April 7, 2015


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This monthly newsletter aims to keep you updated on all things TREC and other information relevant to researchers and knowledge users involved in the long term care sector.

Abstracts

New TREC Article
Dying in a Nursing Home: Treatable Symptom Burden and its Link to Modifiable Features of Work Context.
Non UofA Access
Estabrooks CA, Hoben M, Poss JW, Chamberlain SA, Thompson GN, Silvius JL, et al.
Journal of the American Medical Directors Association 2015 Mar 21

High-quality care at the end of life supports freedom from pain and other potentially burdensome symptoms. Lowering symptom burden at the end of life is an urgent and achievable goal in delivering services in nursing home settings. Few published reports describe symptom burden among older adults in nursing homes; none examine links between symptom burden and modifiable features of nursing home organizational context (work environment). OBJECTIVES: To examine the influence of organizational context on symptom burden and to compare symptom burden in the last year of life between nursing home residents with and without dementia. DESIGN: Retrospective analysis of longitudinal survey data. SETTING: A stratified random sample of 36 nursing homes in the Canadian provinces of Alberta, Manitoba, and Saskatchewan. PARTICIPANTS: A total of 2635 residents with dementia and 1012 without dementia; 1381 front-line care staff. MEASUREMENTS: (1) Trajectories of 6 symptoms (dyspnea, pain, pressure ulcers, urinary tract infections, challenging behavior, delirium), assessed with the Resident Assessment Instrument-Minimum Data Set, version 2.0, between 2008 and 2012. All residents received assessments in each quarter of the year before death. (2) Modifiable organizational context, assessed with the Alberta Context Tool. Hierarchical mixed model, repeated measures regression, to simultaneously evaluate effects of time, dementia, and context on symptom trajectories. RESULTS: For all residents, prevalence of symptoms increased over time. In the last quarter before death, challenging behavior was the most frequent symptom in the dementia group (40.2%), delirium the most frequent symptom in the nondementia group (31.0%), and urinary tract infections least frequent (9.0% to 10.0%). Facilities with more favorable context had significantly higher prevalence of challenging behavior and delirium and significantly lower use of antipsychotics without diagnosis of psychosis. CONCLUSION: Symptom burden increases as the end of life approaches but differs between high- and low-context facilities and between residents with and without dementia. Trajectories of treatable, burdensome symptoms at the end of life in nursing homes should be a priority focus for quality improvement. Modifiable features of organizational context that are linked to symptom burden offer new potential strategies and interventions for quality improvement. Copyright © 2015 AMDA

New article by Dr. Kim Fraser
Embedding the perceptions of people with dementia into quantitative research design.
Non UofA Access
O’Rourke HM, Duggleby W, Fraser KD.
Quality of life research 2015 Mar 26

Patient perspectives about quality of life are often found in the results of qualitative research and could be applied to steer the direction of future research. The purpose of this paper was to describe how findings from a body of qualitative research on patient perspectives about quality of life were linked to a clinical administrative dataset and then used to design a subsequent quantitative study. METHODS: Themes from two systematic reviews of qualitative evidence (i.e., metasyntheses) identified what affects quality of life according to people with dementia. Selected themes and their sub-concepts were then mapped to an administrative dataset (the Resident Assessment Instrument 2.0) to determine the study focus, formulate nine hypotheses, and select a patient-reported outcome. A literature review followed to confirm existence of a knowledge gap, identify adjustment variables, and support design decisions. RESULTS: A quantitative study to test the association between conflict and sadness for people with dementia in long-term care was derived from metasynthesis themes. Challenges included (1) mapping broad themes to the administrative dataset; (2) decisions associated with inclusion of variables not identified by people with dementia from the qualitative research; and (3) selecting a patient-reported outcome, when the dataset lacked a valid subjective quality-of-life measure. CONCLUSIONS: Themes derived from a body of qualitative research capturing a target populations’ perspective can be linked to administrative data and used to design a quantitative study. Using this approach, the quantitative findings will be meaningful with respect to the quality of life of the target population.

CALL FOR ABSTRACTS & SHORT COURSES:
Society for Medical Decision Making (SMDM) 37th Annual North American Meeting.
18-21 October St. Louis MO
DEADLINE 22 May

The National Institutes of Health (NIH) define Implementation Science as, “the study of methods to promote the integration of research findings and evidence into healthcare policy and practice.” SMDM is uniquely positioned to bring experts from a broad range of health science disciplines together to explore implementation and exchange ideas on how to improve the translation of research findings into better bedside care and health care utilization. The combination of short-courses, symposia and research presentations continues to foster lively debates and deeper understandings of how our scientific research can be applied to improve care. Whether through decision modeling approaches, bedside studies of patient preferences, or exploration of decision psychology, SMDM can bring innovative and disruptive changes to healthcare

CALL FOR PAPERS:
Special Issue of Organization Studies: Inequality, Institutions, and Organizations
DEADLINE 31 August

This Special Issue focuses on the relationships between inequality, institutions and organizations. Although the relevance of organizational research to societal problems has spawned debate for at least a decade, and has generated a proliferation of polemics and prescriptions, there has been insufficient theoretical and empirical engagement among organization scholars on questions that primarily relate to the relationships between social inequality and institutional development. The ways in which organizations and institutions contribute to or mitigate inequality is of particular concern. As such, the potential for management scholars to inform understanding of the mechanisms that exacerbate or reduce inequality is significant; similarly, the study of inequality poses fundamental questions for management theory.

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Grants & Awards

NHS Test Beds Programme: Call for expressions of interest
DEADLINE 29 May

The NHS Five Year Forward View, published in October 2014, set out the intention to develop a small number of ‘test beds’. These sites will evaluate the real world impact of new technologies offering both better care and better value for taxpayers, testing them together with innovations in how NHS services are delivered. Together with the UK Government and the Academic Health Science Networks (AHSNs), NHS England would now like to invite innovators from the UK and globally to express interest in deploying and testing their innovations in this flagship initiative.

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Publications

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

KT

Evidence-Based Practice Beliefs and Behaviors 
of Nurses Providing Cancer Pain Management: 
A Mixed-Methods Approach
Non UofA Access
Eaton LH, Meins AR, Mitchell PH, Voss J, Doorenbos AZ.
Oncology nursing forum 2015 Mar 1;42(2):165-173

To describe evidence-based practice (EBP) beliefs and behaviors of nurses who provide cancer pain management. . DESIGN: Descriptive, cross-sectional with a mixed-methods approach. . SETTING: Two inpatient oncology units in the Pacific Northwest. . SAMPLE: 40 RNs. . METHODS: Data collected by interviews and web-based surveys. . MAIN RESEARCH VARIABLES: EBP beliefs, EBP implementation, evidence-based pain management. . FINDINGS: Nurses agreed with the positive aspects of EBP and their implementation ability, although implementation level was low. They were satisfied with their pain management practices. Oncology nursing certification was associated with innovativeness, and innovativeness was associated with EBP beliefs. Themes identified were (a) limited definition of EBP, (b) varied evidence-based pain management decision making, (c) limited identification of evidence-based pain management practices, and (d) integration of nonpharmacologic interventions into patient care. . CONCLUSIONS: Nurses’ low level of EBP implementation in the context of pain management was explained by their trust that standards of care and medical orders were evidence-based. . IMPLICATIONS FOR NURSING: Nurses’ EBP beliefs and behaviors should be considered when developing strategies for sustaining evidence-based pain management practices. Implementation of the EBP process by nurses may not be realistic in the inpatient setting; therefore, hospital pain management policies need to be evidence-based and reinforced with nurses. .

Re-conceptualising the link between research and practice in social work: A literature review on knowledge utilisation
Non UofA Access
Heinsch M, Gray M, Sharland E.
International Journal of Social Welfare 2015

Despite the recent movement towards greater research use in many areas of social work, criticisms persist that decision making in practice is seldom informed by sound research evidence. Discourse about the research-to-practice gap in social work has tended to focus on the feasibility of evidence-based practice for the profession, but has rarely drawn from the broader knowledge utilisation literature. There are important understandings to be gained from the knowledge utilisation field, which spans more than six decades of interdisciplinary research.This article introduces the wider knowledge utilisation literature to a social work audience. It considers the potential of this body of literature to facilitate research use in social work, as well as conceptual issues that may be hindering it from informing improvements to research utilisation in practice.

