Measuring implementation fidelity in a cluster-randomized pragmatic trial: development and use of a quantitative multi-component approach

Table 6 Characteristics of low- and high-fidelity nursing homes, as identified by the Composite adherence score

	Low-fidelity nursing homes (n = 8)	High-fidelity nursing homes (n = 10)
	Mean (SD)	Mean (SD)
Resident composition and acuity^a
Female (%)	67.5 (12.6)	65.0 (8.0)
Black (%)	24.7 (27.1)	23.1 (20.0)
Moderate or severe cognitive impairment (%)	59.8 (10.1)	65.9 (16.5)
Any antipsychotic use (%)	16.4 (10.1)	20.6 (10.1)
Total ADL score^b	16.4 (1.4)	17.1 (1.9)
Nursing home characteristics
Total beds (#)	107.4 (28.6)	89.0 (20.7)
Alzheimer’s unit (%)	12.5 (35.4)	22.2 (44.1)
CMS^c 5-Star Quality Rating^d	2.0 (0.5)	3.6 (1.4)
Medicaid as primary payer (%)^e	63.0 (22.2)	67.6 (15.2)
Medicare as primary payer (%)	9.6 (4.3)	13.8 (8.9)
Other/self-pay (%)	27.5 (21.6)	18.7 (13.8)
Registered nurse hours per resident day (#)	0.3 (0.2)	0.3 (0.2)
Licensed practical nurse hours per resident day (#)	0.8 (0.3)	0.9 (0.4)

^aAll data represent facility-level characteristics at baseline
^bDescribes ability of resident to perform activities of daily living (ADLs). Higher scores indicate more dependence on staff [32].
^cCenters for Medicare & Medicaid Services
^dScore ranges from 1 to 5 stars, with five stars indicating the highest quality nursing homes [31].
^eIn the US, Medicare is a health insurance program for citizens aged 65 years and older. Medicare does not provide coverage for long-term care but does provide payment for qualified short-term rehabilitation after hospitalization. Medicaid is a health program for qualified people of all ages related to disability, income, or disease. Medicaid does provide long-term care, and the payment is generally well below that of Medicare. From the nursing home perspective, Medicare is a payor of choice [33]

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