New Brunswick announces aging strategy
The provincial government has announced, following a commitment from seniors groups to work together to develop a sustainable aging strategy, find efficiencies and improve the quality of care in New Brunswick, that it will not be moving forward with the proposed changes to the nursing home policy announced in the 2015-16 budget. This includes the consideration of assets and the rise in the daily cost for nursing home care.
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Qualitative Methods (QM) Conference
3-5 May Glasgow, United Kingdom
DEADLINE 30 November
Join us to discuss how diverse participants can work together to define a problem, ask questions, interpret data, and disseminate findings. Consider how theory and practicality should be balanced and ponder the limits to collaboration. Share you own experiences, issues, and successes with collaborative research. Come to the 2016 Qualitative Methods conference to explore the methodological, ethical, and theoretical complexities and possibilities of collaborative research.
Grants & Awards
TVN 2015 Call for Catalyst Grant proposals
DEADLINE Notice of Intent to Apply Monday 5 October
DEADLINE Full Application 9 November
The Catalyst Grant Program supports scalable research studies including pilot studies, feasibility studies, translational studies, and novel and innovative approaches aligned with TVN research priorities and themes. Successful Catalyst projects may be suitable for future larger scale TVN funding opportunities.
Evaluating implementation of methicillin-resistant Staphylococcus aureus (MRSA) prevention guidelines in spinal cord injury centers using the PARIHS framework: a mixed methods study
S. N. Balbale, J. N. Hill, M. Guihan, et al.
Implement Sci 2015 Sep 9;10:130-015-0318-x
BACKGROUND: To prevent methicillin-resistant Staphylococcus aureus (MRSA) in Spinal Cord Injury and Disorder (SCI/D) Centers, the “Guidelines for Implementation of MRSA Prevention Initiative in the Spinal Cord Injury Centers” were released in July 2008 in the Veterans Affairs (VA) Health Care System. The purpose of this study was to use the Promoting Action on Research Implementation in Health Systems (PARiHS) framework to evaluate the experiences of implementation of SCI/D MRSA prevention guidelines in VA SCI/D Centers approximately 2-3 years after the guidelines were released. METHODS: Mixed methods were used across two phases in this study. The first phase included an anonymous, web-based cross-sectional survey administered to providers at all 24 VA SCI/D Centers. The second phase included semi-structured telephone interviews with providers at 9 SCI/D Centers. The PARiHS framework was used as the foundation of both the survey questions and semi-structured interview guide. RESULTS: The survey was completed by 295 SCI/D providers (43.8 % response rate) from 22 of the 24 SCI/D Centers (91.7 % participation rate). Respondents included nurses (57.3 %), therapists (24.4 %), physicians (11.1 %), physician assistants (3.4 %), and other health care professionals (3.8 %). Approximately 36 % of the SCI/D providers surveyed had not seen, did not remember seeing, or had never heard of the MRSA SCI/D guidelines, whereas 42.3 % of providers reported that the MRSA SCI/D guidelines were fully implemented in their SCI/D Center. Data revealed numerous barriers and facilitators to guideline implementation. Facilitators included enhanced leadership support and provider education, focused guideline dissemination to reach SCI/D providers, and strong perceived evidence supporting the guidelines. Barriers included lack of awareness of the guidelines among physical therapists and physician assistants and challenges in cohorting/isolating MRSA-positive patients and following contact precautions. CONCLUSIONS: Successful implementation of MRSA infection prevention guidelines in SCI/D settings requires (1) guideline dissemination that reaches the full range of SCI/D providers working in inpatient, outpatient, and other care settings, (2) provider education that is frequent and systematic, (3) strong leadership support, and (4) that barriers unique to the recommendations are addressed. These findings may be used to inform selection of implementation strategies and optimize infection prevention beyond MRSA as well as in other specialty care populations.
Despite advances in research-informed public policy, research remains underutilized in government. To develop a firmer understanding of governmental capacity to use research in decision making, we investigate Canadian provincial ministries overseeing education, higher education, and science and technology. The findings from semi-structured interviews indicate that capacity to generate and access research is limited. However, we find evidence of a recent change in which provincial agencies sought to bolster capacity with research use strategies and by leveraging relationships with researchers. Leaders? support for well-coordinated research use initiatives also seems critical to instilling a culture of research-informed decision making in government agencies.
An exploratory analysis of the nature of informal knowledge underlying theories of planned action used for public health oriented knowledge translation.
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A. Kothari, J. A. Boyko and A. Campbell-Davison.
BMC Res Notes 2015 Sep 9;8(1):424-015-1391-6
BACKGROUND: Informal knowledge is used in public health practice to make sense of research findings. Although knowledge translation theories highlight the importance of informal knowledge, it is not clear to what extent the same literature provides guidance in terms of how to use it in practice. The objective of this study was to address this gap by exploring what planned action theories suggest in terms of using three types of informal knowledge: local, experiential and expert. We carried out an exploratory secondary analysis of the planned action theories that informed the development of a popular knowledge translation theory. Our sample included twenty-nine (n = 29) papers. We extracted information from these papers about sources of and guidance for using informal knowledge, and then carried out a thematic analysis. RESULTS: We found that theories of planned action provide guidance (including sources of, methods for identifying, and suggestions for use) for using local, experiential and expert knowledge. CONCLUSION: This study builds on previous knowledge translation related work to provide insight into the practical use of informal knowledge. Public health practitioners can refer to the guidance summarized in this paper to inform their decision-making. Further research about how to use informal knowledge in public health practice is needed given the value being accorded to using informal knowledge in public health decision-making processes.
