New Article by Drs. Susan Salughter, Carole Estabrooks, and Adrian Wagg
Sustaining Transfers through Affordable Research Translation (START): study protocol to assess knowledge translation interventions in continuing care settings.
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Slaughter SE, Estabrooks CA, Jones CA, Wagg AS, Eliasziw M.
Trials 2013 Oct 26;14(1):355
Bridging the research-practice gap is an important research focus in continuing care facilities, because the population of older adults (aged 65 years and over) requiring continuing care services is the fastest growing demographic among countries in the Organisation for Economic Co-operation and Development (OECD). Unlicensed practitioners, known as health care aides, provide the majority of care for residents living in continuing care facilities. However, little research examines how to sustain health care aide behavior change following initial adoption of current research evidence.Methods/designWe will conduct a phase III, multicentre, cluster randomized controlled trial (RCT) using a stratified 2 x 2 additive factorial design, including an embedded process evaluation, in 24 supportive living facilities within the health zone of Edmonton, AB, Canada. We will determine which combination of frequency and intensity of reminders most effectively sustains the completion of the sit-to-stand activity by health care aides with residents. Frequency refers to how often a reminder is implemented; intensity refers to whether a reminder is social or paper-based. We will compare monthly reminders with reminders implemented every 3 months, and we will compare low intensity, paper-based reminders and high intensity reminders provided by a health care aide peer.Using interviews, questionnaires, and observations, Sustaining Transfers through Affordable Research Translation (START) will evaluate the processes that inhibit or promote the mobility innovation’s sustainability among health care aides in daily practice. We will examine how the reminders are implemented and perceived by health care aides and licensed practical nurses, as well as how health care aides providing peer reminders are identified, received by their peers, and supported by their supervisors. DISCUSSION: START will connect up-to-date innovation research with the practice of health care aides providing direct care to a growing population of older Albertans. The project’s reach extends to both supportive living and long-term care settings. Furthermore, START has the potential to introduce and sustain a broad range of innovations in various care areas, such as dementia care, wound care, and pain management — domains where the uptake and sustainability of innovations also encounter significant challenges. By identifying the optimal frequency and intensity of knowledge translation interventions, we hope to enable continuing care organizations to efficiently integrate care innovations into the day-to-day care of residents.Trial registrationClinicalTrials.gov: NCT01746459.
Article recommended by Dr. Carole Estabrooks
Assessing Ontario’s Personal Support Worker Registry
Laporte A, Rudoler D.
Health Reform Observer-Observatoire des Réformes de Santé;2013:1(2)
In response to the growing role of personal support workers (PSWs) in the delivery of health care services to Ontarians, the Ontario government has moved forward with the creation of a PSW registry. This registry will be mandatory for all PSWs employed by publicly funded health care employers, and has the stated objectives of better highlighting the work that PSWs do in Ontario, providing a platform for PSWs and employers to more easily access the labour market, and to provide government with information for human resources planning. In this paper we consider the factors that brought the creation of a PSW registry onto the Ontario government’s policy agenda, discuss how the registry is being implemented, and provide an analysis of the strengths and weaknesses of this policy change.
CALL FOR POSTERS: CapitalCare People & Progress Continuing Care Conference
6-7 February 2014 Edmonton
DEADLINE 15 November 2013
This year’s continuing care conference promises to fuel the persistence, resilience and creativity leaders need to become inspirational leaders. It is a time for leaders to come together to learn new approaches to common challenges and become energized by the networking opportunities afforded by taking time away from their day-to-day activities. Submission form is available here
CALL FOR ABSTRACTS: Canadian Agency for Drugs and Technologies in Health 2014 Symposium
6-8 April 2014 Gatineau PQ
The 2014 CADTH Symposium Program Committee invites submissions of abstracts for panel sessions and oral and poster presentations that are related to the theme of “The Realities of Health Care Decision-Making: Evidence, Values, and Collaboration”or that are of significant interest to producers and users of evidence-based information and advice on health technologies.
Grants & Awards
Scholarship opportunity for trainees involved in arts & health
DEADLINE 15 November 2013
A $1000 scholarship from the Global Alliance for Arts & Health is available for a student who has made a contribution to the field of arts in healthcare or shows significant interest in the field of arts in healthcare as a future career.
Enhanced implementation of low back pain guidelines in general practice: study protocol of a cluster randomised controlled trial.
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Riis A, Jensen CE, Bro F, Maindal HT, Petersen KD, Jensen MB.
Implementation science 2013 Oct 20;8(1):124
The aim of this study is to evaluate whether a complex, multifaceted implementation strategy of the low back pain guidelines will reduce secondary care referral and improve patient outcomes compared to the usual simple implementation strategy.Methods/design: In a two-armed cluster randomised trial, 100 general practices (clusters) and 2,700 patients aged 18 to 65 years from the North Denmark region will be included. Practices are randomly allocated 1:1 to a simple or a complex implementation strategy. Intervention practices will receive a complex implementation strategy, including guideline facilitator visits, stratification tools, and quality reports on low back pain treatment. Primary outcome is referral to secondary care. Secondary outcomes are pain, physical function, health-related quality of life, patient satisfaction with care and treatment outcome, employment status, and sick leave. Primary and secondary outcomes pertain to the patient level.
Wikis and Collaborative Writing Applications in Health Care: A Scoping Review.
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Archambault PM, van de Belt TH, Grajales Iii FJ, Faber MJ, Kuziemsky CE, Gagnon S, et al.
Journal of medical Internet research 2013 Oct 8;15(10):e210
Collaborative writing applications (eg, wikis and Google Documents) hold the potential to improve the use of evidence in both public health and health care. The rapid rise in their use has created the need for a systematic synthesis of the evidence of their impact as knowledge translation (KT) tools in the health care sector and for an inventory of the factors that affect their use. We identified 48 barriers and 91 facilitators in 4 major themes (factors related to the CWA, users’ knowledge and attitude towards CWAs, human environment, and organizational environment). We also found 57 positive and 23 negative effects that we classified into processes and outcomes. Although we found some experimental and quasi-experimental studies of the effectiveness and safety of CWAs as educational and KT interventions, the vast majority of included studies were observational case studies about CWAs being used by health professionals and patients. More primary research is needed to find ways to address the different barriers to their use and to make these applications more useful for different stakeholders.
Evidence-based health information from the users’ perspective – a qualitative analysis
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Hirschberg I, Seidel G, Strech D, Bastian H, Dierks ML.
BMC health services research 2013 Oct 10;13(1):405
This study is based on an external user evaluation of EBHI produced by the German Institute for Quality and Efficiency in Health Care (IQWiG), commissioned by the IQWiG. The EBHI were examined within guided group discussions, carried out with lay people. The test readers’ first impressions and their appraisal of the informational content, presentation, structure, comprehensibility and effect were gathered. Then a qualitative text analysis of 25 discussion transcripts involving 94 test readers was performed. Based on the qualitative text analysis a framework for reaction patterns was developed, comprising eight main categories: (i) interest, (ii) satisfaction, (iii) reassurance and trust, (iv) activation, (v) disinterest, (vi) dissatisfaction and disappointment, (vii) anxiety and worry, (viii) doubt. CONCLUSIONS: Many lay people are unfamiliar with core characteristics of this special information type. Two particularly critical issues are the description of insufficient evidence and the attendant absence of clear-cut recommendations.
