July 15, 2013


Abstracts
Grants & Awards
Publications
News
Resources

Abstracts

CALL FOR ABSTRACTS: 6th International Conference on Patient- and Family-Centered Care: Partnerships for Quality & Safety
6-8 August 2014 Vancouver BC
DEADLINE 15 August 2013

The Conference showcases innovative health care programs that are dedicated to partnerships with patients and families to improve outcomes and enhance the quality and safety of health care.

CALL FOR ABSTRACTS: RTNA 2013 Conference
Banff, AB 9-11 October 2013
DEADLINE Friday 26 July 2013

The theme of the conference is about being inspired to practice KT that results in positive change. To accomplish this, we need to focus on finding real solutions for real problems using evidence from research, tacit or experiential knowledge, and learning from other sectors to best inform decisions. We also need to explore tools and techniques that help stimulate change: how to engage audiences, develop partnerships and collaborations, use implementation science, and evaluate impact.

CALL FOR ABSTRACTS: 2014 Annual NICHE Conference
6-8 April 2014 San Diego CA
DEADLINE 10 September 2013

The 2014 Annual NICHE Conference is a three-day event highlighting evidence-based innovations, research and collaboration. The goal is to deliver support to hospitals and other healthcare facilities in meeting one of the most critical challenge of our times – quality care of older adults.

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Grants & Awards

AIHS: Partnership for Research and Innovation in the Health System (PRIHS) September 2013
DEADLINE 6 September 2013 at 16:00 MT

PRIHS supports networks of health researchers and clinical practitioners across the continuum of care, with an emphasis on population health and community and primary care, that can reassess potentially inefficient activities within the health system and identify sustainable solutions to improve overall quality of care and value for money in the health system.

CIHR: Planning Grants – Fall 2013 Priority Announcements
DEADLINE 15 October 2013

The Planning Grants – Aging opportunity will provide funding for applications that address research priority areas that are consistent with the mandate of the Institute, that will stimulate planning activities and/or partnership development, and exchange. The maximum amount awarded for a single Planning Grant is $25,000 for eligible non-recurring meetings and events, for up to one year.

CIHR: Partnerships for Health Systems Improvement (PHIS)
DEADLINE 1 November 2013

Partnerships for Health System Improvement (PHSI) aims to strengthen Canada’s healthcare system through collaborative, applied and policy-relevant research. PHSI is Canada’s premier health services and policy research competition — and with its strong emphasis on partnerships and knowledge translation it is also a major resource for managers and policy makers who want relevant research to inform their decision-making. PHSI funds teams of decision makers and researchers to conduct applied health services and policy research. PHSI projects can last up to three years and receive up to a maximum of $400,000 from CIHR over the life of the project. Additional funding from external partners is required. $1.2 M is available to fund applications relevant to the Institute of Aging.

CIHR: Knowledge Synthesis Fall 2013 Competition
DEADLINE 1 October 2013

The purpose of this funding opportunity is to support teams of researchers and knowledge users to produce knowledge syntheses and scoping reviews that will contribute to the use of synthesized evidence in decision-making and practice. The maximum amount for a knowledge synthesis is $100,000 for up to one year and the maximum amount for a scoping review is $50,000 for up to one year.

CIHR: Operating Grant: Knowledge to Action (2013-2014)
DEADLINE 2 December 2013

The intent of this funding opportunity is to accelerate the translation of knowledge by linking researchers and knowledge users to move knowledge into action, and in so doing, increase the understanding of knowledge application through the process. The maximum amount per grant is $200,000 for over a period of up to two years.

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Publications

KT
Health Care Administration and Organization
Health Care Innovation and Quality Assurance
Organizational Change
Research Methodology & Practice
Aging

KT

Compliance with clinical guidelines for whiplash improved with a targeted implementation strategy: a prospective cohort study
Non UofA Access
Rebbeck T, Macedo LG, Maher CG.
BMC health services research 2013 Jun 13;13(1):213

BACKGROUND: Implementation strategies for clinical guidelines have shown modest effects in changing health professional’s knowledge and practice, however, targeted implementations are suggested to achieve greater improvements. This study aimed to examine the effect of a targeted implementation strategy of the Australian whiplash guidelines on health professionals’ knowledge, beliefs and practice and to identify predictors of improved knowledge. METHODS: 94 health professionals (Physiotherapists, Chiropractors and Osteopaths) who manage whiplash participated in this study. Prior to their inclusion in the study, health professionals were classified as compliant with clinical guidelines for whiplash (n = 52) or non-compliant (n = 42), according to a record of clinical practice. All participants completed a 2- day interactive workshop with outcomes measured at baseline and 3 months following the workshop. The workshop was delivered by opinion leaders, with the educational content focused on the pre-identified knowledge and practice gaps in relation to clinical guidelines for whiplash. Knowledge and health professional beliefs were assessed by a questionnaire and professional practice by record of clinical practice. RESULTS: Participants significantly increased knowledge (p < 0.0001) and were more likely to be compliant with the guidelines at follow-up (compliant at baseline 58%, follow-up 79%, p = 0.002). Health professional belief systems significantly changed to be more behavioural (p = 0.02) and less biomedical (p = 0.000). Predictors of improved knowledge were baseline knowledge (parameter estimate = -0.6, p = 0.000) and profession (parameter estimate = -3.8, p = 0.003) (adj R2 = 35%). CONCLUSIONS: A targeted implementation strategy improved health professional’s knowledge and clinical practice so that they became more compliant with clinical guidelines for whiplash. In addition health professionals’ belief systems significantly changed to be more behavioural in orientation. Baseline knowledge and profession predicted 35% of the variance in improved knowledge.

Improving the utilization of research knowledge in agri-food public health: a mixed-method review of knowledge translation and transfer.
Non UofA Access
Rajic A, Young I, McEwen SA.
Foodborne pathogens and disease 2013 May;10(5):397-412

Knowledge translation and transfer (KTT) aims to increase research utilization and ensure that the best available knowledge is used to inform policy and practice. Many frameworks, methods, and terms are used to describe KTT, and the field has largely developed in the health sector over the past decade. There is a need to review key KTT principles and methods in different sectors and evaluate their potential application in agri-food public health. We conducted a structured mixed-method review of the KTT literature. From 827 citations identified in a comprehensive search, we characterized 160 relevant review articles, case studies, and reports. A thematic analysis was conducted on a prioritized and representative subset of 33 articles to identify key principles and characteristics for ensuring effective KTT. The review steps were conducted by two or more independent reviewers using structured and pretested forms. We identified five key principles for effective KTT that were described within two contexts: to improve research utilization in general and to inform policy-making. To ensure general research uptake, there is a need for the following: (1) relevant and credible research; (2) ongoing interactions between researchers and end-users; (3) organizational support and culture; and (4) monitoring and evaluation. To inform policy-making, (5) researchers must also address the multiple and competing contextual factors of the policy-making process. We also describe 23 recommended and promising KTT methods, including six synthesis (e.g., systematic reviews, mixed-method reviews, and rapid reviews); nine dissemination (e.g., evidence summaries, social media, and policy briefs); and eight exchange methods (e.g., communities of practice, knowledge brokering, and policy dialogues). A brief description, contextual example, and key references are provided for each method. We recommend a wider endorsement of KTT principles and methods in agri-food public health, but there are also important gaps and challenges that should be addressed in the future.

Building organizational capacity for evidence use: the experience of two Canadian healthcare organizations.
Non UofA Access
Humphries S, Hampe T, Larsen D, Bowen S.
Healthcare management forum 2013 Spring;26(1):26-32

The use of evidence to inform decisions at the program level within healthcare organizations is a priority. The purpose of this article is to provide an overview of an innovative collaboration between two Canadian healthcare organizations to build organizational capacity for evidence use in program planning, implementation, and evaluation. The lessons learned from the initiative suggest that other healthcare organizations would find the capacity-building strategies identified and developed through the initiative useful.

Behavioural intention and user acceptance of research evidence for Queensland nurses: Provision of solutions from the clinician.
Non UofA Access
Moloney CW.
Nurse education in practice 2013 Jul;13(4):310-316

In order to maintain high standards of care in practice, renal nurses must become effective utilisers of research and evidence based practice. Many models for effective evidence based implementation have been published in an attempt to encourage a positive cultural shift in meeting this necessary nurse competency. Yet in reality a great disparity still exists between what the profession knows to be an ideal world and what they are actually able to achieve. This paper presents an evaluation of that reality through the eyes of Queensland renal nurses. Initially known barriers to research or evidence based practice utilisation will be discussed in addition to some home grown solutions from those clinicians. Nurses who participated in this study presented some unique perspectives on known barriers to research utilisation, re-affirming those detailed within the literature and conversely revealing new concepts worth additional exploration. New concepts warranting a broader in-depth exploration included the influence of family on nurse decision making and the effect of overseas trained health professionals on necessary change. In addition Queensland renal nurse’s overwhelming supported the need for a filtered or a controlled approach to research activity naming this model in post interview discussions “The Spillway Model”. Copyright © 2013 Elsevier Ltd. All rights reserved.

Knowledge brokering between researchers and policymakers in Fiji to develop policies to reduce obesity: a process evaluation.
Non UofA Access
Waqa G, Mavoa H, Snowdon W, Moodie M, Schultz J, McCabe M, et al.
Implementation science 2013 Jul 1;8:74-5908-8-74

BACKGROUND: The importance of using research evidence in decisionmaking at the policy level has been increasingly recognized. However, knowledge brokering to engage researchers and policymakers in government and non-government organizations is challenging. This paper describes and evaluates the knowledge exchange processes employed by the Translational Research on Obesity Prevention in Communities (TROPIC) project that was conducted from July 2009 to April 2012 in Fiji. TROPIC aimed to enhance: the evidence-informed decisionmaking skills of policy developers; and awareness and utilization of local and other obesity-related evidence to develop policies that could potentially improve the nation’s food and physical activity environments. The specific research question was: Can a knowledge brokering approach advance evidence-informed policy development to improve eating and physical activity environments in Fiji. METHODS: The intervention comprised: recruiting organizations and individuals; mapping policy environments; analyzing organizational capacity and support for evidence-informed policymaking (EIPM); developing EIPM skills; and facilitating development of evidence-informed policy briefs. Flexible timetabling of activities was essential to accommodate multiple competing priorities at both individual and organizational levels. Process diaries captured the duration, frequency and type of each interaction and/or activity between the knowledge brokering team and participants or their organizations. RESULTS: Partnerships were formalized with high-level officers in each of the six participating organization. Participants (n = 49) developed EIPM skills (acquire, assess, adapt and apply evidence) through a series of four workshops and applied this knowledge to formulate briefs with ongoing one-to-one support from TROPIC team members. A total of 55% of participants completed the 12 to18 month intervention, and 63% produced one or more briefs (total = 20) that were presented to higher-level officers within their organizations. The knowledge brokering team spent an average of 30 hours per participant during the entire TROPIC process. CONCLUSIONS: Active engagement of participating organizations from the outset resulted in strong individual and organizational commitment to the project. The TROPIC initiative provided a win-win situation, with participants expanding skills in EIPM and policy development, organizations increasing EIPM capacity, and researchers providing data to inform policy.

