Evidence map›Paper›PMID 34344486›Full record

ReviewImplementation science communications2021

Champions for improved adherence to guidelines in long-term care homes: a systematic review.

Amanda M Hall, Gerd M Flodgren, Helen L Richmond, Sheila Welsh, Jacqueline Y Thompson, Bradley M Furlong, Andrea Sherriff

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Implementation science communications, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
15citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

15 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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  12. Clinical practice selectively follows acute appendicitis guidelines.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2023
    Observational
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Amanda M HallPrimary Healthcare Research Unit (PHRU), Faculty of Medicine, Memorial University of Newfoundland, Janeway Hostel, Health Sciences Centre, 300 Prince Philip Parkway, St. John's, NL, A1B 3 V6, Canada.
Gerd M FlodgrenDivision for Health Services, Norwegian Institute of Public Health, Marcus Thranes gate 6, Oslo, 0403, Norway.
Helen L RichmondPrimary Healthcare Research Unit (PHRU), Faculty of Medicine, Memorial University of Newfoundland, Janeway Hostel, Health Sciences Centre, 300 Prince Philip Parkway, St. John's, NL, A1B 3 V6, Canada.
Sheila WelshPublic Health Department, NHS Ayrshire & Arran, Ayr, UK.
Jacqueline Y ThompsonInstitute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
Bradley M FurlongPrimary Healthcare Research Unit (PHRU), Faculty of Medicine, Memorial University of Newfoundland, Janeway Hostel, Health Sciences Centre, 300 Prince Philip Parkway, St. John's, NL, A1B 3 V6, Canada. bradley.furlong@mun.ca.ORCID http://orcid.org/0000-0002-2013-7624
Andrea SherriffSchool of Medicine, Dentistry and Nursing, College of MVLS, University of Glasgow, Glasgow, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe champion model is increasingly being adopted to improve uptake of guideline-based care in long-term care (LTC). Studies suggest that an on-site champion may improve the quality of care residents' health outcomes. This review assessed the effectiveness of the champion on staff adherence to guidelines and subsequent resident outcomes in LTC homes.

methodThis was a systematic review and meta-analyses of randomised controlled trials. Eligible studies included residents aged 65 or over and nursing staff in LTC homes where there was a stand-alone or multi-component intervention that used a champion to improve staff adherence to guidelines and resident outcomes. The measured outcomes included staff adherence to guidelines, resident health outcomes, quality of life, adverse events, satisfaction with care, or resource use. Study quality was assessed with the Cochrane Risk of Bias tool; evidence certainty was assessed using the GRADE approach.

resultsAfter screening 4367 citations, we identified 12 articles that included the results of 1 RCT and 11 cluster-RCTs. All included papers evaluated the effects of a champion as part of a multicomponent intervention. We found low certainty evidence that champions as part of multicomponent interventions may improve staff adherence to guidelines. Effect sizes varied in magnitude across studies including unadjusted risk differences (RD) of 4.1% [95% CI: - 3%, 9%] to 44.8% [95% CI: 32%, 61%] for improving pressure ulcer prevention in a bed and a chair, respectively, RD of 44% [95% CI: 17%, 71%] for improving depression identification and RD of 21% [95% CI: 12%, 30%] for improving function-focused care to residents.

conclusionChampions may improve staff adherence to evidence-based guidelines in LTC homes. However, methodological issues and poor reporting creates uncertainty around these findings. It is premature to recommend the widespread use of champions to improve uptake of guideline-based care in LTC without further study of the champion role and its impact on cost.

trial registrationPROSPERO CRD42019145579 . Registered on 20 August 2019.

Indexed as

ChampionEvidence-based careGuidelinesImplementationLong-term care

Identifiers

PMID34344486
PMCPMC8330034

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.