Factors contributing to evidence-based pressure ulcer prevention. A cross-sectional study.
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Sving E, Idvall E, Hogberg H, Gunningberg L.
International journal of nursing studies 2013 Oct 4
A one-day prevalence study was conducted using the methodology specified by the European Pressure Ulcer Advisory Panel, together with the established methods used by the Collaborative Alliance for Nursing Outcomes. Patients at risk of developing pressure ulcers (Braden<17) had higher odds of having risk assessment documented, and of receiving pressure-reducing mattresses and planned repositioning. Patients at the general hospital were less likely to have risk and skin assessment documented and to receive pressure-reducing mattresses. On the other hand, planned repositioning was more likely to be used at the general hospital. When total hours of nursing care was lower, patients had higher odds of having pressure-reducing mattresses but were less likely to have planned repositioning. Copyright © 2013 Elsevier Ltd. All rights reserved.
Application of the Antipsychotic Use in Dementia Assessment audit tool to facilitate appropriate antipsychotic use in long term care residents with dementia.
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Watson-Wolfe K, Galik E, Klinedinst J, Brandt N.
Geriatric nursing (New York, N.Y.) 2013 Oct 16
Approximately 25% of all nursing home residents take antipsychotics for behavioral disturbances, despite limited efficacy and warnings against their use. The purpose of this quality improvement project was to test the utility of an educational in-service to facilitate the appropriate use of antipsychotics for nursing home residents with dementia. A single group pre/post design targeting the reduction of antipsychotic medications in older adults was guided by Rogers’ Diffusion of Innovations theory. Descriptive analyses were done to evaluate antipsychotic use and supporting documentation at baseline and 2 months following an educational intervention that focused on appropriate antipsychotic use, documentation requirements and non-pharmacologic interventions. The prescribing rate for antipsychotics showed a reduction from 20.3% to 15.4% and nursing documentation of non-pharmacological interventions increased from 16.7% to 75%. Assuring appropriate use of antipsychotics is currently mandated and is consistent with high quality, person centered care. This simple, yet individualized educational intervention and assessment can serve as a model for use in other long term care facilities. Copyright © 2013 Mosby, Inc. All rights reserved.
“Us and Them”: a social network analysis of physicians’ professional networks and their attitudes towards EBM.
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Mascia D, Cicchetti A, Damiani G.
BMC health services research 2013 Oct 22;13(1):429
Data pertain to a sample of Italian physicians, whose professional network relationships, demographics and work-profile characteristics were collected. A social network analysis was performed to capture the structural importance of physicians in the collaboration network by the means of a core-periphery analysis and the computation of network centrality indicators. Then, regression analysis was used to test the association between the network position of individual clinicians and their attitudes towards EBM. RESULTS: Findings documented that the overall network structure is made up of a dense cohesive core of physicians and of less connected clinicians who occupy the periphery. A negative association between the physicians’ attitudes towards EBM and the coreness they exhibited in the professional network was also found. Network centrality indicators confirmed these results documenting a negative association between physicians’ propensity to use EBM and their structural importance in the professional network.
Do knowledge brokers facilitate implementation of the stroke guideline in clinical practice?
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Willems M, Schroder C, Post M, van der Weijden T, Visser-Meily A.
BMC health services research 2013 Oct 23;13(1):434
This study includes a quantitative evaluation with a non controlled pre-post intervention design and a mixed methods process evaluation. From each stroke unit, an enterprising nurse and therapist will be recruited and trained as KB. The KB will work for one year on the implementation of the guideline recommendations in their team. To evaluate the effectiveness of the KB, a questionnaires will be administered to patients, health professionals and KBs at baseline (T0) and after one year (T1). Furthermore, semi structured interviews with 5 KBs will be performed at T1.The primary outcome of this implementation project is the support health professionals give patients to exercise and be physically active, as reported by patients and health professionals themselves. The support immediately after the intervention is compared with the support at the start of the intervention.Additionally we will explore the influence of socio-demographic characteristics of health professionals and determinants identified in the Theory of Planned Behavior (intention, attitude, subjective norm and perceived behavioral control) on the change of supportive behavior of health professionals. Finally, KBs will be complete a questionnaire on their own psychological and social demographic characteristics and on organizational conditions needed for health-care improvement such as time, workforce, sponsoring and support from management.
Assessing communities of practice in health policy: a conceptual framework as a first step towards empirical research.
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Bertone MP, Meessen B, Clarysse G, Hercot D, Kelley A, Kafando Y, et al.
Health research policy and systems / BioMed Central 2013 Oct 20;11(1):39
Communities of Practice (CoPs) are groups of people that interact regularly to deepen their knowledge on a specific topic. Thanks to information and communication technologies, CoPs can involve experts distributed across countries and adopt a ‘transnational’ membership. This has allowed the strategy to be applied to domains of knowledge such as health policy with a global perspective. CoPs represent a potentially valuable tool for producing and sharing explicit knowledge, as well as tacit knowledge and implementation practices. They may also be effective in creating links among the different ‘knowledge holders’ contributing to health policy (e.g., researchers, policymakers, technical assistants, practitioners, etc.).CoPs in global health are growing in number and activities. As a result, there is an increasing need to document their progress and evaluate their effectiveness. This paper represents a first step towards such empirical research as it aims to provide a conceptual framework for the analysis and assessment of transnational CoPs in health policy.The framework is developed based on the findings of a literature review as well as on our experience, and reflects the specific features and challenges of transnational CoPs in health policy. It organizes the key elements of CoPs into a logical flow that links available resources and the capacity to mobilize them, with knowledge management activities and the expansion of knowledge, with changes in policy and practice and, ultimately, with an improvement in health outcomes. Additionally, the paper addresses the challenges in the operationalization and empirical application of the framework.
Keys to Successfully Embedding Scientific Research in Nursing Homes: A Win-Win Perspective
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Verbeek H, Zwakhalen SMG, Schols JMGA, Hamers JPH.
Journal of the American Medical Directors Association 2013 10/28.
The quality of institutional care for older people has been criticized over the past decade and the International Association of Gerontology and Geriatrics and the World Health Organization have recently stressed the need for quality improvement initiatives in nursing homes.1 Both community and institutional care service systems face more complex care demands, as policies aim to enable people to live at home for as long as possible and provide institutional care services only in more advanced stages of their disease. The care complexity in nursing homes has thus increased tremendously over the past decades, not only caused by aggregated care needs of residents but also through technological and related health care innovations. Despite the increasing complexity of care, the number of well-trained staff is decreasing.2 Simultaneously, there is a strong need for the development and implementation of technology and evidence-based practice. Therefore, a solid interaction among clinical practice, education, and scientific research is badly needed, as a tradition of scientific research in nursing homes is lacking.
Limitations of medical research and evidence at the patient-clinician encounter scale.
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Morris AH, Ioannidis JP.
