July 28, 2020



Calls for Abstracts
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Opportunities

Calls for Abstracts

CALL FOR ABSTRACTS:
AbSPORU Virtual Institute on Patient Oriented Research

DEADLINE: 21 August
You are invited to submit abstracts for presentation at the fifth annual AbSPORU Patient-Oriented Research (POR) Institute 2020!
Most selected abstracts will be presented as either a digital poster display or a short video presentation of up to 3 minutes. A limited number of abstracts will be selected for highlighted video presentation of 7-10 minutes, with the opportunity for presenter(s) to participate in a live virtual Q&A session. More information about these presentation categories and formats is provided below.
Please read the following information carefully before accessing the abstract submission form on the next page.
RESEARCH THEMES
We are interested in presentations that are related to patient-oriented research which provide insights for the following themes:
– Innovative methods in knowledge synthesis, knowledge translation and/or implementation science
– Innovative patient-oriented research techniques in clinical trials
– Leveraging Alberta’s provincial data resources for patient-oriented research
– Practical approaches to meaningfully engage patients in health research
– Innovative methods for conducting patient-oriented research

 

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Grants & Awards

SSHRC Knowledge Synthesis Grants Skills and Work in the Digital Economy September 2020 Competition

DEADLINE 3 September
Knowledge Synthesis Grants support researchers in producing knowledge synthesis reports and evidence briefs that:
-support the use of evidence in decision-making and the application of best practices; and assist in developing future research agendas.
Applicants must address the following three objectives in their proposals:
-State of knowledge, strengths and gaps critically assess the state of knowledge of the future challenge theme under consideration from a variety of sources, as appropriate;
-identify knowledge strengths and gaps within the theme; and
-identify the most promising policies and practices related to the theme.
Research data
assess the quality, accuracy and rigour (i.e., methodological approaches) of current work in the field; and
identify strengths and gaps in the quantitative and qualitative data available.
Knowledge mobilization engage cross-sectoral stakeholders (academic, public, private and not-for-profit sectors) and/or First Nations, Métis and Inuit rights-holders throughout the project to mobilize knowledge related to promising policies and practices; and use effective knowledge mobilization methods to facilitate the sharing of research findings with cross-sectoral stakeholders and Indigenous rights-holders.

 

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Publications

 

COVID-19 and Long Term Care
KT
Health Care Administration and Organization
Health Care Innovation and Quality Assurance
Organizational Culture and Change
Research Practice and Methodology
Aging

COVID-19 and Long Term Care

Collection of articles on COVID and LTC is available here

COVID-19 and Resident Care

Care Homes and COVID-19: Results of an Online Survey in Germany

Heinz Rothgang, Karin Wolf-Ostermann, Dominik Domhoff, Anna Carina Friedrich, Franziska Heinze, Benedikt Preuss, Annika Schmidt, Kathrin Seibert, and Claudia Stolle (University of Bremen)
International Long Term Care Policy Network, 2020
Key findings:
About half of all COVID-19 deaths in Germany are of care home residents. This is similar to findings from other Western countries. Like in those countries, care homes are the most important hotspot for COVID-19 deaths. It is likely that the absolute number of deceased care home residents in Germany is lower than in other countries because COVID-19-related mortality is generally lower than in many other countries, not so much because there is better protection in care homes than elsewhere.
80 percent of all care homes do not have even one SARS-CoV-2 case among their residents. Of those that have cases, one third have eleven cases or more. Once the virus enters the facility, it seems to be difficult to prevent further spreading.
At the beginning of the pandemic, care homes suffered from severe shortages of personal protective equipment and surface disinfectants. Since then, the situation has improved considerably but some shortages still persist.
In order to protect their residents, care homes restricted all physical contact to persons outside the care home. Consequently, this restriction in itself has endangered the mental health of residents. These measures should be replaced by provisions that allow contact without significantly increasing the risk of infection.
When the survey was conducted, residents and employees were only tested if they showed symptoms. As the results only return a few days later, most of the infections had happened by then. In order to restrict the spreading of the virus, it is therefore important to introduce regular serial testing of all care home employees, all visitors and those residents that move in or return from hospital.