The Mobilization of Scientific Evidence by Public Policy Analysts
SAGE Open 2015 09/10;5(3)
Research on knowledge mobilization in policy making has been largely focused on identifying relevant factors having an effect on the uptake of evidence by actors and organizations. However, evidence on the magnitude of those effects remains limited and existing methods allowing for this have been scarcely used in this field. In this article, we first provide a rationale for greater investigation of substantive effect sizes, using methods such as mediation analysis and conditional probabilities. Using cross-sectional data from Quebec (Canada) government policy analysts, we test an absorptive capacity model and describe direct, specific indirect, and total effects estimated from a path analysis. The results show that some factors have considerable effects, such as physical access and individual field of training, whereas some mediated relations are worth considering. Finally, we discuss some practical implications with regard to policy making and policy analysis but also the methodological standards of empirical research in this field.
Collaborative development and implementation of a knowledge brokering program to promote research use in Burkina Faso, West Africa.
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C. Dagenais, T. D. Some, M. Boileau-Falardeau, E. McSween-Cadieux and V. Ridde.
Glob Health Action 2015 Jan 27;8:26004
Despite efforts expended over recent decades, there is a persistent gap between the production of scientific evidence and its use. This is mainly due to the difficulty of bringing such knowledge to health workers and decision-makers so that it can inform practices and decisions on a timely basis. One strategy for transferring knowledge to potential users, that is, gaining increasing legitimacy, is knowledge brokering (KB), effectiveness of which in certain conditions has been demonstrated through empirical research. However, little is known about how to implement such a strategy, especially in the African context. The KB program presented here is aimed specifically at narrowing the gap by making scientific knowledge available to users with the potential to improve health-related practices and decision making in Burkina Faso. The program involves Canadian and African researchers, a knowledge broker, health practitioners, and policy-makers. This article presents the collaborative development of the KB strategy and the evaluation of its implementation at year 1. The KB strategy was developed in stages, beginning with a scoping study to ensure the most recent studies were considered. Two one-day workshops were then conducted to explore the problem of low research use and to adapt the strategy to the Burkinabe context. Based on these workshops, the KB program was developed and brokers were recruited and trained. Evaluation of the program’s implementation after the first year showed that: 1) the preparatory activities were greatly appreciated by participants, and most considered the content useful for their work; 2) the broker had carried out his role in accordance with the logic model; and 3) this role was seen as important by the participants targeted by the activities and outputs. Participants made suggestions for program improvements in subsequent years, stressing particularly the need to involve decision-makers at the central level.
Health Care Administration and Organization
Association of 12 h shifts and nurses’ job satisfaction, burnout and intention to leave: findings from a cross-sectional study of 12 European countries.
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C. Dall’Ora, P. Griffiths, J. Ball, M. Simon and L. H. Aiken.
BMJ Open 2015 Aug 23;5(9):e008331-2015-008331
OBJECTIVES: 12 h shifts are becoming increasingly common for hospital nurses but there is concern that long shifts adversely affect nurses’ well-being, job satisfaction and intention to leave their job. The aim of this study is to examine the association between working long shifts and burnout, job dissatisfaction, dissatisfaction with work schedule flexibility and intention to leave current job among hospital nurses. METHODS: Cross-sectional survey of 31 627 registered nurses in 2170 general medical/surgical units within 488 hospitals across 12 European countries. RESULTS: Nurses working shifts of >/=12 h were more likely than nurses working shorter hours (/=12 h were more likely to experience job dissatisfaction (aOR=1.40; 95% CI 1.20 to 1.62), dissatisfaction with work schedule flexibility (aOR=1.15; 95% CI 1.00 to 1.35) and report intention to leave their job due to dissatisfaction (aOR=1.29; 95% CI 1.12 to 1.48). CONCLUSIONS: Longer working hours for hospital nurses are associated with adverse outcomes for nurses. Some of these adverse outcomes, such as high burnout, may pose safety risks for patients as well as nurses.
Assessment of immigrant certified nursing assistants’ communication when responding to standardized care challenges.
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M. Massey and D. L. Roter.
Patient Educ Couns 2015 Aug 12
OBJECTIVE: Certified nursing assistants (CNAs) provide 80% of the hands-on care in US nursing homes; a significant portion of this work is performed by immigrants with limited English fluency. This study is designed to assess immigrant CNA’s communication behavior in response to a series of virtual simulated care challenges. METHODS: A convenience sample of 31 immigrant CNAs verbally responded to 9 care challenges embedded in an interactive computer platform. The responses were coded with the Roter Interaction Analysis System (RIAS), CNA instructors rated response quality and spoken English was rated. RESULTS: CNA communication behaviors varied across care challenges and a broad repertoire of communication was used; 69% of response content was characterized as psychosocial. Communication elements (both instrumental and psychosocial) were significant predictors of response quality for 5 of 9 scenarios. Overall these variables explained between 13% and 36% of the adjusted variance in quality ratings. CONCLUSION: Immigrant CNAs responded to common care challenges using a variety of communication strategies despite fluency deficits. PRACTICE IMPLICATIONS: Virtual simulation-based observation is a feasible, acceptable and low cost method of communication assessment with implications for supervision, training and evaluation of a para-professional workforce.