Utilization of evidence-based practice knowledge, attitude, and skill of clinical nurses in the planning of professional development programming.
Non UofA Access
Williamson KM, Almaskari M, Lester Z, Maguire D.
Journal for nurses in professional development 2015 Mar-Apr;31(2):73-80

This collaborative study explored nurses’ knowledge, attitudes, and skills related to the evidence-based practice (EBP) process. It also explored the nurses’ perceptions of the barriers and facilitators that they face related to fully using EBP in the workplace. Findings will afford the healthcare system the information to develop, plan, and restructure the educational services to meet the demand of enhancing EBP strategies and utilization.

Research to reality: moving evidence into practice through an online community of practice.
Non UofA Access
Farrell MM, La Porta M, Gallagher A, Vinson C, Bernal SB.
Preventing chronic disease 2014 May 8;11:E78

How can a community of practice help further the practical application of cancer control research? In 2011, the National Cancer Institute (NCI) launched an online community of practice, Research to Reality (R2R). R2R aims to infuse evidence-based strategies into communities by engaging researchers and practitioners in a joint approach to research dissemination. To measure community growth and engagement, NCI measures data across 3 program domains: content, interaction, and activity. NCI uses Web analytics, usability testing, and content analyses to manage and evaluate R2R. As of December 2013, R2R had more than 1,700 registered members. More than 500 researchers and practitioners register for the monthly cyber-seminars, and 40% return each month. R2R hosts more than 15,500 page views and 5,000 site visits in an average month. This article describes the process of convening this online community and quantifies our experiences to date.

Trading quality for relevance: non-health decision-makers’ use of evidence on the social determinants of health
McGill E, Egan M, Petticrew M, Mountford L, Milton S, Whitehead M, et al.
BMJ Open 2015 04/01;5(4)

Local government services and policies affect health determinants across many sectors such as planning, transportation, housing and leisure. Researchers and policymakers have argued that decisions affecting wider determinants of health, well-being and inequalities should be informed by evidence. This study explores how information and evidence are defined, assessed and utilised by local professionals situated beyond the health sector, but whose decisions potentially affect health: in this case, practitioners working in design, planning and maintenance of the built environment. Design A qualitative study using three focus groups. A thematic analysis was undertaken. Setting The focus groups were held in UK localities and involved local practitioners working in two UK regions, as well as in Brazil, USA and Canada. Participants UK and international practitioners working in the design and management of the built environment at a local government level. Results Participants described a range of data and information that constitutes evidence, of which academic research is only one part. Built environment decision-makers value empirical evidence, but also emphasise the legitimacy and relevance of less empirical ways of thinking through narratives that associate their work to art and philosophy. Participants prioritised evidence on the acceptability, deliverability and sustainability of interventions over evidence of longer term outcomes (including many health outcomes). Participants generally privileged local information, including personal experiences and local data, but were less willing to accept evidence from contexts perceived to be different from their own. Conclusions Local-level built environment practitioners utilise evidence to make decisions, but their view of ‘best evidence’ appears to prioritise local relevance over academic rigour. Academics can facilitate evidence-informed local decisions affecting social determinants of health by working with relevant practitioners to improve the quality of local data and evaluations, and by advancing approaches to improve the external validity of academic research.

Geriatric hospital nurses’ perceived barriers to research utilization and empowerment.
Non UofA Access
Kang H.
Asian nursing research 2015 Mar;9(1):65-72

The quality of nursing care in geriatric hospitals has been of concern. Nurses need to provide evidence-based nursing using best available research findings in order to maximize the quality of care. Research utilization is a major part of evidence-based nursing practice. Empowerment is an important factor that may influence the context of nursing practice. The purpose of this study was to identify the barriers to research utilization in nursing practice and its relationship to empowerment perceived by registered nurses (RNs) in geriatric hospitals. METHODS: A descriptive, correlational design was used. A total of 147 RNs from six geriatric hospitals in K province of Korea participated. The BARRIERS scale and the Conditions of Work Empowerment Questionnaire-II were administered to identify perceived barriers to the use of research findings and the level of perceived empowerment respectively. RESULTS: Participants rated that research reports being written in English constituted the greatest barrier to the use of research findings. The score was the highest for the Communication domain, suggesting the greatest barrier, and the lowest for the Adopter domain. Subscales of the Conditions of Work Empowerment Questionnaire-II were significant predictors of the Adopter, Organization, and Communication domains of the BARRIERS scale. CONCLUSIONS: This study found that RNs in geriatric hospitals perceived that interpreting and understanding research reports in English was the greatest barrier to the use of research findings. Administrators and nurse managers of geriatric hospitals need to provide RNs with opportunities to participate in research-related activities and to empower RNs in order to facilitate research utilization. Copyright © 2015.

Perceptions of national guidelines and their (non) implementation in mental healthcare: a deductive and inductive content analysis
Sandstrom B, Willman A, Svensson B, Borglin G.
Implementation Science 2015;10(1):43

National guidelines are being produced at an increasing rate, and politicians and managers are expected to promote these guidelines and their implementation in clinical work. However, research seldom deals with how decision-makers can perceive these guidelines or their challenges in a cultural context. Therefore, the aim of this study was twofold: to investigate how well Promoting Action on Research Implementation in Health Services (PARIHS) reflected the empirical reality of mental healthcare and to gain an extended understanding of the perceptions of decision-makers operating within this context, in regard to the implementation of evidence-based guidelines. Methods The study took place in the southeast of Sweden and employed a qualitative design. The data were collected through 23 interviews with politicians and managers working either in the county council or in the municipalities. The transcribed text was analysed iteratively and in two distinct phases, first deductively and second inductively by means of qualitative content analysis. Results Our deductive analysis showed that the text strongly reflected two out of three categorisation matrices, i.e. evidence and context representing the PARIHS framework. However, the key element of facilitation was poorly mirrored in the text. Results from the inductive analysis can be seen in light of the main category sitting on the fence; thus, the informants’ perceptions reflected ambivalence and contradiction. This was illustrated by conflicting views and differences in culture and ideology, a feeling of security in tradition, a certain amount of resistance to change and a lack of role clarity and clear directions. Together, our two analyses provide a rich description of an organisational culture that is highly unlikely to facilitate the implementation of the national guidelines, together with a distrust of the source behind such guidelines, which stands in stark contrast to the high confidence in the knowledge of experienced people in authority within the organisational context. Conclusions Our findings have highlighted that, regardless of by whom guidelines are released, they are not likely to be utilised or implemented if those who are responsible for implementing them do not trust the source. This aspect (i.e. contextual trust) is not covered by PARIHS.

Implementing Evidence-Based Practice in Healthcare: A Facilitation Guide
Non UofA Access
Harvey G., Kitson, A. 2015; Routledge

The successful implementation of evidence into practice is dependent on aligning the available evidence to the particular context through the active ingredient of facilitation. Designed to support the widely recognised PARIHS framework, which works as a guide to plan, action and evaluate the implementation of evidence into practice, this book provides a very practical ‘how-to’ guide for facilitating the whole process. Includes a chapter by Dr. Lars Wallin on Using Facilitation to Improve Neonatal Health and Survival in Vietnam.

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Health Care Administration and Organization


Supporting Direct Care Workers in Dementia Care: Effects of a Psychoeducational Intervention

Non UofA Access
Barbosa A, Nolan M, Sousa L, Figueiredo D.
American Journal of Alzheimer’s Disease and Other Dementias 2015 Mar;30(2):130-138

An experimental study using a pre-posttest control group design was conducted to assess the effects of a person-centered care-based psychoeducational intervention on direct care workers’ stress, burnout, and job satisfaction. The intervention aimed to develop person-centered care competences and tools for stress management. Four aged care facilities were randomly assigned to a psychoeducational or an education-only intervention (control). Data were collected from 56 direct care workers (female, mean age 44.72 ± 9.02) through measurements of burnout (Maslach Burnout Inventory), job satisfaction (Minnesota Satisfaction Questionnaire-short form), and stress (Perceived Stress Scale) and focus-group interviews. Results showed significant positive effects in emotional exhaustion (P = .029) and positive but no significant effects in stress and job satisfaction. According to qualitative data, the experimental group perceived enhanced group cohesion, emotional management, and self-care awareness. Psychoeducational interventions may contribute to reduce direct care workers’ burnout. Further work is needed to determine the extent of its benefits. © The Author(s) 2014.

