Design and Implementation of a Competency-Based Training Framework for Home Health Aides in Community Settings
DOI:
https://doi.org/10.61919/rwsgtk17Keywords:
implementation science; competency-based training; home health aides; RE-AIM framework; feasibility; acceptability; adoption; fidelity; sustainability; home healthcare.Abstract
Background: Home health aides provide essential support to patients receiving care in community and home-based settings, yet their training often varies across institutions and may lack structured competency validation. Competency-based training may improve practical performance, but implementation evidence in home health aide education remains limited. Objective: This study aimed to design and implement a competency-based training framework for home health aide trainees and evaluate its implementation outcomes, including adoption, feasibility, acceptability, fidelity, maintenance, and cost, alongside secondary caregiver and patient-related outcomes. Methods: A cluster-based hybrid effectiveness–implementation study was conducted across six healthcare training institutes in the United States. Three institutes implemented an 8-week competency-based training framework organized into basic, intermediate, and advanced skill levels, while three comparison institutes continued traditional training. The RE-AIM framework guided implementation evaluation. Outcomes included caregiver competency scores, patient satisfaction, infection incidence, medication errors, fall rates, readmissions, SF-36 quality-of-life scores, adoption, acceptability, fidelity, maintenance, and preliminary cost-offset estimates. Results: A total of 180 trainees participated, including 92 in the intervention group and 88 in the comparison group. Program completion was higher in the intervention group than in the comparison group (93.4% vs 81.8%). Fidelity was 91.0%, and 87.0% of trainees reported that the competency-based program was more useful than traditional training. Competency scores improved from 58.2 to 84.6 post-training in the intervention group and from 59.1 to 68.3 in the comparison group. At 6 months, scores remained higher in the intervention group than in the comparison group (78.9 vs 63.4). Patient-related indicators favored the intervention group, including satisfaction (88.5% vs 74.2%), infection incidence (6.8% vs 11.9%), medication errors (4.1 vs 9.3 per 100 cases), falls (5.7 vs 10.6 per 100 patients), readmissions (12.3% vs 18.8%), and SF-36 score (72.4 vs 61.7). The average training cost was USD 420 per caregiver, with an estimated annual cost offset of USD 950 per patient. Conclusion: The competency-based training framework was feasible, acceptable, adoptable, and deliverable with high reported fidelity across participating institutes. The findings suggest favorable early maintenance of caregiver competency and improved patient-related indicators, but larger cluster-adjusted studies with complete statistical and economic evaluation are needed before definitive effectiveness or cost-effectiveness conclusions can be made
References
1. Chan EY, Wu LT, Ng EJY, Glass GF Jr, Tan RHT. Applying the RE-AIM framework to evaluate a holistic caregiver-centric hospital-to-home programme. BMC Health Serv Res. 2022;22:933. doi:10.1186/s12913-022-08317-3.
2. D’Lima D, Soukup T, Hull L. Evaluating the application of the RE-AIM framework. Front Public Health. 2021;9:755738. doi:10.3389/fpubh.2021.755738.
3. Glasgow RE, Harden SM, Gaglio B, Rabin B, Smith ML, Porter GC, et al. RE-AIM planning and evaluation framework. Am J Public Health. 2019;109(2):247-254. doi:10.2105/AJPH.2018.304783.
4. Holtrop JS, Estabrooks PA, Gaglio B, Harden SM. Understanding and applying RE-AIM. J Clin Transl Sci. 2021;5(1):e126. doi:10.1017/cts.2021.789.
5. Stone RI, Bryant NS. The future of the home care workforce. J Am Geriatr Soc. 2019;67(S2):S444-S448. doi:10.1111/jgs.15846.
6. Boscart VM, Sidani S, Poss J, Davey M, d’Avernas J. The effectiveness of competency-based education in long-term care. Gerontologist. 2020;60(7):1302-1312. doi:10.1093/geront/gnz152.
7. Altmiller G. Competency-based education in nursing. J Contin Educ Nurs. 2019;50(2):69-74. doi:10.3928/00220124-20190115-06.