Improving implementation of evidence-based practice in mental health service delivery: protocol for a cluster randomised quasi-experimental investigation of staff-focused values interventions.
Non UofA Access
Williams V, Oades LG, Deane FP, Crowe TP, Ciarrochi J, Andresen R.
Implementation science 2013 Jul 2;8(1):75

BACKGROUND: There is growing acceptance that optimal service provision for individuals with severe and recurrent mental illness requires a complementary focus on medical recovery (i.e., symptom management and general functioning) and personal recovery (i.e., having a ‘life worth living’). Despite significant research attention and policy-level support, the translation of this vision of healthcare into changed workplace practice continues to elude. Over the past decade, evidence-based training interventions that seek to enhance the knowledge, attitudes, and skills of staff working in the mental health field have been implemented as a primary redress strategy. However, a large body of multi-disciplinary research indicates disappointing rates of training transfer. There is an absence of empirical research that investigates the importance of worker-motivation in the uptake of desired workplace change initiatives. ‘Autonomy’ is acknowledged as important to human effectiveness and as a correlate of workplace variables like productivity, and wellbeing. To our knowledge, there have been no studies that investigate purposeful and structured use of values-based interventions to facilitate increased autonomy as a means of promoting enhanced implementation of workplace change. METHODS: This study involves 200 mental health workers across 22 worksites within five community-managed organisations in three Australian states. It involves cluster-randomisation of participants within organisation, by work site, to the experimental (values) condition, or the control (implementation). Both conditions receive two days of training focusing on an evidence-based framework of mental health service delivery. The experimental group receives a third day of values-focused intervention and 12 months of values-focused coaching. Well-validated self-report measures are used to explore variables related to values concordance, autonomy, and self-reported implementation success. Audits of work files and staff work samples are reviewed for each condition to determine the impact of implementation. Self-determination theory and theories of organisational change are used to interpret the data. DISCUSSION: The research adds to the current knowledge base related to worker motivation and uptake of workplace practice. It describes a structured protocol that aims to enhance worker autonomy for imposed workplace practices. The research will inform how best to measure and conceptualise transfer. These findings will apply particularly to contexts where individuals are not ‘volunteers’ in requisite change processes.Trial registration: ACTRN: ACTRN12613000353796.

New graduate nurses as knowledge brokers in general practice in New Zealand: a constructivist grounded theory.
Non UofA Access
Hoare KJ, Mills J, Francis K.
Health & social care in the community 2013 Jul;21(4):423-431

Practice nursing in New Zealand is not well described in the literature. One survey illustrated that most of the New Zealand practice nurses sampled did not know of the country’s two premier evidence-based health websites. A recent review compared general practice in the UK, New Zealand and Australia and found that whereas there had been significant developments in empowering the practice nurse workforce to run nurse-led clinics in the UK, New Zealand and Australia lagged behind. The aim of this reported constructivist grounded theory study was to investigate practice nurses’ use of information. Conducted in Auckland, New Zealand, data were collected through ethnographic techniques in one general practice between September 2009 and January 2010 to enhance theoretical sensitivity to the area of information use. Subsequently, six experienced practice nurses (one twice after moving jobs) and five new graduate nurses from five different general practices were interviewed, using open-ended questions, between January 2010 and August 2011. Concurrent data collection and analysis occurred throughout the study period. The use of memos, the constant comparative method, data categorisation and finally, data abstraction resulted in the final theory of reciprocal role modelling. Experienced practice nurses role modelled clinical skills to new graduate nurses. Unexpectedly, new graduate nurses were unconscious experts at sourcing information and role modelled this skill to experienced practice nurses. Once this attribute was acknowledged by the experienced practice nurse, mutual learning occurred that enabled both groups of nurses to become better practitioners. Graduate nurses of the millennial generation were identified as a resource for experienced practice nurses who belong to the baby boomer generation and generation X. © 2013 John Wiley & Sons Ltd.

Getting the message out – Disseminating research findings to employees in large rural mining organisations
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Drury V, Hart K.
Australian Journal of Advanced Nursing 2013;30(4):19-22.

Objective: To identify that effective dissemination of research results in large organisations is possible through novel approaches. Setting: Two mine sites in Western Australia. Subjects: All employees working in two large mining organisations in rural Australia. Primary argument: To encourage employees to participate in research it is essential to disseminate findings. Currently utilised dissemination methods include conference presentations, journal articles and company reports. However these methods of dissemination do not reach all employees and often neglect to inform employees below middle management levels of the outcomes of projects. It is imperative that researchers develop strategies through a consultative process with industry to inform people of research findings. This paper argues that despite ongoing rhetoric concerning the need to disseminate research there is little evidence in the literature that describes effective methods of dissemination in large organisations. Conclusion: Discussion during each focus group highlighted the dissatisfaction staff had regarding involvement in research projects as they rarely received any feedback or perceived any improvement. By organising a research steering group including membership by all key stakeholder groups from senior management to junior staff and identifying dissemination of results as a priority the research team developed a climate of trust. Dissemination of results through posters was a decision made by the team in response to staff dissatisfaction. This ‘bottom up’ approach created a climate of ownership catalysing behaviour change.

Awareness of evidence-based practices alone does not translate to implementation: insights from implementation research.
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Rangachari P, Rissing P, Rethemeyer K.
Quality management in health care 2013 Apr-Jun;22(2):117-125

This article offers a scholarly review and perspective on the potential of “implementation research” to generate incremental, context-sensitive, evidence-based management strategies for the successful implementation of evidence-based practices (EBPs) (such as the “central line bundle”). Many hospitals have difficulty consistently implementing EBPs at the unit level. This problem has been broadly characterized as “change implementation failure” in health care organizations. The popular hospital response to this challenge has been to raise clinician awareness of EBPs through mandated educational programs. However, this approach has not always succeeded in changing practice. The health services research literature has emphasized the role of several organizational variables (eg, leadership, safety culture, organizational learning, teamwork and communication, and physician/staff engagement) in successful change implementation. Correspondingly, this literature has developed broad frameworks and programs for change in health care organizations. While these broad change frameworks have been successfully applied by some facilities to change practice, they are not incrementally actionable. As such, several facilities have not leveraged broad change frameworks because of resource and/or contextual limitations; a majority of hospitals continue to resort to mandated clinician education (awareness-building) for change implementation. The recent impetus toward “implementation research” in health care has the potential to generate incremental, context-sensitive, evidence-based management strategies for practice change. Authors discuss specific insights from a recently completed study on central line bundle implementation in 2 intensive care units in an academic health center. The study demonstrates that awareness of EBPs alone does not translate to implementation. More importantly, the study also identifies incremental, context-sensitive, evidence-based management strategies for successful implementation of EBPs at the unit level.

(Mis)perceptions of Continuing Education: Insights From Knowledge Translation, Quality Improvement, and Patient Safety Leaders.
Non UofA Access
Kitto SC, Bell M, Goldman J, Peller J, Silver I, Sargeant J, et al.
The Journal of continuing education in the health professions 2013 Mar;33(2):81-88

INTRODUCTION: Minimal attention has been given to the intersection and potential collaboration among the domains of continuing education (CE), knowledge translation (KT), quality improvement (QI), and patient safety (PS), despite their overlapping objectives. A study was undertaken to examine leaders’ perspectives of these 4 domains and their relationships to each other. In this article, we report on a subset of the data that focuses on how leaders in KT, PS, and QI define and view the domain of CE and opportunities for collaboration. METHODS: This study is based on a qualitative interpretivist framework to guide the collection and analysis of data in semistructured interviews. Criterion-based, maximum variation, and snowball sampling were used to identify key opinion leaders in each domain. The sample consisted of 15 individuals from the domains KT, QI, and PS. The transcripts were coded using a directed content analysis approach. RESULTS: The findings are organized into 3 thematic subsections: (1) definition and interpretation of CE, (2) concerns about relevance and effectiveness of CE, and (3) opportunities for collaboration among CE and the other domains. While there were slight differences among the data from the leaders of each domain, common themes were generally reported. DISCUSSION: The findings provide CE leaders with information about KT, QI, and PS leaders’ (mis)perceptions about CE that can inform future strategic planning and activities. CE leaders can play an important role in building upon initial collaborations among the domains to enable their strengths to complement each other. Copyright © 2013 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

Brief report: creating a culture of evidence-based practice and nursing research in a pediatric hospital.
Non UofA Access
Straka KL, Brandt P, Brytus J.
Journal of pediatric nursing 2013 Jul-Aug;28(4):374-378

Evidence-based practice and nursing research are fundamental to the profession of nursing. However, enculturating these processes into daily nursing practice presents challenges. In an effort to identify these challenges specific to our organization’s nursing division, the Barriers to Nursing Research survey was distributed to staff nurses (n=239) to assess barriers in utilizing evidence-based practice and research in their daily practice. Based on these findings, our Evidence-Based Practice/Research Council developed a dissemination plan to be implemented over a 1year time period that provided staff resources to implement evidence-based practice and nursing research. Upon completion of the year long implementation period, the same Barriers to Nursing Research survey was redistributed to staff (n=157). Pre and post survey results were compared for significance. Outcomes included an increase in projects, nurse driven research, and national presentations and publications. Copyright © 2013 Elsevier Inc. All rights reserved.

The challenges of communicating research evidence in practice: perspectives from UK health visitors and practice nurses.
Non UofA Access
van Bekkum JE, Hilton S.
BMC nursing 2013 Jul 9;12(1):17

BACKGROUND: Health practitioners play a pivotal role in providing patients with up-to-date evidence and health information. Evidence-based practice and patient-centred care are transforming the delivery of healthcare in the UK. Health practitioners are increasingly balancing the need to provide evidence-based information against that of facilitating patient choice, which may not always concur with the evidence base. There is limited research exploring how health practitioners working in the UK, and particularly those more autonomous practitioners such as health visitors and practice nurses working in community practice settings, negotiate this challenge. This research provides a descriptive account of how health visitors and practice nurses negotiate the challenges of communicating health information and research evidence in practice. METHODS: A total of eighteen in-depth telephone interviews were conducted in the UK between September 2008 and May 2009. The participants comprised nine health visitors and nine practice nurses, recruited via adverts on a nursing website, posters at a practitioner conference and through recommendation. Thematic analysis, with a focus on constant comparative method, was used to analyse the data. RESULTS: The data were grouped into three main themes: communicating evidence to the critically-minded patient; confidence in communicating evidence; and maintaining the integrity of the patient-practitioner relationship. These findings highlight some of the daily challenges that health visitors and practice nurses face with regard to the complex and dynamic nature of evidence and the changing attitudes and expectations of patients. The findings also highlight the tensions that exist between differing philosophies of evidence-based practice and patient-centred care, which can make communicating about evidence a daunting task. CONCLUSIONS: If health practitioners are to be effective at communicating research evidence, we suggest that more research and resources need to be focused on contextual factors, such as how research evidence is negotiated, appraised and communicated within the dynamic patient-practitioner relationship.