Dying With Carolyn: Using Simulation to Improve Communication Skills of Unregulated Care Providers Working in Long-Term Care. Canada-flat-icon
Non UofA Access
Kortes-Miller K, Jones-Bonofiglio K, Hendrickson S, Kelley ML.
Journal of applied gerontology 2015 Mar

This article examines the development, implementation, and evaluation of a pilot project utilizing high-fidelity simulation (HFS) to improve frontline staff members’ confidence and skills to communicate about death and dying in long-term care homes. The target group was unregulated care providers who provide palliative care for residents and their families. Eighteen participants engaged in the educational intervention and evaluation. Results supported the effectiveness of HFS as an educational tool for unregulated health care providers. Quantitative data showed statistically significant improvements in participants’ self-efficacy scores related to communicating about death and dying and end-of-life care. Qualitative data indicated that the experience was a valuable learning opportunity and helped participants develop insights into their own values, beliefs, and fears providing end-of-life care. HFS is therefore recommended as an innovative training strategy to improve palliative care communication in long-term care homes. © The Author(s) 2015.

Staffing subsidies and the quality of care in nursing homes.
Non UofA Access
Foster AD, Lee YS.
Journal of health economics 2015 Feb 19;41:133-147

Concerns about the quality of state-financed nursing home care has led to the wide-scale adoption by states of pass-through subsidies, in which Medicaid reimbursement rates are directly tied to staffing expenditure. We examine the effects of Medicaid pass-through on nursing home staffing and quality of care by adapting a two-step FGLS method that addresses clustering and state-level temporal autocorrelation. We find that pass-through subsidies increases staffing by about 1% on average and 2.7% in nursing homes with a low share of Medicaid patients. Furthermore, pass-through subsidies reduce the incidences of pressure ulcer worsening by about 0.9%. Copyright © 2015 Elsevier B.V.

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Health Care Innovation and Quality Assurance

The use of mystery guests by the Dutch Health Inspectorate: Results of a pilot study in long-term intramural elderly care.
Non UofA Access
Adams SA, Paul KT, Ketelaars C, Robben P.
Health policy (Amsterdam, Netherlands) 2015 Feb 20

This paper examines the use of ‘mystery guests’ as an instrument for monitoring quality and safety in healthcare. The Dutch Health Inspectorate initiated a mystery guest pilot project in elderly care as a response to political and social pressure. An independent evaluation of this project revealed that the primary goal of this approach – to provide a better view of the exigencies of daily practice in elderly care – was not met. Inspectors did not use the information delivered by the mystery guests because how they evaluated quality and reported findings did not align with practices used by the health inspectorate. Additionally, the inspectors felt that other instruments being developed were more appropriate for providing a better view of practice. While political pressure is important for effecting change in general, the specific instruments to be used for formal supervision of health institutions should be developed and implemented within the organization in accordance with existing standards and approaches. The choice to implement a new supervision instrument, including sending mystery guests into care institutions, should be preceded by an ethical analysis that takes into account the specific context of its use. Copyright © 2015 Elsevier Ireland Ltd.

Nonpharmacological therapeutic techniques to decrease agitation in geriatric psychiatric patients with dementia.
Non UofA Access
Mitchell AM, Chiappetta L, Boucek L, Cain M, Patterson G, Owens K, et al.
Journal of gerontological nursing 2015 Feb;41(2):53-59

Agitation is not only a frequent and disturbing behavior for many patients with dementia, but it also troubles their caregivers and families. Many serious problems and side effects are associated with the use of medications to treat agitation; therefore, alternative approaches to treating agitation must be assessed. The current article presents results from a quality improvement pilot project that examined the usefulness of a specially designed, multisensory room intervention for geriatric psychiatric inpatients with mild to moderate agitation. Thirty-two visits to the sensory room were made by 13 inpatients with dementia. A significant decrease occurred in the Pittsburgh Agitation Scale (PAS) total scores over time from pre-room to post-room intervention, as well as 1-hour post-room intervention (F = 95.3, p < 0.001). Significant effects were found for all PAS subscales (i.e., aberrant vocalizations, motor agitation, and resistance to care), with the exception of the aggression subscale. The multisensory room intervention was effective in decreasing some symptoms of agitation in the geriatric psychiatric patient, thus contributing to positive patient, family, and nursing outcomes. Copyright 2015, SLACK Incorporated.

Effects of organizational context on Lean implementation in five hospital systems.
Non UofA Access
Harrison MI, Paez K, Carman KL, Stephens J, Smeeding L, Devers KJ, et al.
Health care management review 2014 Dec 23

Despite broad agreement among researchers about the value of examining how context shapes implementation of improvement programs and projects, limited attention has been paid to contextual effects on implementation of Lean. PURPOSE:: To help reduce gaps in knowledge of effects of intraorganizational context, we researched Lean implementation initiatives in five organizations and examined 12 of their Lean rapid improvement projects. All projects aimed at improving clinical care delivery. METHODOLOGY/APPROACH:: On the basis of the literature on Lean, innovation, and quality improvement, we developed a framework of factors likely to affect Lean implementation and outcomes. Drawing on the framework, we conducted semistructured interviews and applied qualitative codes to the transcribed interviews. Available documents, data, and observations supplemented the interviews. We constructed case studies of Lean implementation in each organization, compared implementation across organizations, and compared the 12 projects. FINDINGS:: Intraorganizational characteristics affecting organization-wide Lean initiatives and often also shaping project outcomes included CEO commitment to Lean and active support for it, prior organizational capacity for quality improvement-based performance improvement, alignment of the Lean initiative with the organizational mission, dedication of resources and experts to Lean, staff training before and during projects, establishment of measurable and relevant project targets, planning of project sequences that enhance staff capabilities and commitment without overburdening them, and ensuring communication between project members and other affected staff. Dependence of projects on inputs of new information technology was a barrier to project success. Incremental implementation of Lean produced reported improvements in operational efficiency and occasionally in care quality. However, even under the relatively favorable circumstances prevailing in our study sites, incremental implementation did not readily change organizational culture. PRACTICE IMPLICATIONS:: This study should alert researchers, managers, and teachers of management to ways that contexts shape Lean implementation and may affect other types of process redesign and quality improvement.

Structure and process quality as predictors of satisfaction with elderly care.
Non UofA Access
Kajonius PJ, Kazemi A.
Health & social care in the community 2015 Mar 25

The structure versus process approach to quality of care presented by Donabedian is one of the most cited ever. However, there has been a paucity of research into the empirical validity of this framework, specifically concerning the relative effects of structure and process on satisfaction with elderly care as perceived by the older persons themselves. The current research presents findings from a national survey, including a wide range of quality indicators for elderly care services, conducted in 2012 at the request of the Swedish National Board of Health and Welfare in which responses from 95,000 elderly people living in 324 municipalities and districts were obtained. The results revealed that the only structural variable which significantly predicted quality of care was staffing, measured in terms of the number of caregivers per older resident. More interestingly, process variables (e.g. respect and access to information) explained 40% and 48% of the variance in satisfaction with care, over and above the structural variables, in home care and nursing homes respectively. The findings from this large nationwide sample examining Donabedian’s model suggest that quality in elderly care is primarily determined by factors pertaining to process, that is, how caregivers behave towards the older persons. This encourages a continued quality improvement in elderly care with a particular focus on process variables. © 2015 The Authors.

A Long-Term Care-Comprehensive Geriatric Assessment (LTC-CGA) Tool: Improving Care for Frail Older Adults? Canada-flat-icon
Non UofA Access
Marshall EG, Clarke BS, Varatharasan N, Andrew MK.
Canadian geriatrics journal 2015 Mar 31;18(1):2-10

Most older adults living in long-term care facilities (LTCF) are frail and have complex care needs. Holistic understanding of residents’ health status is key to providing good care. Comprehensive Geriatric Assessment (CGA) is a valid assessment method which aims to embrace complexity. Here we aimed to study a CGA that has been modified for use in long-term care (the LTC-CGA) and to investigate its acceptability and usefulness to stakeholders and users. METHODS: This mixed methods study, conducted in 10 LTCFs in Halifax, Nova Scotia, reviewed 598 resident charts from pre- and post-implementation of the LTC-CGA. Qualitative methods explored stakeholder perspectives (physicians, nurses, paramedics, administrators, residents and families) though focus groups. RESULTS: The LTC-CGA was present in 78% of LTCF charts in the post -implementation, period though it did not appear in acute care charts of transferred residents, despite the intention that it accompany residents between care sites. Some items had suboptimal completion rates (e.g., Advance Directives at 56.4%), though these were located in other sections of the LTCF chart (98.2%). Nevertheless, qualitative findings suggest the LTC-CGA describes a clinical baseline health status which enabled timely and informed clinical decision-making. CONCLUSIONS: The LTC-CGA is a useful resource whose full capacity may not yet have been realized.

