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Table 1 TRAIN-AD intervention components integrating infectious disease and palliative care principles

From: The trial to reduce antimicrobial use in nursing home residents with Alzheimer’s disease and other dementias: study protocol for a cluster randomized controlled trial

Provider training




Poster and pocket card displaying algorithms to guide clinical management of suspected UTIs and LRIs in advanced dementia that consider patient preferences

Targeted providersa

Online course

Online, 1-h interactive course hosted by the HMS DCE presenting management principles using virtual patient cases, algorithms, and communication demonstration videos

Targeted providers


In-person, 1-h training seminar led by a physician, dually boarded in geriatrics and palliative care, presenting management principles and program components

Targeted providers

Communication tips

Pocket card, based on VitalTalk [39] framework, displaying quick tips to communicate with proxies about managing infections in advanced dementia and goals of care

Targeted providers

Prescribing feedback reports

Every 2 months, reports prepared by the research team for medical providers on the appropriateness of their antimicrobial initiation for suspected UTIs and LRIs

Medical providers, site champion

Proxy education booklet

Booklet for proxies of nursing home residents providing information on infections management and preference-based decision-making in advanced dementia


  1. aTargeted providers are: 1) nurses (registered or licensed practical nurses) who work a minimum of two shifts most weeks caring for advanced dementia residents; and 2) prescribing medical providers (physicians, nurse practitioners and physician assistants) who have a minimum of two advanced dementia residents on their regular patient panel
  2. bProviders unable to attend the seminar are offered a 10-min one-on-one mini-orientation
  3. HMS DCE Harvard Medical School Department of Continuing Education, LRI lower respiratory tract infection, TRAIN-AD Trial to reduce antimicrobial use in nursing home residents with Alzheimer’s disease and other dementias, UTI urinary tract infection