Mortality and the Use of Antithrombotic Therapies Among Nursing Home Residents with COVID-19
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S. H. Brouns, R. Brüggemann, A. E. M. J. H. Linkens, et al.
J Am Geriatr Soc 2020 Jul 7
Nursing home (NH) residents are a vulnerable population, susceptible to respiratory disease outbreaks such as coronavirus disease 2019 (COVID-19). Poor outcome in COVID-19 is at least partly attributed to hypercoagulability, resulting in a high incidence of thromboembolic complications. It is unknown whether commonly used antithrombotic therapies may protect the vulnerable NH population with COVID-19 against mortality. This study aimed to investigate whether the use of oral antithrombotic therapy (OAT) was associated with a lower mortality in NH residents with COVID-19. DESIGN: A retrospective case series. SETTING: Fourteen NH facilities from the NH organization Envida, Maastricht, the Netherlands PARTICIPANTS: A total of 101 NH residents with COVID-19 were enrolled. MEASUREMENTS: The primary outcome was all-cause mortality. The association between age, sex, comorbidity, OAT, and mortality was assessed using logistic regression analysis. RESULTS: Overall mortality was 47.5% in NH residents from 14 NH facilities. Age, comorbidity, and medication use were comparable among NH residents who survived and who died. OAT was associated with a lower mortality in NH residents with COVID-19 in the univariable analysis (odds ratio (OR) = 0.89; 95% confidence interval (CI) = 0.41-1.95). However, additional adjustments for sex, age, and comorbidity attenuated this difference. Mortality in males was higher compared with female residents (OR = 3.96; 95% CI = 1.62-9.65). Male residents who died were younger compared with female residents (82.2 (standard deviation (SD) = 6.3) vs 89.1 (SD = 6.8) years; P < .001). CONCLUSION: NH residents in the 14 facilities we studied were severely affected by the COVID-19 pandemic, with a mortality of 47.5%. Male NH residents with COVID-19 had worse outcomes than females. We did not find evidence for any protection against mortality by OAT, necessitating further research into strategies to mitigate poor outcome of COVID-19 in vulnerable NH populations.; Publisher: Abstract available from the publisher.

Preparing for COVID-19: The experiences of a long-term care facility in Taiwan.
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C. R. Chen, H. C. Huang, H. C. Huang and W. Chen.
Geriatr Gerontol Int 2020 Jul;20(7):734-735
To prevent large‐scale community transmission of COVID‐19, Taiwan has taken advanced steps in terms of medical care planning (e.g. border control, identifying cases, quarantining suspicious cases, proactively searching for cases, allocating resources etc.).

COVID-19 Pandemic and Ageism: A Call for Humanitarian Care.
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C. C. Colenda, C. F. Reynolds, W. B. Applegate, et al.
J Am Geriatr Soc 2020 Jul 14
The severe acute respiratory syndrome coronavirus 2 is a deadly threat, and although all individuals are susceptible, advanced age is one of the risk factors for its direst consequences in those who are infected. There are precious few times when individuals can come together to make clear a common cause for advocacy and health. We, the consortium of the editors of the nation’s major geriatric and gerontology journals, offer this perspective as a way to raise awareness about ageism in association with the coronavirus disease 2019 (COVID‐19) pandemic, and to acknowledge the extraordinary work that healthcare providers across all disciplines, including geriatrics, are doing at the frontlines of care. We also offer these thoughts as advocates for older patients, their families, their providers, and the broader community.

Do COVID-19 control guidelines for Long-term care facilities include oral health care orientations?
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L. G. Rodrigues, F. L. Campos, L. S. Alonso, et al.
J Am Geriatr Soc 2020 Jul 15
The COVID-19 pandemic represents a global health challenge. Controlling the spread of the virus in long-term care facilities (LTCFs) is considered a specific challenge since the older population has a worse prognosis and higher mortality rates. Institutionalized people generally suffer from physical or mental disability, some of who are of advanced age with dependence on daily activities, including oral hygiene. This procedure is performed most often by caregivers who may not have received proper training and may represent an additional risk of the virus spreading since the high viral load in the upper respiratory tract of infected individuals.

A Double Burden of Exclusion? Digital and Social Exclusion of Older Adults in Times of COVID-19.
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A. Seifert, S. R. Cotten and B. Xie.
J Gerontol B Psychol Sci Soc Sci 2020 Jul 16
The COVID-19 pandemic has excluded older adults from a society based on physical social contact. Vulnerable populations like older adults also tend to be excluded from digital services because they opt not to use the internet, lack necessary devices and network connectivity, or inexperience using the technology. Older adults who are frail and are not online, many of whom are in long-term care facilities, struggle with the double burden of social and digital exclusion. This paper discusses the potential outcomes of this exclusion and provides recommendations for rectifying the situation, with a particular focus on older adults in long-term care facilities.

Quality Improvement

Nursing Homes, the Pandemic, and Caring Enough.
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J. H. Gurwitz and A. Bonner.
J Gen Intern Med 2020 Jul 14:1-3
As of May 28, 2020, among 39 states reporting deaths related to COVID-19 in long-term care facilities, fatalities numbered nearly 40,000, and long-term care facility deaths accounted for 43% of all deaths related to COVID-19.1 In Massachusetts, a microcosm of the pandemic’s national impact on the nursing home population, the percentage of all deaths occurring in nursing homes, exceeds 60% (Fig. ​(Fig.1).1). While calls go out for investigations of outbreaks in low-rated nursing homes, many facilities, highly rated for their care, have been similarly affected. As long-term care policy expert David Grabowski has stated, “This is not a ‘bad apples’ problem; this is a systems problem.”

