Fig. 1

Schedule of enrolment, intervention, and assessments. ^aThe Institutional Review Board waived individual consent and thus almost all eligible residents are enrolled. ^bThe Trial to Reduce Antimicrobial Use in Nursing Home Residents with Alzheimer’s Disease and other Dementias. ^cResident assessments include chart reviews done at baseline (2-month look back), every 2 months and death, and each resident is followed for up to 12 months. ^dBedford Alzheimer Nursing Severity-Subscale (BANS-S: range 7–28, higher scores indicate more functional disability) [32]. ^eUrinary tract (UTIs) and lower respiratory tract (LRIs) infections. ^fVital signs (e.g., temperature, respiratory rate), localized signs and symptoms (e.g., cough, hematuria) are recorded 24 h before or 72 h after initial documentation of the suspected infection. ^gInvestigations include urinalysis and urine, blood cultures, complete blood counts, and chest x-rays. ^hAny new major acute illnesses other than infections such as bone fracture, stroke, or seizures. ⁱFacility data are collected from three sources: LTCfocus.org website [31]; Medicare.gov website (Medicare NH Compare) [33]; and survey administered to a senior administrator. ^jMinimum Data Set Cognitive Function Scale (MDS CFS; score = 4 indicates severe impairment) [34]. ^kNursing Home Compare five-star rating (range 0–5; higher scores indicate better care quality)