December 14th, 2015


Abstracts
Grants & Awards
Publications
Events
Courses
News
Opportunities

Happy Holidays!!!

Announcements

December TREC Newsletter

Read all about what TREC has been up to.

New TREC Article
Can Resident Life Stories Help Nursing Aides Learn about Residents? A Pilot Study

M.C. Smith, C.M. Kreklewetz
The Journal of Nursing Home Research Science; 2015

This research investigated the use of resident life stories to help nursing aides learn about nursing home residents. Forty-one nursing aides from seven nursing homes viewed an intake form, read a story about the resident’s background, and watched a video about the resident’s background. Dependent measures included how absorbed/transported they were into the information, how distracted they were while taking in the information, the usefulness and relevance of the information to them in their jobs, and the overall usefulness of each mode of communication. In many cases, the story or video was superior to the regular information form used by nursing homes. Few empirical studies have examined the role of resident life stories to assist nursing aides in caring for residents. Results provide evidence that resident life stories are a useful method for delivering information about the residents to this target group.

Excellent example of using YouTube to diffuse research findings
Healthcare support workers: Education and training to improve skills and standards in older people’s services

This video from the OPWISE Study describes how to create effective training for support workers working with the elderly.

New article by Dr Lars Wallin
Exploring the influence of context in a community-based facilitation intervention focusing on neonatal health and survival in Vietnam: a qualitative study.
Non UofA Access

D. M. Duong, A. Bergstrom, L. Wallin, H. T. Bui, L. Eriksson and A. C. Eldh.
BMC Public Health 2015 Aug 22;15(1):814-015-2142-2

BACKGROUND: In the Neonatal health – Knowledge into Practice (NeoKIP) trial in Vietnam, local stakeholder groups, supported by trained laywomen acting as facilitators, promoted knowledge translation (KT) resulting in decreased neonatal mortality. In general, as well as in the community-based NeoKIP trial, there is a need to further understand how context influences KT interventions in low- and middle-income countries (LMICs). Thus, the objective of this study was to explore the influence of context on the facilitation process in the NeoKIP intervention. METHODS: A secondary content analysis was performed on 16 Focus Group Discussions with facilitators and participants of the stakeholder groups, applying an inductive approach to the content on context through naive understanding and structured analysis. RESULTS: The three main-categories of context found to influence the facilitation process in the NeoKIP intervention were: (1) Support and collaboration of local authorities and other communal stakeholders; (2) Incentives to, and motivation of, participants; and (3) Low health care coverage and utilization. In particular, the role of local authorities in a KT intervention was recognized as important. Also, while project participants expected financial incentives, non-financial benefits such as individual learning were considered to balance the lack of reimbursement in the NeoKIP intervention. Further, project participants recognized the need to acknowledge the needs of disadvantaged groups. CONCLUSIONS: This study provides insight for further understanding of the influence of contextual aspects to improve effects of a KT intervention in Vietnam. We suggest that future KT interventions should apply strategies to improve local authorities’ engagement, to identify and communicate non-financial incentives, and to make disadvantaged groups a priority. Further studies to evaluate the contextual aspects in KT interventions in LMICs are also needed.

Abstracts

CALL FOR ABSTRACTS:
2016 Gerontological Society of America (GSA) Annual Scientific Meeting

16-20 November New Orleans, LA
DEADLINE 15 March

Discover what’s new in aging. GSA’s Annual Scientific Meeting brings together 4,000 international experts and partners from academia, industry, government, and beyond to exchange information and to discuss the broader role of aging science. This meeting is the premier gathering of gerontologists from both the United States and around the world. They participate in over 450 scientific sessions including symposia, paper, and poster presentations.

CALL FOR ABSTRACTS:
2nd International Mixed Methods International Research Association

3 -5 August Durham UK
DEADLINE 28 February

This conference will provide an outstanding opportunity for attendees to examine the role of mixed methods in applied social research. We seek to address the complexity of questions and critical concerns through a form of social inquiry that stresses the importance of understanding the complexity of the social world and addresses the issues identified by Unger when he noted that: … a practice of social and historical explanation, sensitive to structure but aware of contingency is not yet at hand.

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Grants & Awards

AAL 2016 Call for proposals of the AAL Programme: Living well with dementia. The contribution of ICT to integrated solutions for enabling the wellbeing of people living with dementia and their communities

The aim of this call is to support innovative, transnational and multi-disciplinary collaborative projects. The proposal must demonstrate a clear route to market and added-value for the different types of end-users. People with dementia are confronted with a syndrome that increasingly affects their memory, thinking, behaviour and ability to perform everyday activities. The average duration of dementia is between 2 and 10 years and ranges from mild cognitive impairments to severe dementia. Dementia is overwhelming not only for the people who have it, but also for their caregivers and families and impacts them physically, psychologically and economically. Dementia is strongly linked with age. In the near future effective treatments for dementia are not expected. This means that support and care to an increasing number of people living with dementia will be needed in the coming years.

TVN & CFHI: Acute Care for Elders (ACE) Collaborative

Expression of Commitment: 1 February

The CFHI-TVN partnership is providing up to 15 improvement teams across Canada with funding of up to $40,000 each, coaching, educational materials and other tools as part of a 12-month quality improvement effort to adapt Mount Sinai’s successful ACE strategy to local care settings. The Canadian Foundation for Healthcare Improvement, in partnership with the Technology Evaluation in the Elderly Network, is launching a 12-month quality improvement collaborative aimed at supporting elder-friendly practices. Improvement teams that are accepted into the collaborative will receive funding, coaching, educational materials and tools to support the adaptation of Mount Sinai Hospital’s Acute Care for Elders (ACE) Strategy elder-friendly components to their local context.

SSHRC Knowledge Synthesis Grants: How can emerging technologies be leveraged to benefit Canadians?

DEADLINE 12 January

These grants will foster a deeper understanding of the state of knowledge regarding the human dimensions involved in emerging technologies. The resulting syntheses will also help identify roles that the academic, public, private and not-for-profit sectors may play in seizing future opportunities and mitigating risks related to these technologies. This knowledge will pave the way for developing robust policies, strategies, practices and tools for a sustainable, equitable and prosperous future for Canada and the world.

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Publications

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

KT

Strategies to promote practice nurse capacity to deliver evidence-based care.
Non UofA Access

A. Dadich, P. Abbott and H. Hosseinzadeh.
J Health Organ Manag 2015 Nov 16;29(7):988-1010

Purpose – Evidence-based practice is pivotal to effective patient care. However, its translation into practice remains limited. Given the central role of primary care in many healthcare systems, it is important to identify strategies that bolster clinician-capacity to promote evidence-based care. The purpose of this paper is to identify strategies to increase Practice Nurse capacity to promote evidence-based sexual healthcare within general practice. Design/methodology/approach – A survey of 217 Practice Nurses in an Australian state and ten respondent-interviews regarding two resources to promote evidence-based sexual healthcare – namely, a clinical aide and online training. Findings – The perceived impact of both resources was determined by views on relevance and design – particularly for the clinical aide. Resource-use was influenced by role and responsibilities within the workplace, accessibility, and support from patients and colleagues. Research limitations/implications – This is the first Australian study to reveal strategies to promote evidence-based sexual healthcare among Practice Nurses. The findings provide a platform for future research on knowledge translation processes, particularly among clinicians who might be disengaged from sexual healthcare. Practical implications – Given the benefits of evidence-based practices, it is important that managers recognize their role, and the role of their services, in promoting these. Without explicit support for evidence-based care and recognition of the Practice Nurse role in such care, knowledge translation is likely to be limited. Originality/value – Knowledge translation among Practice Nurses can be facilitated by: resources-deemed informative, relevant, and user-friendly, as well as support from patients, colleagues, and their workplace.

Barriers in implementing research among registered nurses working in the care of the elderly: a multicenter study in Spain.
Non UofA Access

C. M. Sarabia-Cobo, A. B. Sarabia-Cobo, V. Perez, C. Hermosilla, M. J. Nunez and P. de Lorena.
Appl Nurs Res 2015 Nov;28(4):352-355

OBJECTIVE: This study identified barriers to the utilization of research results perceived by nurses who work in nursing homes in Spain. METHODS: An observational, cross-sectional, descriptive, and multicentre study was conducted in 126 nursing homes in different Spanish cities. The BARRIERS to Research Utilization Scale (BARRIERS scale) was used to identify barriers. RESULTS: A total of 756 nurses responded (92.48%). BARRIERS scale variables with the highest scores included Characteristics of the organization (mean=24.89, SD=4.37), followed by Professional features (mean=21.87, SD=4.85). The specific barriers that were rated the highest included “not enough time on the job to implement new ideas” (mean=3.89, SD=0.98), followed by “unknown nursing research” (mean=2.75; SD=1.22) and “Doctors do not cooperate in the implementation” (mean=3.01, SD=1.85). CONCLUSIONS: Geriatric nurses perceive time as the main barrier to implementing the results of research in practice. The number and nature of the barriers are consistent with studies from other countries. Knowledge of the barriers is crucial for institutions and educators to instigate measures that improve the implementation of nursing research, especially in an area like elderly care. To our knowledge, this is the first study conducted among geriatric nurses in Spain.

