ABSTRACT
We launched an Age-Friendly Nursing Home Project ECHO in October 2021 focused on the 4Ms (mobility, medications, mentation, what matters most) with emphasis on dementia and QI in long-term care. One-hour virtual sessions included a short expert presentation and case discussion, were offered twice weekly, and recordings were posted online. Topics included person-centered care, advance care planning, LGBTQIA+ care, fall prevention, medication reduction, dementia resident activities, oral health, skin integrity, staff retention, COVID-19, PDSA cycles, root cause analysis, team huddles, among others. 235 individuals from 80 nursing homes, 19 ALFs, 6 continuing care communities, and 10 VA-affiliated sites in 5 states (OK, AR, KS, MO, CO) participated in the first four 6-week ECHO series;27% attended ≥2 series. Most attendees were nursing home administrators (46%), directors of nursing (20%), nursing assistants (12%), or activity directors (11%). Most were female (91%) and worked in rural settings (77%). 237 attended an additional COVID-19 update session. 152 participants (65%) completed an evaluation. 91% rated the program as valuable (score≥8/10);99% would recommend to others;57% discussed topics with colleagues;59% reviewed materials after sessions;25% implemented new QI processes;and 25% made a change to resident care. Suggestions for future sessions included: active shooter training, antibiotic stewardship, team building, staff-resident communication, dementia training for non-clinical staff, weight loss, capacity determination, and family caregiver support. An age-friendly nursing home Project ECHO was well-received by health professionals in long-term care. ECHO can successfully expand the reach of training in long-term care, especially in rural areas.
ABSTRACT
Background: Pulmonary rehabilitation is an effective treatment for people with chronic respiratory disease, but is delivered to <5% of eligible individuals. Due to COVID-19 remote rehabilitation models may be critical for future delivery of services. Aims: To compare the efficacy of home-based telerehabilitation (TR) and centre-based pulmonary rehabilitation (PR) in people with chronic respiratory disease. Methods: Assessor blinded, multi-centre RCT, powered for equivalence. Participants were randomised to centre-based PR or home-based TR. Both programs were 2 sessions/week for 8 weeks. Telerehabilitation used a stationary cycle and group videoconferencing to enable social interaction and real time monitoring. The primary outcome was change in chronic respiratory disease questionnaire dyspnea domain (CRQ-D) at end rehabilitation, with a pre-specified equivalence margin of 2.5 points. Results: We randomised 142 participants to PR (n=72) orTR (n=72). Both groups had clinically important improvements in CRQ-D following rehabilitation (TR mean (95%CI) 4 (2 to 5) vs PR 5 (3 to 7)), however equivalence of TR was not confirmed (mean difference between groups (MD) -1 point (-3 to 1)), with similar findings at 12 month followup (MD -1 point (-4 to 1)). The 6-minute walk distance (6MWD) was equivalent at end rehabilitation (MD -6 metres (-26 to 15) and at 12 months superiority of TR could not be excluded (MD 14 metres (-10 to 38). The proportion of participants who completed >70% of prescribed sessions was high (84% TR vs 79% PR). Conclusions: Home-based TR achieved clinically important gains in health-related quality of life, but equivalence to centre-based PR was not confirmed.