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Table 3 Summary of findings table for included studies

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

Champion(s) as part of an intervention compared with the same intervention without the champion for implementing various guidelines/hospital protocols in long-term care (LTC) homes

Population: Nursing Staff; Settings: LTC Homes; Intervention: Champions as part of an implementation intervention; Comparison: the same implementation intervention without the champion

Staff outcomes

Outcomes

Impacts (risk differences (RD)s or mean differences (MD) are reported where possible)

No studies, clusters (staff)

Certainty

(GRADE)**

Adherence to best-practice recommendations*

It is uncertain if champions as part of a multi-component intervention may improve adherence to the use of a depression screening tool (RD = 23% [95% CI: 5%, 52%]) as compared to the same intervention but without the champion.

1 RCT (69 staff)

⊕⊖⊖⊖

Very low1,2,3

Champion(s) as part of a multicomponent implementation intervention compared with no intervention for implementing various guidelines/hospital protocols in LTC homes

Population: Nursing Staff), and residents > 65 years old; Settings: LTC homes; Intervention: Champions as part of multi-component implementation intervention; Comparison: no intervention

Outcomes

Impact (risk differences (RD)s or Mean differences (MD) are reported where possible)

No studies, clusters (Staff)

Certainty

(GRADE)**

Staff outcomes

Adherence to guidelines*

Champions as part of multicomponent interventions may improve staff adherence to guidelines. Champions, as part of multicomponent interventions, may improve staff adherence to guidelines (pressure ulcer prevention, function-focused care, and depression identification). The effect sizes (unadjusted RD) ranged from 4.1% to 44% improvement across studies.

Note: The effect unadjusted RDs varied in magnitude across studies: pressure ulcer prevention in a bed and a chair respectively (4.1% [95% CI: − 3%, 9%] to 44.8% [95% CI: 32%, 61%]), identifying depression (44% [95% CI: 17%, 71%]), providing function-focused care (21% [95% CI: 12%, 30%]).

2 CRCTs,1 RCT, 15 clusters (260 staff)

⊕⊕⊖⊖

Low1,2

Resident outcomes

No studies, clusters (residents)

Certainty

(GRADE)**

Oral hygienea (pooled data)

Champions, as part of multicomponent interventions, possibly reduce the levels of dental plaque (adjusted MD = − 0.28 [95% CI: − 0.55, 0.00]; n =167) and denture plaque (adjusted MD = − 0.34 [95% CI: − 0.50, − 0.18]; n = 388). One study, that could not be included in the meta-analysis reported a reduction in oral debris (adjusted MD = − 0.2 [95% CI: − 7.3, 7.0]; n = 113).

3 CRCTs, 37 clusters (640 residents)

⊕⊕⊕⊖

Moderate1

Agitationb (pooled data)

Champions, as part of multicomponent interventions, may have little or no effect on resident’s level of agitation (adjusted MD = 0.49 [95% CI: − 2.39, 3.37]).

2 CRCTs, 31 clusters

(503 residents)

⊕⊕⊖⊖

Low1,2

Other clinical outcomesc

It is uncertain whether champions, as part of a multifaceted intervention may improve other clinical outcomes because the certainty of evidence is very low.

Clinical Physical Function (unadjusted MD = 4.77 [95% CI: 1.39, 8.15]), Pressure ulcer prevalence (unadjusted RD = 0.00 [95% CI: − 0.03, 0.02]), Moderate-severe malnourishment (adjusted OR = 1.6 [95% CI: 0.8, 3.1])h, prevalence of delirium (unadjusted RD = − 0.03 [95% CI: − 0.10, 0.04]), infections (adjusted hazard ratio = 0.99 [95% CI: 0.87, 1.12])h, comfort in the last week of dying (adjusted MD = 0.91 [95% CI: − 1.03, 2.85]).