Incorporating research evidence into decision-making processes: researcher and decision-maker perceptions from five low- and middle-income countries
Non UofA Access

Z. Shroff, B. Aulakh, L. Gilson, I. A. Agyepong, F. El-Jardali and A. Ghaffar.
Health Res Policy Syst 2015 Nov 30;13(1):70-015-0059-y

BACKGROUND: The ‘Sponsoring National Processes for Evidence-Informed Policy Making in the Health Sector of Developing Countries’ program was launched by the Alliance for Health Policy and Systems Research, WHO, in July 2008. The program aimed to catalyse the use of evidence generated through health policy and systems research in policymaking processes through (1) promoting researchers and policy advocates to present their evidence in a manner that is easy for policymakers to understand and use, (2) creating mechanisms to spur the demand for and application of research evidence in policymaking, and (3) increased interaction between researchers, policy advocates, and policymakers. Grants ran for three years and five projects were supported in Argentina, Bangladesh, Cameroon, Nigeria and Zambia. This paper seeks to understand why projects in some settings were perceived by the key stakeholders involved to have made progress towards their goals, whereas others were perceived to have not done so well. Additionally, by comparing experiences across five countries, we seek to illustrate general learnings to inform future evidence-to-policy efforts in low- and middle-income countries. METHODS: We adopted the theory of knowledge translation developed by Jacobson et al. (J Health Serv Res Policy 8(2):94-9, 2003) as a framing device to reflect on project experiences across the five cases. Using data from the projects’ external evaluation reports, which included information from semi-structured interviews and quantitative evaluation surveys of those involved in projects, and supplemented by information from the projects’ individual technical reports, we applied the theoretical framework with a partially grounded approach to analyse each of the cases and make comparisons. RESULTS AND CONCLUSION: There was wide variation across projects in the type of activities carried out as well as their intensity. Based on our findings, we can conclude that projects perceived as having made progress towards their goals were characterized by the coming together of a number of domains identified by the theory. The domains of Jacobson’s theoretical framework, initially developed for high-income settings, are of relevance to the low- and middle-income country context, but may need modification to be fully applicable to these settings. Specifically, the relative fragility of institutions and the concomitantly more significant role of individual leaders point to the need to look at leadership as an additional domain influencing the evidence-to-policy process.

What is the effectiveness of printed educational materials on primary care physician knowledge, behaviour, and patient outcomes: a systematic review and meta-analyses. Canada-flat-icon
Non UofA Access

A. Grudniewicz, R. Kealy, R. N. Rodseth, J. Hamid, D. Rudoler and S. E. Straus.
Implement Sci 2015 Dec 1;10:164-015-0347-5

BACKGROUND: Printed educational materials (PEMs) are commonly used simple interventions that can be used alone or with other interventions to disseminate clinical evidence. They have been shown to have a small effect on health professional behaviour. However, we do not know whether they are effective in primary care. We investigated whether PEMs improve primary care physician (PCP) knowledge, behaviour, and patient outcomes. METHODS: We conducted a systematic review of PEMs developed for PCPs. Electronic databases were searched for randomized controlled trials, quasi randomized controlled trials, controlled before and after studies, and interrupted time series. We combined studies using meta-analyses when possible. Statistical heterogeneity was examined, and meta-analysis was performed using a random effects model when significant statistical heterogeneity was present and a fixed effects model otherwise. The template for intervention description and replication (TIDieR) checklist was used to assess the quality of intervention description. RESULTS: Our search identified 12,439 studies and 40 studies met our inclusion criteria. We combined outcomes from 26 studies in eight meta-analyses. No significant effect was found on clinically important patient outcomes, physician behaviour, or physician cognition when PEMs were compared to usual care. In the 14 studies that could not be included in the meta-analyses, 14 of 71 outcomes were significantly improved following receipt of PEMs compared to usual care. Most studies lacked details needed to replicate the intervention. CONCLUSIONS: PEMs were not effective at improving patient outcomes, knowledge, or behaviour of PCPs. Further trials should explore ways to optimize the intervention and provide detailed information on the design of the materials. PROTOCOL REGISTRATION: PROSPERO, CRD42013004356.

The evolution of social networks through the implementation of evidence-informed decision-making interventions: a longitudinal analysis of three public health units in Canada. Canada-flat-icon
Non UofA Access

R. Yousefi-Nooraie, M. Dobbins, A. Marin, R. Hanneman and L. Lohfeld.
Implement Sci 2015 Dec 3;10(1):166-015-0355-5

BACKGROUND: We studied the evolution of information-seeking networks over a 2-year period during which an organization-wide intervention was implemented to promote evidence-informed decision-making (EIDM) in three public health units in Ontario, Canada. We tested whether engagement of staff in the intervention and their EIDM behavior were associated with being chosen as information source and how the trend of inter-divisional communications and the dominance of experts evolved over time. METHODS: Local managers at each health unit selected a group of staff to get engage in Knowledge Broker-led workshops and development of evidence summaries to address local public health problems. The staff were invited to answer three online surveys (at baseline and two annual follow-ups) including name generator questions eliciting the list of the staff they would turn to for help integrating research evidence into practice. We used stochastic actor-oriented modeling to study the evolution of networks. We tested the effect of engagement in the intervention, EIDM behavior scores, organizational divisions, and structural dynamics of social networks on the tendency of staff to select information sources, and the change in its trend between year 1 and year 2 of follow-up. RESULTS: In all the three health units, and especially in the two units with higher levels of engagement in the intervention, the network evolved towards a more centralized structure, with an increasing significance of already central staff. The staff showed greater tendencies to seek information from peers with higher EIDM behavior scores. In the public health unit that had highest engagement and stronger leadership support, the engaged staff became more central. In all public health units, the engaged staff showed an increasing tendency towards forming clusters. The staff in the three public health units showed a tendency towards limiting their connections within their divisions. CONCLUSIONS: The longitudinal analysis provided us with a means to study the microstructural changes in public health units, clues to the sustainability of the implementation. The hierarchical transformation of networks towards experts and formation of clusters among staff who were engaged in the intervention show how implementing organizational interventions to promote EIDM may affect the knowledge flow and distribution in health care communities, which may lead to unanticipated consequences.

Dealing with the complexity of evaluating knowledge transfer strategies: Guiding principles for developing valid instruments Canada-flat-icon
Non UofA Access

Mathieu-Joël Gervais, Caroline Marion, Christian Dagenais, François Chiocchio and Nathalie Houlfort
Research Evaluation 2015 11/30

While there is an abundance of theoretical literature on knowledge transfer strategies, the evidence on their effectiveness remains limited. There is a need to support researchers and practitioners seeking to strengthen the validity of the instruments they develop to evaluate knowledge transfer strategies. Based on an analysis of the literature in three fields of research—health, human and social sciences, and programme evaluation—we propose five guiding principles for this purpose. We also discuss critical issues pertaining to the practices involved in evaluating knowledge transfer strategies.

Translating knowledge into practice: An exploratory study of dementia-specific training for community-based service providers.
Non UofA Access

G. O’Sullivan, C. Hocking and K. McPherson.
Dementia (London) 2015 Dec 6

OBJECTIVE: To develop, deliver, and evaluate dementia-specific training designed to inform service delivery by enhancing the knowledge of community-based service providers. METHODS: This exploratory qualitative study used an interdisciplinary, interuniversity team approach to develop and deliver dementia-specific training. Participants included management, care staff, and clients from three organizations funded to provide services in the community. Data on the acceptability, applicability, and perceived outcomes of the training were gathered through focus group discussions and individual interviews. Transcripts were analyzed to generate open codes which were clustered into themes and sub-themes addressing the content, delivery, and value of the training. FINDINGS: Staff valued up-to-date knowledge and “real stories” grounded in practice. Clients welcomed the strengths-based approach. Contractual obligations impact on the application of knowledge in practice. IMPLICATIONS: The capacity to implement new knowledge may be limited by the legislative policies which frame service provision, to the detriment of service users.