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Health Care Administration and Organization

Nurses Improving the Care of Healthsystem Elders: Creating a Sustainable Business Model to Improve Care of Hospitalized Older Adults.
Non UofA Access
Capezuti EA, Briccoli B, Boltz MP.
Journal of the American Geriatrics Society 2013 Jun 17

The Nurses Improving the Care of Healthsystem Elders (NICHE) program helps its more than 450 member sites to build the leadership capabilities to enact system-level change that targets the unique needs of older adults and embeds evidence-based geriatrics knowledge into practice. NICHE received expansion funding to establish a sustainable business model for operations while positioning the program to continue as a leader in innovative senior care programs. The expansion program focused on developing an internal business infrastructure, expanding NICHE-specific resources, creating a Web platform, increasing the number of participating NICHE hospitals, enhancing and expanding the NICHE benchmarking service, supporting research that generates evidence-based practices, fostering interorganizational collaboration, developing sufficient diversified revenue sources, and increasing the penetration and level of activity of current NICHE sites. These activities (improved services, Web-based tools, better benchmarking) added value and made it feasible to charge hospitals an annual fee for access and participation. NICHE does not stipulate how institutions should modify geriatric care; rather, NICHE principles and tools are meant to be adapted to each site’s unique institutional culture. This article describes the historical context, the rationale, and the business plan that has resulted in successful organizational outcomes, including financial sustainability of the business operations of NICHE.© 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

Do governance choices matter in health care networks?: an exploratory configuration study of health care networks.
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Willem A, Gemmel P.
BMC health services research 2013 Jun 24;13(1):229

BACKGROUND: Health care networks are widely used and accepted as an organizational form that enables integrated care as well as dealing with complex matters in health care. However, research on the governance of health care networks lags behind. The research aim of our study is to explore the type and importance of governance structure and governance mechanisms for network effectiveness. METHODS: The study has a multiple case study design and covers 22 health care networks. Using a configuration view, combinations of network governance and other network characteristics were studied on the level of the network. Based on interview and questionnaire data, network characteristics were identified and patterns in the data looked for. RESULTS: Neither a dominant (or optimal) governance structure or mechanism nor a perfect fit among governance and other characteristics were revealed, but a number of characteristics that need further study might be related to effective networks such as the role of governmental agencies, legitimacy, and relational, hierarchical, and contractual governance mechanisms as complementary factors. CONCLUSIONS: Although the results emphasize the situational character of network governance and effectiveness, they give practitioners in the health care sector indications of which factors might be more or less crucial for network effectiveness.

Practical care work and existential issues in palliative care: experiences of nursing assistants.
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Ahsberg E, Carlsson M.
International journal of older people nursing 2013 Jun 20

BACKGROUND: Despite increasing international interest in palliative care, little focus has been given to the role of nursing assistants, nor to research on existential issues. AIMS AND OBJECTIVES: To investigate nursing assistants’ experiences of existential issues in palliative care. DESIGN: An explorative study using focus group discussions as data. Seven nursing assistants working in a palliative care unit and a nursing home participated on three occasions. METHOD: Data were analysed using a content analysis approach. RESULTS: Two overlapping domains were extracted: practical care, interpreted in themes as meeting others, the patient’s body and organisational boundaries; and existential issues, interpreted as the difficult part, the valuable part and death and dying. Communication seemed to be a theme central to both domains. CONCLUSIONS: The results indicate that nursing assistants may give existential support in addition to practical aspects of care. The intimate interactions inherent in practical aspects of personal care create opportunities for meaningful conversations. Such conversations may constitute existential support for patients and a meaningful task for staff. IMPLICATIONS FOR PRACTICE: It is important that nursing assistants are given an opportunity for further education and time for reflection. The simple intervention in the present study, that is, focus group discussions, gave them an opportunity to reflect upon their work. Education in gentle massage, for example, can also be suggested as it may improve non-verbal contact and be beneficial for dying patients. © 2013 John Wiley & Sons Ltd.

Developing a public health policy-research nexus: An evaluation of Nurse Practitioner models in aged care.
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Prosser B, Clark S, Davey R, Parker R.
Evaluation and program planning 2013 Jun 6;40C:55-63

A frustration often expressed by researchers and policy-makers in public health is an apparent mismatch between respective priorities and expectations for research. Academics bemoan an oversimplification of their work, a reticence for independent critique and the constant pressure to pursue evaluation funding. Meanwhile, policy-makers look for research reports written in plain language with clear application, which are attuned to current policy settings and produced quickly. In a context where there are calls in western nations for evidence based policy with stronger links to academic research, such a mismatch can present significant challenges to policy program evaluation. The purpose of this paper is to present one attempt to overcome these challenges. Specifically, the paper describes the development of a conceptual framework for a large-scale, multifaceted evaluation of an Australian Government health initiative to expand Nurse Practitioner models of practice in aged care service delivery. In doing so, the paper provides a brief review of key points for the facilitation of a strong research-policy nexus in public health evaluations, as well as describes how this particular evaluation embodies these key points. As such, the paper presents an evaluation approach which may be adopted and adapted by others undertaking public health policy program evaluations. Copyright © 2013 Elsevier Ltd. All rights reserved.

OECD: Health Workforce Planning in OECD Countries
June 2013

Health workforce planning aims to achieve a proper balance between the supply and demand for different categories of health workers, in both the short and longer-term. Workforce planning in the health sector is particularly important, given the time and cost involved in training new doctors and other health professionals. In a context of tight budget constraints, proper health workforce planning is needed not only to guide policy decisions on entry into medical and nursing education programmes, but also to assess the impact of possible re-organisations in health service delivery to better respond to changing health care needs…

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Health Care Innovation and Quality Assurance

Rationale and design of the Multicenter Medication Reconciliation Quality Improvement Study (MARQUIS).
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Salanitro AH, Kripalani S, Resnic J, Mueller SK, Wetterneck TB, Haynes KT, et al.
BMC health services research 2013 Jun 25;13:230-6963-13-230

BACKGROUND: Unresolved medication discrepancies during hospitalization can contribute to adverse drug events, resulting in patient harm. Discrepancies can be reduced by performing medication reconciliation; however, effective implementation of medication reconciliation has proven to be challenging. The goals of the Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS) are to operationalize best practices for inpatient medication reconciliation, test their effect on potentially harmful unintentional medication discrepancies, and understand barriers and facilitators of successful implementation. METHODS: Six U.S. hospitals are participating in this quality improvement mentored implementation study. Each hospital has collected baseline data on the primary outcome: the number of potentially harmful unintentional medication discrepancies per patient, as determined by a trained on-site pharmacist taking a “gold standard” medication history. With the guidance of their mentors, each site has also begun to implement one or more of 11 best practices to improve medication reconciliation. To understand the effect of the implemented interventions on hospital staff and culture, we are performing mixed methods program evaluation including surveys, interviews, and focus groups of front line staff and hospital leaders. DISCUSSION: At baseline the number of unintentional medication discrepancies in admission and discharge orders per patient varies by site from 2.35 to 4.67 (mean=3.35). Most discrepancies are due to history errors (mean 2.12 per patient) as opposed to reconciliation errors (mean 1.23 per patient). Potentially harmful medication discrepancies averages 0.45 per patient and varies by site from 0.13 to 0.82 per patient. We discuss several barriers to implementation encountered thus far. In the end, we anticipate that MARQUIS tools and lessons learned have the potential to decrease medication discrepancies and improve patient outcomes. TRIAL REGISTRATION: Clinicaltrials.gov identifier NCT01337063.

Evaluation of a Theory-Informed Implementation Intervention for the Management of Acute Low Back Pain in General Medical Practice: The IMPLEMENT Cluster Randomised Trial.
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French SD, McKenzie JE, O’Connor DA, Grimshaw JM, Mortimer D, Francis JJ, et al.
PloS one 2013 Jun 13;8(6):e65471

INTRODUCTION: This cluster randomised trial evaluated an intervention to decrease x-ray referrals and increase giving advice to stay active for people with acute low back pain (LBP) in general practice. METHODS: General practices were randomised to either access to a guideline for acute LBP (control) or facilitated interactive workshops (intervention). We measured behavioural predictors (e.g. knowledge, attitudes and intentions) and fear avoidance beliefs. We were unable to recruit sufficient patients to measure our original primary outcomes so we introduced other outcomes measured at the general practitioner (GP) level: behavioural simulation (clinical decision about vignettes) and rates of x-ray and CT-scan (medical administrative data). All those not involved in the delivery of the intervention were blinded to allocation. RESULTS: 47 practices (53 GPs) were randomised to the control and 45 practices (59 GPs) to the intervention. The number of GPs available for analysis at 12 months varied by outcome due to missing confounder information; a minimum of 38 GPs were available from the intervention group, and a minimum of 40 GPs from the control group. For the behavioural constructs, although effect estimates were small, the intervention group GPs had greater intention of practising consistent with the guideline for the clinical behaviour of x-ray referral. For behavioural simulation, intervention group GPs were more likely to adhere to guideline recommendations about x-ray (OR 1.76, 95%CI 1.01, 3.05) and more likely to give advice to stay active (OR 4.49, 95%CI 1.90 to 10.60). Imaging referral was not statistically significantly different between groups and the potential importance of effects was unclear; rate ratio 0.87 (95%CI 0.68, 1.10) for x-ray or CT-scan. CONCLUSIONS: The intervention led to small changes in GP intention to practice in a manner that is consistent with an evidence-based guideline, but it did not result in statistically significant changes in actual behaviour. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN012606000098538.

