Flanders Nursing Home (FLANH) project: Protocol of a multicenter longitudinal observational study on staffing, work environment, rationing of care, and resident and care worker outcomes

Lisa Geyskens; Anja Declercq; Koen Milisen; Johan Flamaing; Mieke Deschodt; the FLANH research consortium

doi:10.1371/journal.pone.0293624

Peer Review History

Original SubmissionJune 6, 2023
30 Aug 2023 Decision Letter - Jonas Preposi Cruz, Editor PONE-D-23-16826Flanders Nursing Home (FLANH) project: Protocol of a multicenter longitudinal observational study on staffing, work environment, rationing of care, and resident and care worker outcomes PLOS ONE Dear Dr. Deschodt, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Oct 14 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. One of the noted authors is a group or consortium [Leuven Institute for Healthcare Policy, KU Leuven]. In addition to naming the author group, please list the individual authors and affiliations within this group in the acknowledgments section of your manuscript. Please also indicate clearly a lead author for this group along with a contact email address. 3. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions? The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses? The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory. Reviewer #1: Yes Reviewer #2: Yes ****** 3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable? Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Have the authors described where all data underlying the findings will be made available when the study is complete? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics. You may also provide optional suggestions and comments to authors that they might find helpful in planning their study. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: This is a longitudinal study protocol that aims to investivate Flemish Nursing Homes' staffing, work environment, rationing of care and resident and care worker outcomes. The study is relevant in that it contributes to understanding on human resource and work environment and its impact to several outcomes. In particular, this study will provide evidence in the context of Nursing Homes. However, the following are important review comments that can further improve the paper: 1. In Data Sources, particularly, the survey development, it was mentioned in lines145 - 146 that the scales were translated if not available in dutch. Provide the measured done or planned to ensure validity of the translated scales. 2. In the Data Analysis, describe the analysis procedures and parameters in the interpretation of the included scales. 3. In the discussion section, strengths and limitations were explained. Limitations were backed up by planned measures to mitigate its effects. The authors might also want to consider adding the use of self-report questionnaires as a limitation and possible source of bias. Probable, the authors would like to add measures to address these limitations. Reviewer #2: Dear Authors, the protocol of your study is well presented. Some minor suggestions: in line 172 explain what is understood by "productive hours" section from 186-200: are the quality indicators you use from the flemish Institute for Quality of Care retrievable from the BelRAI databse? If not, think about to give the section another title. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes: Joel Estacio Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0293624.r001
Revision 1
22 Sep 2023 Author Response COMMENTS EDITOR 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. 2. One of the noted authors is a group or consortium. In addition to naming the author group, please list the individual authors and affiliations within this group in the acknowledgments section of your manuscript. Please also indicate clearly a lead author for this group along with a contact email address. We would like to refer to the Acknowledgments section (lines 310-318) where all members of the FLANH research consortium are listed. The authors of this manuscript are actually also part of the consortium and are hereby also added. The lead author of the consortium is prof. Mieke Deschodt, who is the corresponding author of this manuscript. Her contact email address is provided on the title page, and again added in the Acknowledgments section. 3. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. No changes were made to the reference list. COMMENTS REVIEWER #1 1. In Data Sources, particularly, the survey development, it was mentioned in lines145 - 146 that the scales were translated if not available in Dutch. Provide the measured done or planned to ensure validity of the translated scales. Most of the scales and items were available in Dutch, but some indeed had to be translated. A bilingual researcher who was fluent in both English and Dutch performed a forward translation, which was then reviewed by a second bilingual researcher. In addition, as we describe in the manuscript, an expert panel review was performed were linguistic and conceptual equivalence was assessed. We also conducted a pre-test with end-users to identify any potential issues with comprehension or wording. All feedback was used to refine the translations further. However, although we believe appropriate steps were taken to ensure the reliability of the translations, for pragmatic reasons no backward translation was performed. We acknowledge that this is a limitation and have therefore reformulated the sentence to make it clear that only forward translation was performed (lines 145-148): “Where necessary, adaptations were made for use in the nursing home setting (e.g. referring to ‘resident’ instead of ‘patient’) and for scales not available in Dutch, a forward translation was performed by a bilingual researcher.” 2. In the Data Analysis, describe the analysis procedures and parameters in the interpretation of the included scales. Thank you for this suggestion. To provide more clarity, we have described the anchor of answer options and score interpretation for each included scale in Table 1. In the following results papers, we will of course go into more detail regarding scale calculation and transformation for statistical analysis. 3. In the discussion section, strengths and limitations were explained. Limitations were backed up by planned measures to mitigate its effects. The authors might also want to consider adding the use of self-report questionnaires as a limitation and possible source of bias. Probable, the authors would like to add measures to address these limitations. Thank you for this suggestion. We acknowledge the importance of addressing this limitation and have added the following in the discussion section (lines 305-308): “Another potential risk to consider is response bias, as care workers may tend to give responses influenced by social desirability. To mitigate this, we will emphasize that all surveys will be sent directly to the research team and that confidentiality will be guaranteed.” COMMENTS REVIEWER #2 1. In line 172 explain what is understood by "productive hours" Thank you for this comment. We have added the following sentence to clarify this (lines 173-174): “Productive hours are the actual worked hours and do not include paid or scheduled hours for vacation, sick leave, or education.” 2. Section from 186-200: are the quality indicators you use from the Flemish Institute for Quality of Care retrievable from the BelRAI database? If not, think about to give the section another title. Currently, the Flemish Institute for Quality of Care gathers the quality indicators at the nursing home level through self-reporting by nursing home management and not through the BelRAI. However, as part of the BelRAI assessment, these quality indicators and many more outcomes are now also being collected at the resident level. Although the Flemish Institute for Quality of Care is planning to switch to the BelRAI in the future, we already decided to retrieve these outcomes from the BelRAI database. So to answer the question, all resident outcomes we will use will be retrieved from the BelRAI database and will not be obtained from the Flemish Institute for Quality of Care. We agree that the text reads ambiguously and have therefore removed the reference to the Flemish Institute for Quality of Care from the paragraph (lines 195-198). Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0293624.r002
17 Oct 2023 Decision Letter - Jonas Preposi Cruz, Editor Flanders Nursing Home (FLANH) project: Protocol of a multicenter longitudinal observational study on staffing, work environment, rationing of care, and resident and care worker outcomes PONE-D-23-16826R1 Dear Dr. Deschodt, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Jonas Preposi Cruz Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions? The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field. Reviewer #1: Yes ******** 2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses? The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory. Reviewer #1: Yes ****** 3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable? Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible. Reviewer #1: Yes ****** 4. Have the authors described where all data underlying the findings will be made available when the study is complete? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics. You may also provide optional suggestions and comments to authors that they might find helpful in planning their study. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The article is a protocol. Ensure that all ethical considerations are met during the implementation. Provide descriptions of ethical considerations in the publication of results. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes: Joel Estacio ******** https://doi.org/10.1371/journal.pone.0293624.r003
Formally Accepted
19 Oct 2023 Acceptance Letter - Jonas Preposi Cruz, Editor PONE-D-23-16826R1 Flanders Nursing Home (FLANH) project: Protocol of a multicenter longitudinal observational study on staffing, work environment, rationing of care, and resident and care worker outcomes Dear Dr. Deschodt: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Jonas Preposi Cruz Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0293624.r004

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