The privileged role of researchers in “evidence-based” policy: implications and engagement of other voices
Non UofA Access

Alison Ritter
Drugs and Alcohol Today 2015 12/07; 2015/12;15(4):181-191

Purpose – This paper starts from the familiar premise of evidence-based policy, and examines the active role that researchers play in policy development processes. The interactive nature of much research translation immediately suggests the need to consider the dynamic way in which problems come to be understood, which is explored in this paper. Furthermore, the integration of research knowledge with the knowledges of “ordinary” citizens is a key challenge. The paper aims to discuss these issues. Design/methodology/approach – This paper represents a synthesis of recent studies conducted by the author and her colleagues along with other drug policy literature. Findings – The interactive and dialogic processes that researchers engage with, whether as knowledge brokers or participants in elite policy development forums, have implications for how policy problems (and solutions) come to be constituted. Four perspectives and theoretical approaches are briefly outlined: research design; policy processes; problematization; and critical social sciences analyses. These offer different ways of seeing, understanding and analyzing the relationship between problems, policy solutions and the policy processes. Yet all have lessons for the ways in which research evidence and researchers constitute policy. This needs to sit alongside the role of other drug policy stakeholders – notably the “ordinary” citizen. It is argued that the elite role of research can be tempered with engagement of ordinary citizens. While it can be challenging to reconcile general public views about drugs with the evidence-base, deliberative democracy approaches may hold some promise. Originality/value – This paper draws together a number of central themes for drug policy processes research: where the evidence-based policy paradigm intersects with participatory democracy; how problems are constituted; and the privileged role of research and researchers.

Transforming Patient-Centered Care: Development of the Evidence Informed Decision Making through Engagement Model.
Non UofA Access

J. E. Moore, M. G. Titler, L. Kane Low, V. K. Dalton and C. M. Sampselle.
Womens Health Issues 2015 May-Jun;25(3):276-282

BACKGROUND: In response to the passage of the Affordable Care Act in the United States, clinicians and researchers are critically evaluating methods to engage patients in implementing evidence-based care to improve health outcomes. However, most models on implementation only target clinicians or health systems as the adopters of evidence. Patients are largely ignored in these models. A new implementation model that captures the complex but important role of patients in the uptake of evidence may be a critical missing link. DISCUSSION: Through a process of theory evaluation and development, we explore patient-centered concepts (patient activation and shared decision making) within an implementation model by mapping qualitative data from an elective induction of labor study to assess the model’s ability to capture these key concepts. The process demonstrated that a new, patient-centered model for implementation is needed. In response, the Evidence Informed Decision Making through Engagement Model is presented. We conclude that, by fully integrating women into an implementation model, outcomes that are important to both the clinician and patient will improve. CONCLUSIONS: In the interest of providing evidence-based care to women during pregnancy and childbirth, it is essential that care is patient centered. The inclusion of concepts discussed in this article has the potential to extend beyond maternity care and influence other clinical areas. Utilizing the newly developed Evidence Informed Decision Making through Engagement Model provides a framework for utilizing evidence and translating it into practice while acknowledging the important role that women have in the process.

Evidence-informed policy formulation and implementation: a comparative case study of two national policies for improving health and social care in Sweden
Non UofA Access

H. Strehlenert, L. Richter-Sundberg, M. E. Nystrom and H. Hasson.
Implement Sci 2015 Dec 8;10(1):169-015-0359-1

BACKGROUND: Evidence has come to play a central role in health policymaking. However, policymakers tend to use other types of information besides research evidence. Most prior studies on evidence-informed policy have focused on the policy formulation phase without a systematic analysis of its implementation. It has been suggested that in order to fully understand the policy process, the analysis should include both policy formulation and implementation. The purpose of the study was to explore and compare two policies aiming to improve health and social care in Sweden and to empirically test a new conceptual model for evidence-informed policy formulation and implementation. METHODS: Two concurrent national policies were studied during the entire policy process using a longitudinal, comparative case study approach. Data was collected through interviews, observations, and documents. A Conceptual Model for Evidence-Informed Policy Formulation and Implementation was developed based on prior frameworks for evidence-informed policymaking and policy dissemination and implementation. The conceptual model was used to organize and analyze the data. RESULTS: The policies differed regarding the use of evidence in the policy formulation and the extent to which the policy formulation and implementation phases overlapped. Similarities between the cases were an emphasis on capacity assessment, modified activities based on the assessment, and a highly active implementation approach relying on networks of stakeholders. The Conceptual Model for Evidence-Informed Policy Formulation and Implementation was empirically useful to organize the data. CONCLUSIONS: The policy actors’ roles and functions were found to have a great influence on the choices of strategies and collaborators in all policy phases. The Conceptual Model for Evidence-Informed Policy Formulation and Implementation was found to be useful. However, it provided insufficient guidance for analyzing actors involved in the policy process, capacity-building strategies, and overlapping policy phases. A revised version of the model that includes these aspects is suggested.

Engagement in research: an innovative three-stage review of the benefits for health-care performance.
Non UofA Access

S. Hanney, A. Boaz, T. Jones and B. Soper.
Health Services and Delivery Research, No. 1.8 2013 Oct

There is a widely held assumption that research engagement improves health-care performance at various levels, but little direct empirical evidence. To conduct a theoretically and empirically grounded synthesis to map and explore plausible mechanisms through which research engagement might improve health services performance. A review of the effects on patients of their health-care practitioner’s or institution’s participation in clinical trials was published after submission of the proposal for this review. It identified only 13 relevant papers and, overall, suggested that the evidence that research engagement improves health-care performance was less strong than some thought. We aimed to meet the need for a wider review. An hourglass review was developed, consisting of three stages: (1) a planning and mapping stage; (2) a focused review concentrating on the core question of whether or not research engagement improves health care; and (3) a wider (but less systematic) review of papers identified during the two earlier stages. Studies were included in the focused review if the concept of ‘engagement in research’ was an input and some measure of ‘performance’ an output. The search strategy covered the period 1990 to March 2012. MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science and other relevant databases were searched. A total of 10,239 papers were identified through the database searches, and 159 from other sources. A further relevance and quality check on 473 papers was undertaken, and identified 33 papers for inclusion in the review. A standard meta-analysis was not possible on the heterogeneous mix of papers in the focused review. Therefore an explanatory matrix was developed to help characterise the circumstances in which research engagement might improve health-care performance and the mechanisms that might be at work, identifying two main dimensions along which to categorise the studies: the degree of intentionality and the scope of the impact. Of the 33 papers in the focused review, 28 were positive (of which six were positive/mixed) in relation to the question of whether or not research engagement improves health-care performance. Five papers were negative (of which two were negative/mixed). Seven out of 28 positive papers reported some improvement in health outcomes. For the rest, the improved care took the form of improved processes of care. Nine positive papers were at a clinician level and 19 at an institutional level. The wider review demonstrated, for example, how collaborative and action research can encourage some progress along the pathway from research engagement towards improved health-care performance. There is also evidence that organisations in which the research function is fully integrated into the organisational structure out-perform other organisations that pay less formal heed to research and its outputs. The focused and wider reviews identified the diversity in the mechanisms through which research engagement might improve health care: there are many circumstances and mechanisms at work, more than one mechanism is often operative, and the evidence available for each one is limited. To address the complexities of this evidence synthesis of research we needed to spend significant time mapping the literature, and narrowed the research question to make it feasible. We excluded many potentially relevant papers (though we partially addressed this by conducting a wider additional synthesis). Studies assessing the impact made on clinician behaviour by small, locally conducted pieces of research could be difficult to interpret without full knowledge of the context. Drawing on the focused and wider reviews, it is suggested that when clinicians and health-care organisations engage in research there is the likelihood of a positive impact on health-care performance. Organisations that have deliberately integrated the research function into organisational structures demonstrate how research engagement can, among other factors, contribute to improved health-care performance. Further explorations are required of research networks and schemes to promote the engagement of clinicians and managers in research. Detailed observational research focusing on research engagement within organisations would build up an understanding of mechanisms. PROSPERO: CRD42012001990. The National Institute for Health Research Health Services and Delivery Research programme.