Chest 2013 Apr;143(4):1127-1135
We explore some philosophical and scientific underpinnings of clinical research and evidence at the patient-clinician encounter scale. Insufficient evidence and a common failure to use replicable and sound research methods limit us. Both patients and health care may be, in part, complex nonlinear chaotic systems, and predicting their outcomes is a challenge. When trustworthy (credible) evidence is lacking, making correct clinical choices is often a low-probability exercise. Thus, human (clinician) error and consequent injury to patients appear inevitable. Individual clinician decision-makers operate under the philosophical influence of Adam Smith’s “invisible hand” with resulting optimism that they will eventually make the right choices and cause health benefits. The presumption of an effective “invisible hand” operating in health-care delivery has supported a model in which individual clinicians struggle to practice medicine, as they see fit based on their own intuitions and preferences (and biases) despite the obvious complexity, errors, noise, and lack of evidence pervading the system. Not surprisingly, the “invisible hand” does not appear to produce the desired community health benefits. Obtaining a benefit at the patient-clinician encounter scale requires human (clinician) behavior modification. We believe that serious rethinking and restructuring of the clinical research and care delivery systems is necessary to assure the profession and the public that we continue to do more good than harm. We need to evaluate whether, and how, detailed decision-support tools may enable reproducible clinician behavior and beneficial use of evidence.
This document describes a strategic informational approach to improve public health and reduce inequalities. The strategy is focused around eight priorities for public health knowledge that support system-wide changes across England. It addresses the entire information lifecycle from understanding the requirements of those who are using public health knowledge through to what technologies PHE will use to disseminate knowledge.
Health Care Administration and Organization
Are Nursing Home Survey Deficiencies Higher in Facilities With Greater Staff Turnover.
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Lerner NB, Johantgen M, Trinkoff AM, Storr CL, Han K.
Journal of the American Medical Directors Association 2013 Oct 7
OBJECTIVES: To examine CNA and licensed nurse (RN+LPN/LVN) turnover in relation to numbers of deficiencies in nursing homes. RESULTS: High CNA turnover was associated with high numbers of Quality of Care (OR 1.53, 95% CI 1.10-2.13), Resident Behavior (OR 1.42, 95% CI 1.03-1.97) and total selected deficiencies (OR 1.54, 95% CI 1.12-2.12). Licensed nurse turnover was significantly related to Quality of Care deficiencies (OR 2.06, 95% CI 1.50-2.82) and total selected deficiencies (OR 1.71, 95% CI 1.25-2.33). When both CNA turnover and licensed nurse turnover were included in the same model, high licensed nurse turnover was significantly associated with Quality of Care and total deficiencies, whereas CNA turnover was not associated with that category of deficiencies. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.
The Influences of Computer System Success and Informatics Competencies on Organizational Impact in Nursing Environments.
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Lin HC, Hsu MH, Yang CW.
Computers, informatics, nursing 2013 Oct 15
The previous literature provides evidence that the characteristics of a successful computer system and the informatics competencies of individuals play a critical role in the adoption of information technology. However, while the combined effects of the two may provide a comprehensive view in understanding nursing informatics research, they have rarely been studied simultaneously. Therefore, this study aimed to examine the influences of computer system success and informatics competencies on nursing organizational impact. We surveyed 454 nurses who worked at international patient centers in Taiwan. The results show that both nurses’ informatics competencies and nursing computer system success do have influence on nursing organizational impact. Moreover, nurses’ informatics competencies have a greater effect than the superior characteristics of a nursing computer system on nursing organizational performance. Finally, implications for practitioners complete this study.
Applying workability in the Australian residential aged care context.
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Brooke E, Goodall J, Handrus M, Mawren D.
Australasian journal on ageing 2013 Jun;32(2):130-134
The study is based on an innovative demonstration project which trialled the implementation of the Finnish ‘workability’ framework and research measures. It aimed, firstly, to test the applicability of the Workability Index (WAI) to the Australian residential aged care workforce, focusing on personal care assistants (PCAs), and secondly, to assess the effectiveness of actions aimed at improving workability. The facility manager implemented multidimensional ‘actions’ according to the workability framework. The Workability Survey (WAS) and WAI and intervention instruments were administered (n = 64). Completed responses to ‘pre’ and ‘post’ instruments formed matched pairs (n = 15). WAI scores increased significantly, by 3 points on average, after all ‘actions’ were implemented. The only significant ‘action’ was increasing the number of PCAs in high care. Workability provides a useful research workforce development instrument measuring interactions between aged care workers and organisational demands and the outcomes of ‘actions’. © 2013 The Authors. Australasian Journal on Ageing © 2013 ACOTA.
Trends in Postacute Care and Staffing in US Nursing Homes, 2001-2010.
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Tyler DA, Feng Z, Leland NE, Gozalo P, Intrator O, Mor V.
Journal of the American Medical Directors Association 2013 Nov;14(11):817-820
The objective of this study was to document the growth of postacute care and contemporaneous staffing trends in US nursing homes over the decade 2001 to 2010. In freestanding nursing homes, all postacute care intensity measures increased considerably each year throughout the study period. In contrast, in hospital-based facilities, all but one of these measures decreased. Similarly, therapy staffing has risen substantially in freestanding homes but declined in hospital-based facilities. Postacute care case mix acuity appeared to correlate reasonably well with therapy staffing levels in both types of facilities. CONCLUSION: There has been a marked and steady shift toward postacute care in the nursing home industry in the past decade, primarily in freestanding facilities, accompanied by increased therapy staffing. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.
The effectiveness of an aged care specific leadership and management program on workforce, work environment, and care quality outcomes: design of a cluster randomised controlled trial.
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Jeon YH, Simpson JM, Chenoweth L, Cunich M, Kendig H.
Implementation science 2013 Oct 25;8(1):126
Twenty-four residential and community aged care sites were recruited as managers at each site agreed in writing to participate in the study and ensure that leaders allocated to the control arm would not be offered the intervention program. Sites undergoing major managerial or structural changes were excluded. The 24 sites were randomly allocated to receive the CLiAC program (intervention) or usual care (control), stratified by type (residential vs. community, six each for each arm). Treatment allocation was masked to assessors and staff of all participating sites. The objective is to establish the effectiveness of the CLiAC program in improving work environment, workforce retention, as well as care safety and quality, when compared to usual care. The primary outcomes are measures of work environment, care quality and safety, and staff turnover rates. Secondary outcomes include manager leadership capacity, staff absenteeism, intention to leave, stress levels, and job satisfaction. Differences between intervention and control groups will be analysed by researchers blinded to treatment allocation using linear regression of individual results adjusted for stratification and clustering by site (primary analysis), and additionally for baseline values and potential confounders (secondary analysis). Outcomes measured at the site level will be compared by cluster-level analysis. The overall costs and benefits of the program will also be assessed.
Health Care Innovation and Quality Assurance
Quality Improvement in Nursing Homes: Testing of an Alarm Elimination Program.
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Crogan NL, Dupler AE.
Journal of nursing care quality 2013 Oct 16
Falls are the most common cause of injury deaths and nonfatal injuries in older adults. In an effort to detect a resident’s movement, many nursing homes use bed or chair alarms to alert staff that the resident may get up and possibly fall. However, there is little evidence that bed or chair alarms prevent falls, and mounting evidence that alarms can impede the functional status and negatively impact feelings of dignity among older adults in nursing homes. The purpose of this article was to describe the development and pilot testing of an alarm elimination program for nursing homes. A program aimed at decreasing or eliminating the use of alarms may enhance quality of life of older adults in nursing homes.