Health Care Innovation and Quality Assurance
The TRANSFORM Patient Safety Project: a microsystem approach to improving outcomes on inpatient units.
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C. H. Braddock 3rd, N. Szaflarski, L. Forsey, L. Abel, T. Hernandez-Boussard and J. Morton.
J Gen Intern Med 2015 Apr;30(4):425-433
BACKGROUND: Improvements in hospital patient safety have been made, but innovative approaches are needed to accelerate progress. Evidence is emerging that microsystem approaches to quality and safety improvement in hospital care are effective. OBJECTIVE: We aimed to evaluate the effects of a multifaceted, microsystem-level patient safety program on clinical outcomes and safety culture on inpatient units. DESIGN: A 1-year prospective interventional study was conducted, followed by a 6-month sustainability phase. SETTING AND PARTICIPANTS: Four medical and surgical inpatient units within an academic university medical center were included, with registered nurses and residents representing study participants. INTERVENTIONS: In situ simulation training; debriefing of medical emergencies; monthly patient safety team meetings; patient safety champion role; interdisciplinary patient safety conferences; recognition program for exemplary teamwork. OUTCOMES: Hospital-acquired severe sepsis/septic shock and acute respiratory failure; unplanned transfers to higher level of care (HLOC); weighted risk-adjusted mortality. Safety culture was measured using a widely accepted, validated survey. RESULTS: Rates of hospital-acquired severe sepsis/septic shock and acute respiratory failure decreased on study units, from 1.78 to 0.64 (p = 0.04) and 2.44 to 0.43 per 1,000 unit discharges (p = 0.03), respectively. The mean number of days between cases of severe sepsis/septic shock increased from baseline to the intervention period (p = 0.03). Unplanned transfers to HLOC increased from 715 to 764 per 1,000 unit transfers (p = 0.08). The weighted risk-adjusted observed-to-expected mortality ratio on all study units decreased from 0.50 to 0.40 (p < 0.001). Overall scores of safety culture on study units improved after the 1-year intervention, significantly for nurses (p < 0.001), but not for residents (p = 0.06). Scores significantly improved in nine of twelve survey dimensions for nurses, compared to in four dimensions for residents. CONCLUSION: A multifaceted patient safety program suggested an association with improved hospital-acquired complications and weighted, risk-adjusted mortality, and improved nurses’ perceptions of safety culture on inpatient study units.
Safety culture in long-term care: a cross-sectional analysis of the Safety Attitudes Questionnaire in nursing and residential homes in the Netherlands.
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M. Buljac-Samardzic, J. D. van Wijngaarden and C. M. Dekker-van Doorn.
BMJ Qual Saf 2015 Jul 24
OBJECTIVE: The first objective was to investigate if the Safety Attitudes Questionnaire (SAQ) is appropriate to measure the safety attitude of caregivers in nursing and residential homes, and second, to compare safety attitude of these caregivers with available data of caregivers in other settings (ie, inpatients, intensive care unit (ICU) and ambulatory care). METHODS: Using a cross-sectional survey methodology, we obtained completed SAQ surveys from 521 caregivers (response rate of 53%) working in nine units in nine different nursing and residential homes in The Netherlands. Exploratory factor and Cronbach’s alpha measures were used to analyse the psychometric properties of the SAQ. A correlation matrix was performed to study the relationship among the SAQ dimensions. A t test was performed to test significant differences between our sample and the benchmark settings. RESULTS: The factor analyses and calculated Cronbach’s alphas (alpha=0.56-0.80) for this sample confirmed the robustness of the SAQ scales. There was a high positive correlation between teamwork climate, job satisfaction, perceptions of management, safety climate and working conditions (r=0.31 to 63), but stress recognition had a negative correlation with each of the other dimensions (r=-0.13 to -0.18). Overall, the scores from the nursing and residential homes differed significantly from the benchmark settings. CONCLUSIONS: The findings in this study confirmed that the SAQ could also be used in the nursing and residential homes setting. However, stress recognition in nursing and residential homes setting does not seem to be one of the dimensions of the safety attitude construct. Furthermore, Dutch nursing and residential homes have significantly higher scores on most dimensions of the SAQ compared with US inpatient units and comparable scores to ICUs (Dutch and US) and ambulatory services.
Perceptions of Barriers and Facilitators During Implementation of a Complex Model of Group Prenatal Care in Six Urban Sites.
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G. Novick, J. A. Womack, J. Lewis, et al.