Building a knowledge translation platform in Malawi to support evidence-informed health policy.
Non UofA Access

J. Berman, C. Mitambo, B. Matanje-Mwagomba, et al.
Health Res Policy Syst 2015 Dec 8;13(1):73-015-0061-4

With the support of the World Health Organization’s Evidence-Informed Policy Network, knowledge translation platforms have been developed throughout Africa, the Americas, Eastern Europe, and Asia to further evidence-informed national health policy. In this commentary, we discuss the approaches, activities and early lessons learned from the development of a Knowledge Translation Platform in Malawi (KTPMalawi). Through ongoing leadership, as well as financial and administrative support, the Malawi Ministry of Health has strongly signalled its intention to utilize a knowledge translation platform methodology to support evidence-informed national health policy. A unique partnership between Dignitas International, a medical and research non-governmental organization, and the Malawi Ministry of Health, has established KTPMalawi to engage national-level policymakers, researchers and implementers in a coordinated approach to the generation and utilization of health-sector research. Utilizing a methodology developed and tested by knowledge translation platforms across Africa, a stakeholder mapping exercise and initial capacity building workshops were undertaken and a multidisciplinary Steering Committee was formed. This Steering Committee prioritized the development of two initial Communities of Practice to (1) improve data utilization in the pharmaceutical supply chain and (2) improve the screening and treatment of hypertension within HIV-infected populations. Each Community of Practice’s mandate is to gather and synthesize the best available global and local evidence and produce evidence briefs for policy that have been used as the primary input into structured deliberative dialogues. While a lack of sustained initial funding slowed its early development, KTPMalawi has greatly benefited from extensive technical support and mentorship by an existing network of global knowledge translation platforms. With the continued support of the Malawi Ministry of Health and the Evidence-Informed Policy Network, KTPMalawi can continue to build on its role in facilitating the use of evidence in the development and refinement of health policy in Malawi.

A survey of knowledge-to-action pathways of aging policies and programs in the Arab region: the role of institutional arrangements

Anthony Rizk, Nabil Kronfol, Suzanne Moffatt, Shahaduz Zaman, Souha Fares and Abla Sibai.
Implementation Science 2015;10(1):170

While population aging challenges Arab governments to ensure well-being in old age, knowledge translation is gaining support worldwide in evidence-based policymaking and service provision. This study examines the status of existing knowledge translation efforts of aging-related research in Arab countries and evaluates the additional role that institutional arrangements (such as ministry departments, national committees, etc.) play in the relationship between knowledge creation and social and health policies and programs.METHODS:Data were triangulated from two regional surveys and a supplementary desk review of academic, civil society, ministry, and UN documents. Using a set of indicators, standardized summative indices (out of 100) were generated for five constructs, namely knowledge creation, institutional arrangements, knowledge translation, and health and social policies and programs. Correlations were assessed using Spearman’s rank correlation (rs ), and bootstrap multiple linear regression models were used.RESULTS:Arab countries scored highest on the institutional arrangements index (median=69.5), followed by the knowledge creation index (median=45.9), and lowest on the knowledge translation index (median=30.2). Both institutional arrangements and knowledge creation significantly correlated with social and health policies and programs. However, when adjusted for knowledge translation, only institutional arrangements retained a significant association with both outcomes (rs =0.63, p value =0.009 and rs =0.69, p value =0.01, respectively). Adjusting for institutional arrangements and knowledge creation, the association of knowledge translation with social and health policies and programs was attenuated and non-significant (rs =0.08, p value =0.671 and rs =0.12, p value =0.634, respectively).CONCLUSIONS:There are two key messages from this study. Firstly, institutional arrangements play a central role in aging social and health policy and program development in the Arab region. Secondly, knowledge translation paradigms in Arab countries may be deficient in factors pertinent for promoting evidence-based decision-making and policy-relevant research. These findings call for the need of strengthening institutional arrangements on aging and for promoting knowledge production that meets policy-relevant priorities.

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Health Care Administration and Organization

Closing the loop: a process evaluation of inpatient care team communication.
Non UofA Access

K. Kummerow Broman, C. Kensinger, H. Hart, J. Mathisen and S. Kripalani.
BMJ Qual Saf 2015 Nov 27.

Our interprofessional team of providers, nurses and administrative leaders mapped processes for nurse-to-provider communication on two types of medical and surgical units that use different communication systems at Vanderbilt University Medical Center, a southeastern US academic medical centre.

Understanding Elderspeak from the Perspective of Certified Nursing Assistants.
Non UofA Access

T. M. Grimme, J. Buchanan and S. Afflerbach.
J Gerontol Nurs 2015 Nov 1;41(11):42-49

Elderspeak is a form of patronizing speech that is often used with older adults. The current study attempted to learn more about the conditions under which elderspeak is used as well as the intent behind using elderspeak. The sample comprised 26 certified nursing assistants (CNAs) working with older adults in long-term care facilities. Data were collected using semistructured interviews. Findings indicated that the intended purposes of elderspeak were to (a) make residents feel more comfortable, (b) make caregivers seem friendlier, (c) help residents better comprehend verbal communication, and (d) increase the likelihood that residents would cooperate during caregiving tasks. In addition, one half of the CNAs reported that elderspeak is more appropriate with individuals with dementia; many also believed that the use of elderspeak was always inappropriate. The current findings may have implications for improving training and education programs for CNAs and other professionals working in long-term care facilities.

Sources of moral distress for nursing staff providing care to residents with dementia. Canada-flat-icon
Non UofA Access

S. Spenceley, C. S. Witcher, B. Hagen, B. Hall and A. Kardolus-Wilson.
Dementia (London) 2015 Dec 1

The World Health Organization estimates the number of people living with dementia at approximately 35.6 million; they project a doubling of this number by 2030 and tripling by 2050. Although the majority of people living with a dementia live in the community, residential facility care by nursing care providers is a significant component of the dementia journey in most countries. Research has also shown that caring for persons with dementia can be emotionally, physically, and ethically challenging, and that turnover in nursing staff in residential care settings tends to be high. Moral distress has been explored in a variety of settings where nurses provide acute or intensive care. The concept, however, has not previously been explored in residential facility care settings, particularly as related to the care of persons with dementia. In this paper, we explore moral distress in these settings, using Nathaniel’s definition of moral distress: the pain or anguish affecting the mind, body, or relationships in response to a situation in which the person is aware of a moral problem, acknowledges moral responsibility, makes a moral judgment about the correct action and yet, as a result of real or perceived constraints, cannot do what is thought to be right. We report findings from a qualitative study of moral distress in a single health region in a Canadian province. Our aim in this paper is to share findings that elucidate the sources of moral distress experienced by nursing care providers in the residential care of people living with dementia.

Nursing staff work patterns in a residential aged care home: a time-motion study.
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S. Qian, P. Yu and D. Hailey.
Aust Health Rev 2015 Nov 30

Objective Residential aged care services are challenged by an increasing number of residents and a shortage of nursing staff. Developing strategies to overcome this challenge requires an understanding of nursing staff work patterns. The aim of the present study was to investigate the work processes followed by nursing staff and how nursing time is allocated in a residential aged care home.Methods An observational time-motion study was conducted at two aged care units for 12 morning shifts. Seven nurses were observed, one per shift.Results In all, there were 91 h of observation. The results showed that there was a common work process followed by all nurse participants. Medication administration, documentation and verbal communication were the most time-consuming activities and were conducted most frequently. No significant difference between the two units was found in any category of activities. The average duration of most activities was less than 1 min. There was no difference in time utilisation between the endorsed enrolled nurses and the personal carers in providing nursing care.Conclusion Medication administration, documentation and verbal communication were the major tasks in morning shifts in a residential aged care home. Future research can investigate how verbal communication supports nursing care.What is known about the topic? The aging population will substantially increase the demand for residential aged care services. There is a lack of research on nurses’ work patterns in residential aged care homes.What does this paper add? The present study provides a comprehensive understanding of nurses’ work patterns in a residential aged care home. There is a common work process followed by nurses in providing nursing care. Medication administration, verbal communication and documentation are the most time-consuming activities and they are frequently conducted in the same period of time. Wound care, physical review and documentation on desktop computers are arranged flexibly by the nurses.What are the implications for practitioners? When developing a task reallocation strategy to improve work efficiency, effort can be put into tasks that can be arranged more flexibly.