Development and testing of a scale for assessing the quality of home nursing.
Non UofA Access
Chiou CJ, Wang HH, Chang HY.
Geriatrics & gerontology international 2015 Mar 21

To develop a home nursing quality scale and to evaluate its psychometric properties. METHOD: This was a 3-year study. In the first year, 19 focus group interviews with caregivers of people using home nursing services were carried out in northern, central and southern Taiwan. Content analysis was carried out and a pool of questionnaire items compiled. In the second year (2007), study was carried out on a stratified random sample selected from home nursing organizations covered by the national health insurance scheme in southern Taiwan. The study population was the co-resident primary caregivers of home care nursing service users. Item analysis and exploratory factor analysis were carried out on data from 365 self-administered questionnaires collected from 13 selected home care organizations. In the third year (2008), a random sample of participants was selected from 206 hospital-based home care nursing organizations throughout Taiwan, resulting in completion of 294 questionnaires from 27 organizations. Confirmatory factor analysis was then carried out on the scale, and the validity and reliability of the scale assessed. RESULTS: The present study developed a reliable and valid home nursing quality scale from the perspective of users of home nursing services. The scale comprised three factors: dependability, communication skills and service usefulness. This scale is of practical value for the promotion of long-term community care aging in local policies. CONCLUSION: The scale is ready to be used to assess the quality of services provided by home care nursing organizations. © 2015 Japan Geriatrics Society.

The role of the named nurse in long-term settings.
Non UofA Access
Mitchell G, Strain J.
Nursing older people 2015 Mar 26;27(3):26-29

The term ‘named nursing’ was introduced in the UK more than 25 years ago but it has re-emerged recently in the light of recommendations made in the Francis report on the poor standards of care at Mid-Staffordshire NHS Foundation Trust. The original definition of named nurse by the Department of Health was someone that a patient could identify as responsible for their care from hospital admission to discharge. It was largely practised in the UK exclusively but there are now various accounts of its use throughout Europe, particularly Scandinavia, and North America. This article provides an overview of the named nursing concept. It provides recommendations for implementation of a named nursing system in nursing home settings, because most previous recommendations have referred to acute hospitals.

What to expect when you’re evaluating healthcare improvement: a concordat approach to managing collaboration and uncomfortable realities
Brewster L, Aveling E, Martin G, Tarrant C, Dixon-Woods M, The Safer Clinical Systems Phase 2 Core Group Collaboration,& Writing Committee.
BMJ Quality & Safety 2015

Evaluation of improvement initiatives in healthcare is essential to establishing whether interventions are effective and to understanding how and why they work in order to enable replication. Although valuable, evaluation is often complicated by tensions and friction between evaluators, implementers and other stakeholders. Drawing on the literature, we suggest that these tensions can arise from a lack of shared understanding of the goals of the evaluation; confusion about roles, relationships and responsibilities; data burdens; issues of data flows and confidentiality; the discomforts of being studied and the impact of disappointing or otherwise unwelcome results. We present a possible approach to managing these tensions involving the co-production and use of a concordat. We describe how we developed a concordat in the context of an evaluation of a complex patient safety improvement programme known as Safer Clinical Systems Phase 2. The concordat development process involved partners (evaluators, designers, funders and others) working together at the outset of the project to agree a set of principles to guide the conduct of the evaluation. We suggest that while the concordat is a useful resource for resolving conflicts that arise during evaluation, the process of producing it is perhaps even more important, helping to make explicit unspoken assumptions, clarify roles and responsibilities, build trust and establish open dialogue and shared understanding. The concordat we developed established some core principles that may be of value for others involved in evaluation to consider. But rather than seeing our document as a ready-made solution, there is a need for recognition of the value of the process of co-producing a locally agreed concordat in enabling partners in the evaluation to work together effectively.

IOM: Spread, Scale, and Sustainability in Population Health—Workshop in Brief (US)
March 2015

On December 4, 2014, the Roundtable on Population Health Improvement held its 10th workshop in New York City. The workshop, titled “Achieving Meaningful Population Health Outcomes: A Workshop on Spread and Scale,” focused on the spread, scale, and sustainability of strategies to improve population health in a variety of contexts and sectors. The workshop explored: the different meanings of spread and scale; what could be learned about a variety of approaches to the spread and scale of ideas, practices, programs, and policies; how users measure whether their strategies of spread and scale were effective; and how to accelerate a focus on spread and scale strategies in population health.

The King’s Fund: Acute hospitals and integrated care: From hospitals to health systems (UK)
2015

This report describes lessons from five case studies where acute hospitals are working collaboratively with local partners to build integrated models of care – three of these sites have since been chosen as vanguards by NHS England. The report assesses the achievements made so far, distils the lessons learnt for other local health economies, and makes recommendations for national policy-makers.

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Research Practice and Methodology

How to study improvement interventions: a brief overview of possible study types.
Non UofA Access
Portela MC, Pronovost PJ, Woodcock T, Carter P, Dixon-Woods M.
BMJ quality & safety 2015 Mar 25

Improvement (defined broadly as purposive efforts to secure positive change) has become an increasingly important activity and field of inquiry within healthcare. This article offers an overview of possible methods for the study of improvement interventions. The choice of available designs is wide, but debates continue about how far improvement efforts can be simultaneously practical (aimed at producing change) and scientific (aimed at producing new knowledge), and whether the distinction between the practical and the scientific is a real and useful one. Quality improvement projects tend to be applied and, in some senses, self-evaluating. They are not necessarily directed at generating new knowledge, but reports of such projects if well conducted and cautious in their inferences may be of considerable value. They can be distinguished heuristically from research studies, which are motivated by and set out explicitly to test a hypothesis, or otherwise generate new knowledge, and from formal evaluations of improvement projects. We discuss variants of trial designs, quasi-experimental designs, systematic reviews, programme evaluations, process evaluations, qualitative studies, and economic evaluations. We note that designs that are better suited to the evaluation of clearly defined and static interventions may be adopted without giving sufficient attention to the challenges associated with the dynamic nature of improvement interventions and their interactions with contextual factors. Reconciling pragmatism and research rigour is highly desirable in the study of improvement. Trade-offs need to be made wisely, taking into account the objectives involved and inferences to be made.

Developing standards for reporting implementation studies of complex interventions (StaRI): a systematic review and e-Delphi
Pinnock H, Epiphaniou E, Sheikh A, Griffiths C, Eldridge S, Craig P, et al.
Implementation Science 2015;10(1):42

Dissemination and implementation of health care interventions are currently hampered by the variable quality of reporting of implementation research. Reporting of other study types has been improved by the introduction of reporting standards (e.g. CONSORT). We therefore developed guidelines for reporting implementation studies (StaRI). Methods Using established methodology for developing health research reporting guidelines, we systematically reviewed the literature to generate items for a checklist of reporting standards. We then recruited an international, multidisciplinary panel for an e-Delphi consensus-building exercise which comprised an initial open round to revise/suggest a list of potential items for scoring in the subsequent two scoring rounds (scale 1 to 9). Consensus was defined a priori as 80% agreement with the priority scores of 7, 8, or 9. Results We identified eight papers from the literature review from which we derived 36 potential items. We recruited 23 experts to the e-Delphi panel. Open round comments resulted in revisions, and 47 items went forward to the scoring rounds. Thirty-five items achieved consensus: 19 achieved 100% agreement. Prioritised items addressed the need to: provide an evidence-based justification for implementation; describe the setting, professional/service requirements, eligible population and intervention in detail; measure process and clinical outcomes at population level (using routine data); report impact on health care resources; describe local adaptations to the implementation strategy and describe barriers/facilitators. Over-arching themes from the free-text comments included balancing the need for detailed descriptions of interventions with publishing constraints, addressing the dual aims of reporting on the process of implementation and effectiveness of the intervention and monitoring fidelity to an intervention whilst encouraging adaptation to suit diverse local contexts. Conclusions We have identified priority items for reporting implementation studies and key issues for further discussion. An international, multidisciplinary workshop, where participants will debate the issues raised, clarify specific items and develop StaRI standards that fit within the suite of EQUATOR reporting guidelines, is planned.