Res Nurs Health 2015 Sep 4
Group prenatal care improves perinatal outcomes, but implementing this complex model places substantial demands on settings designed for individual care. To describe perceived barriers and facilitators to implementing and sustaining CenteringPregnancy Plus (CP+) group prenatal care, 24 in-depth interviews were conducted with 22 clinicians, staff, administrators, and study personnel in six of the 14 sites of a randomized trial of the model. All sites served low-income, minority women. Sites for the present evaluation were selected for variation in location, study arm, and initial implementation response. Implementing CP+ was challenging in all sites, requiring substantial adaptations of clinical systems. All sites had barriers to meeting the model’s demands, but how sites responded to these barriers affected whether implementation thrived or struggled. Thriving sites had organizational cultures that supported innovation, champions who advocated for CP+, and staff who viewed logistical demands as manageable hurdles. Struggling sites had bureaucratic organizational structures and lacked buy-in and financial resources, and staff were overwhelmed by the model’s challenges. Findings suggested that implementing and sustaining health care innovation requires new practices and different ways of thinking, and health systems may not fully recognize the magnitude of change required. Consequently, evidence-based practices are modified or discontinued, and outcomes may differ from those in the original controlled studies. Before implementing new models of care, clinical settings should anticipate model demands and assess capacity for adapting to the disruptions of innovation. (c) 2015 Wiley Periodicals, Inc.
Quality Improvement in Skilled Nursing Facilities for Residents With Alzheimer’s Disease
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Martin R. Farlow, Soo Borson, Stephen R. Connor, George T. Grossberg and Mary S. Mittelman.
Am J Alzheimers Dis Other Demen 2015
This report describes a quality improvement continuing medical education activity designed to enhance the recognition and treatment of residents with Alzheimer’s disease (AD) or other dementias in skilled-nursing facilities (SNFs).Methods: Charts were compared in 6 areas prior to and following (stages A and C) a live, faculty-led workshop (stage B). Four SNFs completed stages A (n = 67 residents) and B, and 3 SNFs completed stage C (n = 52 residents). All charts came from residents with AD or a diagnosis of dementia or dementia-like symptoms.Results/Conclusion: The SNFs had >95% baseline performance in both the frequency of cognitive assessments and documented medication reviews. The percentage of residents who received a quality-of-life assessment and those who had a mental health care plan in place represent areas for improvement. As part of this activity, a toolkit was developed to help guide facilities and clinicians in instituting care improvements for residents with AD/dementia.
COSMOS-improving the quality of life in nursing home patients: protocol for an effectiveness-implementation cluster randomized clinical hybrid trial.
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B. S. Husebo, E. Flo, D. Aarsland, et al.
Implement Sci 2015 Sep 15;10(1):131-015-0310-5
BACKGROUND: Nursing home patients have complex mental and physical health problems, disabilities and social needs, combined with widespread prescription of psychotropic drugs. Preservation of their quality of life is an important goal. This can only be achieved within nursing homes that offer competent clinical conditions of treatment and care. COmmunication, Systematic assessment and treatment of pain, Medication review, Occupational therapy, Safety (COSMOS) is an effectiveness-implementation hybrid trial that combines and implements organization of activities evidence-based interventions to improve staff competence and thereby the patients’ quality of life, mental health and safety. The aim of this paper is to describe the development, content and implementation process of the COSMOS trial. METHODS/DESIGN: COSMOS includes a 2-month pilot study with 128 participants distributed among nine Norwegian nursing homes, and a 4-month multicenter, cluster randomized effectiveness-implementation clinical hybrid trial with follow-up at month 9, including 571 patients from 67 nursing home units (one unit defined as one cluster). Clusters are randomized to COSMOS intervention or current best practice (control group). The intervention group will receive a 2-day education program including written guidelines, repeated theoretical and practical training (credited education of caregivers, physicians and nursing home managers), case discussions and role play. The 1-day midway evaluation, information and interviews of nursing staff and a telephone hotline all support the implementation process. Outcome measures include quality of life in late-stage dementia, neuropsychiatric symptoms, activities of daily living, pain, depression, sleep, medication, cost-utility analysis, hospital admission and mortality. DISCUSSION: Despite complex medical and psychosocial challenges, nursing home patients are often treated by staff possessing low level skills, lacking education and in facilities with a high staff turnover. Implementation of a research-based multicomponent intervention may improve staff’s knowledge and competence and consequently the quality of life of nursing home patients in general and people with dementia in particular. TRIAL REGISTRATION: ClinicalTrials.gov NCT02238652.
Menu Planning in Residential Aged Care-The Level of Choice and Quality of Planning of Meals Available to Residents.
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K. L. Abbey, O. R. Wright and S. Capra.
Nutrients 2015 Sep 9;7(9):7580-7592
BACKGROUND: Choice of food is an imperative aspect of quality of life for residents in Residential Aged Care Homes (RACHs), where overall choice and control is diminished upon entering a home to receive care. The purpose of this study was to examine the current strategies of menu planning in a range of RACHs in Australia, and whether this facilitated appropriate levels of choice for residents receiving texture modified and general diets. METHODS: The study comprised a National Menu Survey using a new survey instrument collecting general information about the RACH and foodservice system, menu information and staffing information (n = 247); a national menu analysis (n = 161) and an observational case study of 36 meal environments. RESULTS: Choice was low for the entire sample, but particularly for those receiving pureed texture modified diets. Evidence of menu planning to facilitate the inclusion of choice and alternatives was limited. DISCUSSION: Regulation and monitoring of the Australian Aged Care Accreditation Standards needs to be strengthened to mandate improvement of the choice and variety offered to residents, particularly those on pureed texture modified diets. Further research on how menu choice and a lack of variety in meals affects the quality of life residents is needed in this context, but current evidence suggests the effect would be detrimental and undermine resident autonomy and nutritional status.