Linguistic Stereotyping in Older Adults’ Perceptions of Health Care Aides.
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D. Rubin, V. B. Coles and J. T. Barnett.
Health Commun 2015 Nov 25:1-6

The cultural and linguistic diversity of the U.S. health care provider workforce is expanding. Diversity among health care personnel such as paraprofessional health care assistants (HCAs)-many of whom are immigrants-means that intimate, high-stakes cross-cultural and cross-linguistic contact characterizes many health interactions. In particular, nonmainstream HCAs may face negative patient expectations because of patients’ language stereotypes. In other contexts, reverse linguistic stereotyping has been shown to result in negative speaker evaluations and even reduced listening comprehension quite independently of the actual language performance of the speaker. The present study extends the language and attitude paradigm to older adults’ perceptions of HCAs. Listeners heard the identical speaker of Standard American English as they watched interactions between an HCA and an older patient. Ethnolinguistic identities-either an Anglo native speaker of English or a Mexican nonnative speaker-were ascribed to HCAs by means of fabricated personnel files. Dependent variables included measures of perceived HCA language proficiency, personal characteristics, and professional competence, as well as listeners’ comprehension of a health message delivered by the putative HCA. For most of these outcomes, moderate effect sizes were found such that the HCA with an ascribed Anglo identity-relative to the Mexican guise-was judged more proficient in English, socially superior, interpersonally more attractive, more dynamic, and a more satisfactory home health aide. No difference in listening comprehension emerged, but the Anglo guise tended to engender a more compliant listening mind set. Results of this study can inform both provider-directed and patient-directed efforts to improve health care services for members of all linguistic and cultural groups.

Assessing Progress on the IOM Report The Future of Nursing (US)

Institute of Medicine 2015

Nurses make up the largest segment of the health care profession, with 3 million registered nurses in the United States. Nurses work in a wide variety of settings, including hospitals, public health centers, schools, and homes, and provide a continuum of services, including direct patient care, health promotion, patient education, and coordination of care. They serve in leadership roles, are researchers, and work to improve health care policy. As the health care system undergoes transformation due in part to the Affordable Care Act (ACA), the nursing profession is making a wide-reaching impact by providing and affecting quality, patient-centered, accessible, and affordable care. In 2010, The Institute of Medicine (IOM) released the report The Future of Nursing: Leading Change, Advancing Health, which made a series of recommendations pertaining to the roles for nurses in the new health care landscape. Shortly after release of The Future of Nursing report, AARP and the Robert Wood Johnson Foundation launched the Future of Nursing: Campaign for Action to shepherd The Future of Nursing report’s recommendations. In 2014, the Robert Wood Johnson Foundation asked the IOM to convene a committee to assess progress made on implementing The Future of Nursing report recommendations and identify areas that should be emphasized over the next 5 years.

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Health Care Innovation and Quality Assurance

Pragmatic cluster randomised controlled trial of facilitated family case conferencing compared with usual care for improving end of life care and outcomes in nursing home residents with advanced dementia and their families: the IDEAL study protocol.
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M. Agar, E. Beattie, T. Luckett, et al.
BMC Palliat Care 2015 Nov 21;14(1):63-015-0061-8

BACKGROUND: Care for people with advanced dementia requires a palliative approach targeted to the illness trajectory and tailored to individual needs. However, care in nursing homes is often compromised by poor communication and limited staff expertise. This paper reports the protocol for the IDEAL Project, which aims to: 1) compare the efficacy of a facilitated approach to family case conferencing with usual care; 2) provide insights into nursing home- and staff-related processes influencing the implementation and sustainability of case conferencing; and 3) evaluate cost-effectiveness. DESIGN/METHODS: A pragmatic parallel cluster randomised controlled trial design will be used. Twenty Australian nursing homes will be randomised to receive either facilitated family case conferencing or usual care. In the intervention arm, we will train registered nurses at each nursing home to work as Palliative Care Planning Coordinators (PCPCs) 16 h per week over 18 months. The PCPCs’ role will be to: 1) use evidence-based ‘triggers’ to identify optimal time-points for case conferencing; 2) organise, facilitate and document case conferences with optimal involvement from family, multi-disciplinary nursing home staff and community health professionals; 3) develop and oversee implementation of palliative care plans; and 4) train other staff in person-centred palliative care. The primary endpoint will be symptom management, comfort and satisfaction with care at the end of life as rated by bereaved family members on the End of Life in Dementia (EOLD) Scales. Secondary outcomes will include resident quality of life (Quality of Life in Late-stage Dementia [QUALID]), whether a palliative approach is taken (e.g. hospitalisations, non-palliative medical treatments), staff attitudes and knowledge (Palliative Care for Advanced Dementia [qPAD]), and cost effectiveness. Processes and factors influencing implementation, outcomes and sustainability will be explored statistically via analysis of intervention ‘dose’ and qualitatively via semi-structured interviews. The pragmatic design and complex nature of the intervention will limit blinding and internal validity but support external validity. DISCUSSION: The IDEAL Project will make an important contribution to the evidence base for dementia-specific case conferencing in nursing homes by considering processes and contextual factors as well as overall efficacy. Its strengths and weaknesses will both lie in its pragmatic design. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12612001164886

Development methods of guidelines and documents with recommendations on physical restraint reduction in nursing homes: a systematic review.
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R. Mohler and G. Meyer.
BMC Geriatr 2015 Nov 21;15(1):152-015-0150-9

BACKGROUND: Physical restraint, e.g. bedrails or belts in beds or chairs, are commonly used in nursing homes. However, there have been reports of pronounced differences in the prevalence between different facilities. Guidelines or other documents with recommendations for clinical practice are one approach to overcome centre variation and improve the quality of care. Rigorous development methods are deemed to ensure the validity, clarity and clinical applicability of practice recommendations. This study aims at describing the development methods of documents offering recommendations on physical restraint reduction in geriatric long-term care. METHODS: We performed a systematic search (February 2014) in electronic databases (PubMed, CINAHL, Gerolit, Carelit), the World Wide Web (via google.de) and on the homepages of 34 international scientific or healthcare organisations, using various terms related to documents offering guidance for clinical practice and physical restraints. All German and English language documents with recommendations for clinical practice aimed at reducing physical restraints’ in nursing homes were included. Documents targeting mental health or acute care settings were excluded. Two reviewers independently selected the documents and extracted data, using a self-developed and piloted data extraction form. RESULTS: We identified 28 documents from Germany, USA, Australia, Switzerland, Canada and UK, published between 2002 and 2014. The documents were developed or published by governmental organisations, nursing or healthcare organisations, non-profit organisation, research institutions and private organisations. Two documents were developed mono-disciplinary (nursing) and eight documents interdisciplinary (including different healthcare professionals, lawyers or other stakeholders). In 18 documents the composition of the development group was not described. Two documents described the methods used for developing the recommendations. In both documents, the recommendations were based on a systematic literature search, critical appraisal of the evidence and developed in a consensus process. Materials or tools supporting the implementation were mentioned in 18 documents. CONCLUSIONS: This review shows that most of the identified documents with recommendations to reduce physical restraints in nursing homes did not adhere to rigorous scientific development methods. Only two documents comprised a systematic literature search and critical appraisal. Guidance aimed to inform clinical practice should rely on transparent and evidence-based methodologically with sound developed recommendations.

Effects of a geriatric intervention aiming to improve quality care in nursing homes on benzodiazepine use and discontinuation.
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P. de Souto Barreto, M. Lapeyre-Mestre, P. Cestac, B. Vellas and Y. Rolland.
Br J Clin Pharmacol 2015 Nov 27

BACKGROUND: Benzodiazepines and “Z drugs” are often prescribed in residents of nursing homes (NH) despite their well-known deleterious effects. We aimed to investigate if a general intervention on quality of care led to discontinuation of benzodiazepine, and to examine which NH-related factors were associated in change of benzodiazepines use. METHODS: IQUARE is a quasi-experimental study, investigating the impact of an intervention based on a geriatric education with NH staff on several quality indicators of care (including appropriate prescriptions). All participating NH received an initial and 18-month audit regarding drug prescriptions and other quality of care variables. The analysis included 3973 residents, 2151 subjects (mean age: 84.6+/-8.5 years; 74.3% women) in the control group and 1822 (mean age: 85.5+/-8.1 years; 77.4% women) in the intervention group. Outcomes at 18 months were benzodiazepines use, long-acting benzodiazepines use, new-use of benzodiazepines, and discontinuation. The effect of the intervention was investigated using mixed-effect logistic regression models, including NH variables and residents’ health status as confounders. RESULTS: Higher reductions in benzodiazepine use (-2.8% vs. -1.5%) and long-acting benzodiazepine (-3.7% vs. -3.5%) were observed in intervention group, but not statistically significant. None of the structural and organisational NH-related variables predicted either discontinuation or new-use of benzodiazepines; hospitalisations and initial use of meprobamate increased the likelihood of becoming a new-user of benzodiazepines. Multivariate analysis suggested that living in a particular NH could affect benzodiazepines discontinuation. CONCLUSIONS: A general intervention designed to improve overall NH quality indicators did not succeed in reducing benzodiazepines use. External factors interfered with the intervention. Further studies are needed to examine which NH-related aspects could impact benzodiazepines discontinuation.

