Importance  New approaches are needed to enhance implementation of complex interventions for geriatric syndromes such as falls.

Objective  To test whether a complexity science–based staff training intervention (CONNECT) promoting high-quality staff interactions improves the impact of an evidence-based falls quality improvement program (FALLS).

Design, Setting, and Participants  Cluster-randomized trial in 24 nursing homes receiving either CONNECT followed by FALLS (intervention), or FALLS alone (control). Nursing home staff in all positions were asked to complete surveys at baseline, 3, 6, and 9 months. Medical records of residents with at least 1 fall in the 6-month pre- and postintervention windows (n = 1794) were abstracted for fall risk reduction measures, falls, and injurious falls.

Interventions  CONNECT taught staff to improve their connections with coworkers, increase information flow, and use cognitive diversity in problem solving. Intervention components included 2 classroom sessions, relationship mapping, and self-monitoring. FALLS provided instruction in the Agency for Healthcare Research and Quality’s Falls Management Program.

Main Outcomes and Measures  Primary outcomes were (1) mean number of fall risk reduction activities documented within 30 days of falls and (2) median fall rates among residents with at least 1 fall during the study period. In addition, validated scales measured staff communication quality, frequency, timeliness, and safety climate.

Results  Surveys were completed by 1545 staff members, representing 734 (37%) and 811 (44%) of eligible staff in intervention and control facilities, respectively; 511 (33%) respondents were hands-on care workers. Neither the CONNECT nor the FALLS-only facilities improved the mean count of fall risk reduction activities following FALLS (3.3 [1.6] vs 3.2 [1.5] of 10); furthermore, adjusted median recurrent fall rates did not differ between the groups (4.06 [interquartile range {IQR}, 2.03-8.11] vs 4.06 [IQR, 2.04-8.11] falls/resident/y). A modest improvement in staff communication measures was observed overall (mean, 0.03 [SE, 0.01] points on a 5-point scale; P = .03) and for communication timeliness (mean, 0.8 [SE, 0.03] points on a 5-point scale; P = .02). There was wide variation across facilities in intervention penetration.

Conclusions and Relevance  An intervention targeting gaps in staff communication and coordination did not improve the impact of a falls quality improvement program. New approaches to implementing evidence-based care for complex conditions in the nursing home are urgently needed.

Trial Registration  clinicaltrials.gov Identifier: NCT00636675

重要性  需要新的方法来增强对诸如跌倒之类的老年综合症的复杂干预措施的实施。

目的  测试以复杂度科学为基础的员工培训干预（CONNECT）是否能促进高质量的员工互动，从而提高基于证据的跌倒质量改进计划（FALLS）的影响。

设计，设置和参与者  在24个疗养院中接受CONNECT，然后进行FALLS（干预）或单独进行FALLS（对照）的整群随机试验。要求所有职位的疗养院工作人员在基线，3、6和9个月时完成调查。在干预前后前后6个月内（n = 1794），至少有1次跌倒的居民的医疗记录被提取以减少跌倒风险，跌倒和伤害性跌倒。

干预措施  CONNECT教会员工改善与同事的联系，增加信息流，并在解决问题中运用认知多样性。干预组件包括2个课堂会议，关系映射和自我监控。FALLS在医疗保健研究与质量管理局的瀑布管理计划中提供了指导。

主要结果和措施  主要结果是（1）在跌倒后30天内记录的减少跌倒风险活动的平均数量，以及（2）在研究期间，至少跌倒1次的居民中位跌倒率。此外，经过验证的量表可以衡量员工的沟通质量，频率，及时性和安全氛围。

结果  调查由1545名工作人员完成，分别代表干预和控制设施中合格人员的734（37％）和811（44％）；511（33％）被调查者是动手护理人员。CONNECT和仅FALLS设施均未提高FALLS减少跌倒风险活动的平均数量（3.3 [1.6]对3.2 [1.5] of 10）；此外，调整后的平均跌倒率在两组之间没有差异（4.06 [四分位间距{IQR}，2.03-8.11]与4.06 [IQR，2.04-8.11]跌落/居民/年）。总体上，员工沟通措施有所改善（在5分制下，平均值为0.03 [SE，0.01]分；P  = .03）；在沟通及时性上，则为5-分，平均水平为0.8 [SE，0.03]分。点刻度; P = .02）。各个机构在干预渗透方面差异很大。

结论和相关性  针对人员沟通和协调中的差距的干预措施并没有改善跌倒质量改进计划的影响。迫切需要新的方法来对疗养院中的复杂情况实施循证护理。

试验注册  临床试验.gov标识符：NCT00636675