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In Switzerland, the INTERCARE model has demonstrated effectiveness, with core components including deployment of nurses in expanded roles (INTERCARE nurses), evidence-based communication tools, and advance care planning. However, resource-intensive implementation strategies such as 1:1 support meetings for model implementers pose challenges for scale-up, underscoring the need for more scalable implementation support. The INTERSCALE study compares two modes of delivering implementation support\u2014an individualized and a collective-oriented approach\u2014testing the hypothesis that the latter achieves non-inferior fidelity to the INTERCARE model and comparable reductions in unplanned hospital transfers at the LTCF level. Secondary aims are to compare implementation (acceptability, feasibility), economic (costs, cost-effectiveness), clinical (unplanned transfers), and organizational (staff absences, turnover) outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This non-inferiority, effectiveness\u2013implementation hybrid type III trial uses a cluster-randomized controlled design, with LTCFs as the unit of randomization. Forty German-speaking LTCFs in Switzerland (\u226520 long-term care beds; cantonal accreditation) will be randomized (1:1) after formal consent to either individualized or collective implementation support, without blinding of LTCFs or the research team. In the individualized arm (20 LTCFs), leadership receives 1:1 support meetings, and INTERCARE nurses receive 1:1 coaching, mirroring the original INTERCARE trial. In the collective arm (20 LTCFs), leadership support and INTERCARE nurse coaching are delivered in group formats involving several LTCFs\/INTERCARE nurses together at two-monthly intervals. The primary outcome is LTCF-level fidelity to the INTERCARE core components, analyzed with a binomial generalized linear mixed model including a random LTCF effect. Non-inferiority of the collective mode will be concluded if the lower bound of its 95% confidence interval for fidelity is within 15% of the individualized mode. A 12-month cost-effectiveness analysis from a multi-stakeholder perspective (LTCFs and research group) will estimate the incremental cost-effectiveness ratio using differences in implementation costs and unplanned transfers between arms; secondary outcomes include unplanned transfers, staff turnover, and absences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This type III hybrid cluster trial addresses a key scaling challenge in implementation science by testing less resource-intensive implementation strategies for disseminating an evidence-based care model across LTCFs in routine practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      Prospectively registered on June 25, 2024, at ClinicalTrials.gov nr.\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT06473051\" ext-link-type=\"uri\">NCT06473051<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13012-026-01489-0","type":"journal-article","created":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T03:16:45Z","timestamp":1771557405000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sustainable improvement of interprofessional care for better resident outcomes: protocol for the INTERSCALE hybrid type III effectiveness cluster-randomized trial comparing individualized and collaborative delivery of an evidence-based care model for long-term care"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8844-4903","authenticated-orcid":false,"given":"Franziska","family":"Z\u00fa\u00f1iga","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5441-6888","authenticated-orcid":false,"given":"Lea","family":"Saringer-Hamiti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5653-1869","authenticated-orcid":false,"given":"Flaka","family":"Siqeca","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4625-495X","authenticated-orcid":false,"given":"Sarah","family":"Holzer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0893-2633","authenticated-orcid":false,"given":"Rapha\u00eblle-Ashley","family":"Guerbaai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0369-1826","authenticated-orcid":false,"given":"Thekla","family":"Brunkert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3932-7281","authenticated-orcid":false,"given":"Farah","family":"Islam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5392-7801","authenticated-orcid":false,"given":"Jana","family":"Bart\u00e1kov\u00e1","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2384-1363","authenticated-orcid":false,"given":"Anja","family":"Orschulko","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3762-2407","authenticated-orcid":false,"given":"Sandra","family":"Staudacher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3215-7681","authenticated-orcid":false,"given":"Reto W.","family":"Kressig","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6170-8745","authenticated-orcid":false,"given":"Andreas","family":"Zeller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4638-8365","authenticated-orcid":false,"given":"Christine","family":"Serdaly","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9372-1960","authenticated-orcid":false,"given":"Nathalie I. 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