCLUSIONS
  CMS nurse staffing rating, leadership turnover, and questionnaire response rate are associated with adherence to a CRT intervention. Pretrial evaluation of NH staffing rating by CMS and of response to a questionnaire can help investigators improve trial efficiency by screening for NHs likely to adhere to a CRT intervention.
authors.affiliation: Division of Geriatric Medicine, Medical School, University of Massachusetts, Worcester, Massachusetts 01605, USA. jennifer.tjia@umassmed.edu
authors.forename: Jennifer
authors.initials: J
authors.lastname: Tjia
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Mazor
authors.forename: Terry
authors.initials: T
authors.lastname: Field
authors.forename: Peter
authors.initials: P
authors.lastname: Doherty
authors.forename: Ann
authors.initials: A
authors.lastname: Spenard
authors.forename: Jerry H
authors.initials: JH
authors.lastname: Gurwitz
mesh_terms: D000368:Aged; D005544:Forecasting; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006707:Homes for the Aged; D006801:Humans; D009735:Nursing Homes; D016032:Randomized Controlled Trials as Topic; D011795:Surveys and Questionnaires
references.citation: Am J Nurs. 2005 Nov;105(11):58-70; quiz 71
references.pmid: 16264305
references.citation: Arch Intern Med. 1997 May 12;157(9):978-84
references.pmid: 9140268
references.citation: J Patient Saf. 2009 Sep;5(3):145-52
references.pmid: 19927047
references.citation: J Nurs Care Qual. 2004 Apr-Jun;19(2):130-6
references.pmid: 15077830
references.citation: Med Care. 2005 Jun;43(6):616-26
references.pmid: 15908857
references.citation: J Gerontol B Psychol Sci Soc Sci. 2000 Sep;55(5):S278-87
references.pmid: 10985299
references.citation: Am J Med. 2011 Feb;124(2):179.e1-7
references.pmid: 21295198
references.citation: Gerontologist. 1989 Aug;29(4):502-10
references.pmid: 2521110
references.citation: J Am Med Dir Assoc. 2005 Jan-Feb;6(1):50-3
references.pmid: 15871871
references.citation: Gerontologist. 1992 Jun;32(3):414-9
references.pmid: 1500006
references.citation: JAMA. 1992 Sep 16;268(11):1417-22
references.pmid: 1512909
references.citation: J Health Econ. 1996 Feb;15(1):23-48
references.pmid: 10157427
references.citation: Health Serv Res. 2009 Feb;44(1):56-78
references.pmid: 18823448
references.citation: J Am Geriatr Soc. 2011 Mar;59(3):506-11
references.pmid: 21361882
references.citation: J Gerontol A Biol Sci Med Sci. 2005 Sep;60(9):1173-9
references.pmid: 16183959
references.citation: BMJ. 2004 Mar 20;328(7441):702-8
references.pmid: 15031246
references.citation: Health Serv Res. 2008 Jun;43(3):1025-42
references.pmid: 18454779