Findings of Sequential Pilot Trials of Aliviado Dementia Care to Inform an Embedded Pragmatic Clinical Trial

Shih Yin Lin; Catherine E. Schneider; Alycia A. Bristol; Maureen Clancy; Sara A. Sprague; Melissa Aldridge; Tara Cortes; Keith S. Goldfeld; Jean S. Kutner; Susan L. Mitchell; Joseph W. Shega; Bei Wu; Carolyn W. Zhu; Abraham A. Brody

doi:10.1093/geront/gnaa220

Findings of Sequential Pilot Trials of Aliviado Dementia Care to Inform an Embedded Pragmatic Clinical Trial

Shih Yin Lin, Catherine E. Schneider, Alycia A. Bristol, Maureen Clancy, Sara A. Sprague, Melissa Aldridge, Tara Cortes, Keith S. Goldfeld, Jean S. Kutner, Susan L. Mitchell, Joseph W. Shega, Bei Wu, Carolyn W. Zhu, Abraham A. Brody

Research output: Contribution to journal › Article › peer-review

9 Scopus citations

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.

Original language	English
Journal	The Gerontologist
Volume	62
Issue number	2
DOIs	https://doi.org/10.1093/geront/gnaa220
State	Published - 1 Mar 2022

Keywords

ADRD
Hospice
Implementation science
Interdisciplinary workforce training
Quality assurance and performance improvement

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10.1093/geront/gnaa220

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Lin, S. Y., Schneider, C. E., Bristol, A. A., Clancy, M., Sprague, S. A., Aldridge, M., Cortes, T., Goldfeld, K. S., Kutner, J. S., Mitchell, S. L., Shega, J. W., Wu, B., Zhu, C. W., & Brody, A. A. (2022). Findings of Sequential Pilot Trials of Aliviado Dementia Care to Inform an Embedded Pragmatic Clinical Trial. The Gerontologist, 62(2). https://doi.org/10.1093/geront/gnaa220

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title = "Findings of Sequential Pilot Trials of Aliviado Dementia Care to Inform an Embedded Pragmatic Clinical Trial",

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.",

keywords = "ADRD, Hospice, Implementation science, Interdisciplinary workforce training, Quality assurance and performance improvement",

author = "Lin, {Shih Yin} and Schneider, {Catherine E.} and Bristol, {Alycia A.} and Maureen Clancy and Sprague, {Sara A.} and Melissa Aldridge and Tara Cortes and Goldfeld, {Keith S.} and Kutner, {Jean S.} and Mitchell, {Susan L.} and Shega, {Joseph W.} and Bei Wu and Zhu, {Carolyn W.} and Brody, {Abraham A.}",

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doi = "10.1093/geront/gnaa220",

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AU - Lin, Shih Yin

AU - Schneider, Catherine E.

AU - Bristol, Alycia A.

AU - Clancy, Maureen

AU - Sprague, Sara A.

AU - Aldridge, Melissa

AU - Cortes, Tara

AU - Goldfeld, Keith S.

AU - Kutner, Jean S.

AU - Mitchell, Susan L.

AU - Shega, Joseph W.

AU - Wu, Bei

AU - Zhu, Carolyn W.

AU - Brody, Abraham A.

PY - 2022/3/1

Y1 - 2022/3/1

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AB - 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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Findings of Sequential Pilot Trials of Aliviado Dementia Care to Inform an Embedded Pragmatic Clinical Trial

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