Relationship between structural characteristics and outcome quality indicators at health care facilities for the elderly requiring long-term care in Japan from a nationwide survey.
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Sandoval Garrido FA, Tamiya N, Kashiwagi M, Miyata S, Okochi J, Moriyama Y, et al.
Geriatrics & gerontology international 2013 Jun 18

AIM: To clarify the performance situation of selected quality indicators: falls, pressure ulcers and dehydration, at health care facilities for the elderly in Japan, and what structural characteristics are related to them. METHODS: The operational population consisted of 1057 institutionalized users (approximately 10 randomly selected per facility) from a survey answered by the care staff. The facilities were divided into two groups according to their prevalence of negative outcomes (falls, pressure ulcers, dehydration): the best 25% (the very good performers) and the remaining 75% (not so good performers). Logistic regression analysis was carried out to examine the relationship between the structure characteristics of the facilities and their performance regarding each quality indicator. RESULTS: After controlling for sex, years of operation and average age of the users, our results showed a beneficial significant relationship between falls and the total number of nurses per 100 users with an adjusted odds ratio (AOR) of 0.77 (95% CI 0.59-0.98); In contrast, for pressure ulcers, harmful associations between a higher number of registered nurses (AOR 1.23, 95% CI 1.01-1.05) and the availability of 24-h nurse staffing (AOR 4.95, 95% CI 1.19-24.91) were found; regarding dehydration, we did not find any related staffing characteristics. CONCLUSION: Nursing staff might be considered as a potentially related variable in the quality of care in health care facilities for the elderly. The present study is the first to show a relationship between structural characteristics and quality outcomes in health care facilities for the elderly.

Impact of organizational culture on preventability assessment of selected adverse events in the ICU: evaluation of morbidity and mortality conferences.
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Pelieu I, Djadi-Prat J, Consoli SM, Cariou A, Guidet B, You-Harada C, et al.
Intensive care medicine 2013 Jul;39(7):1214-1220

PURPOSE: To determine whether organizational culture is associated with preventability assessment of reported adverse events (AE) in intensive care units (ICU). DESIGN: Blind review of time randomly distributed case notes written in the form of structured abstracts by the nurses who participated in recently implemented morbidity and mortality conferences from December 2006 to June 2010 in a 18-bed ICU in France. Ninety-five abstracts summarizing the discussions of 95 AE involving 95 patients were reviewed by two external blinded pairs (each comprised of one senior intensivist and one psychologist). METHODS: A score for each organizational culture style was determined, with the highest scorer being considered the dominant style present in the abstract. RESULTS: Reliability of the classification and quantification of culture traits between pairs was very good or good for 13 dimensions and moderate for two others. The two pairs deemed 32/95 and 43/95 of AE preventable (κ = 0.59). Concordance was very good (κ = 0.85) between the external pairs for evaluation of the dominant culture style. The Cochran-Armitage trend test indicated an increasing trend for change of the dominant organizational culture style over time: the team-satisfaction-oriented culture took a leading role (p = 0.02), while the people-security-oriented culture decreased dramatically (p < 0.001). The task-security-oriented culture was significantly associated with a preventable judgment, while the people-security-oriented culture was significantly associated with an unpreventable judgment (p < 0.001). CONCLUSIONS: This study demonstrated a strong relationship between preventability assessment of AE reported by caregivers and their organizational culture in the ICU.

A feedback system to improve the quality of nutritional care.
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Meijers JM, Halfens RJ, Mijnarends DM, Mostert H, Schols JM.
Nutrition 2013 Jul-Aug;29(7-8):1037-1041

OBJECTIVE: The main objective of this study was to develop a feedback system that improves the translation of malnutrition performance data from the Dutch National Prevalence Measurement of Care Problems (LPZ) into relevant evidence- and practice-based interventions in care homes. METHODS: The process consisted of two stages. The first was the development of a feedback system. Twenty-four interviews were held with health care professionals in care homes that participated in the LPZ to gain insight into needs regarding the translation of performance data into relevant improvement interventions. Subsequently, three multidisciplinary focus groups discussed how to develop a feedback system to deal with those needs. In the second stage, the feasibility of this system was evaluated via a questionnaire (N = 93) that was sent to care homes participating in LPZ. RESULTS: It was important that performance data be more transparent regarding which information was relevant and that insight was gained into how to improve nutritional care. To address these needs, a dashboard was developed to present performance data in a transparent way. Subsequently, a decision tree was developed that links LPZ dashboard outcomes to evidence-based nutritional interventions for care homes. Forty-seven respondents (50.5%) evaluated the new feedback system (the dashboard and the decision tree) as feasible. The content and design were perceived to be very useful. Half of the participating institutions had already started working with improvement activities. CONCLUSION: The developed feedback system was evaluated as useful for improving nutritional patient care in the future. This system will also be developed for other health care settings. Copyright © 2013. Published by Elsevier Inc.

Experience of adapting and implementing an evidence-based nursing guideline for prevention of diaper dermatitis in a paediatric oncology setting.
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Espirito Santo A, Choquette A.
International journal of evidence-based healthcare 2013 Jun;11(2):121-127

BACKGROUND: Diaper dermatitis is one of the most common skin problems in children often caused by irritants that promote skin breakdown, such as moisture and faecal enzymes. It has been estimated that the incidence of diaper dermatitis is as high as 50% in children receiving chemotherapy. The scientific literature suggests a variety of preventative measures, but only a minority are systematically tested and supported by clinical evidence. AIM: The purpose of this paper is to adapt and implement a skincare guideline to better prevent diaper dermatitis in the paediatric oncology population. METHODS: The Knowledge to Action process was used to guide the adaptation and implementation of the new guideline. As part of this process, different tools were used to identify and review selected knowledge (Appraisal of Guidelines Research Evaluation instrument), to tailor and adapt knowledge to the local context (ADAPTE process), to implement interventions (Registered Nurses’ Association of Ontario toolkit) and to evaluate outcomes (qualitative analysis). The main outcomes measured included implementation of the guideline and nursing practice change. RESULTS: The guideline was successfully implemented as reported by nurses in focus group sessions and as measured by changes in nursing documentation. CONCLUSION: The implementation of the guideline was successful on the account of the interplay of three core elements: The level and nature of the evidence; the context in which the research was placed; the method in which the process was facilitated. © 2013 The Authors. International Journal of Evidence-Based Healthcare © 2013 The Joanna Briggs Institute.

Nurse-Driven Quality Improvement Interventions to Reduce Hospital-Acquired Infection in the NICU.
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Ceballos K, Waterman K, Hulett T, Makic MB.
Advances in neonatal care 2013 Jun;13(3):154-163

Hospital-acquired infections are a leading cause of morbidity and mortality in neonatal intensive care units. Central line-associated blood stream infection (CLABSI) and ventilator-associated pneumonia (VAP) are costly, preventable infections targeted for eradication by the Centers for Disease Control and Prevention. After evaluation of current practice and areas for improvement, neonatal-specific CLABSI and VAP bundles were developed and implemented on the basis of available best evidence. The overall goal was to reduce infection rates at or below benchmarks set by National Healthcare Safety Network. All neonates with central lines (umbilical or percutaneous) and/or patients who were endotracheally intubated were included. All patients were risk stratified on the basis of weight per National Healthcare Safety Network reporting requirements: less than 750 g, 751-1000 g, 1001-1500 g, 1501-2500 g, and greater than 2500 g. The research was conducted as a quality improvement study. Neonatal-specific educational modules were developed by neonatal nurse leaders for CLABSI and VAP. Bundle development entailed combining select interventions, mainly from the adult literature, that the nurse leaders believed would reduce infection rates. Nursing practice guidelines and supply carts were updated to ensure understanding, compliance, and convenience. A CLABSI checklist was initiated and used at the time of line insertion by the nurse to ensure standardized infection control practices. Compliance audits were performed by nurse leaders weekly on intubated patients to validate VAP bundle implementation. CLABSI and VAP bundle compliance was audited and infection rates were measured before and after both bundle implementations following strict National Healthcare Safety Network inclusion criteria for CLABSI and VAP determination. The reduction in CLABSI elicited 84 fewer hospital days, estimated cost savings of $348,000, a 92% reduction in CLABSI (preintervention to postintervention), and a reduction in central line days by 27%. The reduction in VAP resulted in 72 fewer hospital days, estimated cost savings of $300,000, 71% reduction in VAP (preintervention to postintervention), and a reduction in vent days by 31%. Nurses are central in hospital efforts to improve quality care. The bundled interventions provided the nurses with a structure to successfully implement a systematic process for improvement. Nursing leaders ensured that bundles were implemented strategically and provided consistent and specific feedback on intervention compliance with quarterly CLABSI and VAP rates. Real-time feedback assisted the registered nurses, neonatal nurse practitioners, and physicians appreciation of the effectiveness of the change in practice. Finally, empowering the bedside nurse to lead the bundle implementation increased personal ownership and compliance and ultimately improved practice and patient outcomes.

Evaluation of a multisite educational intervention to improve mobilization of older patients in hospital: protocol for mobilization of vulnerable elders in Ontario (MOVE ON).
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Liu B, Almaawiy U, Moore JE, Chan WH, Straus SE.
Implementation science 2013 Jul 3;8(1):76

BACKGROUND: Functional decline is a common adverse outcome of hospitalization in older people. Often, this decline is not related to the illness that precipitated admission, but to the process of care delivered in hospital. The association between immobility and adverse consequences is well established, yet older inpatients spend significant amounts of time supine in bed. We aim to implement and evaluate the impact of an evidence-based strategy to promote early mobilization and prevent functional decline in older patients admitted to university-affiliated acute care hospitals in Ontario, Canada. We will implement a multi-component educational intervention to support a change in practice to enhance mobilization of older patients.Methods/design: Implementation of our early mobilization strategy is guided by the Knowledge to Action Cycle. Through focus groups with frontline staff, we will identify barriers and facilitators to early mobilization. We will tailor the intervention at each site to the identified barriers and facilitators, focusing on the following key messages: to complete a mobility assessment and care plan within 24 hours of the decision to admit patients aged 65 years and older; to achieve mobilization at least 3 times per day; and, to ensure that mobilization is scaled and progressive. The primary outcome, number of patients observed out of bed, will be documented three times per day (in the morning, at lunch and in the afternoon), two days each week. This data collection will occur over 3 phases: pre-implementation (10 weeks), implementation (8 weeks), and post-implementation (20 weeks). DISCUSSION: This is the first large, multisite study to evaluate the impact of a multi-component knowledge translation strategy on rates of mobilization of older patients in hospital. Our implementation is framed by the Knowledge to Action Cycle, and the intervention is being adapted to the local context. These unique features render our intervention approach more generalizable to multiple practice settings. Contextualization of the intervention has also facilitated engagement of participants from multiple hospitals. Upon completion of this study, we will better understand the barriers and facilitators to implementing an early mobilization strategy across a spectrum of hospitals, as well as the impact of a mobilization strategy.