Fear and overprotection in Australian residential aged care facilities: The inadvertent impact of regulation on quality continence care.
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J. Ostaszkiewicz, B. O’Connell and T. Dunning.
Australas J Ageing 2015 Sep 13
AIM: Most residents in residential aged care facilities are incontinent. This study explored how continence care was provided in residential aged care facilities, and describes a subset of data about staffs’ beliefs and experiences of the quality framework and the funding model on residents’ continence care. METHODS: Using grounded theory methodology, 18 residential aged care staff members were interviewed and 88 hours of field observations conducted in two facilities. Data were analysed using a combination of inductive and deductive analytic procedures. RESULTS: Staffs’ beliefs and experiences about the requirements of the quality framework and the funding model fostered a climate of fear and risk adversity that had multiple unintended effects on residents’ continence care, incentivising dependence on continence management, and equating effective continence care with effective pad use. CONCLUSION: There is a need to rethink the quality of continence care and its measurement in Australian residential aged care facilities.
Facilitating Nurses’ Engagement in Hospital Quality Improvement: The New Jersey Hospital Association’s Implementation of Transforming Care at the Bedside.
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M. L. Pearson, J. Needleman, R. Beckman and B. Han.
J Healthc Qual 2015 Sep 7
Transforming Care at the Bedside (TCAB) is a program designed by the Robert Wood Johnson Foundation and the Institute for Healthcare Improvement to engage frontline staff in change processes to improve the work environment and patient care on nursing units. Originally designed and piloted in a small number of hospitals, TCAB is being disseminated through large-scale quality improvement (QI) collaboratives facilitated by professional organizations, such the New Jersey Hospital Association’s Institute for Quality and Patient Safety (NJHA). This article presents the results of an evaluation of the NJHA dissemination effort. The evaluation team used an observational mixed-method evaluation design and multiple data sources to assess implementation of TCAB by nursing units in these facilities. The results show that most of the participating units successfully implemented the TCAB improvement processes. Nursing teamwork and three nursing-sensitive outcomes improved significantly over the course of TCAB, and TCAB unit managers attributed important improvements to their unit’s participation. These findings suggest that TCAB is a viable mechanism for engaging frontline nursing staff in valuable QI activities. Other hospitals interested in furthering the culture and capacity for QI among frontline nursing unit staff should consider a TCAB collaborative for achieving these goals.
Association between organizational climate and perceptions and use of an innovation in Swedish primary health care: a prospective study of an implementation.
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S. Carlfjord and K. Festin.
BMC Health Serv Res 2015 Sep 10;15(1):364-015-1038-2
BACKGROUND: There is a need for new knowledge regarding determinants of a successful implementation of new methods in health care. The role of a receptive context for change to support effective diffusion has been underlined, and could be studied by assessing the organizational climate. The aim of this study was to assess the association between organizational climate when a computer-based lifestyle intervention tool (CLT) was introduced in primary health care (PHC) and the implementation outcome in terms of how the tool was perceived and used after 2 years. METHODS: The CLT was offered to 32 PHC units in Sweden, of which 22 units agreed to participate in the study. Before the introduction of the CLT, the creative climate at each participating unit was assessed. After 24 months, a follow-up questionnaire was distributed to the staff to assess how the CLT was perceived and how it was used. A question on the perceived need for the CLT was also included. RESULTS: The units were divided into three groups according to the creative climate: high, medium and low. The main finding was that the units identified as having a positive creative climate demonstrated more frequent use and more positive perceptions regarding the new tool than those with the least positive creative climate. More positive perceptions were seen at both individual and unit levels. CONCLUSIONS: According to the results from this study there is an association between organizational climate at baseline and implementation outcome after 2 years when a tool for lifestyle intervention is introduced in PHC in Sweden. Further studies are needed before measurement of organizational climate at baseline can be recommended in order to predict implementation outcome.
Research Practice and Methodology
SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process
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G. Ogrinc, L. Davies, D. Goodman, P. Batalden, F. Davidoff and D. Stevens.
BMJ Qual Saf 2015 Sep 14
Since the publication of Standards for QUality Improvement Reporting Excellence (SQUIRE 1.0) guidelines in 2008, the science of the field has advanced considerably. In this manuscript, we describe the development of SQUIRE 2.0 and its key components. We undertook the revision between 2012 and 2015 using (1) semistructured interviews and focus groups to evaluate SQUIRE 1.0 plus feedback from an international steering group, (2) two face-to-face consensus meetings to develop interim drafts and (3) pilot testing with authors and a public comment period. SQUIRE 2.0 emphasises the reporting of three key components of systematic efforts to improve the quality, value and safety of healthcare: the use of formal and informal theory in planning, implementing and evaluating improvement work; the context in which the work is done and the study of the intervention(s). SQUIRE 2.0 is intended for reporting the range of methods used to improve healthcare, recognising that they can be complex and multidimensional. It provides common ground to share these discoveries in the scholarly literature.
