Systematic Review of Interdisciplinary Interventions in Nursing Homes

doi:10.1016/j.jamda.2013.02.005

Journal of the American Medical Directors Association

Volume 14, Issue 7, July 2013, Pages 471-478

https://doi.org/10.1016/j.jamda.2013.02.005 Get rights and content

Abstract

Background

The role of interdisciplinary interventions in the nursing home (NH) setting remains unclear. We conducted a systematic evidence review to study the benefits of interdisciplinary interventions on outcomes of NH residents. We also examined the interdisciplinary features of successful trials, including those that used formal teams.

Data Sources

Medline was searched from January 1990 to August 2011. Search terms included residential facilities, long term care, clinical trial, epidemiologic studies, epidemiologic research design, comparative study, evaluation studies, meta-analysis and guideline.

Study Selection

We included randomized controlled trials (RCTs) evaluating the efficacy of interdisciplinary interventions conducted in the NH setting.

Measurements

We used the Cochrane Collaboration tools to appraise each RCT, and an RCT was considered positive if its selected intervention had a significant positive effect on the primary outcome regardless of its effect on any secondary outcome. We also extracted data from each trial regarding the participating disciplines; for trials that used teams, we studied the reporting of various team elements, including leadership, communication, coordination, and conflict resolution.

Results

We identified 27 RCTs: 7 had no statistically significant effect on the targeted primary outcome, 2 had a statistically negative effect, and 18 demonstrated a statistically positive effect. Participation of residents’ own primary physicians (all 6 trials were positive) and/or a pharmacist (all 4 trials were positive) in the intervention were common elements of successful trials. For interventions that used formal team meetings, presence of communication and coordination among team members were the most commonly observed elements.

Conclusion

Overall interdisciplinary interventions had a positive impact on resident outcomes in the NH setting. Participation of the residents’ primary physician and/or a pharmacist in the intervention, as well as team communication and coordination, were consistent features of successful interventions.

Section snippets

Search Strategies

A comprehensive MEDLINE search was performed for articles published between January 1990 and August 2011. MeSH search terms included residential facilities, long term care, clinical trial, epidemiologic studies, epidemiologic research design, comparative study, evaluation studies, meta-analysis, and guideline. Two reviewers (A.N. and M.T.) reviewed the titles and abstracts to exclude irrelevant studies. The remaining articles were retrieved, and those not meeting the inclusion criteria were

Results

The initial search led to a total of 4841 citations. Figure 1 describes the detailed process for selecting the final pool of 27 articles.

Table 1 describes basic characteristics of these trials, various disciplines that were included in the intervention, and the outcomes of these trials. Only RCTs were included, and among these, cluster randomization was the most common design. Fourteen studies received an A and others received a B quality rating. Ten trials were performed in the United States,

Discussion

This review summarizes the trials that used interdisciplinary interventions in the NH setting and documents team elements in trials that used team care. The overall success rate for the NH trials included in this review was positive, with 66% of the trials successfully affecting the primary outcome. Interdisciplinary interventions have also yielded convincing outcomes in other health care settings, in acute care, for example, team assessments have been shown to shorten the length of patient

Conclusion

This review provides an overview of NH RCTs that used interdisciplinary interventions, 12 of which used formal team meetings. Most of the studied trials were positive. All interventions that included residents’ primary PCPs and/or a pharmacist had positive outcomes. For trials that used formal team-based care, communication, coordination, and leadership were consistent features of successful interventions. This review identifies future areas of research for enhancing impact of interdisciplinary

Acknowledgments

We acknowledge the assistance of Thomas W. Emmett, MD, MLS, at the Ruth Lilly Medical Library, Indiana University School of Medicine for his assistance with devising and executing the search strategy for this review.

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: A.N. was supported by a Health Resources and Services Administration, Geriatric Academic Career Award, Grant No. K01HP20517. A.N. acted independently in producing this manuscript and the sponsor had no impact on the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. The sponsor did not influence the study design or analysis or the study conclusions.

: None of the authors have reported any conflicts of interest relevant to this manuscript. A.N., M.T., and M.B. participated in review of the selected titles and data extraction. K.U. and M.T. performed the study appraisals. All authors equally participated in the conception of the study design, methodology, analysis of results and manuscript preparation.

View full text

ReviewSystematic Review of Interdisciplinary Interventions in Nursing Homes

Abstract

Background

Data Sources

Study Selection

Measurements

Results

Conclusion

Section snippets

Search Strategies

Results

Discussion

Conclusion

Acknowledgments

Jt Comm J Qual Improv

Arch Gerontol Geriatr

J Am Med Dir Assoc

Nutrition

Crossing the Quality Chiasm: A New Health System for the 21st Century

Teams in health care settings

The OBRA-87 nursing home regulations and implementation of the Resident Assessment Instrument: Effects on process quality

J Am Geriatr Soc

What do we know about health care team effectiveness? A review of the literature

Med Care Res Rev

Getting the basics right. Care delivery in nursing homes

J Gerontol Nurs

Geriatric Resources for Assessment and Care of Elders (GRACE): A new model of primary care for low-income seniors

J Am Geriatr Soc

Implementing innovative models of dementia care: The Healthy Aging Brain Center

Aging Ment Health

Effects of a multicomponent intervention on functional outcomes and process of care in hospitalized older patients: A randomized controlled trial of Acute Care for Elders (ACE) in a community hospital

J Am Geriatr Soc

Comprehensive geriatric assessment for older adults admitted to hospital: Meta-analysis of randomised controlled trials

BMJ

Self-managed work teams in nursing homes: Implementing and empowering nurse aide teams

Gerontologist

Organizational assessment in intensive care units (ICUs): Construct development, reliability, and validity of the ICU nurse-physician questionnaire

Med Care

Measuring interdisciplinary team performance in a long-term care setting

Med Care

Nursing homes as complex adaptive systems: Relationship between management practice and resident outcomes

Nurs Res

Integrated care programmes for chronically ill patients: A review of systematic reviews

Int J Qual Health Care

Effective healthcare teams require effective team members: Defining teamwork competencies

BMC Health Serv Res

The Cochrane Collaboration's tool for assessing risk of bias in randomised trials

BMJ

Prevention of fall-related injuries in long-term care: A randomized controlled trial of staff education

Arch Intern Med

Fall prevention in residential care: A cluster, randomized, controlled trial

J Am Geriatr Soc

A cluster-randomized trial of an educational intervention to reduce the use of physical restraints with psychogeriatric nursing home residents

J Am Geriatr Soc

A randomized controlled trial of fall prevention strategies in old peoples' homes

Gerontology

Falls prevention in residential care homes: A randomised controlled trial

Age Ageing

A randomized trial of dementia care in nursing homes

J Am Geriatr Soc

Review
Systematic Review of Interdisciplinary Interventions in Nursing Homes