Managing COVID-19 within and across health systems: why we need performance intelligence to coordinate a global response.
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D. Kringos, F. Carinci, E. Barbazza, et al.
Health Res Policy Syst 2020 Jul 14;18(1):80-020-00593-x
The COVID-19 pandemic is a complex global public health crisis presenting clinical, organisational and system-wide challenges. Different research perspectives on health are needed in order to manage and monitor this crisis. Performance intelligence is an approach that emphasises the need for different research perspectives in supporting health systems’ decision-makers to determine policies based on well-informed choices. In this paper, we present the viewpoint of the Innovative Training Network for Healthcare Performance Intelligence Professionals (HealthPros) on how performance intelligence can be used during and after the COVID-19 pandemic. DISCUSSION: A lack of standardised information, paired with limited discussion and alignment between countries contribute to uncertainty in decision-making in all countries. Consequently, a plethora of different non-data-driven and uncoordinated approaches to address the outbreak are noted worldwide. Comparative health system research is needed to help countries shape their response models in social care, public health, primary care, hospital care and long-term care through the different phases of the pandemic. There is a need in each phase to compare context-specific bundles of measures where the impact on health outcomes can be modelled using targeted data and advanced statistical methods. Performance intelligence can be pursued to compare data, construct indicators and identify optimal strategies. Embracing a system perspective will allow countries to take coordinated strategic decisions while mitigating the risk of system collapse.A framework for the development and implementation of performance intelligence has been outlined by the HealthPros Network and is of pertinence. Health systems need better and more timely data to govern through a pandemic-induced transition period where tensions between care needs, demand and capacity are exceptionally high worldwide. Health systems are challenged to ensure essential levels of healthcare towards all patients, including those who need routine assistance. CONCLUSION: Performance intelligence plays an essential role as part of a broader public health strategy in guiding the decisions of health system actors on the implementation of contextualised measures to tackle COVID-19 or any future epidemic as well as their effect on the health system at large. This should be based on commonly agreed-upon standardised data and fit-for-purpose indicators, making optimal use of existing health information infrastructures. The HealthPros Network can make a meaningful contribution.

Could we have done better with COVID-19 in nursing homes?
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K. Szczerbińska.
Eur Geriatr Med 2020 Jul 16:1-5
The epidemic is not over yet. Moreover, during the potential next wave, we may once again witness a disaster, if we do not back-reflect on the events of the past months and learn a lesson on how to avoid such a scenario. Therefore, right now is the time to analyse which features of LTC did and did not work, and specify which measures may be undertaken in the nearest weeks, and in the future.

Health Care Administration and Organization

Vulnerable: The Law, Policy and Ethics of COVID-19

Colleen M. Flood, Vanessa MacDonnell, Jane Philpott, Sophie Thériault, Sridhar Venkatapuram
14 July 2020
Vulnerable: The Law, Policy and Ethics of COVID-19 confronts the vulnerabilities that have been revealed by the pandemic and its consequences. It examines vulnerabilities for people who have been harmed or will be harmed by the virus directly and those harmed by measures taken to slow its relentless march; vulnerabilities exposed in our institutions, governance, and legal structures; and vulnerabilities in other countries and at the global level where persistent injustices affect us all. COVID-19 has forced us to not only reflect on how we govern and how we set policy priorities, but also to ensure that pandemic preparedness, precautions, and recovery include all individuals, not just some.

Covid-19 lessons learned from the voices of our geriatric nurses: Leadership, resilience, and heroism.
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B. Resnick.
Geriatr Nurs 2020 Jun 18
We have heard much about the nurses working in acute care and the recognition of those nurses as heroes. My grandchildren often call me at 7 pm to let me hear the accolades and shout outs for nurses occurring every evening in New York City. We are not hearing the same shout outs for those of us working in long term care. Conversely, what we hear about is the large number of older adults dying in our long term care facilities. Driven by my own practice and talking with others practicing in long term care across the country I wanted to share the stories of nursing working in long term care in the fight again Covid-19.