Interventions to reduce dependency in personal activities of daily living in community-dwelling adults who use homecare services: protocol for a systematic review.
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Whitehead PJ, Drummond AE, Walker MF, Parry RH.
Systematic reviews 2013 Jul 2;2:49-4053-2-49

BACKGROUND: There is a growing demand for services whereby individuals receive assistance from care workers for personal care within the home. This has led to the development of re-ablement or restorative homecare services that provide time-limited input aimed at reducing dependency in personal activities of daily living, and preventing or delaying the need for further homecare support. However, little is currently known about how such interventions are configured, or how they may affect individuals’ ability to carry out personal care independently. METHODS/DESIGN: We will seek to identify studies that compare an intervention designed to reduce dependency in personal activities of daily living with routine input or usual care as the control. We will include randomised controlled trials, nonrandomised controlled trials, and controlled before and after studies. We will also include interrupted time series studies.We shall search electronic databases in addition to searching for ongoing and unpublished studies, and where appropriate will contact key authors. Two reviewers will independently screen articles for inclusion; will assess risk of bias using quality assessment tools; and will carry out data extraction using pre-prepared forms. Any disagreements, at any stage, will be resolved by discussion and the involvement of a third reviewer if needed. We will produce a narrative summary of the results. A meta-analysis will be conducted if sufficient data are available of appropriate quality and comparability. DISCUSSION: The findings from this review will inform future practice within homecare re-ablement services; will inform policy decisions about the structure, organisation and content of such services; and will identify areas where further research is warranted. TRIAL REGISTRATION: This review protocol has been registered on the PROSPERO database (CRD42013004163).

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Organizational Change

Organizational culture and innovation: A meta-analytic review
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Büschgens T, Bausch A, Balkin DB.
Journal of Product Innovation Management 2013;30(4):763-781

The relationship of organizational culture and innovation has been subject to extensive research over the last decades. The multitude of cultural variables under investigation has led to a fragmented concept of culture for innovation, and an inclusion into management theory is still missing. Further, managerial practice requires an underlying structure in order to decide what culture should be implemented in order to foster innovation, and to assess if a specific culture is an effective and efficient coordination instrument. Hence, a framework is needed which allows classification of cultural values without residuals, to draw expedient comparisons with reference to the criteria by which they are grouped, and to assess their relationship with organizational innovation. This meta-analysis, which comprises 43 studies with a combined sample size of 6341 organizations, reveals that Quinn and Rohrbaugh’s Competing Values Framework provides a meaningful structure for the ideational aspects of organizational culture. The Competing Values Framework describes value systems based on two main dimensions. Those two pairs of opposing values are flexibility versus control and internal versus external orientation. The analysis shows that the congruence of different cultures with organizational goals of innovation can be described based on that framework. Control theory is used to explain the relationship of organizational culture and innovation. While culture describes the ideational aspects of organizational values, clan control describes their coordinative effect. Managers may choose different clan control strategies according to the Competing Values Framework. They will most likely follow the strategy that provides a high level of congruence between the goals of management and the goals of their organization’s social system. Individuals that have internalized the organizational values apply them as a form of self-control. Those values will also be applied in groups, such as product development teams. While development teams may be formed and disbanded with certain projects and individuals may leave the company, the organization forms the steady frame of those activities. The cumulative data confirms the hypothesis that managers of innovative organizations most likely implement a developmental culture, which emphasizes an external and a flexibility orientation. Yet also group and rational cultures are to a certain extent consistent with the goals of an innovative organization and may thus be appropriate social control strategies. Hierarchical cultures emphasize control and an internal orientation and are less likely to be found in innovative organizations. A moderator analysis of the culture-innovation relationship revealed that it is not influenced by the differentiation between radical and incremental innovation, and only weak evidence exists for an influence of innovation adoption versus innovation generation. A potential reason is that those organizations that are geared toward innovation will pursue it consequently, without differentiating between different kinds of innovation. Therefore, managers that follow a (radical) innovation strategy should establish a developmental culture in their organization. If innovation rather represents a minor aspect of the firm’s long-term objectives, the efficiency-oriented rational culture or a group culture may also be the right choice. © 2013 Product Development & Management Association.

Impact of engaging middle management in practice interventions on staff support and learning culture: a quasi-experimental design.
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Henderson A, Burmeister L, Schoonbeek S, Ossenberg C, Gneilding J.
Journal of nursing management 2013 Jun 26

AIM: This study evaluated the impact of different levels of engaging middle management in ward based strategies implemented by a project educator. BACKGROUND: The challenge for learning in practice is to develop effective teams where experienced staff engage and foster learning with students and other novice staff. DESIGN: A quasi-experimental pre- and post- intervention four group design was conducted from November 2009 to May 2010 across four general surgical and four general medical inpatient matched units in two settings in South East Queensland, Australia. METHOD: Staff survey data was used to compare control and intervention groups (one actively engaging nurse managers) before and after ‘practice learning’ interventions. The survey comprised demographic data and data from two validated scales (support instrument for nurses facilitating learning and clinical learning organisational culture). RESULTS: Number of surveys returned pre- and post-intervention was 336 from 713 (47%). There were significant differences across many subscales pertaining to staff perception of support in the intervention groups, with only one change in the control group. The number of significant different subscales in the learning culture was also greater when middle management supported the intervention. IMPLICATIONS FOR NURSING MANAGEMENT: Middle management should work closely with facilitators to assist embedding practice interventions. © 2013 Blackwell Publishing Ltd.

Organizational coherence in health care organizations: conceptual guidance to facilitate quality improvement and organizational change.
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McAlearney AS, Terris D, Hardacre J, Spurgeon P, Brown C, Baumgart A, et al.
Quality management in health care 2013 Apr-Jun;22(2):86-99

OBJECTIVE: We sought to improve our understanding of how health care quality improvement (QI) methods and innovations could be efficiently and effectively translated between settings to reduce persistent gaps in health care quality both within and across countries. We aimed to examine whether we could identify a core set of organizational cultural attributes, independent of context and setting, which might be associated with success in implementing and sustaining QI systems in health care organizations. METHODS: We convened an international group of investigators to explore the issues of organizational culture and QI in different health care contexts and settings. This group met in person 3 times and held a series of conference calls to discuss emerging ideas over 2 years. Investigators also conducted pilot studies in their home countries to examine the applicability of our conceptual model. RESULTS AND CONCLUSIONS: We suggest that organizational coherence may be a critical element of QI efforts in health care organizations and propose that there are 3 key components of organizational coherence: (1) people, (2) processes, and (3) perspectives. Our work suggests that the concept of organizational coherence embraces both culture and context and can thus help guide both researchers and practitioners in efforts to enhance health care QI efforts, regardless of organizational type, location, or context.

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Research Methodology & Practice

Building a Community of Research Practice: Intragroup Team Social Dynamics in Interdisciplinary Mixed Methods
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Hemmings A, Beckett G, Kennerly S, Yap T.
Journal of Mixed Methods Research 2013;7(3):261-273

This article explicates the intragroup social dynamics and work of a nursing and education research team as a community of research practice interested in organizational cultures and occupational subcultures. Dynamics were characterized by processes of socialization through reeducation and group social identity formation that enabled members to cross discipline-bordered traditions and produce interdisciplinary mixed methods combinations. Combinations were achieved at the paradigm level through the generation of a shared viewing position and theoretical model. At methods and technique levels, such achievements were accomplished through methodological capitalization and prioritization and the development of a quantitative culture assessment tool that can be used in combination with complementary qualitative observation and interview protocols. Recommendations for other teams are provided. © The Author(s) 2013.

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Health Care in Canada

Decision maker perceptions of resource allocation processes in Canadian health care organizations: a national survey.
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Smith N, Mitton C, Bryan S, Davidson A, Urquhart B, Gibson JL, et al.
BMC health services research 2013 Jul 2;13(1):247

BACKGROUND: Resource allocation is a key challenge for healthcare decision makers. While several case studies of organizational practice exist, there have been few large-scale cross-organization comparisons. METHODS: Between January and April 2011, we conducted an on-line survey of senior decision makers within regional health authorities (and closely equivalent organizations) across all Canadian provinces and territories. We received returns from 92 individual managers, from 60 out of 89 organizations in total. The survey inquired about structures, process features, and behaviours related to organization-wide resource allocation decisions. We focus here on three main aspects: type of process, perceived fairness, and overall rating. RESULTS: About one-half of respondents indicated that their organization used a formal process for resource allocation, while the others reported that political or historical factors were predominant. Seventy percent (70%) of respondents self-reported that their resource allocation process was fair and just over one-half assessed their process as ‘good’ or ‘very good’. This paper explores these findings in greater detail and assesses them in context of the larger literature. CONCLUSION: Data from this large-scale cross-jurisdictional survey helps to illustrate common challenges and areas of positive performance among Canada’s health system leadership teams.

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Aging

Effect of a Person-Centered Mouth Care Intervention on Care Processes and Outcomes in Three Nursing Homes.
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Sloane PD, Zimmerman S, Chen X, Barrick AL, Poole P, Reed D, et al.
Journal of the American Geriatrics Society 2013 Jun 17

OBJECTIVES: To develop and test a person-centered, evidence-based mouth care program in nursing homes. DESIGN: Pre-post assessment, with an 8-week intervention period and a pilot 6-month extension at one site. SETTING: Three North Carolina nursing homes. PARTICIPANTS: Ninety-seven residents and six certified nursing assistants (CNAs). INTERVENTION: CNAs already working in the facilities were trained as dedicated mouth care aides. A psychologist and dental hygienist provided didactic and hands-on training in evidence-based mouth care products and techniques and in person-centered behavioral care. MEASUREMENTS: Primary outcome measures for natural teeth were the Plaque Index for Long-Term Care (PI-LTC) and Gingival Index for Long-Term Care(GI-LTC) and for dentures the Denture Plaque Index (DPI); a dentist unmasked to study design obtained measures. Secondary outcomes included quantity and quality of care provided. RESULTS: Outcome scores significantly improved (P < .001 for PI-LTC and GI-LTC; P = .04 for DPI). Coding of videotaped care episodes indicated that care was more thorough (P < .001-P = .03) but took more time (P < .001) after training. Consistency of care appeared to be more important for natural teeth than dentures. CONCLUSION: As little as 8 weeks of mouth care can significantly improve oral hygiene outcomes. Given the consequences of poor oral hygiene, greater attention to mouth care education and provision are merited. The dedicated worker model is controversial, and future work should assess whether other models of care are equally beneficial. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

Quality of End-of-Life Care of Long-Term Nursing Home Residents with and without Dementia.
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Li Q, Zheng NT, Temkin-Greener H.
Journal of the American Geriatrics Society 2013 Jun 17