Time to Treatment Initiation in People With Alzheimer Disease: A Meta-Analysis of Randomized Controlled Trials
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Kelvin K. F. Tsoi, Hoyee W. Hirai, Joyce Y. C. Chan and Timothy C. Y. Kwok.
Journal of the American Medical Directors Association
Alzheimer disease (AD) is a global health problem which afflicts millions of old age population worldwide. Acetylcholinesterase inhibitors and memantine are recognized drug treatments with limited clinical efficacy. It is uncertain if earlier initiation of these drugs will result in better outcomes in the longer term.; BackgroundAlzheimer disease (AD) is a global health problem which afflicts millions of old age population worldwide. Acetylcholinesterase inhibitors and memantine are recognized drug treatments with limited clinical efficacy. It is uncertain if earlier initiation of these drugs will result in better outcomes in the longer term.
Shared Homes as an Alternative to Nursing Home Care: Impact of VA’s Medical Foster Home Program on Hospitalization.
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C. R. Levy, F. Alemi, A. E. Williams, et al.
Gerontologist 2015 Sep 18
PURPOSE OF THE STUDY: This study compares hospitalization rates for common conditions in the Veteran Affairs (VA) Medical Foster Home (MFH) program to VA nursing homes, known as Community Living Centers (CLCs). DESIGN AND METHODS: We matched 817 MFH residents to 3 CLC residents selected from a pool of 325,031 CLC residents. CLC and MFH cases were matched on (a) baseline time period, (b) follow-up time period, (c) age, (d) gender, (e) race, (f) risk of mortality calculated from comorbidities, and (g) history of hospitalization for the selected condition during the baseline period. Odds ratio (OR) and related confidence interval (CI) were calculated to contrast MFH cases and matched CLC controls. RESULTS: Compared with matched CLC cases, MFH residents were less likely to be hospitalized for adverse care events, (OR = 0.13, 95% CI = 0.03-0.53), anxiety disorders (OR = 0.52, 95% CI = 0.33-0.80), mood disorders (OR = 0.57, 95% CI = 0.42-0.79), skin infections (OR = 0.22, 95% CI = 0.10-0.51), pressure ulcers (OR = 0.22, 95% CI = 0.09-0.50) and bacterial infections other than tuberculosis or septicemia (OR = 0.54, 95% CI = 0.31-0.92). MFH cases and matched CLC controls did not differ in rates of urinary tract infections, pneumonia, septicemia, suicide/self-injury, falls, other injury besides falls, history of injury, delirium/dementia/cognitive impairments, or adverse drug events. Hospitalization rates were not higher for any conditions studied in the MFH cohort compared with the CLC cohort. IMPLICATIONS: MFH participants had the same or lower rates of hospitalizations for conditions examined compared with CLC controls suggesting that noninstitutional care by a nonfamilial caregiver does not increase hospitalization rates for common medical conditions.
Clinical Burden and Nonpharmacologic Management of Nursing Facility Residents with Overactive Bladder and/or Urinary Incontinence.
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B. J. Zarowitz, C. Allen, T. O’Shea, E. Tangalos, T. Berner and J. G. Ouslander.
Consult Pharm 2015;30(9):533-542
OBJECTIVE: To identify clinical characteristics of residents with a diagnosis of overactive bladder (OAB) and/or urinary incontinence (UI) to determine the prevalence of comorbidities, severe mobility impairment (SMI), moderate-to-severe cognitive impairment (MSCI), and a toileting program and the response to that program. DESIGN: Cross-sectional retrospective analysis. SETTING: Skilled nursing facilities. PATIENTS, PARTICIPANTS: Residents with a diagnosis of OAB and/or UI and an age range, and gender frequency-matched 1:1 control cohort without OAB and/or UI. INTERVENTIONS: None. MAIN OUTCOME MEASURE(S): De-identified Minimum Data Set data 3.0 records (October 1, 2010, to September 30, 2012). RESULTS: Of the 175,632 residents, 65% had a diagnosis of UI and 1% had a diagnosis of OAB. Those with UI and/or OAB were more likely to have MSCI (mean Brief Inventory of Mental Status score 10.2 +/- 4.5 vs. 12.5 +/- 3.6; P = 0.001) and SMI (49.4% vs. 26.4%; P < 0.001), multiple comorbid conditions, falls and falls with injury, hip fractures (5.5% vs. 4.9%; P < 0.001), urinary tract infections (21.4% vs. 16.5%; P = 0.001), and moisture-associated skin damage (5.2% vs. 2.6%; P = 0.001) than the control cohort. Toileting programs were attempted more often (17.0% vs. 5.1%; P < 0.001) in those with UI and/or OAB but were only minimally successful, with 4.2% having decreased wetness and 0.9% being completely dry. CONCLUSION: Residents with UI and/or OAB exhibit a higher burden of MSCI, SMI, and comorbidities than do residents without these diagnoses. Nonpharmacologic therapies such as toileting programs should be a primary focus in the nursing facility.
Treated Behavioral Symptoms and Mortality in Medicare Beneficiaries in Nursing Homes with Alzheimer’s Disease and Related Dementias.
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T. Y. Huang, Y. J. Wei, P. Moyo, I. Harris, J. A. Lucas and L. Simoni-Wastila.