AHRQ: Comparison of Effects as Evidence Evolves From Single Trials to High-Quality Bodies of Evidence (US)
2015

The objective of our methods project was to use a diverse sample of medical interventions to assess empirically whether first trials rendered substantially different treatment effect estimates than reliable, high-quality bodies of evidence. Study design and setting. We employed a meta-epidemiological study design using 100 bodies of evidence from Cochrane reports that had been graded as high quality of evidence. To determine the concordance of effect estimates between first and subsequent trials, we applied both quantitative and qualitative approaches. For quantitative assessment, we used Lin’s concordance correlation and calculated z-scores; to determine the magnitude of differences of treatment effects, we calculated standardized mean differences (SMDs) and ratios of relative risks. We determined qualitative concordance based on a 2-tiered approach incorporating changes in statistical significance and magnitude of effect. Results. First trials both over- and under-estimated the true treatment effects in no discernible pattern. Nevertheless, depending on the definition of concordance, effect estimates of first trials were concordant with pooled subsequent studies in at least 33 percent but up to 50 percent of comparisons. The pooled magnitude of change as bodies of evidence advanced from single trials to high-quality bodies of evidence was 0.16 SMD (95% confidence interval [CI], 0.12 to 0.21). In 80 percent of comparisons the difference in effect estimates was smaller than 0.5 SMDs. In first trials with large treatment effects (>0.5 SMD), however, estimates of effect substantially changed as new evidence accrued (mean change 0.68 SMD, 95% CI, .50 to 0.86) Conclusion. Results of first trials often change but the magnitude of change, on average, is small. Exceptions are first trials that present large treatment effects which often dissipate as new evidence accrues.

Council of Canadian Academies: Accessing Health And Health-Related Data in Canada Canada-flat-icon
2015

Accessing Health and Health-Related Data in Canada examines the technological and methodological challenges of accessing data; the benefits and risks of such access; legal and ethical considerations; and best practices for governance mechanisms that enable access. This report provides a foundation of knowledge that will support policy-makers, administrators, clinicians, and researchers in health-related fields who seek to improve the delivery of health and social services to the public.

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Aging

Resident health-related quality of life in Swiss nursing homes.
Non UofA Access
Chouiter L, Wodchis WP, Abderhalden C, von Gunten A.
European psychiatry : the journal of the Association of European Psychiatrists 2015 Mar 20

Health-related quality of life (HRQOL) levels and their determinants in those living in nursing homes are unclear. The aim of this study was to investigate different HRQOL domains as a function of the degree of cognitive impairment and to explore associations between them and possible determinants of HRQOL. METHOD: Five HRQOL domains using the Minimum Data Set – Health Status Index (MDS-HSI) were investigated in a large sample of nursing home residents depending on cognitive performance levels derived from the Cognitive Performance Scale. Large effect size associations between clinical variables and the different HRQOL domains were looked for. RESULTS: HRQOL domains are impaired to variable degrees but with similar profiles depending on the cognitive performance level. Basic activities of daily living are a major factor associated with some but not all HRQOL domains and vary little with the degree of cognitive impairment. LIMITATIONS: This study is limited by the general difficulties related to measuring HRQOL in patients with cognitive impairment and the reduced number of variables considered among those potentially influencing HRQOL. CONCLUSION: HRQOL dimensions are not all linearly associated with increasing cognitive impairment in NH patients. Longitudinal studies are required to determine how the different HRQOL domains evolve over time in NH residents. Copyright © 2015.

End-of-Life Care in Nursing Homes with Greater Versus Less Palliative Care Knowledge and Practice.
Non UofA Access
Miller SC, Lima JC, Thompson SA.
Journal of palliative medicine 2015 Mar 16

Many older adults in nursing homes (NHs) lack palliative care (PC) access; but little is known about whether access to PC knowledge and practice (beyond hospice) impacts residents’ care. OBJECTIVE: The study objective was to evaluate how differing levels of NH PC knowledge and practice are associated with residents’ end-of-life health care use. METHODS: In 2009/10 we surveyed a stratified random sample of U.S. NHs and asked directors of nursing (DONs) PC knowledge and practice questions from Thompson and colleagues’ validated PC Survey. This study includes 1981 NHs with complete survey responses and the 58,876 residents who died in these facilities between July 2009 and June 2010. Medicare resident assessment (minimum data set [MDS]) and claims data from July 2009 through June 2010 were used to determine outcomes and a NH’s hospice use. Multivariate logistic regressions examined whether residing in NHs with higher PC scores was associated with documented six-month prognoses and receipt of aggressive treatments, including hospital and emergency room (ER) use in the last 30 days of life. RESULTS: Controlling for NH hospice use, being in a NH with higher PC care knowledge scores was associated with residents having a higher likelihood of documented six-month prognoses and lower likelihoods of having feeding tubes, injections, restraints, suctioning, and end-of-life hospital and ER use. Being in a NH with higher PC practice scores was associated with a lower likelihood of having feeding tubes and ER visits. CONCLUSION: Policies and advocacy promoting the development of NH PC knowledge and practices could potentially improve care and reduce hospital and ER use.

The Minimum Data Set 3.0 Cognitive Function Scale.
Non UofA Access
Thomas KS, Dosa D, Wysocki A, Mor V.
Medical care 2015 Mar 11

The Minimum Data Set (MDS) 3.0 introduced the Brief Interview for Mental Status (BIMS), a short performance-based cognitive screener for nursing home (NH) residents. Not all residents are able to complete the BIMS and are consequently assessed by staff. We designed a Cognitive Function Scale (CFS) integrating self-report and staff-report data and present evidence of the scale’s construct validity. DESIGN: A retrospective cohort study. SUBJECTS: The subjects consisted of 3 cohorts: (1) long-stay NH residents (N=941,077) and (2) new admissions (N=2,066,580) during 2011-2012, and (3) residents with the older MDS 2.0 assessment in 2010 and the newer MDS 3.0 assessment (n=688,511). MEASURES: MDS 3.0 items were used to create a single, integrated 4-category hierarchical CFS that was compared with residents’ prior MDS 2.0 Cognitive Performance Scale scores and other concurrent MDS 3.0 measures of construct validity. RESULTS: The new CFS suggests that 28% of the long-stay cohort in 2011-2012 were cognitively intact, 22% were mildly impaired, 33% were moderately impaired, and 17% were severely impaired. For the admission cohort, the CFS noted 56% as cognitively intact, 23% as mildly impaired, 17% as moderately impaired, and 4% as severely impaired. The CFS corresponded closely with residents’ prior MDS 2.0 Cognitive Performance Scale scores and with performance of Activities of Daily Living, and nurses’ judgments of function and behavior in both the admission and long-stay cohorts. CONCLUSIONS: The new CFS is valuable to researchers as it provides a single, integrated measure of NH residents’ cognitive function, regardless of the mode of assessment.

The prevalence of uncontrolled pain in long-term care: a pilot study examining outcomes of pain management processes.
Non UofA Access
Good H, Riley-Doucet CK, Dunn KS.
Journal of gerontological nursing 2015 Feb;41(2):33-41

Pain in long-term care (LTC) is common among older residents despite the vast options available for optimal pain management. Inadequate pain management affects individual health care outcomes. Researcher evidence has shown that nurse practitioners (NPs) improve the quality of care in LTC but are challenged by multiple barriers that inhibit optimal pain control. The purpose of the current pilot study was to explore both the pain management processes used by nurses in LTC and the documented patient outcomes that come from these processes. In addition, factors were identified that may impact the NP role in providing adequate pain control in LTC. This descriptive study used a retrospective, case-controlled research design that incorporated reviewing 55 LTC resident medical records. Results show how the process of pain management in LTC can be improved by expanding the professional role of the NP. Copyright 2015, SLACK Incorporated.