OBJECTIVES: To describe the longitudinal patterns and the within- and between-facility differences in hospice use and in-hospital deaths between long-term nursing home (NH) residents with and without dementia. DESIGN: Retrospective analyses of secondary data sets from 2003 to 2007. SETTING: NHs in the United States. PARTICIPANTS: A total of 1,261,726 decedents in 16,347 NHs were included in 2003 to 2007 trend analysis and 236,619 decedents in 15,098 NHs in 2007 were included in the within- and between-facility analyses. MEASUREMENTS: Hospice use in the last 100 days of life and in-hospital deaths were outcome measures. Dementia was defined as having a diagnosis of Alzheimer’s disease or other dementia based on Minimum Data Set (MDS) health assessments. RESULTS: Overall hospice use increased from 25.6% in 2003 to 35.7% in 2007. During this time, hospice use for decedents with dementia increased from 25.1% to 36.5%, compared with an increase from 26.5% to 34.4% for decedents without dementia. The rate of in-hospital deaths remained virtually unchanged. Within the same facility, decedents with dementia were significantly more likely to use hospice (odds ratio (OR) = 1.07, 95% confidence interval (CI) = 1.04-1.11) and less likely to die in a hospital (OR = 0.76, 95% CI = 0.74-0.78). Decedents in NHs with higher dementia prevalence, regardless of individual dementia status, were more likely to use hospice (OR = 1.67, 95% CI = 1.22-2.27). CONCLUSION: NHs appear to provide less-aggressive end-of-life care to decedents with dementia than to those without. Although significantly more residents with dementia now receive hospice care at the end of life, the quality evaluation and monitoring of hospice programs have not been systematically conducted, and additional research in this area is warranted. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

Adverse events among Ontario home care clients associated with emergency room visit or hospitalization: a retrospective cohort study.
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Doran DM, Hirdes JP, Blais R, Baker GR, Poss JW, Li X, et al.
BMC health services research 2013 Jun 22;13(1):227

BACKGROUND: Home care (HC) is a critical component of the ongoing restructuring of healthcare in Canada. It impacts three dimensions of healthcare delivery: primary healthcare, chronic disease management, and aging at home strategies. The purpose of our study is to investigate a significant safety dimension of HC, the occurrence of adverse events and their related outcomes. The study reports on the incidence of HC adverse events, the magnitude of the events, the types of events that occur, and the consequences experienced by HC clients in the province of Ontario. METHODS: A retrospective cohort design was used, utilizing comprehensive secondary databases available for Ontario HC clients from the years 2008 and 2009. The data were derived from the Canadian Home Care Reporting System, the Hospital Discharge Abstract Database, the National Ambulatory Care Reporting System, the Ontario Mental Health Reporting System, and the Continuing Care Reporting System. Descriptive analysis was used to identify the type and frequency of the adverse events recorded and the consequences of the events. Logistic regression analysis was used to examine the association between the events and their consequences. RESULTS: The study found that the incident rate for adverse events for the HC clients included in the cohort was 13%. The most frequent adverse events identified in the databases were injurious falls, injuries from other than a fall, and medication-related incidents. With respect to outcomes, we determined that an injurious fall was associated with a significant increase in the odds of a client requiring long-term-care facility admission and of client death. We further determined that three types of events, delirium, sepsis, and medication-related incidents were associated directly with an increase in the odds of client death. CONCLUSIONS: Our study concludes that 13% of clients in homecare experience an adverse event annually. We also determined that an injurious fall was the most frequent of the adverse events and was associated with increased admission to long-term care or death. We recommend the use of tools that are presently available in Canada, such as the Resident Assessment Instrument and its Clinical Assessment Protocols, for assessing and mitigating the risk of an adverse event occurring.

Certified nursing assistants’ perception of pain in people with dementia: a hermeneutic enquiry in dementia care practice.
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Karlsson C, Sidenvall B, Bergh I, Ernsth-Bravell M.
Journal of clinical nursing 2013 Jul;22(13-14):1880-1889

AIMS AND OBJECTIVES: To interpret certified nursing assistants’ perception of pain in people with dementia in nursing care practice. BACKGROUND: Detection and understanding of pain in people with dementia remains a challenge due to their difficulty in verbalising their pain. Nursing assistants provide daily nursing care and therefore play a vital role in pain detection. Nevertheless, pain research from the nursing assistants’ perspective is sparse. DESIGN: A qualitative approach within the interpretive tradition was adopted. METHODS: Individual interviews with twelve certified nursing assistants, all working in dementia care, were conducted and interpreted using philosophical hermeneutics. RESULTS: Nursing assistants’ perception of pain is on three levels. Each level consists of a theme. The first theme ‘Being in the facing phase’ refers to the initial perception of the person’s expressions. The second theme ‘Being in the reflecting phase’ means ability to reflect more deeply on one’s perception, together with other colleagues and next of kins. The third theme ‘Being in the acting phase’ means perception arising from preventive and protective care focusing on contributing to well-being. The themes served as a basis for comprehensive understanding, where perception of pain arises from closeness, compassion and dialogue based on personhood, accompanied by professional knowledge of pain and dementia. CONCLUSION: Nursing assistants’ perception of pain is based on ethical concerns and on their own subjective pain experiences rather than on medical skills. Their perception derives from fundamental values that are important aspects of nursing care. Interdisciplinary solidarity may strengthen cooperation amongst CNAs and RNs to achieve best pain management practice. RELEVANCE TO CLINICAL PRACTICE: Attention to nursing assistants’ perception of pain needs to be highlighted when they are front-line staff and have developed important pain detection skills. Their skills are essential complements and must be used in the development of pain management in dementia care practice. © 2013 John Wiley & Sons Ltd.

Nurses’ Responses to Initial Moral Distress in Long-Term Care.
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Edwards MP, McClement SE, Read LR.
Journal of bioethical inquiry 2013 Jun 22

While researchers have examined the types of ethical issues that arise in long-term care, few studies have explored long-term care nurses’ experiences of moral distress and fewer still have examined responses to initial moral distress. Using an interpretive description approach, 15 nurses working in long-term care settings within one city in Canada were interviewed about their responses to experiences of initial moral distress, resources or supports they identified as helpful or potentially helpful in dealing with these situations, and factors that hindered nurses in their responses. Using a thematic analysis process, three major themes were identified from the nurses’ experiences: (i) the context of the situation matters; (ii) the value of coming together as a team; and (iii) looking for outside direction. The work of responding to initial moral distress was more fruitful if opportunities existed to discuss conflicts with other team members and if managers supported nurses in moving their concerns forward through meetings or conversations with the team, physician, or family. Access to objective others and opportunities for education about ethics were also identified as important for dealing with value conflicts.

Perception of quality of care among residents of public nursing-homes in Spain: a grounded theory study.
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Rodriguez-Martin B, Martinez-Andres M, Cervera-Monteagudo B, Notario-Pacheco B, Martinez-Vizcaino V.
BMC geriatrics 2013 Jun 28;13(1):65

BACKGROUND: The quality of care in nursing homes is weakly defined, and has traditionally focused on quantify nursing homes outputs and on comparison of nursing homes’ resources. Rarely the point of view of clients has been taken into account. The aim of this study was to ascertain what means “quality of care” for residents of nursing homes. METHODS: Grounded theory was used to design and analyze a qualitative study based on in-depth interviews with a theoretical sampling including 20 persons aged over 65 years with no cognitive impairment and eight proxy informants of residents with cognitive impairment, institutionalized at a public nursing home in Spain. RESULTS: Our analysis revealed that participants perceived the quality of care in two ways, as aspects related to the persons providing care and as institutional aspects of the care’s process. All the participants agreed that aspects related to the persons providing care was a pillar of quality, something that, in turn, embodied a series of emotional and technical professional competences. Regarding the institutional aspects of the care’s process, participants laid emphasis on round-the-clock access to health care services and on professional’s job stability. CONCLUSIONS: This paper includes perspectives of the nursing homes residents, which are largely absent. Incorporating residents’ standpoints as a complement to traditional institutional criteria would furnish health providers and funding agencies with key information when it came to designing action plans and interventions aimed at achieving excellence in health care.

Measures of frailty in population-based studies: an overview.
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Bouillon K, Kivimaki M, Hamer M, Sabia S, Fransson EI, Singh-Manoux A, et al.
BMC geriatrics 2013 Jun 21;13(1):64

BACKGROUND: Although research productivity in the field of frailty has risen exponentially in recent years, there remains a lack of consensus regarding the measurement of this syndrome. This overview offers three services: first, we provide a comprehensive catalogue of current frailty measures; second, we evaluate their reliability and validity; third, we report on their popularity of use. METHODS: In order to identify relevant publications, we searched MEDLINE (from its inception in 1948 to May 2011); scrutinized the reference sections of the retrieved articles; and consulted our own files. An indicator of the frequency of use of each frailty instrument was based on the number of times it had been utilized by investigators other than the originators. RESULTS: Of the initially retrieved 2,166 papers, 27 original articles described separate frailty scales. The number (range: 1 to 38) and type of items (range of domains: physical functioning, disability, disease, sensory impairment, cognition, nutrition, mood, and social support) included in the frailty instruments varied widely. Reliability and validity had been examined in only 26% (7/27) of the instruments. The predictive validity of these scales for mortality varied: for instance, hazard ratios/odds ratios (95% confidence interval) for mortality risk for frail relative to non-frail people ranged from 1.21 (0.78; 1.87) to 6.03 (3.00; 12.08) for the Phenotype of Frailty and 1.57 (1.41; 1.74) to 10.53 (7.06; 15.70) for the Frailty Index. Among the 150 papers which we found to have used at least one of the 27 frailty instruments, 69% (n = 104) reported on the Phenotype of Frailty, 12% (n = 18) on the Frailty Index, and 19% (n = 28) on one of the remaining 25 instruments. CONCLUSIONS: Although there are numerous frailty scales currently in use, reliability and validity have rarely been examined. The most evaluated and frequently used measure is the Phenotype of Frailty.

Managing Agitation Using Nonpharmacological Interventions for Seniors With Dementia.
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Janzen S, Zecevic AA, Kloseck M, Orange JB.
American Journal of Alzheimer’s Disease and Other Dementias 2013 Jun 27

Approximately 36 million people have Alzheimer’s disease worldwide, and many experience behavioral issues such as agitation. The purpose of this study was to investigate the perceptions of long-term care (LTC) staff regarding the current use of nonpharmacological interventions (NPIs) for reducing agitation in seniors with dementia and to identify facilitators and barriers that guide NPI implementation. Qualitative methods were used to gather data from interviews and focus groups. A total of 44 staff from 5 LTC facilities participated. Findings showed that both medications and NPIs are used for the management of agitation. The use of NPIs was facilitated by consistency in staffing, and the ability of all the staff members to implement them. Common barriers to NPI use included the perceived lack of time, low staff-to-resident ratios, and the unpredictable and short-lasting effectiveness of NPIs. This study offers insight into perceived factors that influence implementation of NPIs and the perceived effectiveness of NPIs.