Is higher nursing home quality more costly?
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L. D. Giorgio, M. Filippini and G. Masiero.
Eur J Health Econ 2015 Nov 26

Widespread issues regarding quality in nursing homes call for an improved understanding of the relationship with costs. This relationship may differ in European countries, where care is mainly delivered by nonprofit providers. In accordance with the economic theory of production, we estimate a total cost function for nursing home services using data from 45 nursing homes in Switzerland between 2006 and 2010. Quality is measured by means of clinical indicators regarding process and outcome derived from the minimum data set. We consider both composite and single quality indicators. Contrary to most previous studies, we use panel data and control for omitted variables bias. This allows us to capture features specific to nursing homes that may explain differences in structural quality or cost levels. Additional analysis is provided to address simultaneity bias using an instrumental variable approach. We find evidence that poor levels of quality regarding outcome, as measured by the prevalence of severe pain and weight loss, lead to higher costs. This may have important implications for the design of payment schemes for nursing homes.

Depicting the interplay between organisational tiers in the use of a national quality registry to develop quality of care in Sweden.
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A. C. Eldh, M. Fredriksson, S. Vengberg, et al.
BMC Health Serv Res 2015 Nov 25;15(1):519-015-1188-2

BACKGROUND: With a pending need to identify potential means to improved quality of care, national quality registries (NQRs) are identified as a promising route. Yet, there is limited evidence with regards to what hinders and facilitates the NQR innovation, what signifies the contexts in which NQRs are applied and drive quality improvement. Supposedly, barriers and facilitators to NQR-driven quality improvement may be found in the healthcare context, in the politico-administrative context, as well as with an NQR itself. In this study, we investigated the potential variation with regards to if and how an NQR was applied by decision-makers and users in regions and clinical settings. The aim was to depict the interplay between the clinical and the politico-administrative tiers in the use of NQRs to develop quality of care, examining an established registry on stroke care as a case study. METHODS: We interviewed 44 individuals representing the clinical and the politico-administrative settings of 4 out of 21 regions strategically chosen for including stroke units representing a variety of outcomes in the NQR on stroke (Riksstroke) and a variety of settings. The transcribed interviews were analysed by applying The Consolidated Framework for Implementation Research (CFIR). RESULTS: In two regions, decision-makers and/or administrators had initiated healthcare process projects for stroke, engaging the health professionals in the local stroke units who contributed with, for example, local data from Riksstroke. The Riksstroke data was used for identifying improvement issues, for setting goals, and asserting that the stroke units achieved an equivalent standard of care and a certain level of quality of stroke care. Meanwhile, one region had more recently initiated such a project and the fourth region had no similar collaboration across tiers. Apart from these projects, there was limited joint communication across tiers and none that included all individuals and functions engaged in quality improvement with regards to stroke care. CONCLUSIONS: If NQRs are to provide for quality improvement and learning opportunities, advances must be made in the links between the structures and processes across all organisational tiers, including decision-makers, administrators and health professionals engaged in a particular healthcare process.

Person-Centered Care: A Definition and Essential Elements.
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American Geriatrics Society Expert Panel on Person-Centered Care.
J Am Geriatr Soc 2015 Dec 2

Improving healthcare safety, quality, and coordination, as well as quality of life, are important aims of caring for older adults with multiple chronic conditions and/or functional limitations. Person-centered care is an approach to meeting these aims, but there are no standardized, agreed-upon parameters for delivering such care. The SCAN Foundation charged a team from the American Geriatrics Society (AGS) in collaboration with a research and clinical team from the Keck School of Medicine of the University of Southern California to provide the evidence base to support a definition of person-centered care and its essential elements. An interprofessional panel of experts in person-centered care principles and practices that the AGS convened developed this statement.

Person-Centered Care for Older Adults with Chronic Conditions and Functional Impairment: A Systematic Literature Review.
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A. C. Kogan, K. Wilber and L. Mosqueda.
J Am Geriatr Soc 2015 Dec 2

Person-centered care (PCC) shifts focus away from the traditional biomedical model in favor of embracing personal choice and autonomy for people receiving health services. It has become an important avenue for improving primary care, and older adults remain a priority target for PCC because they are more likely to have complex care needs than younger individuals. Nevertheless, despite a growing body of evidence regarding its use, PCC still lacks an agreed-upon definition. A literature review was conducted to explore extant scholarship on PCC for older adults, assess corresponding definitions of PCC, and identify important elements of quality PCC. Nearly 3,000 articles published between 1990 and 2014 were identified. Excluding search results outside the parameters of this study, the final review comprised 132 nonduplicate sources focused on patient-centered care or PCC in older adults. Fifteen descriptions of PCC were identified, addressing 17 central principles or values. The six most-prominent domains of PCC were holistic or whole-person care, respect and value, choice, dignity, self-determination, and purposeful living. The body of evidence reviewed suggests that PCC is an important area of growing interest. Although multiple definitions and elements of PCC abound-with many commonalities and some overlap-the field would benefit from a consensus definition and list of essential elements to clarify how to operationalize a PCC approach to health care and services for older adults. This work guided the development of a separate American Geriatrics Society expert panel statement presenting a standardized definition and a list of PCC elements for older adults with chronic conditions or functional impairment.

Integrating new practices: a qualitative study of how hospital innovations become routine

Amanda Brewster, Leslie Curry, Emily Cherlin, Kristina Talbert-Slagle, Leora Horwitz and Elizabeth Bradley.
Implementation Science 2015;10(1):168

BACKGROUND:Hospital quality improvement efforts absorb substantial time and resources, but many innovations fail to integrate into organizational routines, undermining the potential to sustain the new practices. Despite a well-developed literature on the initial implementation of new practices, we have limited knowledge about the mechanisms by which integration occurs.METHODS:We conducted a qualitative study using a purposive sample of hospitals that participated in the State Action on Avoidable Rehospitalizations (STAAR) initiative, a collaborative to reduce hospital readmissions that encouraged members to adopt new practices. We selected hospitals where risk-standardized readmission rates (RSRR) had improved (n=7) or deteriorated (n=3) over the course of the first 2years of the STAAR initiative (2010-2011 to 2011-2012) and interviewed a range of staff at each site (90 total). We recruited hospitals until reaching theoretical saturation. The constant comparative method was used to conduct coding and identification of key themes.RESULTS:When innovations were successfully integrated, participants consistently reported that a small number of key staff held the innovation in place for as long as a year while more permanent integrating mechanisms began to work. Depending on characteristics of the innovation, one of three categories of integrating mechanisms eventually took over the role of holding new practices in place. Innovations that proved intrinsically rewarding to the staff, by making their jobs easier or more gratifying, became integrated through shifts in attitudes and norms over time. Innovations for which the staff did not perceive benefits to themselves were integrated through revised performance standards if the innovation involved complex tasks and through automation if the innovation involved simple tasks.CONCLUSIONS:Hospitals have an opportunity to promote the integration of new practices by planning for the extended effort required to hold a new practice in place while integration mechanisms take hold. By understanding how integrating mechanisms correspond to innovation characteristics, hospitals may be able to foster integrating mechanisms most likely to work for particular innovations.

Beyond clinical engagement: a pragmatic model for quality improvement interventions, aligning clinical and managerial priorities.
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S. Pannick, N. Sevdalis and T. Athanasiou.
BMJ Qual Saf 2015 Dec 8

Despite taking advantage of established learning from other industries, quality improvement initiatives in healthcare may struggle to outperform secular trends. The reasons for this are rarely explored in detail, and are often attributed merely to difficulties in engaging clinicians in quality improvement work. In a narrative review of the literature, we argue that this focus on clinicians, at the relative expense of managerial staff, has proven counterproductive. Clinical engagement is not a universal challenge; moreover, there is evidence that managers-particularly middle managers-also have a role to play in quality improvement. Yet managerial participation in quality improvement interventions is often assumed, rather than proven. We identify specific factors that influence the coordination of front-line staff and managers in quality improvement, and integrate these factors into a novel model: the model of alignment. We use this model to explore the implementation of an interdisciplinary intervention in a recent trial, describing different participation incentives and barriers for different staff groups. The extent to which clinical and managerial interests align may be an important determinant of the ultimate success of quality improvement interventions.

Promising Practices in Long Term Care Canada-flat-icon

Canadian Centre for Policy Alternatives

This book reports on the findings of an international team of 26 researchers and more than 50 graduate students who went to six countries in a search for promising practices in long term residential care for the elderly. It presents concrete examples of how long term care might be organized and undertaken in more promising ways that respect the needs of residents, families, workers and managers. Using statistical data that confirms Canada can afford the same promising care found in other countries, the book provides ideas on how we might re-imagine long term care in promising and hopeful ways.