Prevalence and Spread

Correlations between COVID-19 and burden of dementia: An ecological study and review of literature.
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M. R. Azarpazhooh, A. Amiri, N. Morovatdar, et al.
J Neurol Sci 2020 Jul 4;416:117013
Current evidence on the association between COVID-19 and dementia is sparse. This study aims to investigate the associations between COVID-19 caseload and the burden of dementia. METHODS: We gathered data regarding burden of dementia (disability-adjusted life years [DALYs] per 100,000), life expectancy, and healthy life expectancy (HALE) from the Global Burden of Disease (GBD) 2017 study. We obtained COVID-19 data from Our World in Data database. We analyzed the association of COVID-19 cases and deaths with the burden of dementia using Spearman’s rank correlation coefficient. RESULTS: Globally, we found significant positive (p < .001) correlations between life expectancy (r = 0.60), HALE (r = 0.58), and dementia DALYs (r = 0.46) with COVID-19 caseloads. Likewise, we found similar correlations between life expectancy (r = 0.60), HALE (r = 0.58) and dementia DALYs (r = 0.54) with COVID-19 mortality. CONCLUSION: Health policymakers should clarify a targeted model of disease surveillance in order to reduce the dual burden of dementia and COVID-19.

Outcomes of Universal COVID-19 Testing Following Detection of Incident Cases in 11 Long-term Care Facilities.
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B. F. Bigelow, O. Tang, B. Barshick, et al.
JAMA Intern Med 2020 Jul 14
This cross-sectional study evaluates the outcomes of universal COVID-19 testing following discovery of incident cases in 11 long-term care facilities in the US.

Mitigation of a COVID-19 Outbreak in a Nursing Home Through Serial Testing of Residents and Staff.
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D. J. Escobar, M. Lanzi, P. Saberi, et al.
Clin Infect Dis 2020 Jul 20
Nursing homes and long-term care facilities represent highly vulnerable environments for respiratory disease outbreaks, such as COVID-19. We describe a COVID-19 outbreak in a nursing home that was rapidly contained by using a universal testing strategy of all residents and nursing home staff.

Risk Factors Associated With Mortality Among Residents With Coronavirus Disease 2019 (COVID-19) in Long-term Care Facilities in Ontario, Canada.
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D. N. Fisman, I. Bogoch, L. Lapointe-Shaw, J. McCready and A. R. Tuite.
JAMA Netw Open 2020 Jul 1;3(7):e2015957
The coronavirus disease 2019 (COVID-19) pandemic has been particularly severe among individuals residing in long-term care (LTC) facilities. As of April 10, 2020, half of Canada’s COVID-19 deaths had occurred in LTC facilities. OBJECTIVE: To better understand trends and risk factors associated with COVID-19 death in LTC facilities in Ontario, Canada. DESIGN, SETTING, AND PARTICIPANTS: This cohort study of 627 LTC facilities included 269 total individuals who died of COVID-19 in Ontario to April 11, 2020, and 83 individuals who died of COVID-19 in Ontario LTC facilities to April 7, 2020. Because population denominators were not available for LTC residents, they were approximated as the total number of LTC facility beds in Ontario (79 498), assuming complete occupancy. EXPOSURES: Confirmed or suspected COVID-19 outbreaks; confirmed COVID-19 infection among residents and staff, diagnosed by real-time polymerase chain reaction testing. MAIN OUTCOMES AND MEASURES: COVID-19-specific mortality incidence rate ratios (IRRs) for LTC residents were calculated with community-living Ontarians older than 69 years as the comparator group. Count-based regression methods were used to model temporal trends and to identify associations of infection risk among staff and residents with subsequent LTC resident death. Model-derived IRRs for COVID-19-specific mortality were generated through bootstrap resampling (1000 replicates) to generate median and 95% credible intervals for IRR over time. RESULTS: Of 627 LTC facilities, 272 (43.4%) reported COVID-19 infection in residents or staff. Of 1 731 315 total individuals older than 69 years living in Ontario during the study period, 229 (<0.1%) died; of 79 498 potential residents in LTC facilities, 83 (0.1%) died. The IRR for COVID-19-related death in LTC residents was 13.1 (95% CI, 9.9-17.3) compared with community-living adults older than 69 years. The IRR increased sharply over time and was 87.3 (95% credible interval, 6.4-769.8) by April 11, 2020. Infection among LTC staff was associated with death among residents with a 6-day lag (eg, adjusted IRR for death per infected staff member, 1.17; 95% CI, 1.11-1.26). CONCLUSIONS AND RELEVANCE: In this cohort study of COVID-19-related deaths during the pandemic in Ontario, Canada, mortality risk was concentrated in LTC residents and increased during a short period. Early identification of risk requires a focus on testing, providing personal protective equipment to staff, and restructuring the LTC workforce to prevent the movement of COVID-19 between facilities.