8. Tannenbaum C, et al. Reduction of medication errors through training. JAMA Intern Med. 2019;179(2):265-272. doi:10.1001/jamainternmed.2018.6017.
9. Aiken LH, Sloane DM, Bruyneel L. Nurse staffing and patient outcomes. Lancet. 2014;383(9931):1824-1830. doi:10.1016/S0140-6736(13)62631-8.
10. Ouslander JG, et al. Interventions to reduce hospital readmissions. J Am Geriatr Soc. 2019;67(1):141-147. doi:10.1111/jgs.15601.
11. Leeman J, et al. Implementation strategies in healthcare. Implement Sci. 2017;12:77. doi:10.1186/s13012-017-0605-3.
12. Proctor EK, et al. Outcomes for implementation research. Adm Policy Ment Health. 2011;38(2):65-76. doi:10.1007/s10488-010-0319-7.
13. Kirk MA, et al. Implementation outcomes framework. Implement Sci. 2016;11:97. doi:10.1186/s13012-016-0459-1.
14. Damschroder LJ, et al. CFIR framework. Implement Sci. 2009;4:50. doi:10.1186/1748-5908-4-50.
15. Naylor MD, et al. Transitional care interventions. J Am Geriatr Soc. 2018;66(5):928-935. doi:10.1111/jgs.15347.
16. Zúñiga F, et al. Care worker training and patient outcomes. Int J Nurs Stud. 2021;113:103783. doi:10.1016/j.ijnurstu.2020.103783.
17. Reeves S, et al. Interprofessional teamwork. J Interprof Care. 2017;31(2):147-150. doi:10.1080/13561820.2017.1280002.
18. Blegen MA, et al. Patient safety outcomes and staffing. Med Care. 2019;57(2):128-134. doi:10.1097/MLR.0000000000001040.
19. Pronovost PJ, et al. Reducing infections through training. N Engl J Med. 2006;355:2725-2732. doi:10.1056/NEJMoa061115.
20. Gillespie LD, et al. Interventions for preventing falls. Cochrane Database Syst Rev. 2012;9:CD007146. doi:10.1002/14651858.CD007146.pub3.
21. Black N. Patient reported outcome measures. BMJ. 2013;346:f167. doi:10.1136/bmj.f167.
22. Ware JE Jr, Sherbourne CD. SF-36 health survey. Med Care. 1992;30(6):473-483. doi:10.1097/00005650-199206000-00002.
23. Hibbard JH, et al. Patient activation measure. Health Serv Res. 2004;39(4):1005-1026. doi:10.1111/j.1475-6773.2004.00269.x.
24. Donabedian A. Quality of care framework. Milbank Q. 2005;83(4):691-729. doi:10.1111/j.1468-0009.2005.00397.x.
25. Berwick DM. Improvement science in healthcare. JAMA. 2008;299(10):1182-1184. doi:10.1001/jama.299.10.1182.
26. Kripalani S, et al. Medication safety interventions. Arch Intern Med. 2007;167(6):540-550. doi:10.1001/archinte.167.6.540.
27. McHugh MD, et al. Hospital readmission and staffing. Med Care. 2013;51(1):52-59. doi:10.1097/MLR.0b013e3182763284.
28. Institute of Medicine. Patient safety report. Health Aff. 2000;19(3):26-37. doi:10.1377/hlthaff.19.3.26.
29. Fixsen DL, et al. Implementation research synthesis. Tampa: University of South Florida; 2005. doi:10.13140/RG.2.1.2660.4321.
30. Grol R, Grimshaw J. Evidence implementation in practice. Lancet. 2003;362(9391):1225-1230. doi:10.1016/S0140-6736(03)14546-1.
31. Burke LG, et al. Improving quality in home care. JAMA. 2017;317(7):663-664. doi:10.1001/jama.2016.21070.
32. Bangerter LR, et al. Caregiver training and outcomes. Gerontologist. 2019;59(4):e291-e302. doi:10.1093/geront/gnx174.
33. Isakov TM, Härkönen H, Jansson M. Training needs in hospital-at-home care. J Nurs Manag. 2026. doi:10.1155/jonm/3461359.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Saira Ali (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
© The Authors. This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
.png)
