Abstract
BackgroundA system of dementia-specific case conferences (WELCOME-IdA) was evaluated using a stepped-wedge design in six nursing homes (NHs) to enable nursing staff to analyse properly the behavioural and psychological symptoms (BPSD) of residents with dementia. A process evaluation of the context, the recruitment and target populations reached (residents and nursing staff) and the delivery of the intervention and implementation strategy was carried out to explore the lack of effectiveness of WELCOME-IdA on the residents’ prevalence of BPSD.MethodsThis study was part of a larger process evaluation using a mixed-methods design. Standardised questionnaires, semi-structured interviews, attendance lists, standardised protocols and written self-reports were used to collect the data. The quantitative data were analysed by calculating descriptive statistics. The qualitative interviews were analysed using deductive content analysis and the self-reports were analysed using a documentary analysis.ResultsNone of the NHs had prior experience with dementia-specific case conferences on a specific concept related to BPSD. The number of residents for whom a dementia-specific case conference was held was lower than expected. The number of nursing staff reached was high, although as defined in the study protocol, core nursing teams continuously participating in all components of the intervention were not established throughout the study. An analysis of the delivery of the intervention showed a reduction in the frequency of dementia-specific case conferences and deviations in the process structure and role structure of WELCOME-IdA. The strategy used to facilitate the implementation of WELCOME-IdA was mostly followed. An analysis of the recruitment of residents indicated that the variation in which residents were included in the study sample was high and that the intended sample size required to achieve a power >80% was not reached.ConclusionAn analysis of the process evaluation data indicated that there were inaccuracies in the implementation of WELCOME-IdA and there were methodological limitations within the design of the effectiveness trial, both of which could explain the lack of effectiveness of WELCOME-IdA. To optimise the process structure of WELCOME-IdA, an assessment of BPSD and a pre-selection of possible domains for the behavioural analysis could be conducted prior to a dementia-specific case conference.Trial registrationISRCTN20203855. Registered on 10 July 2013.
Highlights
A system of dementia-specific case conferences (WELCOME-Innovativedemenzorientierte Assessmentsystem (IdA)) was evaluated using a stepped-wedge design in six nursing homes (NHs) to enable nursing staff to analyse properly the behavioural and psychological symptoms (BPSD) of residents with dementia
In future Dementia-specific case conference (DSCC), the approach might be to use an assessment of the case already prepared to assess the behavioural and psychological symptoms of dementia (BPSD) and preselect topics provided by IdA to analyse the behaviour as previously proposed by other approaches related to the behaviour analysis of NH residents [44, 45]
The process evaluation of the context, recruitment, the target population reached, delivery of the intervention and parallel implementation strategy in the Fallbesprechungen bei Menschen mit Demenz (FallDem) trial indicates that the lack of effectiveness of WELCOME-IdA might partially be explained by implementation error
Summary
A system of dementia-specific case conferences (WELCOME-IdA) was evaluated using a stepped-wedge design in six nursing homes (NHs) to enable nursing staff to analyse properly the behavioural and psychological symptoms (BPSD) of residents with dementia. A process evaluation of the context, the recruitment and target populations reached (residents and nursing staff) and the delivery of the intervention and implementation strategy was carried out to explore the lack of effectiveness of WELCOME-IdA on the residents’ prevalence of BPSD. The behavioural and psychological symptoms of dementia (BPSD) affect up to 70% of nursing home (NH) residents with dementia [1]. In the FallDem study, a system of dementia-specific case conferences (DSCCs) titled Wittener Modell der Fallbesprechung bei Menschen mit Demenz mit Hilfe des Innovativen-demenzorientierten-Assessmentsystems (WELCOME-IdA) was implemented in NHs to enable nursing staff to analyse properly the precipitating triggers of BPSD in NH residents [11]. To facilitate the implementation of WELCOME-IdA into routine care, a parallel implementation strategy was introduced
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