Why the elderly appear to be more severely affected by COVID-19: The potential role of immunosenescence and CMV.
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S. Kadambari, P. Klenerman and A. J. Pollard.
Rev Med Virol 2020 Jul 15:e2144
The significantly higher mortality rates seen in the elderly compared with young children during the coronavirus disease 2019 (Covid-19) pandemic is likely to be driven in part by an impaired immune response in older individuals. Cytomegalovirus (CMV) seroprevalence approaches 80% in the elderly. CMV has been shown to accelerate immune ageing by affecting peripheral blood T cell phenotypes and increasing inflammatory mediated cytokines such as IL-6. The elderly with pre-existing but clinically silent CMV infection may therefore be particularly susceptible to severe Covid-19 disease and succumb to a cytokine storm which may have been promoted by CMV. Here, we evaluate the potential role of CMV in those with severe Covid-19 disease and consider how this relationship can be investigated in current research studies.

Lessons from Mass-Testing for COVID-19 in Long Term Care Facilities for the Elderly in San Francisco.
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J. K. Louie, H. M. Scott, A. DuBois, et al.
Clin Infect Dis 2020 Jul 20
COVID-19 can cause significant mortality in the elderly in Long Term Care Facilities (LTCF). We describe four LTCF outbreaks where mass testing identified a high proportion of asymptomatic infections (4-41% in health care workers and 20-75% in residents), indicating that symptom-based screening alone is insufficient for monitoring for COVID-19 transmission.

For-profit long-term care homes and the risk of COVID-19 outbreaks and resident deaths.
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N. M. Stall, A. Jones, K. A. Brown, P. A. Rochon and A. P. Costa.
CMAJ 2020 Jul 22
Long-term care (LTC) homes have been the epicentre of the coronavirus disease 2019 (COVID-19) pandemic in Canada to date. Previous research shows that for-profit LTC homes deliver inferior care across a variety of outcome and process measures, raising the question of whether for-profit homes have had worse COVID-19 outcomes than nonprofit homes. METHODS: We conducted a retrospective cohort study of all LTC homes in Ontario, Canada, from Mar. 29 to May 20, 2020, using a COVID-19 outbreak database maintained by the Ontario Ministry of Long-Term Care. We used hierarchical logistic and count-based methods to model the associations between profit status of LTC homes (for-profit, nonprofit or municipal) and COVID-19 outbreaks in LTC homes, the extent of COVID-19 outbreaks (number of residents infected), and deaths of residents from COVID-19. RESULTS: The analysis included all 623 Ontario LTC homes, comprising 75 676 residents; 360 LTC homes (57.7%) were for profit, 162 (26.0%) were nonprofit, and 101 (16.2%) were municipal homes. There were 190 (30.5%) outbreaks of COVID-19 in LTC homes, involving 5218 residents and resulting in 1452 deaths, with an overall case fatality rate of 27.8%. The odds of a COVID-19 outbreak were associated with the incidence of COVID-19 in the public health unit region surrounding an LTC home (adjusted odds ratio [OR] 1.91, 95% confidence interval [CI] 1.19-3.05), the number of residents (adjusted OR 1.38, 95% CI 1.18-1.61), and older design standards of the home (adjusted OR 1.55, 95% CI 1.01-2.38), but not profit status. For-profit status was associated with both the extent of an outbreak in an LTC home (adjusted risk ratio [RR] 1.96, 95% CI 1.26-3.05) and the number of resident deaths (adjusted RR 1.78, 95% CI 1.03-3.07), compared with nonprofit homes. These associations were mediated by a higher prevalence of older design standards in for-profit LTC homes and chain ownership. INTERPRETATION: For-profit status is associated with the extent of an outbreak of COVID-19 in LTC homes and the number of resident deaths, but not the likelihood of outbreaks. Differences between for-profit and nonprofit homes are largely explained by older design standards and chain ownership, which should be a focus of infection control efforts and future policy.