Antipsychotics, Other Psychotropics, and the Risk of Death in Patients With Dementia: Number Needed to Harm
Non UofA Access
Maust DT, Kim HM, Seyfried LS, Chiang C, Kavanagh J, Schneider LS, et al.
JAMA psychiatry 2015 Mar 18

Antipsychotic medications are associated with increased mortality in older adults with dementia, yet their absolute effect on risk relative to no treatment or an alternative psychotropic is unclear. OBJECTIVE: To determine the absolute mortality risk increase and number needed to harm (NNH) (ie, number of patients who receive treatment that would be associated with 1 death) of antipsychotic, valproic acid and its derivatives, and antidepressant use in patients with dementia relative to either no treatment or antidepressant treatment. DESIGN, SETTING, AND PARTICIPANTS: A retrospective case-control study was conducted in the Veterans Health Administration from October 1, 1998, through September 30, 2009. Participants included 90 786 patients 65 years or older with a diagnosis of dementia. Final analyses were conducted in August 2014. EXPOSURES: A new prescription for an antipsychotic (haloperidol, olanzapine, quetiapine, and risperidone), valproic acid and its derivatives, or an antidepressant (46 008 medication users). MAIN OUTCOMES AND MEASURES: Absolute change in mortality risk and NNH over 180 days of follow-up in medication users compared with nonmedication users matched on several risk factors. Among patients in whom a treatment with medication was initiated, mortality risk associated with each agent was also compared using the antidepressant group as the reference, adjusting for age, sex, years with dementia, presence of delirium, and other clinical and demographic characteristics. Secondary analyses compared dose-adjusted absolute change in mortality risk for olanzapine, quetiapine, and risperidone. RESULTS: Compared with respective matched nonusers, individuals receiving haloperidol had an increased mortality risk of 3.8% (95% CI, 1.0%-6.6%; P < .01) with an NNH of 26 (95% CI, 15-99); followed by risperidone, 3.7% (95% CI, 2.2%-5.3%; P < .01) with an NNH of 27 (95% CI, 19-46); olanzapine, 2.5% (95% CI, 0.3%-4.7%; P = .02) with an NNH of 40 (95% CI, 21-312); and quetiapine, 2.0% (95% CI, 0.7%-3.3%; P < .01) with an NNH of 50 (95% CI, 30-150). Compared with antidepressant users, mortality risk ranged from 12.3% (95% CI, 8.6%-16.0%; P < .01) with an NNH of 8 (95% CI, 6-12) for haloperidol users to 3.2% (95% CI, 1.6%-4.9%; P < .01) with an NNH of 31 (95% CI, 21-62) for quetiapine users. As a group, the atypical antipsychotics (olanzapine, quetiapine, and risperidone) showed a dose-response increase in mortality risk, with 3.5% greater mortality (95% CI, 0.5%-6.5%; P = .02) in the high-dose subgroup relative to the low-dose group. When compared directly with quetiapine, dose-adjusted mortality risk was increased with both risperidone (1.7%; 95% CI, 0.6%-2.8%; P = .003) and olanzapine (1.5%; 95% CI, 0.02%-3.0%; P = .047). CONCLUSIONS AND RELEVANCE: The absolute effect of antipsychotics on mortality in elderly patients with dementia may be higher than previously reported and increases with dose.

A comparative analysis of comprehensive geriatric assessments for nursing home residents receiving palliative care: a systematic review.
Non UofA Access
Hermans K, De Almeida Mello J, Spruytte N, Cohen J, Van Audenhove C, Declercq A.
Journal of the American Medical Directors Association 2014 Jul;15(7):467-476

Nursing homes become important locations for palliative care. By means of comprehensive geriatric assessments (CGAs), an evaluation can be made of the different palliative care needs of nursing home residents. This review aims to identify all CGAs that can be used to assess palliative care needs in long-term care settings and that have been validated for nursing home residents receiving palliative care. The CGAs are evaluated in terms of psychometric properties and content comprehensiveness. DESIGN: A systematic literature search in electronic databases MEDLINE, Web of Science, EMBASE, Cochrane, CINAHL, and PsycInfo was conducted for the years 1990 to 2012. SETTING: Nursing homes. PARTICIPANTS: Nursing home residents with palliative care needs. MEASUREMENTS: Psychometric data on validity and reliability were extracted from the articles. The content comprehensiveness of the identified CGAs was analyzed, using the 13 domains for a palliative approach in residential aged care of the Australian Government Department of Health and Aging. RESULTS: A total of 1368 articles were identified. Seven studies met our inclusion criteria, describing 5 different CGAs that have been validated for nursing home residents with palliative care needs. All CGAs demonstrate moderate to high psychometric properties. The interRAI Palliative Care instrument (interRAI PC) covers all domains for a palliative approach in residential aged care of the Australian Government Department of Health and Aging. The McMaster Quality of Life Scale covers nine domains. All other CGAs cover seven domains or fewer. CONCLUSIONS: The interRAI PC and the McMaster Quality of Life Scale are considered to be the most comprehensive CGAs to evaluate the needs and preferences of nursing home residents receiving palliative care. Future research should aim to examine the effectiveness of the identified CGAs and to further validate the CGAs for nursing home residents with palliative care needs. Copyright © 2014 AMD

Study protocol: cost-effectiveness of multidisciplinary nutritional support for undernutrition in older adults in nursing home and home-care: cluster randomized controlled trial.
Non UofA Access
Beck AM, Gogsig Christensen A, Stenbaek Hansen B, Damsbo-Svendsen S, Kreinfeldt Skovgaard Moller T, Boll Hansen E, et al.
Nutrition journal 2014 Aug 28;13:86-2891-13-86

Older adults in nursing home and home-care are a particularly high-risk population for weight loss or poor nutrition. One negative consequence of undernutrition is increased health care costs. Several potentially modifiable nutritional risk factors increase the likelihood of weight loss or poor nutrition. Hence a structured and multidisciplinary approach, focusing on the nutritional risk factors and involving e.g. dieticians, occupational therapists, and physiotherapist, may be necessary to achieve benefits. Up till now a few studies have been done evaluating the cost-effectiveness of nutritional support among undernourished older adults and none of these have used such a multidisciplinary approach. METHODS: An 11 week cluster randomized trial to assess the cost-effectiveness of multidisciplinary nutritional support for undernutrition in older adults in nursing home and home-care, identified by screening with the Eating validation Scheme. Before start of the study there will be performed a train-the-trainer intervention involving educated nutrition coordinators.In addition to the nutrition coordinator, the participants assigned to the intervention group strategy will receive multidisciplinary nutrition support. Focus will be on treatment of the potentially modifiable nutritional risk factors identified by screening, by involving physiotherapist, registered dietician, and occupational therapist, as relevant and independent of the municipality’s ordinary assessment and referral system.The primary outcome parameter will be change in quality of life (by means of Euroquol-5D-3L). Secondary outcomes will be: physical performance (chair stand), nutritional status (weight, Body Mass Index and hand-grip strength), oral care, fall incidents, hospital admissions, rehabilitation stay, moving to nursing homes (for participants from home-care), use of social services and mortality.An economic evaluation will be conducted to evaluate the cost-effectiveness of the multidisciplinary support.Furthermore, interviews with nursing home and home-care management, nursing staff and nutrition coordinators in both the control and intervention groups, participants in the intervention group and the involved multidisciplinary team will be performed. CONCLUSION: In this study we will evaluate in a randomized controlled trial whether multidisciplinary nutritional support is cost-effective, in undernourished older adults in home-care and nursing home and contribute to important research.