A Control-Based Multidimensional Approach to the Role of Optimism in the Use of Dementia Day Care Services.
Non UofA Access
Contador I, Fernandez-Calvo B, Palenzuela DL, Campos FR, Rivera-Navarro J, Lucena VM.
American Journal of Alzheimer’s Disease and Other Dementias 2013 Jul 9

We examined whether grounded optimism and external locus of control are associated with admission to dementia day care centers (DCCs). A total of 130 informal caregivers were recruited from the Alzheimer’s Association in Salamanca (northwest Spain). All caregivers completed an assessment protocol that included the Battery of Generalized Expectancies of Control Scales (BEEGC-20, acronym in Spanish) as well as depression and burden measures. The decision of the care setting at baseline assessment (own home vs DCC) was considered the main outcome measure in the logistic regression analyses. Grounded optimism was a preventive factor for admission (odds ratio [OR]: 0.34 and confidence interval [CI]: 0.15-0.75), whereas external locus of control (OR: 2.75, CI: 1.25-6.03) increased the probabilities of using DCCs. Depression mediated the relationship between optimism and DCCs, but this effect was not consistent for burden. Grounded optimism promotes the extension of care at home for patients with dementia.

Coping Strategy and Caregiver Burden Among Caregivers of Patients With Dementia.
Non UofA Access
Huang MF, Huang WH, Su YC, Hou SY, Chen HM, Yeh YC, et al.
American Journal of Alzheimer’s Disease and Other Dementias 2013 Jun 29

This study aims to examine whether coping strategies employed by caregivers are related to distinct symptoms of patients with dementia and to investigate the associations between burden and coping among caregivers of patients with dementia.MethodsA cross-sectional study design was used. A total of 57 caregivers of patients with dementia were enrolled. Coping strategies were assessed using the Ways of Coping Checklist, and burden was assessed using the Chinese version of Caregiver Burden Inventory. Correlations between coping and patients’ behavior or memory problems were examined. Severities of behavior and memory problems were adjusted to examine the correlations between caregiver burden and coping strategies.ResultsThe patients’ disruptive behavior problems were associated with avoidance, and depression problems were associated with avoidance and wishful thinking. After adjusting for severity of behavior problems, coping strategies using avoidance were positively correlated with caregiver burden.ConclusionsEmotion-focused coping strategies are a marker of caregiver burden.

Safe home program: a suite of technologies to support extended home care of persons with dementia.
Non UofA Access
McKenzie B, Bowen ME, Keys K, Bulat T.
American Journal of Alzheimer’s Disease and Other Dementias 2013 Jun;28(4):348-354

Objective: To report the implementation/adoption of the Safe Home Program to support caregivers of persons with dementia in (1) ongoing surveillance, (2) provision of care, (3) prevention of injuries, and (4) improving home safety. Methods: For this demonstration project 4 assessment questionnaires (Safety Assessment Scale, Vigilance Scale, Peace of Mind Scale, and Sleep Disorders Inventory) were administered to each dyad to understand their technological needs. After identification and installation of appropriate technologies and education of the caregiver, a final visit (at 3 months) determined whether technologies were useful and being used. Results: The majority of caregivers utilized technologies for ongoing surveillance; other technologies included an identification program and medication organizer. Conclusion: Technologies focused on ongoing surveillance for persons with dementia at the home are needed. These technologies could be quickly adopted by caregivers to ameliorate some of the stress and burden associated with providing care for persons with dementia.

Portraits of people with dementia: three case studies of creating portraits.
Non UofA Access
Webster G, Fels D.
American Journal of Alzheimer’s Disease and Other Dementias 2013 Jun;28(4):371-376

Communication difficulties associated with late-stage dementia can make it difficult for care staff in residential environments to get to know people with dementia. This lack of knowledge can have a negative effect on the social environment of residential facilities, which can have a detrimental effect on the health and well-being of the residents and the job satisfaction of the staff. In this article, we discuss the creation of portraits of people with dementia to aid care staff in understanding the individual. The major findings of these case studies include that it is possible for families to create portraits of their relatives within a relatively short period of time and families found the process enjoyable and a good trigger for reminiscence.

Impact of Dementia Progression on Food-Related Processes: A Qualitative Study of Caregivers’ Perspectives.
Non UofA Access
Papachristou I, Ussher M, Giatra N.
American Journal of Alzheimer’s Disease and Other Dementias 2013 Jun 30

As dementia progresses, one area that can help maintain connection and memories with others is within the food domain. There is little research in this area particularly from the informal caregivers’ perspectives. Therefore, a qualitative study was conducted to explore the impact of dementia progression on food-related processes from the perspectives of informal caregivers. The aim of the study was to document the methodology used and to disseminate the findings to researchers, care providers, and policy makers. A total of 10 men and 10 women caregivers of those with dementia underwent a semistructured interview. Transcripts were analyzed using thematic analysis. The caregivers’ narratives indicated a set pattern of decline, with food shopping being the first ability to decline, followed by food preparation and the ability to eat. Caregivers adapted to their food roles, for example, by becoming responsible for financial issues. These adaptations were described as stressful yet satisfying as food care was seen as an important social time. Educating caregivers’ about the likely adaptations to food processes may increase food satisfaction in both the parties.

Peer Support for Carers: A Qualitative Investigation of the Experiences of Carers and Peer Volunteers.
Non UofA Access
Greenwood N, Habibi R, Mackenzie A, Drennan V, Easton N.
American Journal of Alzheimer’s Disease and Other Dementias 2013 Jun 30

Being a carer of someone with dementia can be rewarding and also challenging. Volunteer peer support schemes for carers are being introduced, little is known about either their impact on carers and volunteers or about volunteers’ and carers’ experiences. This study investigated peer volunteer and carer recipient experiences of a peer support service. Thematic analysis of 13 in-depth interviews with 9 carers and 4 peer volunteers revealed that peer support helped both carers and peer volunteers through the realization that they were “not alone” in their experiences and emotions. Additional carer benefits included opportunities to talk freely about difficult experiences and learning how others cope. Volunteers found their role rewarding, describing satisfaction from putting their own experiences to good use. These findings highlight the isolation and exclusion experienced by current and former carers of people with dementia and draw attention to the benefits of peer support for both the groups.

‘Familiarity’ as a key factor influencing rural family carers’ experience of the nursing home placement of an older relative: a qualitative study.
Non UofA Access
Ryan A, McKenna H.
BMC health services research 2013 Jul 3;13:252-6963-13-252

BACKGROUND: Admission to a nursing home is generally regarded as a stressful time for older people and their carers. Although the choice of home is significant in facilitating a more positive transition, few studies have explored this issue in detail, particularly in the context of rural communities. With a worldwide ageing population and an increasing demand for long-term care facilities, it is important to highlight the factors that can improve the experience of entry to long-term care and the role of nursing home staff in facilitating a more positive transition for older people and their families. METHODS: The overall aim of this qualitative study was to explore rural family carers’ experience of the nursing home placement of an older relative. Semi structured interviews were conducted with 29 relatives of nursing home residents. Participants were selected from a large health and social care trust in the United Kingdom. Data were analysed using grounded theory principles and procedures and NVivo software. RESULTS: Rural family carers had a strong sense of familiarity with the nursing homes in their area and this appeared to permeate all aspects of their experience. Carers who reported a high degree of familiarity appeared to experience a more positive transition than others. This familiarity was influenced by the high degree of social capital that was present in the rural community where the study was conducted. This familiarity, in turn, influenced the choice of nursing home and the responses of family carers. The theory that emerged suggests that familiarity was the key factor influencing rural family carers’ experience of the nursing home placement of an older relative. CONCLUSIONS: The population of the world is ageing and nursing homes are increasingly providing care to older people with multiple and complex needs. This study makes an important contribution to the ways in which the move to long term care can be managed more effectively by increasing awareness of the importance of familiarity, stability and social capital in the lives of older people and their carers.

Agitation in Nursing Home Residents With Dementia (VIDEANT Trial): Effects of a Cluster-Randomized, Controlled, Guideline Implementation Trial.
Non UofA Access
Rapp MA, Mell T, Majic T, Treusch Y, Nordheim J, Niemann-Mirmehdi M, et al.
Journal of the American Medical Directors Association 2013 Jul 1

OBJECTIVE: To test the effect of a complex guideline-based intervention on agitation and psychotropic prescriptions. DESIGN, SETTING, PARTICIPANTS: Cluster randomized controlled trial (VIDEANT) with blinded assessment of outcome in 18 nursing homes in Berlin, Germany, comprising 304 dementia patients. INTERVENTION: Training, support, and activity therapy intervention, delivered at the level of each nursing home, focusing on the management of agitation in dementia. Control group nursing homes received treatment as usual. MEASUREMENTS: Levels of agitated and disruptive behavior (Cohen-Mansfield agitation inventory [CMAI]) as the primary outcome. Number of neuroleptics, antidepressants, and cholinesterase inhibitors (ChEIs) prescribed in defined daily dosages (DDDs). RESULTS: Of 326 patients screened, 304 (93.3%) were eligible and cluster-randomized to 9 intervention (n = 163) and 9 control (n = 141) nursing homes. Data were collected from 287 (94.4%) patients at 10 months. At 10 months, compared with controls, nursing home residents with dementia in the intervention group exhibited significantly less agitation as measured with the CMAI (adjusted mean difference, 6.24; 95% CI 2.03-14.14; P = .009; Cohen’s d = 0.43), received fewer neuroleptics (P < .05), more ChEIs (P < .05), and more antidepressants (P < .05). CONCLUSION: Complex guideline-based interventions are effective in reducing agitated and disruptive behavior in nursing home residents with dementia. At the same time, increased prescription of ChEIs and antidepressants together with decreased neuroleptic prescription suggests an effect toward guideline-based pharmacotherapy. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

The character of behavioural symptoms on admission to three Canadian long-term care homes.
Non UofA Access
Brazil K, Maitland J, Walker M, Curtis A.
Aging & mental health 2013 Jun 18

Objectives: We determined the prevalence and nature of behavioural symptoms at the time of admission to a long-term care home (LTCH) and occurrence of resident-to-resident aggressive behaviour associated with behavioural symptoms within three months following admission. Method: The Cohen-Mansfield Agitation Inventory and Aggressive Behaviour Scale were completed at the time residents were admitted into the LTCH. A chart review, conducted three months after admission into the LTCH, abstracted documented resident-to-resident aggression. Three LTCHs located in Ontario, Canada participated in the study. Results: During a 16-month period, 339 individuals admitted to the LTCHs comprised the study sample. A comparison was made between residents with and without dementia. At admission, residents with dementia had a greater number of behavioural symptoms than those without dementia (mean = 3.79, SD = 3.32 versus mean = 2.56, SD = 2.24, respectively; t(200) = 1.91; p = 0.059). Residents with and without dementia exhibited similar behaviours but differed on the prevalence of these behaviours. The most frequently reported behavioural symptoms for residents in both groups were verbal agitation and non-aggressive physical behaviours. The most frequently recorded aggressive behaviour for all residents was ‘resisting care’. In the three months post admission, 79 (23%) residents were involved in a documented incident that involved aggressive behaviour to another resident. Conclusion: A standardized comprehensive assessment for admission to a LTCH is an important strategy that can be used to identify behavioural symptoms and plan appropriate care management.

