Using Hybrid Effectiveness Studies to Facilitate Implementation in Community-Based Settings: Three Case Studies in Dementia Care Research.
Joseph E Gaugler, Rosa R Baier, Zachary G Baker and 9 others
PMID 37643720WHAT IT FOUND
Dementia care programs tested in real-world settings faced repeated implementation barriers: staff turnover, poor communication, and lack of organizational readiness.
Readiness assessments were incorporated in some examples and were associated with smoother implementation.
Key findings
01In the ADS Plus example, 34 sites and 203 caregivers were randomized at the site level, implementation data came from 24 caregivers and 15 staff, and reported barriers included fluctuating organizational readiness, staff turnover and shortages, disruptions in census and funding levels, COVID-related closures, and cultural adaptation needs.
02In the COPE HCBS example, COPE includes up to 10 home visits over four months by an occupational therapist and one home visit and follow-up phone call by a nurse; staff found it acceptable, but communication between care managers and interventionists and follow-up with medical providers were inconsistent.
03In the COPE PACE example, 10 sites were randomized to a 3–4-day face-to-face training or a self-paced online program with 10 modules of up to 50 minutes each, with 5 sites in each approach; staff confidence is an implementation outcome.
STILL TO COME
How it was doneWhat they foundWhat it means for OTsWhat it means for RNs
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What it does not show
This is a methodological case-study paper, not a trial with a primary outcome. Some examples report staff and care manager perceptions rather than patient or caregiver outcomes. The PACE example is described as a planned training comparison, so no completed patient or family outcome results are reported. Because interventions include multiple components delivered together, the paper cannot separate the contribution of any single component.
Declared interests
The article is labelled as supported by NIH extramural research funding. No additional conflict-of-interest statement is provided in the supplied text.
The easy way to misread this
Do not read this as evidence that any dementia care program improves patient outcomes. It describes research designs and implementation experiences. When COPE is discussed, occupational therapy and nurse visits are delivered together, so the separate contribution of each component cannot be established.