J Am Geriatr Soc 2015 Aug 27
OBJECTIVES: To assess changes in behavioral symptoms associated with Alzheimer’s disease and related dementias (ADRDs) after antipsychotic (AP) or antidepressant (AD) treatment and to estimate the effect of treatment response on mortality risk. DESIGN: Retrospective cohort study using 2006-2009 Medicare administrative and prescription drug claims data linked to Minimum Data Set 2.0. SETTING: Long-stay (>/=101 days) nursing home residents. PARTICIPANTS: Continuously enrolled fee-for-service Medicare beneficiaries who had ADRDs, initiated (no use in prior 6 months) AP (n = 2,035) or AD (n = 1,661) treatment during or after one or more behavioral symptoms (verbally abusive, physically abusive, socially inappropriate or disruptive behavior) presented, and had reassessment of behavioral symptoms after 3 consecutive months of the initiated treatment. MEASUREMENTS: Behavioral symptom change was measured according to score (range 0-9, based on number and frequency of symptoms) change between baseline and reassessment (improved, 0). Survival analyses were conducted on time to death after reassessment, comparing residents whose symptoms improved with those whose symptoms remained unchanged or worsened. RESULTS: APs and ADs were comparable in treatment effectiveness, as evidenced by more than 85% of the behavioral symptom episodes in each cohort improving or remaining stable. Mortality risk was lower in both cohorts (AP: adjusted hazard ratio (aHRAP ) = 0.93, 95% confidence interval (CI) = 0.81-1.07; AD: aHRAD = 0.82, 95% CI = 0.70-0.97) for residents whose symptoms improved than for those whose symptoms unchanged or worsened. CONCLUSION: ADs may be reasonable pharmacological alternatives to APs in clinical management of ADRD-related behavioral symptoms. Initial treatment response may alter medication-associated mortality risk. Further study is needed to confirm findings using other data and behavioral symptom-specific instruments.
The social organization of a sedentary life for residents in long-term care.
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K. Benjamin, J. Rankin, N. Edwards, J. Ploeg and F. Legault.
Nurs Inq 2015 Aug 28
Worldwide, the literature reports that many residents in long-term care (LTC) homes are sedentary. In Canada, personal support workers (PSWs) provide most of the direct care in LTC homes and could play a key role in promoting activity for residents. The purpose of this institutional ethnographic study was to uncover the social organization of LTC work and to discover how this organization influenced the physical activity of residents. Data were collected in two LTC homes in Ontario, Canada through participant observations with PSWs and interviews with people within and external to the homes. Findings explicate the links between meals, lifts and transfers, and the LTC standards to reveal that physical activity is considered an add-on program in the purview of physiotherapists. Some of the LTC standards which are intended to product good outcomes for residents actually disrupt the work of PSWs making it difficult for them to respond to the physical activity needs of residents. This descriptive ethnographic account is an important first step in trying to find a solution to optimize real activities of daily living into life in LTC.
A Case Study of an Irish Success Story in the Field of Ageing
Ageing Well Network, 2015
The ageing field in Ireland owes much to the work of the Network as its various initiatives and stature contributed significantly to an increased focus on ageing in Ireland, helped raise the profile of ageing issues as a national priority and brought issues forward that were not previously discussed. As this case study indicates, while networks are not in short supply, the particular characteristics of the Ageing Well Network are noteworthy and could be useful for other organizations looking to bring together a fragmented field and influence both national and local policy.
Active Ageing: A Policy Framework in Response to the Longevity Revolution
International Longevity Centre Brazil, 2015
The Active Ageing: A Policy Framework in Response to the Longevity Revolution report, written and produced by the International Longevity Centre Brazil in consultation with multiple partners around the world, examines ageing in the context of major contemporary trends, such as urbanization, globalization, growing inequalities migration, technological innovation and environmental and climate change. The report also revisits the Active Ageing framework within the context of the evolving international momentum toward reinforcement of the human rights of older persons. New data and information about the determinants of active ageing are explored and lifelong learning is added as a new pillar to the Active Ageing framework.
Truth or Taste: Nursings’ Identity at Mid-Life
2 November 12:00-13:00 ECHA 5-001
Speaker: Barbara Pesut PhD, RN
Barbara Pesut PhD, RN is an Associate Professor in the School of Nursing at the University of British Columbia, Okanagan Campus and holds a Canada Research Chair in Health, Ethics and Diversity. Philosophic inquiry is central to her program of research in spiritual and religious diversity.
National Collaborating Centre for Healthy Public Policy Webinar: Public Health Ethics in Practice: Applying Frameworks to Cases
Thursday 1 October 12:00-13:00 MT
During this webinar, we will introduce participants to:
-The general nature and role of ethics frameworks in public health,
-Summary versions of two public health ethics frameworks, and
-Cases (drawn from public health and related to healthy public policy) for deliberation using those frameworks.
A big part of this webinar will be focused on a more in-depth application of a framework to a case. Participants will be able to both see and contribute to applying a framework to identify the ethical implications that arise, and to deliberate towards a decision about what to do.
Knowledge Translation Solutions for Overcoming Barriers to Research Use. Knowledge translation (KT) strategies are used by grantees funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) to share their research with a variety of audiences. KT activities are used to create a change in awareness, behavior, or action on the part of the identified audience. This online conference is designed to help grantees to identify both barriers to the use of their NIDILRR-funded research and strategies to overcome them. The conference is oriented toward resolving problems or limitations in KT activities of NIDILRR-funded grantees and other researchers.