Variation in SARS-CoV-2 Prevalence in US Skilled Nursing Facilities.
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E. M. White, C. M. Kosar, R. A. Feifer, et al.
J Am Geriatr Soc 2020 Jul 16
To identify county and facility factors associated with SARS-CoV-2 outbreaks in skilled nursing facilities (SNFs). DESIGSN: Cross-sectional study linking county SARS-CoV-2 prevalence data, administrative data, state reports of SNF outbreaks, and data from Genesis HealthCare, a large multistate provider of post-acute and long-term care. State data are reported as of April 21, 2020; Genesis data are reported as of May 4, 2020. SETTING AND PARTICIPANTS: The Genesis sample consisted of 341 SNFs in 25 states, including a subset of 64 SNFs that underwent universal testing of all residents. The non-Genesis sample included all other SNFs (n = 3,016) in the 12 states where Genesis operates that released the names of SNFs with outbreaks. MEASUREMENTS: For Genesis and non-Genesis SNFs: any outbreak (one or more residents testing positive for SARS-CoV-2). For Genesis SNFs only: number of confirmed cases, SNF case fatality rate, prevalence after universal testing. RESULTS: 118 (34.6%) Genesis SNFs and 640 (21.2%) non-Genesis SNFs had outbreaks. A difference in county prevalence of 1,000 cases per 100,000 (1%) was associated with a 33.6 percentage point (95% CI: 9.6, 57.7, P = .008) difference in the probability of an outbreak for Genesis and non-Genesis SNFs combined, and a difference of 12.5 cases per facility (95% CI: 4.4, 20.8, P = .003) for Genesis SNFs. A 10 bed difference in facility size was associated with a 0.9 percentage point (95% CI: 0.6, 1.2; P < .001) difference in the probability of outbreak. We found no consistent relationship between Nursing Home Compare Five Star-ratings or past infection control deficiency citations and probability or severity of outbreak. CONCLUSIONS: Larger SNFs and SNFs in areas of high SARS-CoV-2 prevalence are at high risk for outbreaks and must have access to universal testing to detect cases, implement mitigation strategies, and prevent further potentially avoidable cases and related complications. This article is protected by copyright. All rights reserved.

 

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KT

Context-aware grading of quality evidences for evidence-based decision-making.
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M. Afzal, M. Hussain, R. B. Haynes and S. Lee.
Health Informatics J 2019 Jun;25(2):429-445
Processing huge repository of medical literature for extracting relevant and high-quality evidences demands efficient evidence support methods. We aim at developing methods to automate the process of finding quality evidences from a plethora of literature documents and grade them according to the context (local condition). We propose a two-level methodology for quality recognition and grading of evidences. First, quality is recognized using quality recognition model; second, context-aware grading of evidences is accomplished. Using 10-fold cross-validation, the proposed quality recognition model achieved an accuracy of 92.14 percent and improved the baseline system accuracy by about 24 percent. The proposed context-aware grading method graded 808 out of 1354 test evidences as highly beneficial for treatment purpose. This infers that around 60 percent evidences shall be given more importance as compared to the other 40 percent evidences. The inclusion of context in recommendation of evidence makes the process of evidence-based decision-making “situation-aware.”.

Towards a comprehensive model for understanding adaptations’ impact: the model for adaptation design and impact (MADI).
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M. A. Kirk, J. E. Moore, S. Wiltsey Stirman and S. A. Birken.
Implement Sci 2020 Jul 20;15(1):56-020-01021-y
Implementation science is shifting from qualifying adaptations as good or bad towards understanding adaptations and their impact. Existing adaptation classification frameworks are largely descriptive (e.g., who made the adaptation) and geared towards researchers. They do not help practitioners in decision-making around adaptations (e.g., is an adaptation likely to have negative impacts? Should it be pursued?). Moreover, they lack constructs to consider “ripple effects” of adaptations (i.e., both intended and unintended impacts on outcomes, recognizing that an adaptation designed to have a positive impact on one outcome may have unintended impacts on other outcomes). Finally, they do not specify relationships between adaptations and outcomes, including mediating and moderating relationships. The objective of our research was to promote systematic assessment of intended and unintended impacts of adaptations by using existing frameworks to create a model that proposes relationships among constructs. MATERIALS AND METHODS: We reviewed, consolidated, and refined constructs from two adaptation frameworks and one intervention-implementation outcome framework. Using the consolidated and refined constructs, we coded qualitative descriptions of 14 adaptations made to an existing evidence-based intervention; the 14 adaptations were designed in prior research by a stakeholder panel using a modified Delphi approach. Each of the 14 adaptations had detailed descriptions, including the nature of the adaptation, who made it, and its goal and reason. Using coded data, we arranged constructs from existing frameworks into a model, the Model for Adaptation Design and Impact (MADI), that identifies adaptation characteristics, their intended and unintended impacts (i.e., ripple effects), and potential mediators and moderators of adaptations’ impact on outcomes. We also developed a decision aid and website ( MADIguide.org ) to help implementation scientists apply MADI in their work. RESULTS AND CONCLUSIONS: Our model and associated decision aids build on existing frameworks by comprehensively characterizing adaptations, proposing how adaptations impact outcomes, and offering practical guidance for designing adaptations. MADI encourages researchers to think about potential causal pathways of adaptations (e.g., mediators and moderators) and adaptations’ intended and unintended impacts on outcomes. MADI encourages practitioners to design adaptations in a way that anticipates intended and unintended impacts and leverages best practice from research.