6 CRCTs, M:12.5 clusters (4–47)

⊕⊖⊖⊖

Very low1,2,3

Adverse outcomesd

It is uncertain whether champions, as part of a multifaceted interventions may have an effect on adverse outcomes because the certainty of evidence is very low. Unadjusted RDs for (i) injury (RD = 7%; [95% CI: − 5%, 20%]), (ii) falls (RD = 1%; [95% CI: − 14, 16%]) and (iii) ED visits related to falls (RD = 4%; [95% CI: − 2%, 10%]).

1 CRCT, study (4 clusters, 169 residents)

⊕⊖⊖⊖

Very low?1,2,3

Quality of lifee (pooled data)

It is uncertain whether champions, as part of multicomponent interventions may improve resident’s quality of life (unadjusted MD = 0.03 [95% CI: − 0.01, 0.07])

3 CRCTs, 45 clusters (653 residents)

⊕⊖⊖⊖

Very low?1,2,3

Satisfaction with caref

It is uncertain whether champions, as part of a multifaceted intervention may improve residents’ satisfaction with care because the certainty of evidence is very low. [adjusted MD 1.72; 95% CI: − 0.15; 3.59]

1 CRCT, 73 clusters (913 residents)

⊕⊖⊖⊖

Very low1,2,3

Resource useg (hospital admissions)

It is uncertain whether champions as part of a multicomponent intervention may decrease the number of hospital admissions. Meta-analysis was not performed due to heterogeneity, unadjusted RD ranged from 7% [95% CI: − 15%, 0%] to 22% [95% CI: − 37%, − 7%] for those in the champion intervention group.

2 CRCT,18 clusters (261 residents)

⊕⊖⊖⊖

Very low1,2,3

  1. CRCT cluster randomised trial, M median, OR odds ratio, RCT randomised controlled trial
  2. *The post-intervention risk differences were adjusted for pre-intervention differences between the comparison groups, where pre values were available. One of the three studies did not report baselines values and did not report on baseline similarities; for this study the unadjusted risk difference is reported
  3. aDental plaque was measured by the Silness and Loe validated plaque index and denture plaque was measured by the Augsburger and Elahi Methylene Blue disclosing solution, oral debris was measured by the Geriatric Simplified Debris Index. bAgitation was measured by the primary caregivers using the Cohen-Mansfield Agitation Inventory. cThe outcomes were: Physical function (measured by the Barthel Index), pressure ulcer prevalence (measured by skin observation and categorised according to the 2009 EPUAP/NPUAP classification system), malnourishment (measured by the research team using the Subjective Global Assessment (SGA) nutrition assessment tool), delirium (measured by trained research assistants using the Delirium Rating Scale-Revised-98), infections (measured by research staff using medical case notes and biologic/radiologic data if available), comfort in the last week of life (measured by staff using the End-of-Life in Dementia Scale Comfort Assessment while dying (EOLD-CAD) tool). dAdverse outcomes (measured with number of injuries, falls, and emergency visits related to falls) and eQuality of life (measured by the EQ5D). fResource (measured by number of hospital admissions). gSatisfaction (measured from a relative’s perspective using the End of-Life in Dementia–Satisfaction with Care tool). hA RD was unable to be calculated and therefore the estimate provided in the paper (e.g. OR or HR) was reported. ** GRADE Working Group grades of evidence
  4. High = This research provides a very good indication of the likely effect. The likelihood that the effect will be substantially different is low. Moderate = This research provides a good indication of the likely effect. The likelihood that the effect will be substantially different is moderate. Low = This research provides some indication of the likely effect. However, the likelihood that it will be substantially different is high. Very low = This research does not provide a reliable indication of the likely effect. The likelihood that the effect will be substantially different is very high. Substantially different = a large enough difference that it might affect a decision
  5. Downgraded due to risk of bias, 2imprecision, 3inconsistency. Note: outcomes with data from single studies were automatically downgraded due to imprecision and inconsistency
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Implementation Science Communications

ISSN: 2662-2211