Examining the lived experience of nursing home quality improvement: the case of a multifacility falls reduction project.
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Abrahamson K, Davila H, Mueller C, Inui T, Arling G.
Journal of gerontological nursing 2013 Sep;39(9):24-30;
We conducted a case study based on interviews with nursing home employees (staff and management) participating in a falls reduction project to better understand the lived experience of nursing home quality improvement. Our case study was part of an evaluation of an innovative pay-for-performance policy in the state of Minnesota. In-depth semi-structured interviews were conducted with 37 nursing home employees from within each of the 13 facilities participating in the successful falls reduction project. Our analysis focused on respondent perceptions of the quality improvement implementation process. Interview respondents noted the importance of organizational flexibility and adaptation to change; communication and connections between residents, family members, and staff; and the importance of input from diverse roles. Importantly, interview respondents noted changes that extended well beyond the domain of falls. Knowledge from this study highlights the experiences of care providers enacting change and potentially informs the development of management and program policies that encourage and reward quality nursing home care.
Copyright 2013, SLACK Incorporated.
Healthcare technologies, quality improvement programs and hospital organizational culture in Canadian hospitals.
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Tyagi RK, Cook L, Olson J, Belohlav J.
BMC health services research 2013 Oct 13;13(1):413
A cross-sectional study of Canadian hospitals was conducted in 2010. The sample consisted of hospital administrators that were selected by provincial review boards. The questionnaire consisted of 3 sections: 20 healthcare technology items, 16 quality improvement program items and 63 culture items. RESULTS: Rasch model analysis revealed that a hierarchy existed among the healthcare technologies based upon the difficulty of implementation. The results also showed a significant relationship existed between the ability to implement healthcare technologies and the number of quality improvement programs adopted. In addition, culture within a hospital served a mediating role in quality improvement programs adoption.
Making change last: applying the NHS institute for innovation and improvement sustainability model to healthcare improvement.
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Doyle C, Howe C, Woodcock T, Myron R, Phekoo K, McNicholas C, et al.
Implementation science 2013 Oct 26;8(1):127
The implementation of evidence-based treatments to deliver high-quality care is essential to meet the healthcare demands of aging populations. However, the sustainable application of recommended practice is difficult to achieve and variable outcomes well recognised. The NHS Institute for Innovation and Improvement Sustainability Model (SM) was designed to help healthcare teams recognise determinants of sustainability and take action to embed new practice in routine care. This article describes a formative evaluation of the application of the SM by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Northwest London (CLAHRC NWL).Data from project teams’ responses to the SM and formal reviews was used to assess acceptability of the SM and the extent to which it prompted teams to take action. Projects were classified as ‘engaged,’ ‘partially engaged’ and ‘non-engaged.’ Quarterly survey feedback data was used to explore reasons for variation in engagement. Score patterns were compared against formal review data and a ‘diversity of opinion’ measure was derived to assess response variance over time.Of the 19 teams, six were categorized as ‘engaged,’ six ‘partially engaged,’ and seven as ‘non-engaged.’ Twelve teams found the model acceptable to some extent. Diversity of opinion reduced over time. A minority of teams used the SM consistently to take action to promote sustainability but for the majority SM use was sporadic. Feedback from some team members indicates difficulty in understanding and applying the model and negative views regarding its usefulness.The SM is an important attempt to enable teams to systematically consider determinants of sustainability, provide timely data to assess progress, and prompt action to create conditions for sustained practice. Tools such as these need to be tested in healthcare settings to assess strengths and weaknesses and findings disseminated to aid development. This study indicates the SM provides a potentially useful approach to measuring teams’ views on the likelihood of sustainability and prompting action. Securing engagement of teams with the SM was challenging and redesign of elements may need to be considered. Capacity building and facilitation appears necessary for teams to effectively deploy the SM.
Study Protocol: Exploring scale-up, spread, and sustainability: an instrumental case study tracing an innovation to enhance dysphagia care
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Ilott I, Gerrish K, Pownall S, Eltringham S, Booth A.
Implementation science 2013 Oct 29;8(1):128
This case study is a prospective, longitudinal design using mixed methods. The fifteen-month (October 2012 to December 2013) instrumental case study is set in large, healthcare organisation in England. The innovation refers to introducing a nationally recognised, inter-disciplinary dysphagia competency framework to guide workforce development about fundamental aspects of care. Adoption and adaptation will be examined at an organisational level and along two, contrasting care pathways: stroke and fractured neck of femur. A number of educational interventions will be deployed, including training a cadre of trainers to cascade the essentials of dysphagia management and developing a Dysphagia Toolkit as a learning resource. Mixed methods will be used to investigate scale-up, spread, and sustainability in acute and community settings. A purposive sample of senior managers and clinical leaders will be interviewed to identify path dependency or the context specific particularities of implementation. A pre- and post-evaluation, using mealtime observations and a survey, will investigate the learning effect on staff adherence to patient specific dysphagia recommendations and attitudes towards dysphagia, respectively. Official documents and an ethnographic field journal allow critical junctures, temporal aspects and confounding factors to be explored.
Research Practice & Methodology
Creating and Supporting a Mixed Methods Health Services Research Team.
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Bowers B, Cohen LW, Elliot AE, Grabowski DC, Fishman NW, Sharkey SS, et al.
Health services research 2013 Oct 21
The Research Initiative Valuing Eldercare (THRIVE) team was organized by the Robert Wood Johnson Foundation to evaluate The Green House nursing home culture change program. This article describes the development of the research team and provides insights into how funders might engage with mixed methods research teams to maximize the value of the team. RESULTS: Like many mixed methods collaborations, the THRIVE team consisted of researchers from diverse disciplines, embracing diverse methodologies, and operating under a framework of nonhierarchical, shared leadership that required new collaborations, engagement, and commitment in the context of finite resources. Strategies to overcome these potential obstacles and achieve success included implementation of a Coordinating Center, dedicated time for planning and collaborating across researchers and methodologies, funded support for in-person meetings, and creative optimization of resources. © Health Research and Educational Trust.
A systematic review of cluster randomised trials in residential facilities for older people suggests how to improve quality.
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Diaz-Ordaz K, Froud R, Sheehan B, Eldridge S.
BMC medical research methodology 2013 Oct 22;13(1):127
Our aim was to assess the quality of cluster randomised trials conducted in residential facilities for older people, and to determine whether (1) statistician involvement in the trial and (2) strength of journal endorsement of the Consolidated Standards of Reporting Trials (CONSORT) statement influence quality. 73 trials met our inclusion criteria. Of these, 20 (27%) reported accounting for clustering in sample size calculations and 54 (74%) in the analyses. In 29 trials (40%), methods used to identify/recruit participants were judged by us to have potentially caused bias or reporting was unclear to reach a conclusion. Some elements of quality improved over time but this appeared not to be related to the publication of the extended CONSORT statement for these trials. Trials with statistician/epidemiologist co-authors were more likely to account for clustering in sample size calculations (unadjusted odds ratio 5.4, 95% confidence interval 1.1 to 26.0) and analyses (unadjusted OR 3.2, 1.2 to 8.5). Journal endorsement of the CONSORT statement was not associated with trial quality.