High rates of hospital admission among older residents in assisted living facilities: opportunities for intervention and impact on acute care. Canada-flat-icon
Non UofA Access
Hogan DB, Amuah JE, Strain LA, Wodchis WP, Soo A, Eliasziw M, et al.
Open medicine 2014 Mar 4;8(1):e33-45

Little is known about health or service use outcomes for residents of Canadian assisted living facilities. Our objectives were to estimate the incidence of admission to hospital over 1 year for residents of designated (i.e., publicly funded) assisted living (DAL) facilities in Alberta, to compare this rate with the rate among residents of long-term care facilities, and to identify individual and facility predictors of hospital admission for DAL residents. METHODS: Participants were 1066 DAL residents (mean age ± standard deviation 84.9 ± 7.3 years) and 976 longterm care residents (85.4 ± 7.6 years) from the Alberta Continuing Care Epidemiological Studies (ACCES). Research nurses completed a standardized comprehensive assessment for each resident and interviewed family caregivers at baseline (2006 to 2008) and 1 year later. We used standardized interviews with administrators to generate facility- level data. We determined hospital admissions through linkage with the Alberta Inpatient Discharge Abstract Database. We used multivariable Cox proportional hazards models to identify predictors of hospital admission. RESULTS: The cumulative annual incidence of hospital admission was 38.9% (95% confidence interval [CI] 35.9%- 41.9%) for DAL residents and 13.7% (95% CI 11.5%-15.8%) for long-term care residents. The risk of hospital admission was significantly greater for DAL residents with greater health instability, fatigue, medication use (11 or more medications), and 2 or more hospital admissions in the preceding year. The risk of hospital admission was also significantly higher for residents from DAL facilities with a smaller number of spaces, no licensed practical and/ or registered nurses on site (or on site less than 24 hours a day, 7 days a week), no chain affiliation, and from select health regions. INTERPRETATION: The incidence of hospital admission was about 3 times higher among DAL residents than among long-term care residents, and the risk of hospital admission was associated with a number of potentially modifiable factors. These findings raise questions about the complement of services and staffing required within assisted living facilities and the potential impact on acute care of the shift from long-term care to assisted living for the facility-based care of vulnerable older people.

The Adult Social Care Outcomes Framework 2015/16 (UK)
Department of Health, UK 2015

This guidance document sets out the indicators for measuring adult social care outcomes in 2015 and 2016.
-The ASCOF measures how well care and support services achieve the outcomes that matter most to people.
The framework:
-supports councils to improve the quality of care and support services they provide.
-gives a national overview of adult social care outcomes in 2013 to 2014.
-looks at how the framework will be developed in future.

Alzheimer’s Association: Alzheimer’s Disease 2015 Facts and Figures (US)
March 2015

Alzheimer’s disrupts the lives of individuals, families and our communities, killing more than breast cancer and prostate cancer combined. Between 2000 and 2012, deaths from Alzheimer’s disease increased 69 percent, while those attributed to the number one cause of death, heart disease, decreased 16 percent.

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Events

Non UofA

The Case of Harry Hospital & Other Stories from the Charles Camsell Indian Hospital
Thursday 9 April 19:00 ATB Financial Arts Barns (10330 – 84 Avenue, Edmonton, AB). A reception will follow after the lecture

Dr. Maureen Lux will speak on: “The Case of Harry Hospital & Other Stories from the Charles Camsell Indian Hospital.” Dr. Lux teaches Canadian and Aboriginal history at Brock. Her book, Medicine That Walks: Medicine, Disease and Canadian Plains Native People, 1880-1940 (University of Toronto Press 2001) won the Canadian Historical Association Clio Prize, as well as the Royal Society of Canada’s Hannah Medal for the History of Medicine. Her research examines the health effects of colonialism on Aboriginal people on the prairies. She is currently at work on a study of twentieth-century hospitalization and health care policy for Canadian Aboriginal people

The Naked Truth: The State of Evaluation in Alberta
Friday 10 April
Delta Edmonton Centre Suite Hotel $30

The Alberta & NWT Chapter of the Canadian Evaluation Society and its partners are pleased to host this one day evaluation forum. The forum was designed by the Chapter to engage participants in provocative discussions and the sharing of information about:
-What is happening in evaluation in Alberta and what evaluators are working on
-The value of evaluation from the perspective of evaluators and those who use evaluations
-An action plan for advancing the profession of evaluation in the province
-The objective of the forum is to provide a gathering place for evaluators to connect with each other and also with the users of evaluation.

Online

CFHI Webinar The Chronic Care Model: Designing Care with ‘Chronic’ as the New Norm
8 May 2015 10:00–11:00 MT

Currently, the governance, management and funding of health services in Canada is most often oriented towards the acute care system, creating big gaps for patients with chronic conditions. Primary care is one domain where better management of resources could benefit patients with chronic conditions Some organizations are now working to address this question and realign services to better support good chronic care.

KT Canada: User-centred design: Designing for the way people are, rather than the way we wish they were
Thursday April 9 10:00-11:00
UofA folks: Edmonton Clinic Health Academy 5-001

Learning Objectives:
-To understand the principles of user-centred design;
-To be prepared to plan and integrate design cycles within a knowledge translation project;
-To understand how user engagement fits within this design framework.

SMDM Webinar: Dissemination and Implementation: Tips for Successful Grant Applications
Wednesday 13 May 10:00-11:30 MT

Speakers will share their expertise and provide pointers on everything from developing dissemination and implementation research to completing the dissemination and implementation sections of your next grant application. Speakers include:
Dr. Jeremy Grimshaw
Dr. Rachel Tabak
Dr. Sharon Straus
Dr. Christina R. Studts

TVN Webinar: Choosing health care options by involving Canada’s elderly: the CHOICE knowledge synthesis project
Wednesday 6 May 10:00 MT
Speaker: Paul Stolee, University of Waterloo

Hear the results of a knowledge synthesis project funded by TVN on engaging the seriously ill, frail elderly in health care research, planning and decision making. We believe that caring for the frail elderly is a complex, Canada-wide issue that requires multi-faceted, national strategies and solutions, and this webinar is one way we bring together talented people to focus on this goal. Join Dr. Stolee and his team as they review the final results from their TVN-funded Knowledge Synthesis Grant research.

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Courses

Introduction to Study Design & Research Methods
University of Oxford
1-5 June Oxford, UK £1640

Choosing and designing the most appropriate study to address your clinical research problem is paramount in generating the best evidence. This module will introduce some of the more advanced concepts and skills of research design, emphasising how they relate to evidence-based health care. Choosing and designing the most appropriate study to address a clinical question is paramount in generating the best evidence. As students learn to identify the strengths and weaknesses of 6 key study designs, they will also learn how to design a research protocol. Participants will design data collection and analysis, to include appropriate statistical tests. They will also learn strategies to manage bias and assess the quality of published research. Students will apply their learning in small groups to develop a protocol for an allocated research question, for which they will receive constructive and academic feedback.

AIHS ARECCI Second Opinion Reviewer Course
20-21 May Edmonton AB

The Second Opinion Reviewer course teaches the advanced skills needed to conduct reviews of higher risk quality improvement or evaluation projects. There is a maximum enrollment of 12 and participants will be selected through an application process based on:
-extensive knowledge of either quality improvement or evaluation principles and methodology;
-in-depth project experience and the ability to overlay project ethics on top of this experience when offering a second review opinion; and
-work-related role that allows for the integration of second opinion project ethics review.

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News

What Measures Should Be Used to Evaluate Health Care? (US)

The push to pay for quality, not quantity in health care is rapidly accelerating. Doctors and hospitals are being evaluated on myriad quality metrics by rating services, insurance companies, professional groups and government programs—with results increasingly tied to financial penalties or bonuses. But payers, providers and patients don’t always agree on what quality means, and there is no official set of standards.

Unhealthy Innovation? Alberta lags on innovation in the health-care industry Canada-flat-icon

To check the pulse of a region’s innovation, patent filings are one of few places to start. How does Alberta measure on this metric of innovation, then? The answer is all about the details, and whether one asks specifically how the province is doing in the health-care industry.

WHO: Tackling dementia – people’s perspectives

WHO has released 2 YouTube videos on the challenges of dementia. The one above and Dementia – it affects us all

A Pan-Canadian Vision and Strategy for Health Services and Policy Research Canada-flat-icon

To position Canada as a global leader in health services and policy research that optimizes health and health system outcomes, the CIHR Institute of Health Services and Policy Research (CIHR-IHSPR), provincial health research funding organizations, and many of Canada’s health charities partnered with the community to develop the first-ever pan-Canadian vision and strategy for health services and policy research (HSPR). The results of the first year of collaboration are complete and available in a comprehensive report, complementary asset map and Pan-Canadian Vision and Strategy for Health Services and Policy Research.

Commission on Improving Urgent Care for Older People (UK)

The NHS Confederation has launched an independent Commission on Improving Urgent Care for Older People. The Commission will be chaired by Mark Newbold, chair of the NHS Confederation Hospitals Forum and former chief executive of The Heart of England NHS Foundation Trust.