 

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Health Care Administration and Organization

The 2015 long-term care reform in the Netherlands: Getting the financial incentives right?
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P. Alders and F. T. Schut.
Health Policy 2019 Mar;123(3):312-316
In 2015 the system of long-term care (LTC) financing and provision in the Netherlands was profoundly reformed. The benefits covered by the former comprehensive public LTC insurance scheme were split up and allocated to three different financing regimes. The objectives of the reform were to improve the coordination between LTC, medical care and social care, and to reinforce incentives for an efficient provision of care by making risk-bearing health insurers and municipalities responsible for procurement. Unintentionally, the reform also created a number of major incentive problems, however, resulting from the way: (i) LTC benefits were split up across the three financing regimes; (ii) the various third party purchasers were compensated; and (iii) co-payments for the beneficiaries were designed. These incentive problems may result in cost shifting, lack of coordination between various LTC providers, inefficient use of LTC services and quality skimping. We discuss several options to get the financial incentives better aligned with the objectives of the reform.

Relationship between labour force satisfaction, wages and retention within the UK National Health Service: a systematic review of the literature
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K. A. A. Bimpong, A. Khan, R. Slight, C. L. Tolley and S. P. Slight.
BMJ Open 2020 Jul 21;10(7):e034919-2019-034919
A systematic review was undertaken to understand the nature of the relationship between the UK National Health Service (NHS) labour force and satisfaction, retention and wages. DESIGN: Narrative systematic review. DATA SOURCES: The literature was searched using seven databases in January 2020: MEDLINE (1996-present), the Cumulative Index to Nursing and Allied Health Literature (CINAHL via EBSCO) (1984-present), Embase (1996-present), PsycINFO (1987-present), ProQuest (1996-present), Scopus (all years) and Cochrane library (all years). We used medical subject headings and key words relating to ‘retention’, ‘satisfaction’ and ‘wages’. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Primary research studies or reviews that focused on the following relationships within the NHS workforce: wages and job satisfaction, job satisfaction and retention or wages and retention. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers screened all titles, abstracts and full texts, with arbitration by a third reviewer. RESULTS: 27 803 articles were identified and after removing duplicates (n=17 156), articles were removed at the title (n=10 421), abstract (n=150) and full-text (n=45) stages. A total of 31 full-text articles were included. They identified three broad themes, low job satisfaction impacting negatively on job retention, poor pay impacting negatively on staff satisfaction and the limitations of increasing pay as a means of improving staff retention. Several factors affected these relationships, including the environment, discrimination, flexibility, autonomy, training and staffing levels. CONCLUSIONS: This review highlighted how multiple factors influence NHS labour force retention. Pay was found to influence satisfaction, which in turn affected retention. An increase in wages alone is unlikely to be sufficient to ameliorate the concerns of NHS workers. More research is needed to identify the role of autonomy on retention. A system leadership approach underpinned by data is required to implement bespoke job satisfaction improvement strategies to improve retention and achieve the goals of the NHS Long Term Plan.

Appropriate Nurse Staffing Levels for U.S. Nursing Homes.
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C. Harrington, M. E. Dellefield, E. Halifax, M. L. Fleming and D. Bakerjian.
Health Serv Insights 2020 Jun 29;13:1178632920934785
US nursing homes are required to have sufficient nursing staff with the appropriate competencies to assure resident safety and attain or maintain the highest practicable level of physical, mental, and psychosocial well-being of each resident. Minimum nurse staffing levels have been identified in research studies and recommended by experts. Beyond the minimum levels, nursing homes must take into account the resident acuity to assure they have adequate staffing levels to meet the needs of residents. This paper presents a guide for determining whether a nursing home has adequate and appropriate nurse staffing. We propose five basic steps to: (1) determine the collective resident acuity and care needs, (2) determine the actual nurse staffing levels, (3) identify appropriate nurse staffing levels to meet residents care needs, (4) examine evidence regarding the adequacy of staffing, and (5) identify gaps between the actual staffing and the appropriate nursing staffing levels based on resident acuity. Data sources and specific methodologies are analyzed, compared, and recommended. The goal is to assist nursing home nurses and administrators to ensure adequate nursing home staffing levels that protect resident health, safety, and well-being.

What makes them happy? Professional care-givers’ job satisfaction.
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J. Höld, J. Späth and C. Kricheldorff.
Z Gerontol Geriatr 2020 Jul 14
Nurses’ job dissatisfaction can be seen as an early warning indicator of occupational change and (early) termination intentions. A better understanding of job satisfaction and its determinants can help to prevent nurses from leaving their profession. AIM: We assessed the impact of nurses’ perception of job characteristics on their overall job satisfaction in order to identify the most relevant factors. We also investigated the potential mechanisms through which the most relevant factor influences job satisfaction. METHOD: We used multiple regression analysis based on a standardized survey of about 800 registered nurses (in long-term care facilities) in both inpatient care and outpatient care in Germany as well as qualitative content analysis of about 50 semi-structured interviews with nurses. RESULTS: We found that collaboration with the team and supervisor to be the most relevant factor associated with job satisfaction. A good team can create professional support and ideational support for professional caregivers and enhance their professional development and the quality of care. DISCUSSION: Our results point to the importance of leadership training, team building methods and other measures for establishing and cultivating a pleasant working atmosphere with flexible shift handovers and team meetings.