Quality of reporting of complex healthcare interventions and applicability of the CReDECI list – a survey of publications indexed in PubMed.
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Mohler R, Bartoszek G, Meyer G.
BMC medical research methodology 2013 Oct 19;13(1):125
Twenty-six publications on eight trials were included. The number of publications per trial ranged from 1 to 6 (mean 3.25). The trials demonstrate a good reporting quality for the criteria referring to the development and feasibility/piloting. For the criteria addressing the introduction of the intervention and the evaluation, quality of reporting varied widely. Two trials fulfilled 7 and 8 items respectively, five trials fulfilled one to five items and one trial offered no information on any item. The mean number of items with differing ratings per trial was two. The time needed to rate a trial ranged from 30 to 90 minutes, depending on the number of publications. CONCLUSIONS: Adherence to the MRC framework seems to have a positive impact on the reporting quality on the development and piloting of complex interventions. Reporting on the evaluation could be improved. CReDECI is a practical instrument to check the reporting quality of complex interventions and could be used alongside design-specific reporting guidelines.
Accessing health services through the back door: a qualitative interview study investigating reasons why people participate in health research in Canada.
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Townsend A, Cox SM.
BMC medical ethics 2013 Oct 12;14(1):40
This is a qualitative exploratory study informed by grounded theory strategies. Thirty-nine participants recruited in British Columbia and Manitoba, Canada, who had taken part in a diverse range of health research studies participated in semi-structured interviews. Participants described their experiences of health research participation including motivations for volunteering. Interviews were recorded, transcribed, and analyzed using constant comparisons. Coding and data management was supported by Nvivo-7. RESULTS: A predominant theme to emerge was ‘participation in health research to access health services.’ Participants described research as ways of accessing: (1) Medications that offered (hope of) relief; (2) better care; (3) technologies for monitoring health or illness. Participants perceived standard medical care to be a “trial and error” process akin to research, which further blurred the boundaries between research and treatment.
Recruiting clinical personnel as research participants: a framework for assessing feasibility
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Hysong SJ, Smitham KB, Knox M, Johnson KE, Sorelle R, Haidet P.
Implementation science 2013 Oct 24;8(1):125
Increasing numbers of research studies test interventions for clinicians in addition to or instead of interventions for patients. Although previous studies have enumerated barriers to patient enrolment in clinical trials, corresponding barriers have not been identified for enrolling clinicians as subjects. We propose a framework of metrics for evidence-based estimation of time and resources required for recruiting clinicians as research participants, and present an example from a federally funded study. Our framework proposes metrics for tracking five steps in the recruitment process: gaining entry into facilities, obtaining accurate eligibility and contact information, reaching busy clinicians, assessing willingness to participate, and scheduling participants for data collection. We analyzed recruitment records from a qualitative study exploring performance feedback at US Department of Veterans Affairs Medical Centers (VAMCs); five recruiters sought to reach two clinicians at 16 facilities for a one-hour interview. Objective metrics were calculable for all five steps; metric values varied considerably across facilities. Obtaining accurate contact information slowed down recruiting the most. Successfully recruiting even small numbers of employees requires considerable resourcefulness and more calendar time than anticipated. Our proposed framework provides an empirical basis for estimating research-recruitment timelines, planning subject-recruitment strategies, and assessing the research accessibility of clinical sites.
Publishing priorities of biomedical research funders.
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BMJ open 2013 Oct 23;3(10):e004171-2013-004171
OBJECTIVES: To understand the publishing priorities, especially in relation to open access, of 10 UK biomedical research funders. DESIGN: Semistructured interviews. SETTING: 10 UK biomedical research funders. PARTICIPANTS: 12 employees with responsibility for research management at 10 UK biomedical research funders; a purposive sample to represent a range of backgrounds and organisation types. CONCLUSIONS: Publicly funded and large biomedical research funders are committed to open access publishing and are pleased with recent developments which have stimulated growth in this area. Smaller charitable funders are supportive of the aims of open access, but are concerned about the practical implications for their budgets and their funded researchers. Across the board, biomedical research funders are turning their attention to other priorities for sharing research outputs, including data, protocols and negative results. Further work is required to understand how smaller funders, including charitable funders, can support open access.
Measuring the impact of caregiving on informal carers: a construct validation study of the CarerQol instrument.
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Hoefman RJ, van Exel J, Brouwer WB.
Health and quality of life outcomes 2013 Oct 21;11(1):173
Data was collected among adult caregivers (n = 1,244) selected from the general population using an online questionnaire in October 2010, in the Netherlands. The CarerQol measures and values the impact of informal care. The CarerQol measures subjective burden (CarerQol-7D) and well-being (CarerQol-VAS). Construct validation comprised clinical, convergent and discriminative validity tests. RESULTS: Clinical validity was supported by statistically significant associations of CarerQol-VAS and caregivers’ health, income and employment status, care recipients’ health, and the relationship between caregiver and care recipient. Convergent validity was supported by positive associations of CarerQol-VAS with the two positive CarerQol-7D dimensions (fulfilment and support) and negative associations with the five negative CarerQol-7D dimensions (relational problems, mental health problems, problems combining daily activities, financial problems and physical health problems). Moreover, CarerQol-VAS was negatively associated with other instruments measuring caregiving burden.
Screening for Cognitive Impairment in Older Adults: A Systematic Review for the U.S. Preventive Services Task Force.
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Lin JS, O’Connor E, Rossom RC, Perdue LA, Eckstrom E.
Annals of Internal Medicine 2013 Oct 22
To systematically review the diagnostic accuracy of brief cognitive screening instruments and the benefits and harms of pharmacologic and nonpharmacologic interventions for early cognitive impairment. The Mini-Mental State Examination (k = 25) is the most thoroughly studied instrument but is not available for use without cost. Publicly available instruments with adequate test performance to detect dementia include the Clock Drawing Test (k = 7), Mini-Cog (k = 4), Memory Impairment Screen (k = 5), Abbreviated Mental Test (k = 4), Short Portable Mental Status Questionnaire (k = 4), Free and Cued Selective Reminding Test (k = 2), 7-Minute Screen (k = 2), and Informant Questionnaire on Cognitive Decline in the Elderly (k = 5). Medications approved by the U.S. Food and Drug Administration for Alzheimer disease (k = 58) and caregiver interventions (k = 59) show a small benefit of uncertain clinical importance for patients and their caregivers. Small benefits are also limited by common adverse effects of acetylcholinesterase inhibitors and limited availability of complex caregiver interventions. Although promising, cognitive stimulation (k = 6) and exercise (k = 10) have limited evidence to support their use in persons with mild to moderate dementia or mild cognitive impairment.
The provision of care for residents dying in UK nursing care homes.
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Kinley J, Hockley J, Stone L, Dewey M, Hansford P, Stewart R, et al.
