| Vraagstelling: Doelstelling / ObjectiveDoelstelling: Main aim of the implementation project:To test the effectiveness and cost-effectiveness of a combined implementation strategy to:1) increase occupational therapists adherence to this EDO-guideline, using a web-based monitoring system with feedback and reminders focusing on improvement of their results scored on the quality indicators; 2)increase referral rate by geriatricians, neurologists, nursing home physicians and general practitioners to this community OT intervention;3) improve managers behaviour to create organisational facilities to implement this occupational therapy intervention in their institute;Secondary aims are: improve OT s knowledge of and skills in the EDO-guideline improve geriatricians, neurologists, nursing home physicians and general practitioners knowledge about the effectiveness and efficiency of this community OT intervention and the health insurance for this OT intervention improve managers knowledge about the effectiveness and efficiency of this community OT intervention and the health insurance for this OT interventionVraagstelling / TaakstellingResearch questions:1) What is the effectiveness of this combined implementation strategy compared to the usual strategy of educating the occupational therapists by post-graduate course focusing on:a)occupational therapists adherence as monitored by quality indicatorsb)community occupational therapy use?2) What is the cost-effectiveness of this combined implementation strategy compared to the usual educational strategy? 1. Implementation objectives: to test effectiveness & efficiency of two implementation strategies of community occupational therapy (OT) in dementia : a combined strategy compared to an educational strategy.2. Design: cluster randomised controlled trial in 3 health care settings: outpatient treatment from 1) nursing home, 2) general hospital, 3) mental health service.3. Study populations: occupational therapists (OT s); physicians, managers; patients & caregivers at home.4. Intervention: evidence based guideline community occupational therapy in dementia ( EDO-guideline).5. Implementation strategies: a combined strategy (education, monitoring, feedback & reminders for OT s, physicians & managers) compared to an usual educational strategy (education for OT s).6. Main outcomes:1)% adherence to use of EDO-guideline by OT s; 2) use of community OT.7. Data analysis: random effects regression models; Sample size:45 institutes of these 3 health care settings, 180 patients and their caregivers.8. Economic evaluation: comparison of cost-effectiveness between both two implementation strategies.9. Time schedule: preparations (6 months); study performance (24 months); report (6 months). |