Does case conferencing for people with advanced dementia living in nursing homes improve care outcomes: Evidence from an integrative review?
Non UofA Access
Phillips JL, West PA, Davidson PM, Agar M.
International journal of nursing studies 2013 Aug;50(8):1122-1135

OBJECTIVE: This integrative review aimed to appraise the evidence for case conferencing as an intervention to improve palliative care outcomes for older people living with advanced dementia in nursing homes. DESIGN: An integrative review of English language citations from CINHAL, MEDLINE, PSYCHINFO and CareSearch using a palliative care filter was undertaken. Two reviewers screened 238 titles to find 77 relevant articles which were reviewed in detail to identify nine studies that addressed the specific review questions. The analysis process allowed study characteristics, process and outcome measures along with implementation barriers and facilitators to be identified and the results synthesised. RESULTS: The highest level of evidence (Level II) was generated by two randomised controlled case conferencing trials which demonstrated enhance medication management for people with dementia living in a nursing home. Several pre-post test studies suggest that case conferencing enhances palliative symptom management and care outcomes in nursing homes. Qualitative evidence suggests that case conferencing is feasible and worthwhile if the identified barriers are addressed and the facilitators optimised. CONCLUSIONS: Case conferencing provides opportunities to improve care palliative care outcomes for older people with dementia by engaging family and all relevant internal and external health providers in prospective care planning. More evidence is needed to determine the efficacy and cost-effectiveness of case conferencing as a strategy for improving care outcomes for older people living with advanced dementia in nursing homes. The evidence generated by this integrative review will be of interest to policy makers, aged care organisations and clinicians alike, especially as services endeavour to meet the increasingly complex care needs of older people admitted to nursing homes with advanced dementia, and the needs of their families. Copyright © 2012 Elsevier Ltd. All rights reserved.

OECD: Public Spending on Health and Long-term Care A new set of projections
June 2013

This paper proposes a new set of public health and long-term care expenditure projections till 2060, following up on the previous set of projections published in 2006. It disentangles health from longterm care expenditure as well as the demographic from the non-demographic drivers, and refines the previous methodology, in particular by better identifying the underlying determinants of health and long-term care spending and by extending the country coverage to include BRIICS countries. A costcontainment and a cost-pressure scenario are provided together with sensitivity analysis. On average across OECD countries, total health and long-term care expenditure is projected to increase by 3.3 and 7.7 percentage points of GDP between 2010 and 2060 in the cost-containment and the cost-pressure scenarios respectively. For the BRIICS over the same period, it is projected to increase by 2.8 and 7.3 percentage points of GDP in the cost-containment and the cost-pressure scenarios respectively.

OECD: Addressing the Global Challenge of Alzheimer’s
June 2013

The economic and social impact of chronic brain disorders (CBD) such as Alzheimer’s disease (AD) and other neurodegenerative diseases will become the number one public-health problem worldwide, directly affecting 100 million people by 2050. On-going demographic trends, namely ageing populations worldwide, are leading to the unprecedented expansion of consumer demand for healthcare services. Healthcare systems worldwide soon will confront a serious crisis as a result of significant growth of the healthcare market, in a climate of shrinking resources.

KPMG: An uncertain age: Reimagining long term care in the 21st century
July 2013

With the number of people aged 60 and over expected to double to two billion in the next 40 years, the world’s population is aging at an unprecedented rate – an urgent issue that societies and healthcare systems simply cannot afford to ignore. Few, if any, societies have truly faced up to the magnitude of the long-term elderly care crisis. If this system fails it will have devastating consequences for elderly individuals, their families, the economy and wider society. Without swift action, such a gloomy outlook is probable rather than possible. KPMG has brought together comments and opinions from 46 thought leaders, professionals and practitioners in the aged care sector in selected countries, including Canada.

CPSI: Safety at Home: A Pan-Canadian Home Care Study
Doran D, Blais R

Home care (HC) is an integral component of the ongoing restructuring of healthcare in Canada. Its continuing growth as a care option is accompanied by an increasing awareness of unique issues related to client safety in the HC context. The occurrence of an adverse event (AE) is a safety issue that has been well documented with respect to patients in acute care settings; however, there are only limited data available about safety problems experienced by clients in HC settings. The Safety at Home study was initiated to address this knowledge gap..

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News

Community Hospital to open Central New York’s first emergency room for the elderly

Syracuse, N.Y.’s Community Hospital is joining a fast growing trend among U.S. hospitals by opening the area’s first emergency room for the elderly designed to be peaceful, quiet and focused on getting patients home instead of admitting them.

CFHI teams up with Institute for Healthcare Improvement of U.S.

The intent of this relationship is to tailor healthcare improvement workshops and learning collaborations developed by IHI to the Canadian healthcare landscape, strengthening the ability of both organizations to address major health system challenges.

Families bear burden of care for seniors, says expert

Family members are carrying the majority of the burden when it comes to caring for Waterloo region’s aging population, says a prominent home care researcher.

‘Hugs, not drugs’ works for seniors with dementia

With the number of dementia cases in B.C. expected to increase 47 per cent by 2026, the residential care sector is acting upon the urgent need to collectively reduce the overreliance on anti-psychotic drugs.

MDS 3.0: Looking Back, Looking Forward A review of critical updates to the RAI user’s manual.

More than 225 pages of the manual are affected by the May update. They include many inconsequential changes to wording, punctuation, and capitalization. But there are also a significant number of clarifications that affect facility staff who care for residents and interdisciplinary team members who code the MDS.

Pace of innovation for Alzheimer’s and dementia needs to accelerate, says OECD, and governments need to help it along

Alzheimer’s afflicts one in eight over 65 and one-half of all those over 85, and the economic, social and personal costs will only increase with age-related demographic change. In 2010, the global cost of Alzheimer’s and dementias equalled 1 percent of global gross domestic product (GDP), or $604 billion. The prevalence and cost, combined with the stigma, which prevents recognition of symptoms and subsequent treatments, signal an urgent call to action.

Redefining Dementia in Denmark

This is an interesting radio report from CBC’s The Sunday Edition about Denmark’s approach towards dementia care. The world looks to Denmark — where it is illegal to imprison people with dementia in locked wards; where nursing homes regularly take their people on holiday, and where people with dementia are asked what they want to do today.

AHRQ: Enhancing the Management of Neuropathic Pain in the Long-Term Care Setting toolkit

The toolkit has outlined a three step process to manage pain that includes: setting goals; educating and training staff on best practices and administering a pain reassessment. All three steps are described in detail in the toolkit, and provided alongside data collection sheets and calculation measurements.

A preliminary report on the recently issued BC health research strategy survey is now available for download

The summary report represents the first phase of feedback on the BC health research strategy survey.

UAlberta researchers develop application for home health care aides

A group of researchers from the University of Alberta, funded by Alberta Health and Wellness, have created a mobile application for tablets that uses a cloud-based service to schedule appointments and record the prescribed care plan. In a study carried out in 2012, the touchpad resource allowed health care aides to stay in touch with the patients’ health care team, in simulated offsite visits to client educators.

UK Healthcare assistants ‘should get standard training’

There is no minimum standard of training for healthcare assistants before they can work unsupervised, an independent report has found. Workers should get at least two weeks’ training to prepare them for providing basic care in hospitals, care homes and at home in England, its author said.

Health service researchers – are we blind to our own conflicts of interest?

Those of us who are health services researchers tend to under-appreciate the potential impact that government funding has upon our willingness to speak entirely freely in public about health policy issues.

Caustic volleys and the sting of peer review: what’s the solution?

Greg Petsko looks at some of the frustrations authors experience in publishing their research, and some possible solutions.

Alberta Health minister orders review of home-care changes

Health Minister Fred Horne has asked Janet Davidson, the new AHS official administrator, to review the health authority’s plan to dramatically scale back the number of home-care providers it hires in the Edmonton and Calgary areas.

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Resources

AHRQ: Practice Facilitation Handbook

The Practice Facilitator’s Handbook is designed to assist in the training of new practice facilitators as they begin to develop the knowledge and skills needed to support meaningful improvement in primary care practices.

AHRQ: Get the Clinical Bottom Line

AHRQ’s Effective Health Care (EHC) Program provides free research summaries that support clinicians in the practice of evidence-based medicine. The summaries are concise, unbiased, and practical, providing reliable comparisons on the benefits and risks of treatments for many chronic conditions.

Research Data Canada Launched

Research Data Canada is a collaborative effort to address the challenges and issues surrounding the access and preservation of data arising from Canadian research. This multi-disciplinary group of universities, institutes, libraries, granting agencies, and individual researchers has a shared recognition of the pressing need to deal with Canadian data management issues from a national perspective.

Decision Aid: Improving Decision-Making about Feeding Options in Dementia

This video from the University of North Carolina website will be of help to family caregivers when making decisions about feeding options for their loved ones with advanced dementia

Quality Compass

Organized by Health Quality Ontario, Quality Compass is an online searchable tool to help health system leaders and healthcare providers improve performance. Quality Compass focuses on best practices and quality indicators, targets and measures, along with tools and resources to bridge care gaps and improve the uptake of best practices. While certain features are aimed at Ontario health care organizations, many of the indicators, tools, and evidence from best practices can be applied in other jurisdictions.

Alzheimer’s Navigator

A new online designed specifically to guide individuals with Alzheimer’s, their families and caregivers through the disease. By answering a series of questions, this tool evaluates individual needs and determines a customized action plan. Every step is individually designed based on the individual’s answers, and creates a unique roadmap.

Quality of Life Outcomes for People with Alzheimer’s Disease and Related Dementia: Care Planning Tool

This guide provides good practice examples and measurable indicators to support quality of life. Written by the Wisconsin Statewide Advisory Committee on Quality of Life Outcomes for People with Alzheimer’s Disease and Related Dementia, the tool is meant to be used by care providers, caregivers and persons with cognitive impairment as a way to plan for a good quality of life as the disease progresses.

When Aggression Follows Dementia

This article reviews common strategies for dealing with aggression.

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