Age and Ageing 2013 Oct 16
OBJECTIVES: to identify the care currently provided to residents dying in UK nursing care homes.Method: study participants were residents who had died within 38 nursing care homes in southeast England over a 3-year period. The nursing care homes had been recruited to take part in a cluster randomised controlled trial looking at different models of facilitation while implementing the Gold Standards Framework in Care Homes (GSFCH) programme. Two researchers examined the notes and daily records of all residents who died in each of these homes between the 1 June 2008 and the 31 May 2011. RESULTS: a total of 2,444 residents died during the 3-year period. Fifty-six percent of these residents died within a year of admission. The support from specialist healthcare services to residents during their last 6 months of life was variable. CONCLUSIONS: nursing care homes have established links with some external healthcare providers. These links included the GP, palliative care nurses and physiotherapy. As dependency of resident increase with 56% residents dying within a year of admission these links need to be expanded. The provision of health care that meets the needs of future nursing care home residents needs to be ‘proactively’ obtained rather than left to chance.
The satisfaction with the quality of dementia care and the health, burnout and work ability of nurses: A longitudinal analysis of 50 German nursing homes.
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Jeon YH, Govett J, Low LF, Chenoweth L, McNeill G, Hoolahan A, et al.
Contemporary nurse 2013 Jun;44(2):156-169
AIM: To assess the feasibility and the effects of a multi-component education toolkit that used the Aged Care Funding Instrument behaviour (ACFI-BEH) scores to trigger care planning for older people experiencing behavioural and psychological symptoms of dementia (BPSD). METHOD: Forty-six older people and 209 staff and managers from five Sydney metropolitan residential aged care (RAC) facilities participated in this pre-post intervention pilot study. RESULTS: The face validity and accessibility/acceptability of the toolkit was established, but potential utility of the ACFI-BEH in informing care planning was proven to be negligible. The ACFI-informed education toolkit did not lead to statistically significant improvements in care planning practice or reduce the severity/frequency of the targetted BPSD. Care plan quality remained low post intervention, with between 31% (N = 12/39) and 65% (N = 13/20) of care plans not addressing the persons’ BPSD, nor utilising the ACFI information in relation to BPSD. CONCLUSION: This study has underscored the problems associated with current care planning practice in RAC settings and the need for developing strategies to ensure quality and safe care through individualised care planning practices. Our study processes, results and lessons discussed in this paper could assist future research on this type of research in RAC settings.
Relationship between nursing staffing and quality of life in nursing homes.
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Contemporary nurse 2013 Jun;44(2):133-143
METHODS: This is a descriptive, correlational study. The independent variables were nursing staffing hours per resident day (HPRD), skill mix HPRD, and turnover rate of nursing staff. The data for the dependent variables were collected using the quality of life (QOL) section of minimum data set (MDS) version 3.0. Hierarchical linear models were used for data analysis. RESULTS: Few staffing variables were statistically associated with residents’ QOL. More RN HPRD were associated with better comfort and enjoyment domains, more licensed practical nurses (LPN) HPRD were associated with better dignity, and more certified nurse assistant (CNA) HPRD were associated with better functional competence domains. In terms of skill mix, the unique contribution of more RNs (to less LPN or CNAs) was supported in the functional competence of residents. However, surprising results were that: (a) as the HPRD of RNs increased, the scores of meaningful activity and relationship decreased; and (b) the contribution of LPNs (more LPNs to less RNs) were supported in the autonomy and spiritual well-being domains. Interestingly, nursing staff turnover is positively correlated with some domains of QOL: (a) a higher score in the enjoyment domain with increased RN turnover; and (b) a higher score in privacy, relationship, and individuality domains with increased turnover of LPNs.
The Personhood in Dementia Questionnaire (PDQ): establishing an association between beliefs about personhood and health providers’ approaches to person-centred care.
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Hunter PV, Hadjistavropoulos T, Smythe WE, Malloy DC, Kaasalainen S, Williams J.
Journal of aging studies 2013 Aug;27(3):276-287
To operationalize Kitwood’s definition of personhood, we generated items to create the Personhood in Dementia Questionnaire (PDQ; Study 1). We then completed preliminary tests of the PDQ’s convergent and discriminant validity (Study 2). Finally, we examined the PDQ’s relationships with other constructs such as burnout and job satisfaction, and we used linear regression to test the hypothesis that health providers’ beliefs about personhood influence intended approaches to dementia care (Study 3). RESULTS: In Study 1, we generated a pool of 64 potential questionnaire items. In Study 2, a 20-item version of the PDQ demonstrated good internal consistency, resistance to socially desirable responding, and evidence of convergent and discriminant validity. In Study 3, PDQ scores accounted for a significant proportion of variance in health providers’ intended approaches to dementia care, including pain management. PDQ scores were not related to job satisfaction or to most aspects of burnout. Copyright © 2013 Elsevier Inc. All rights reserved.
Safe home program: a suite of technologies to support extended home care of persons with dementia.
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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.
Promoting value in dementia care: staff, resident and family experience of the capabilities model of dementia care
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Moyle W, Venturato L, Cooke M, Hughes J, van Wyk S, Marshall J.
Aging & mental health 2013;17(5):587-594
This Australian study examined individual experiences of the implementation of the Capabilities Model of Dementia Care (CMDC) and subsequent outcomes for the care of residents with dementia living in long-term care. Furthermore, this study aimed to explore those factors that facilitated and inhibited the implementation of the new model of care. METHODS: The CMDC was developed and then tested in a non-randomised clinical trial. Staff, residents and family experiences of their involvement and perceptions of the model were captured at the end of 12 months. Semi-structured interviews and focus groups were conducted with the 25 participants (12 nursing staff, 6 residents with dementia, 7 family members). Questions varied depending on the participant group but were designed to assess experiences of and changes to care during the intervention. Inductive thematic analysis was used to identify the experiences of the implementation of the CMDC. RESULTS: Five themes included: general reflections on nursing care, implementation of the CMDC intervention, positive outcomes of the CMDC intervention, challenges in the implementation of the CMDC, difficulty sustaining care and tensions between participants’ perspectives of care.
The experiences of culturally and linguistically diverse family caregivers in utilising dementia services in Australia.
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Xiao LD, De Bellis A, Habel L, Kyriazopoulos H.
BMC health services research 2013 Oct 22;13(1):427
The aim of the study was to explore the experiences of family caregivers from Chinese, Greek, Italian and Vietnamese groups in utilising dementia services. Gadamer’s philosophical hermeneutics was used to interpret the experiences of the participants. Focus group discussions and in-depth individual interviews were used to collect data. Data collection was conducted over a six month period in 2011. In total, 46 family caregivers who were caring for 39 persons with dementia participated. RESULTS: Four themes were revealed: (1) negotiating services for the person with dementia; (2) the impact of acculturation on service utilisation; (3) the characteristics of satisfactory services; and (4) negative experiences in utilising services. The present study revealed that the participation of caregivers from culturally and linguistically diverse groups in planning and managing dementia services ranged markedly from limited participation to full participation.
Effectiveness of a lifestyle exercise program for older people receiving a restorative home care service: study protocol for a pragmatic randomised controlled trial.
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Burton E, Lewin G, Clemson L, Boldy D.
BMC health services research 2013 Oct 18;13(1):419
This paper describes the study protocol to test whether a Lifestyle Functional Exercise (LiFE) program: 1) is undertaken more often; 2) is more likely to be continued over the longer term; and, 3) will result in greater functional gains compared to a standard exercise program for older people receiving a restorative home care service. METHODS: Design: A pragmatic randomised controlled trial (RCT) design was employed with two study arms: LiFE program (intervention) and the current exercise program (control).Setting: Silver Chain, a health and community care organisation in Perth, Western Australia.Participants: One hundred and fifty restorative home care clients, aged 65 years and older.Measurements: The primary outcome is a composite measure incorporating balance, strength and mobility. Other outcome measures include: physical functioning, falls efficacy, and levels of disability and functioning.
