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

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

Provider training	Format	Learners
Algorithms	Poster and pocket card displaying algorithms to guide clinical management of suspected UTIs and LRIs in advanced dementia that consider patient preferences	Targeted providers^a
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
Seminar^b	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	Proxies

^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
^bProviders unable to attend the seminar are offered a 10-min one-on-one mini-orientation
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

ISSN: 1745-6215