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Organizational Change

Cracking the code of process safety culture with organizational network analysis
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Keith O. Hunter and Elliot M. Wolf.
Process Saf Prog 2015

Organizations in the chemical process industry invest considerable amounts of time and resources managing change and implementing best practices to maintain safe operations and achieve operational objectives. Consequently, most executives and senior managers responsible for performance rely on formal organizational structure to achieve these objectives. However, front line employees responsible for ensuring safe operation of hazardous chemical processes are often influenced more by the informal than the formal organization in their daily activities. The dynamics of informal networks among workers are critical determinants of strong operational discipline (OD), process safety culture, and business performance. Yet, organizational social networks are often overlooked or not well understood by management. We discuss how organizational network analysis may improve our understanding of process safety culture. We also share results from our exploratory study that used a novel survey instrument to measure OD at the individual level in conjunction with a social network survey indicating interaction for the exchange of job task information and process safety advice, respectively. © 2015 American Institute of Chemical Engineers Process Saf Prog, 2015.

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Research Practice and Methodology

Twelve recommendations for integrating existing systematic reviews into new reviews: EPC guidance.
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K. A. Robinson, R. Chou, N. D. Berkman, et al.
J Clin Epidemiol 2015 Aug 7

OBJECTIVES: As time and cost constraints in the conduct of systematic reviews increase, the need to consider the use of existing systematic reviews also increases. We developed guidance on the integration of systematic reviews into new reviews. METHODS: A workgroup of methodologists from Evidence-based Practice Centers developed consensus-based recommendations. Discussions were informed by a literature scan and by interviews with organizations that conduct systematic reviews. RESULTS: Twelve recommendations were developed addressing selecting reviews, assessing risk of bias, qualitative and quantitative synthesis, and summarizing and assessing body of evidence. CONCLUSIONS: We provide preliminary guidance for an efficient and unbiased approach to integrating existing systematic reviews with primary studies in a new review.

Realist impact evaluation: an introduction (UK)

Westhorp, G. Better Evaluation 2015

The paper will be useful for evaluators and commissioners of evaluations to decide whether a realist approach is appropriate or feasible for evaluating a particular programme or policy; as well as for anyone interested in understanding a realist approach to impact evaluation.

Peer review in 2015 A global view: A white paper from Taylor & Francis

2015

Within the academic community, peer review is widely recognized as being at the heart of scholarly research. However, faith in peer review’s integrity is of ongoing and increasing concern to many. It is imperative that publishers (and academic editors) of peer-reviewed scholarly research learn from each other, working together to improve practices in areas such as ethical issues, training, and data transparency.

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Aging

The Green House Model of Nursing Home Care in Design and Implementation.
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L. W. Cohen, S. Zimmerman, D. Reed, et al.
Health Serv Res 2015 Nov 25

OBJECTIVE: To describe the Green House (GH) model of nursing home (NH) care, and examine how GH homes vary from the model, one another, and their founding (or legacy) NH. DATA SOURCES/STUDY SETTING: Data include primary quantitative and qualitative data and secondary quantitative data, derived from 12 GH/legacy NH organizations February 2012-September 2014. STUDY DESIGN: This mixed methods, cross-sectional study used structured interviews to obtain information about presence of, and variation in, GH-relevant structures and processes of care. Qualitative questions explored reasons for variation in model implementation. DATA COLLECTION/EXTRACTION METHODS: Interview data were analyzed using related-sample tests, and qualitative data were iteratively analyzed using a directed content approach. PRINCIPAL FINDINGS: GH homes showed substantial variation in practices to support resident choice and decision making; neither GH nor legacy homes provided complete choice, and all GH homes excluded residents from some key decisions. GH homes were most consistent with the model and one another in elements to create a real home, such as private rooms and baths and open kitchens, and in staff-related elements, such as self-managed work teams and consistent, universal workers. CONCLUSIONS: Although variation in model implementation complicates evaluation, if expansion is to continue, it is essential to examine GH elements and their outcomes.

Residents Perceptions of Friendship and Positive Social Networks Within a Nursing Home.
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A. S. Casey, L. F. Low, Y. H. Jeon and H. Brodaty.
Gerontologist 2015 Nov 23

PURPOSE OF THE STUDY: (i) To describe nursing home residents’ perceptions of their friendship networks using social network analysis (SNA) and (ii) to contribute to theory regarding resident friendship schema, network structure, and connections between network ties and social support. DESIGN AND METHODS: Cross-sectional interviews, standardized assessments, and observational data were collected in three care units, including a Dementia Specific Unit (DSU), of a 94-bed Sydney nursing home. Full participation consent was obtained for 36 residents aged 63-94 years. Able residents answered open-ended questions about friendship, identified friendship ties, and completed measures of nonfamily social support. RESULTS: Residents retained clear concepts of friendship and reported small, sparse networks. Nonparametric pairwise comparisons indicated that DSU residents reported less perceived social support (median = 7) than residents from the other units (median = 17; U = 10.0, p = .034, r = -.51), (median = 14; U = 0.0, p = .003, r = -.82). Greater perceived social support was moderately associated with higher number of reciprocated ties [rho(25) = .49, p = .013]. IMPLICATIONS: Though some residents had friendships, many reported that nursing home social opportunities did not align with their expectations of friendship. Relationships with coresidents were associated with perceptions of social support. SNA’s relational perspective elucidated network size, tie direction, and density, advancing understanding of the structure of residents’ networks and flow of subjective social support through that structure. Understanding resident expectations and perceptions of their social networks is important for care providers wishing to improve quality of life in nursing homes.

A Study of Interpersonal Intimacy and Meaning of Life Among Elderly Institutionalized Veterans.
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C. C. Niu, H. M. Huang, Y. Y. Hung and H. L. Lee.
J Nurs Res 2015 Nov 20

BACKGROUND: Most senior veterans who live in veterans’ homes in Taiwan are single and have few intimate, interpersonal relationships. Aging is often accompanied by solitude and illness, which causes senior veterans to doubt the meaning of life and to lose confidence in the value of life. PURPOSE: This study investigated the personal characteristics that influence interpersonal intimacy and the meaning of life as well as the relationship between interpersonal intimacy and the meaning of life among senior veterans living in veterans’ homes. METHODS: A cross-sectional design was used, and 120 senior male veterans were convenience sampled from three veterans’ homes in southern Taiwan. Three structured questionnaires were used in this study: personal characteristics questionnaire, interpersonal intimacy scale, and purpose in life test. RESULTS: (a) Interpersonal intimacy was influenced by source of income or funds, type of residence institution, religious affiliation, and the quality of the participant’s relationships with family, friends, and fellow residents. Educational level and self-perceived health status correlated positively with interpersonal intimacy, and period of residence correlated negatively with interpersonal intimacy. (b) Meaning of life was influenced by the quality of relationships with family and friends. Educational level and self-perceived health status correlated significantly and positively with meaning of life, and period of residence correlated negatively with meaning of life. (c) Significant, positive correlations were found among interpersonal intimacy, the four domains of interpersonal intimacy, and meaning of life. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Health professionals involved in the care of senior veterans in institutions may use the results of this study to develop and implement interventions that promote a higher degree of interpersonal intimacy and a higher appreciation of the meaning of life, thus enabling senior veterans to confront old age in a more positive manner.

Exploration of pressure ulcer and related skin problems across the spectrum of health care settings in Ontario using administrative data. Canada-flat-icon
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K. Y. Woo, K. Sears, J. Almost, R. Wilson, M. Whitehead and E. G. VanDenKerkhof.
Int Wound J 2015 Nov 20

This is a prospective cohort study using population-level administrative data to describe the scope of pressure ulcers in terms of its prevalence, incidence risk, associating factors and the extent to which best practices were applied across a spectrum of health care settings. The data for this study includes the information of Ontario residents who were admitted to acute care, home care, long term care or continuing care and whose health care data is contained in the resident assessment instrument-minimum data set (RAI-MDS) and the health outcomes for better information and care (HOBIC) database from 2010 to 2013. The analysis included 203 035 unique patients. The overall prevalence of pressure ulcers was approximately 13% and highest in the complex continuing care setting. Over 25% of pressure ulcers in long-term care developed one week after discharge from acute care hospitalisation. Individuals with cardiovascular disease, dementia, bed mobility problems, bowel incontinence, end-stage diseases, daily pain, weight loss and shortness of breath were more likely to develop pressure ulcers. While there were a number of evidence-based interventions implemented to treat pressure ulcers, only half of the patients received nutritional interventions.