Change and Predictors of Change in Social Skills of Nursing Home Residents With Dementia.
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Chappell NL, Kadlec H, Reid C.
American Journal of Alzheimer’s Disease and Other Dementias 2013 Oct 27
Social skills are of primary importance for those with dementia and their care providers, yet we know little about the extent to which basic social skills can be maintained over time and the predictors of change.Methods:A total of 18 nursing homes with 149 newly admitted residents with moderate to severe dementia, 195 direct care staff, and 135 family members, in British Columbia, Canada, contributed data on change in social skills from admission to 6 months and 1 year later.Results:Three-quarters of residents maintained or improved their basic social skills during both the time periods. Decline was explained primarily by cognitive status at the time of admission, notably present orientation. However, staff-to-resident communication becomes more important over time.Conclusions:Social skills appear to present an opportunity to maintain interaction with these residents. The findings also suggest that a focus on the present orientation before and following admission and on staff-to-resident communication may be beneficial.
Nurse led care coordination: Trial protocol and development of a best practice resource guide for a cluster controlled clinical trial in Australian aged care facilities.
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Arendts G, Etherton-Beer C, Howard K, Lewin G, Sim M, Pickstock S, et al.
Archives of Gerontology and Geriatrics 2014 Jan-Feb;58(1):15-19
In this paper we describe (i) the protocol for a cluster controlled clinical trial of nurse led care coordination in residential aged care facilities (RACF); and (ii) the development and content of a best practice resource guide to be implemented as part of this trial. We used published systematic reviews of quantitative studies, existing resources and multidisciplinary expert opinion to develop an intervention for testing in a cluster controlled trial (Australian and New Zealand Clinical Trials Registry Number 12611000933954). The trial will determine whether care coordination of multiple evidenced based strategies can improve quality of life and reduce hospitalization rates amongst people living in RACF. Central to the intervention arm of the trial are two components: (i) experienced nurse practitioners responsible for resident care and (ii) a best practice guide for the care processes being delivered and coordinated by those nurses. In this paper we outline how this practice guide, which is published herein, was refined through consultative processes and practitioner testing.
Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Effectiveness of a multi-component intervention to reduce delirium incidence in elderly care wards
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Holt R, Young J, Heseltine D.
Age and Ageing 2013 Nov;42(6):721-727
OBJECTIVE: to examine the effect of a multi-component, delirium prevention intervention on rates of incident delirium for patients admitted to specialist elderly care wards. DESIGN: ‘before’ and ‘after’ study. SETTING: three specialist elderly care wards in a general hospital. SUBJECTS: older people admitted as emergencies. METHODS: a multi-component delirium prevention intervention that targeted delirium risk factors was implemented by clinical staff. Demographic information and assessments for delirium risk factors were recorded by research staff within 24 h of admission to the ward. New onset (incident) delirium was diagnosed by daily research staff assessments using the Confusion Assessment Method and Delirium Rating Scale-Revised-98. RESULTS: a total of 436 patients were recruited (249 in the ‘before’ and 187 in the ‘after’ group). Incident delirium was significantly reduced (‘before’ = 13.3%; ‘after’ = 4.6%; P = 0.006). Delirium severity and duration were significantly reduced in the ‘after’ group. Mortality, length of stay, activities of daily living score at discharge and new discharge to residential or nursing home rates were similar for both groups. CONCLUSIONS: a multi-component, delirium prevention intervention directed at delirium risk factors and implemented by local clinical staff can reduce incident delirium on specialist elderly care wards.
Transitional Care Partners: A hospital-to-home support for older adults and their caregivers.
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Hendrix C, Tepfer S, Forest S, Ziegler K, Fox V, Stein J, et al.
Journal of the American Association of Nurse Practitioners 2013 Aug;25(8):407-414
PURPOSE: To describe the development, implementation, and preliminary results of the Transitional Care (TLC) Partners, a clinical demonstration program that supports the transition from hospital to home of older veterans. DATA SOURCES: Hospital records of TLC patients to track their hospital and emergency department visits before and after the TLC Partners enrollment. Caregivers of patients completed Preparedness in Caregiving and the Short Form Zarit Burden Scale during the first week of the TLC Partners enrollment and on the week when the services ended. CONCLUSIONS: The proportion of patients with one or more emergency department visits and rehospitalization is consistently lower among TLC patients compared to non-TLC patients at 30 and 60 days of hospital discharge. The mean preparedness and burden scores before and after the program essentially remained the same. IMPLICATIONS FOR PRACTICE: The description of the implementation of the TLC Partners offers an example of how nurse practitioner-led interprofessional care models can be adapted to the needs of specific healthcare systems, and how they can be monitored to evaluate their reach, effectiveness, and fidelity to the core components of proved care models. ©2012 The Author(s) ©2012 American Association of Nurse Practitioners.
Diagnostic data for neurological conditions in interRAI assessments in home care, nursing home and mental health care settings: a validity study.
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Foebel AD, Hirdes JP, Heckman GA, Kergoat MJ, Patten S, Marrie RA.
BMC health services research 2013 Nov 1;13(1):457
The interRAI assessments were matched with an inpatient hospital record and emergency department (ED) visit record in the preceding 90 days. Diagnoses captured on the interRAI instruments were compared to those recorded in either administrative record for each individual. Diagnostic validity was examined through sensitivity, specificity and positive predictive value analysis for the following conditions: multiple sclerosis, epilepsy, Alzheimer’s disease and other dementias, Parkinson’s disease, traumatic brain injury, stroke, diabetes mellitus, heart failure and reactive airway disease. RESULTS: In the three large study samples (home care: n = 128,448; long-term care: n = 26,644; mental health: n = 13,812), interRAI diagnoses demonstrated high specificity when compared to administrative records, for both neurological conditions (range 0.80 — 1.00) and comparative chronic diseases (range 0.83 — 1.00). Sensitivity and positive predictive values (PPV) were more varied by specific diagnosis, with sensitivities and PPV for neurological conditions ranging from 0.23 to 0.94 and 0.14 to 0.77, respectively. The interRAI assessments routinely captured more cases of the diagnoses of interest than the administrative records
In 2009–2010, a total of 19.6 million emergency department (ED) visits in the United States were made by persons aged 65 and over. The visit rate for this age group was 511 per 1,000 persons and increased with age. The percentage of ED visits made by nursing home residents, patients arriving by ambulance, and patients admitted to the hospital increased with age. Twenty-nine percent of ED visits by persons aged 65 and over were related to injury, and the percentage was higher among those aged 85 and over than among those aged 65–74 or 75–84. The percentage of ED visits caused by falls increased with age.
Developing a Data Management Plan: New Expectations for Funding Workshop
Thursday 7 November 2013 Room 122 Education South
This workshop will introduce researchers to the resources on campus to help you develop a research data management plan and discuss some best practices. All researchers and other staff or colleagues involved with team or partnership applications are encouraged to attend this workshop.