Restorative care model may provide solution to Alberta’s hospital crisis Canada-flat-icon

This article discusses the potential impact of the restorative care model on hospital overcapacity.

Findings from the National Center for Assisted Living 2013 Assisted Living Staff Vacancy, Retention, and Turnover Survey (US)

The overall retention rate for assisted living staff was just over 73.1 percent in 2013 with a median turnover rate at 24.2 percent, showing improvements from the 2012 data, according the National Center for Assisted Living’s Vacancy, Retention & Turnover Survey.

Nurse practitioners join two Lethbridge continuing care facilities Canada-flat-icon

Specially trained registered nurses have been placed within two local continuing care facilities as part of a pilot project designed to provide timely, on-site care to residents and reduce the need for emergency department visits.

How can scientists better communicate with the public?

Professor Elizabeth Hadley, Stanford University, believes that communication is an obligation for scientists, as a long term dialogue with the public and policy makers. But not everyone feels scientists do a good job engaging with the media.

CIHR’s commitment to basic science questioned Canada-flat-icon

In a move that is rattling some Canadian medical scientists, the Canadian Institutes of Health Research [CIHR] has endorsed an expansive set of programs aimed at harnessing its billion dollar annual budget not only for supporting fundamental science, but also for “delivering better health care” by moving “health knowledge along the innovation pipeline and into health and economic benefits.”

Ask about what doesn’t work- a guide for peer reviewers

t’s the things that don’t work that set the boundaries for a particular method or technique. However, more importantly than that, the unanswered questions as to why something doesn’t work lay the foundations for future research.

When the Reviewers Disagree

I need advice on how to handle peer-review comments, particularly when a journal asks you to revise and resubmit an article. I often find that, with three reviewers offering feedback, they give contradictory suggestions. How should you revise an essay to meet their not-always-aligned advice? When (if ever) can certain suggestions be ignored?

How Manitoba Health used NCCMT resources to increase the relevance of new Public Health Nursing Standards for prenatal, postpartum and early childhood health Canada-flat-icon

In 2012, Jan Schmalenberg, Acting Director, Population Health and Health Equity with Manitoba Health, was asked to facilitate an 18-month, province-wide initiative to develop provincial public health nursing standards for prenatal, postpartum and early childhood health. A long-time public health practitioner, with experience as a public health nurse, manager and program specialist, Jan knew well how important it would be to integrate evidence from a variety of sources to develop provincial public health nursing standards that would be used to guide practice.

CIHI data used to change practice: Anti-psychotics move from a first-line treatment to one of last resort Canada-flat-icon

Weekly mentoring helped staff develop care plans that looked for alternatives to medication. The following week, everyone would brainstorm about what had worked well and what hadn’t. Along the way, RAI data was regularly posted so all staff could see the results of their efforts.

The Department of Health (UK) launches a new prototype dementia website

The NHS Confederation has launched an independent commission on improving urgent care for older people. The Department of Health has launched a new prototype version of the dementia challenge website and is seeking feedback from people who use it.

CARF Revises Standards for Dementia Specialty Programs

Standards body CARF International has revised its standards for dementia specialty programs, available in the 2015 editions of the CARF-CCAC and Aging Services standards manuals. An organization such as an assisted living community may choose to apply these specialty standards if it serves a specialized population for dementia care. The new program integrates services to preserve dignity and personhood, minimize the impact of impairments and secondary complications, maximize participation, including wellness, quality of life and inclusion in the community, decrease environmental barriers, and to promote safety and security.

StatsCan study: Life expectancy gap in Canada between males and females shrinking Canada-flat-icon

The differential in life expectancy between females and males peaked in the late 1970s at more than seven years. It has since been reduced, however, as increases in longevity have been more rapid for men than for women during the last three decades with the convergence in health-related behaviours, such as smoking and work-related stress. For the 2009 to 2011 period, life expectancy was 83.6 years for females and 79.3 years for males, a difference of 4.3 years, a gap that may further converge in the future.

AHS using ankle bracelet technology to track dementia patients Canada-flat-icon

A Red Deer company whose products help enforce probation orders for convicted criminals is now part of a study to help families of dementia patients. SafeTracksGPS, which manufactures ankle bracelets, created tracking devices small enough to hide in shoes and watches to specifically monitor people with cognitive disorders.

CMA launches website to build support for National Seniors Strategy Canada-flat-icon

The Canadian Medical Association (CMA) is ratcheting up its public campaign to encourage development of a national strategy on seniors care. In conjunction with a broad alliance of partner organizations, the CMA has launched DemandAPlan.ca, a website to build a community of support for a National Seniors Strategy and make seniors care a major issue in the upcoming federal election.

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Resources

CFHI Is Research Working for You: Self-Assessment Tool Canada-flat-icon

While many organizations would like to make better use of research, deciding where to start and identifying areas of improvement can be challenging. This tool is designed for organizations to discover strengths, gaps, and plans for addressing future research priority areas.

The Health Foundation: Using communications approaches to spread improvement (UK)

Spreading successful improvement work across the NHS is an essential part of improving health care quality and efficiency. Yet all too often an idea that has been shown to work well in one place is not adopted by others who could benefit from it. We have been running improvement programmes for many years. This guide draws on this experience, and empirical evidence, to provide practical information about how communications approaches can be used to spread improvement ideas.

How can I use Google Scholar Citations for scholarly profiling?

Google Scholar Citations is one of many scholarly profiling services available, allowing researchers to easily and conveniently profile their scholarly products, promote their work, connect with potential collaborators and view scholarly metrics. It’s also a great way to keep your scholarly record up to date.

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Opportunities

Translational Research Facilitator/Systematic Reviewer
School of Medicine – Rheumatology, Orthopaedics & Dermatology, University of Nottingham
DEADLINE Monday 13 April

Applications are invited for the above post to join an established multidisciplinary research team investigating the mechanisms of pain in osteoarthritis of the knee. The project is part of the Arthritis Research UK Pain Centre, studying pain, through a range of perspectives from biological mechanisms to clinical trials.

Manager, Research Programs (Design and Development) Canada-flat-icon
Michael Smith Health Research Foundation Vancouver BC
DEADLINE Friday 10 April

Our ideal candidate has deep knowledge of the health research funding environment – its current challenges, opportunities and trends – in Canada and beyond. Your expertise spans the range of funding competition models, from the well-established to the emerging and innovative. You understand all elements of funding program design from conception to launch, including the critical role of robust peer and merit review processes.

Special Advisor, Partnerships and Stakeholder Relations Canada-flat-icon
Michael Smith Health Research Foundation Vancouver BC
DEADLINE Friday 10 April

Reporting to the President & CEO, this role is responsible for developing partnership and government relations strategies aligned with MSFHR’s strategic plan. This one-year term position involves strengthening and building MSFHR’s relationships with various sectors (including government, not-for-profit, and private sectors) to increase funding and/or collaboration on priorities of mutual interest and of benefit to BC’s health research enterprise. This role works closely with staff who have expertise in/lead projects in these areas as well as other Directors, and is a member of MSFHR’s Management Team.

Post-Doctoral Position – Women’s College Hospital Canada-flat-icon
Toronto, Canada

We are seeking a highly motivated researcher to work with our team on process evaluations embedded within funded trials of knowledge translation initiatives. Specifically, we are looking for a postdoctoral fellow with interest in individual and/or organizational behaviour change interventions who would participate in the evaluation of initiatives aiming to 1) improve appropriateness of prescribing in long-term care homes and 2) to improve adherence to treatments amongst patients with cardiac disease. There would be flexibility to pursue additional projects and analyses related to understanding the effects of interventions in patient sub-groups and tailoring interventions accordingly. For more information, contact Noah Ivers at noahivers@gmail.com

Program Manager – Evidence Innovation
Australasian Cochrane Centre, Melbourne
DEADLINE Wednesday 8 April

As the Program Manager – Evidence Innovation, you will be responsible for overall management of Project Transform, a three-year flagship health evidence project, which will pilot, refine and scale-up innovations in evidence production by the global Cochrane network. Cochrane is the world’s leading independent organisation producing health evidence for informed decisions and better health. The project includes four project components, multiple institutional project partners and a dynamic international network of contributors.

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