CFHI: Data Boot Camp: How to Get Your Data Into Shape!
14 October – Introduction to Healthcare Data for Improvement
18 November – Enhancing Data Quality for Improvement
14 January – Effective Data Quality Management
When working with data and measurement, one critical question that must always be assessed is: How can I know that my improvement data is good enough to drive healthcare transformation? Using data effectively – which includes data preparation and processing, measuring the right things the right way and establishing good data management practices – is key to achieving high quality, data-driven insights that support healthcare improvement.
The ageing population is a growing concern for every country worldwide. In Canada, this issue is being met head on by the CIHR Institute of Aging through their myriad of programmes and collaborations with CIHR’s partners, as Scientific Director Dr Yves Joanette explains
The nation’s healthcare system is endangering the elderly. But few outside the geriatric medical community seem to notice.
Nearly one-quarter had trouble getting out of hospital bed, walking 10 feet and getting back in bed.
Meet the designer behind a state of the art facility in Aalborg, Denmark which is utilising technology and public spaces to revolutionise the concept of an aged care facility.
The Provincial Government has released a status report outlining the progress made on seniors’ initiatives since the launch of the Provincial Healthy Aging Policy Framework in 2007.
Canadian facility creates similar false-reality experience based on Holland’s Hogewey.
The web based consultation and survey for Draft Zero of the Global Strategy and Action Plan on Ageing and Health is now open for public consultation from individuals and institutions.
Four health care policy experts, Dr. Ivy Bourgeault, Dr. Robyn Tamblyn, Dr. Neena Chappell and Dr. Michel Grignon, believe it is time to rethink the philosophy behind long term care in Canada. Long term care for seniors needs to be taken more seriously and better reflect the needs and preferences of seniors.
“There’s definitely times when nurses may not have a piece of equipment that they need at that particular type of moment, and that may cause them to have some anxiety around that or something like that. But I don’t think it’s widespread,” said Linda Dempster, Alberta Health Services’ vice-president of collaborative practice, nursing and health professions.
The goal of the pilot is to find beds in the community for individuals like John, an in-hospital patient who no longer needs to be cared for in a hospital-setting but still requires healthcare services.
The province says it is working on a long-term strategy to deal with the aging population.
Statistics Canada says more than seven percent of Canada’s seniors live in nursing homes — a number on the rise despite research showing that Canadians in long term care are up to four times more likely to fall and break a hip or fracture their backbone. New guidelines just published in the Canadian Medical Association Journal may turn things around.
The dementia money would be spent on screening, early diagnosis and treatment to slow the advance of the devastating conditions, as well as on helping families access care for afflicted family members.
Writing in the Digital Age: Savvy Publishing for Healthcare Professionals
Authors: Dr. Leslie H. Nicoll & Dr. Peggy L. Chinn
If you are an author, or aspire to be one, writing for publication in today’s digital age means you are likely a “digital immigrant,” confronted at every turn with new and unexpected technology and electronic innovations. Writing in the Digital Age: Savvy Publishing for Healthcare Professionals is a valuable resource to orient you to the rapid evolution of digital writing.
Research Associate in the Division of Women’s Health
King’s College London UK
DEADLINE 1 October
This post is for a Post- Doctoral Research Associate in quality and safety improvement, and implementation-related research. The successful applicant will work across a programme of research and collaborate with researchers working in King’s Improvement Science, the NIHR CLAHRC South London Maternity and the Women’s health research team.
Senior Research Fellow in Qualitative Evidence Synthesis/ Qualitative Research
Lee Kong Chian School of Medicine, Singapore
DEADLINE 15 November
The Lee Kong Chian School of Medicine (LKCMedicine) invites applications for a senior post-doctoral research fellow. This position is for a 2 year appointment in the first instance with an optional extension. We are looking for an ambitious and experienced researcher in qualitative research to join our research programme conducted in partnership with the WHO on eLearning for Healthcare Professionals Education. The post involves synthesizing qualitative evidence and conducting systematic reviews on this topic.
Senior/Research Fellows in Health Services Research/ Population Health/ mHealth
Lee Kong Chian School of Medicine, Singapore
DEADLINE 12 October
The Lee Kong Chian School of Medicine (LKCMedicine) invites applications for post-doctoral research fellows. This position is for a 2 year appointment in the first instance with an optional extension. We are looking for ambitious and experienced researchers in Health Services Research, Population Health or mHealth to join several projects ranging from design of new mHealth and eLearning interventions to evaluation of existing services, such as the national Advanced Care Planning programme.
Program Coordinator – Knowledge Translation and Implementation
Faculty of Medicine & Dentistry – Department of Pediatrics, University of Alberta, Edmonton
Open until filled
Reporting to the Director, and under direction from the Assistant Director, Knowledge Translation (KT) Platform, Alberta SPOR SUPPORT unit, the Program Coordinator – Knowledge Translation and Implementation coordinates high level, complex research activities and analysis specific to knowledge translation and implementation. The position requires a high degree of knowledge about the science involved in this work as well as highly developed abilities in management and communication.