20-23 January 2014 Barcelona Spain
GRADE is a five-year project co-funded by the European Commission to improve the dissemination of evidence-based recommendations. DECIDE includes GRADE members and works to ensure effective dissemination of evidence-based recommendations targeted at the key stakeholders.
2nd Annual Data Analytics for Healthcare Summit
3-4 December 2013 Toronto ON
Healthcare organizations are struggling to integrate access to data among many silos. Learn strategies to work through these silos and take away new approaches to your data challenges. Find out which best practices will work for your patients and your organization.
KT Canada Seminar: The PRISMA extension statement for network meta-analysis: development, progress and findings
Wednesday 14 November 2013 10:00-11:00 MT
-To become familiar with how a network meta-analysis differs from a traditional pairwise meta-analysis, and why it’s added features require a PRISMA extension statement to improve reporting of such works relative to current approaches.
-To become familiar with the process for developing a reporting guideline as was followed for the development of the PRISMA NMA extension.
-To become familiar with some of the key guidances which emerged from our efforts that will appear in the PRISMA NMA guidance, and how we plan to distribute this information to our target audiences of researchers, clinicians, decision-makers and journal editors.
CADTH: An Introduction to Network Meta-Analysis
5-6 December 2013, Ottawa ON Costs: $1999
Network meta-analysis is a general term for the statistical method used to compare multiple treatments and their alternatives simultaneously. The method involves combining direct and indirect evidence in a single analysis, resulting in summary estimates of efficacy or safety for treatments that may not have been compared head-to-head in a randomized controlled trial. It is also known as mixed or indirect treatment comparisons. The workshop will provide an overview of network meta-analysis and its applications, including demonstrations of worked examples using SAS and WinBUGs, and hands-on sessions where participants will work through real-world examples.
The King’s Fund: Designing Care Environments for People with Dementia Two-day residential workshop
29-30 January 2014 Swindon UK
Building on our decade of experience in supporting real change in practice, we have designed these unique workshops in partnership with clinical and estates colleagues to equip participants with the knowledge and skills to deliver cost-effective environmental improvements.
The University of Toronto, Institute for Life Course & Aging is holding online workshops from October 2013 until June 2014 on a variety of subjects on aging. The workshops are occurring online and are intended as continuing professional development for healthcare workers working with the aging population and interested in updating their skills.
Hidden cameras and a team of pensioners acting undercover for the authorities could be to be sent into care homes to expose abuse and neglect, according to the new chief care inspector.
The competencies encompass five key areas: ethical and professional foundation, medical care delivery process, systems, medical knowledge, and personal quality assurance and performance improvement. The two-year project involved a workgroup of 25 long-term care LTC physicians and gathered input from multiple long-term and post-acute care organizations.
Alberta is overhauling the long-term care system to try and use its existing beds better – a wise and financially prudent decision. It’s doing this by changing the way it pays long-term care homes, shifting to a new payment model called patient/care-based funding. PCBF provides more money to homes that care for sicker, more complex residents.
PubMed Commons is a system that enables researchers to share their opinions about scientific publications. Researchers can comment on any publication indexed by PubMed, and read the comments of others. PubMed Commons is a forum for open and constructive criticism and discussion of scientific issues.
The Canadian Foundation for Healthcare Improvement (CFHI) is working with the Institute for Healthcare Improvement (IHI) to deliver the Triple Aim Improvement Community (TAIC) in Canada. With CFHI’s support, nine Canadian healthcare delivery organizations are participating in this 10-month collaborative to achieve better population health, better healthcare experience and better per capita cost of care.
Fewer complex health research stories will make it to light now that the Canadian Institutes of Health Research (CIHR) has shuttered a highly prized journalism grant, past recipients warn.
With the development of multi-centre research (research carried out in many different hospitals or settings, instead of just one), there is growing concern that the efficiency of the ethics approval process has not kept pace, and that important research is being delayed or prevented by an ethics bureaucracy plagued by inconsistent quality and needless duplication.
Low-income seniors wait up to three years for Toronto Public Health’s free non-urgent dental care.
As hospital stays get shorter, home care is being touted as an efficient alternative. Ontario Health Minister Deb Mathews said as much in the provincial legislature in March, 2012. “Home care is where we can get the best value for money and the highest quality of care for people.”
When they look ahead to future living arrangements that go with aging, Canada’s baby boomers see staying in their own homes and paying for home care as the best option.
Healthy Debate spoke with Alberta health care providers and former AHS administrators to learn about how recent restructuring has affected them, and their jobs.
This 2-page paper from the Canadian Centre for Policy Alternatives, provides some background information on the challenges of providing long-term care in Manitoba and how these challenges have resulted in the current labour disputes. The paper also presents a brief summary of the events that occurred this past summer.
This document summarizes the evidence on using side-rails in LTC.
This guideline offers practitioners and care providers in long term care (LTC) facilities a systematic approach to the recognition, assessment, treatment, and monitoring of patients with dementia, including impaired cognition and problematic behavior
This guideline hopes to improve the quality of care delivered to patients with diabetes in long-term care (LTC) settings.
This guideline intends to improve the quality of care delivered to patients in long term (LTC) care settings.
This guidelines intends to improve the quality of care delivered to patients with acute or chronic pain in long term care (LTC) settings
This guideline intends to improve the quality of care delivered to patients with urinary incontinence (UI) in long term care (LTC) facilities.
Lots of info on methods, progress of study, staff, and how to access CLSA data.
The Rural Dementia Care project, funded by the University of Saskatchewan and the Canadian Institute for Health Research, is trying to develop new approaches to delivering dementia services to rural and northern communities. This project has created other research projects which have led to publications with the intention of putting into practice the evidence acquired.
This logic model is a first step in guiding the evaluation of our knowledge-sharing activities, in that it breaks down the various aspects to be evaluated and thus helps to develop the corresponding indicators.
Knowledge sharing lies at the heart of the NCCHPP’s mandate. One of the results of our reflections has been the production of this guide for developing a knowledge-sharing plan for a project.
Lecturership in Health Services Research (Quantitative), 2 Posts
London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy
Department of Health Services Research and Policy
DEADLINE: 13 November 2013
We are seeking an enthusiastic senior health services researcher who can manage large-scale health care evaluation projects and contribute to the methodological development of health care performance measures. Applicants should have excellent quantitative skills and extensive experience of research or national clinical audit / service evaluation.
CIHR: Science Policy Fellowships
DEADLINE 16 December 2013
Have you ever wondered how research evidence can be used to inform health policy? Have you ever considered contributing your research knowledge to developing evidence-informed policy? Have you ever asked yourself how your research could be useful to policy makers? If you answered yes to any of these questions, then the Science Policy Fellowships program might be for you.
Systematic Review Trainer
Faculty of Medicine, Nursing and Health Sciences School of Public Health and Preventive Medicine Australasian Cochrane Centre
DEADLINE 14 November 2013
As the Systematic Review Trainer, you will be responsible for the ongoing development, and the overall management, delivery and evaluation of the Centre’s training and support programs, aligned with the broader objectives and training initiatives of the international Cochrane Collaboration. There is also the scope to lead various projects related to preparing systematic reviews or other types of evidence syntheses.