Examining Clinical Predictors of Change in Recreational Preference Congruence Among Nursing Home Residents Over Time.
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A. R. Heid, K. Van Haitsma, M. Kleban, M. J. Rovine and K. M. Abbott.
J Appl Gerontol 2015 Nov 30

OBJECTIVE: There remains a significant gap in the field regarding the measurement of preference-based care over time in nursing homes (NHs). This study discusses the use of a quality indicator that tracks recreational preference congruence (PC; that is, the match between NH residents’ important preferences in recreational activities and their weekly attendance in these preferred activities). METHOD: Using a sample of 199 older adults, we examine the change in PC over 52 weeks using multilevel-mixed effects regression analyses. RESULTS: PC over time is highly variable and residents with greater functional limitations (vision, language comprehension, incontinence) and no diagnoses of mental health or neurological disorders have lower PC over time. DISCUSSION: Certain clinical characteristics have greater impact on resident PC over time. Particular attention needs to be given to the recreational attendance of residents with incontinence, and visual and language comprehension difficulties.

Social Engagement After Nursing Home Admission: Racial and Ethnic Disparities and Risk Factors.
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D. Bliss, S. Harms, L. E. Eberly, et al.
J Appl Gerontol 2015 Nov 26

Older adults admitted to nursing homes (NHs) are at risk for low social engagement, which has associations with medical, psychological, and social well-being. Minorities may be at a disadvantage for social engagement because of their racial or ethnic group identity. This study assessed whether there were racial/ethnic disparities in social engagement among older adults (N = 15,927) at 1 year after their NH admission using multi-level predictors. No racial or ethnic-based disparities in social engagement were found; hence, an analysis of risk factors at NH admission that predicted low social engagement at 1 year for all residents was conducted. Significant risk factors for low social engagement were low social engagement at admission, deficits in activities in daily living and cognition, problems with vision and communication, and residing in an NH in an urban community. Results highlight the importance of initiating interventions to increase social engagement at the time of NH admission.

Multisensory Stimulation as an Intervention Strategy for Elderly Patients With Severe Dementia: A Pilot Randomized Controlled Trial.
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A. Sanchez, M. P. Marante-Moar, C. Sarabia, et al.
Am J Alzheimers Dis Other Demen 2015 Dec 1

The objective of this study was to compare the effect of multisensory stimulation environment (MSSE) and one-to-one activity sessions in the symptomatology of elderly individuals with severe dementia. Thirty-two participants were randomly assigned to the following 3 groups: MSSE, activity, and control group. The MSSE and activity groups participated in two 30-minute weekly sessions over 16 weeks. Pre-, mid-, and posttrial; 8-week follow-up behavior; mood; cognitive status; and dementia severity were registered. Patients in the MSSE group demonstrated a significant improvement in the Neuropsychiatric Inventory and Bedford Alzheimer Nursing Severity Scale scores compared with the activity group. Both MSSE and activity groups showed an improvement during the intervention in the Cohen-Mansfield Agitation Inventory aggressive behavior factor and total score, with no significant differences between groups. The MSSE may have better effects on neuropsychiatric symptoms and dementia severity in comparison with one-to-one activity sessions in patients with severe dementia.

Incontinence: The Canadian Perspective Canada-flat-icon

Canadian Continence Foundation

This CCF publication entitled, “Incontinence: The Canadian Perspective” prepared by the Cameron Institute outlines all types of continence-related issues including their causes, their burden on health care, their influence on quality of life, and available treatments. Also of interest within this publication is a section where urinary incontinence is cited as the most common cause of admission to long term care facilities in Canada and the United States at present. Rates of incontinence rise dramatically (9 to 10 times) for elderly residents of long term care facilities compared to community dwelling elderly.

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Events

Online

Evaluating Research Impact: From General to Specific
Wednesday 20 January 14:00-15:00 MT

Using the impact and outcome evaluation of the Canadian Water Network as a case study, Dr. Anne Bergen (Knowledge to Action Consulting) and Elizabeth Shantz (Canadian Water Network) will discuss:
-defining evaluation goals and indicators
-creating a logic model or theory of change
-considering evaluation at level of projects, programs, and organizations
-promising practices and tensions, including:
-contribution analysis
-partner level inquiry
-success stories vs. quantified impact
-timing of impact

Research to Practice to Research – Using diverse knowledge translation methods to improving pain treatment during painful procedures for infants and children
9 March 14:00-15:00 MT

The aim of this webinar is to present the work by the BSweet2Babies team focused on improving pain treatment for newborn infants during newborn screening and other blood tests, and infants and young children during vaccinations. The work encompasses knowledge generation, knowledge synthesis and knowledge translation (KT). The KT work presented covers health care provider-targeted KT, parent-targeted KT and the effectiveness of social media as a method of knowledge dissemination.

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Courses

CIHR Summer Program in Aging
Late Life Issues: Recognizing Frailty and Improving Care
9-13 May Toronto Registration will open in December 2015

A unique, interactive training program will run from May 9-13, 2016 in Toronto, Ontario. Graduate students and postdoctoral fellows interested in learning about research related to the area of frailty and/or late life issues are encouraged to apply. Trainees will have the opportunity to participate in advanced training that crosses disciplines and brings together trainees, researchers, and members of the public and private sector from Canada and abroad.

Mixed Methods Research Training Program for the Health Sciences
John Hopkins
DEADLINE for applications 15 January

The Mixed Methods Research Training Program for the Health Sciences is funded by the National Institutes of Health through the Office of Behavioral and Social Science Research (OBSSR), and is the only program of its kind in the United States.

Finding and Using Research Evidence: Workshop for Policymakers, Stakeholders and Researchers
16-20 February McMaster Health Forum, Hamilton Ontario $2,480

For interested individual policymakers, stakeholders and researchers, the McMaster Health Forum is offering regular in-person training workshops twice per year, in February and in June. Each workshop consists of a combination of online instruction and five days of in-person workshop in Hamilton, Ontario, Canada.

Online

PH556X: Practical Improvement Science in Health Care: A Roadmap for Getting Results
MOOC starts 20 January

Developed through a collaboration between HarvardX and the Institute for Healthcare Improvement, PH 556x: Practical Improvement Science in Health Care: A roadmap for getting results will provide learners with the valuable skills and simple, well-tested tools they need to translate promising innovations or evidence into practice. A group of expert faculty will explore a scientific approach to improvement — a practical, rigorous methodology that includes a theory of change, measurable aims, and iterative, incremental small tests of change to determine if improvement concepts can be implemented effectively in practice. Faculty will present this science through the lens of improving health and health care, but will also share examples of how improvement can (and does) influence our daily lives.

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News

Private operators squeeze nurses in public home care: Cohn Canada-flat-icon

A bitter seven-month strike is symptomatic of what’s ailing home care in Ontario: Pension privation and salary squeezes.

Ontario long-term care ‘a system in crisis,’ workers say Canada-flat-icon

CUPE says overstretched facilities are providing inadequate service

Caring for seniors is a team effort Canada-flat-icon

Two NPs work as a team in a new Regina program — the Seniors House Call Program. Together, they care for seniors with complex medical needs in their homes or at care homes to ensure the fragile individuals don’t have to go to hospital.

Many Hospitals Neglect Practices To Combat ER Overcrowding, Study Finds

Crowded emergency departments have been vexing patients and hospital staff for years as consumers have increasingly sought care there. But a new study finds that many of the busiest facilities have yet to adopt several well regarded measures to reduce the wait and minimize delays.

Lack of staff, baths a concern in Saskatchewan long-term care homes Canada-flat-icon

Residents of long-term care homes in Saskatchewan and their families have concerns about staffing levels and a lack of baths in the facilities.

Why do so many nursing home residents end up in emergency departments? Canada-flat-icon

Nursing staff can usually call a patient’s provider, but sometimes they avoid calling to not overburden the doctor. In other cases, providers are busy seeing other patients so even when they’re called, they suggest the emergency department. “The arrangements are all over the map,” says Evelyn Williams, president of Ontario Long Term Care Physicians. “It would probably be preferable that in-person assessments with an attending physician or nurse practitioner are available on a daily basis. However, we have got a long way to go to make that happen.”

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Opportunities

Professorship in Evidence-Based Intervention and Policy Evaluation
St. Hilda’s College, Oxford University Oxford UK
DEADLINE 13 January

The University is seeking to appoint a scholar with a particular focus on evidence-based intervention and policy evaluation research and the ability to teach quantitative methods to postgraduate students in evidence-based social intervention and policy evaluation. The appointee will be expected to maintain a programme of personal research, undertake research degree supervision, contribute to the Department’s masters programmes, and participate in the governance and leadership of the Department.

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