Effectiveness of a Technology-Enhanced Integrated Care Model for Frail Older People: A Stepped-Wedge Cluster Randomized Trial in Nursing Homes.
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H. Kim, Y. I. Jung, G. S. Kim, H. Choi and Y. H. Park.
Gerontologist 2020 Jul 15
The objective of this study was to evaluate the impact of an information and communication technologies- (ICT-) enhanced, multidisciplinary integrated care model, called Systems for Person-centered Elder Care (SPEC), on frail older adults at nursing homes. RESEARCH DESIGN AND METHODS: SPEC was implemented at ten nursing homes in South Korea in random order using a stepped-wedge design. Data were collected on all participating older residents in the homes before the first implementation and until six months after the last implementation. The 21-month SPEC intervention guided by the chronic care model (CCM) consists of five strategies: comprehensive geriatric assessment, care planning, optional interdisciplinary case conferences, care coordination, and a cloud-based ICT tool along with free messaging app. The primary outcome was quality of care measured by a composite quality indicator (QI) from the interRAI assessment system. Usual care continued over the control periods. Nursing home staff were not blinded to the intervention. RESULTS: There were a total of 482 older nursing home residents included in the analysis. Overall quality of care measured by the composite QI was significantly improved (adjusted mean difference: -0.025 [95% CI: -0.037 ~ -0.014, p <.0001]). The intervention effect was consistent in the subgroup analysis by cognition and activities of daily living. There were no important adverse events or side effects. DISCUSSION AND IMPLICATIONS: The SPEC, a CCM-guided, ICT-supported, multidisciplinary integrated care management intervention, can improve quality of care measured by health and functional outcomes for frail older persons residing in nursing homes with limited healthcare provision. TRIAL REGISTRATION: ISRCTN11972147; ethical approval: Seoul National University University Institutional Review Board.

Formal Caregiver Burden in Nursing Homes: A Concept Analysis.
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R. Kunkle, C. Chaperon and K. M. Hanna.
J Gerontol Nurs 2020 Jul 8:1-6
Caregiver burden is a phrase often used interchangeably with the concepts of stress, strain, and burnout. Distinct differences may be relevant in formal caregiver burden; however, previous concept analyses have not addressed formal caregiver burden in nursing homes, which would be useful as a foundation for theory development and empirical testing. In the current study, based on Walker and Avant’s concept analysis guidelines, articles were reviewed to identify the attributes, antecedents, and consequences of formal caregiver burden. Formal caregiver burden was defined as the demands of caring for dependent older adults with a level of competency and responsibility within the context of perceived stress. Antecedents were associated with the organization and environment, such as regulatory restraints, whereas consequences were associated with changes in physical and mental health status. The conceptualization of formal caregiver burden may lead to the development of psychometric instruments and interventions for the well-being of direct care staff in multiple care settings for older adults. [Journal of Gerontological Nursing, xx(x), xx-xx.].

Dispositional Optimism, Burnout and Their Relationship with Self-Reported Health Status among Nurses Working in Long-Term Healthcare Centers.
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M. C. Malagón-Aguilera, R. Suñer-Soler, A. Bonmatí-Tomas, et al.
Int J Environ Res Public Health 2020 Jul 8;17(14):E4918. doi: 10.3390/ijerph17144918
The mental health of nurses working in long-term healthcare centers is affected by the care they provide to older people with major chronic diseases and comorbidity and this in turn affects the quality of that care. The aim of the study was to investigate dispositional optimism, burnout and self-reported health among nurses working in long-term healthcare centers. A descriptive, cross-sectional survey design was used. Survey questionnaires were distributed in 11 long-term health care centers (n = 156) in Catalonia (Spain). The instruments used were LOT-R (dispositional optimism), MBI (burnout) and EuroQol EQ-5D (self-reported health). Bivariate analyses and multivariate linear regression models were used. Self-reported health correlated directly with dispositional optimism and inversely with emotional exhaustion and cynicism. Better perceived health was independently associated with greater dispositional optimism and social support, lower levels of emotional exhaustion level and the absence of burnout. Dispositional optimism in nurses is associated with a greater perception of health and low levels of emotional exhaustion.

Effectiveness of online dementia caregivers training programs: A systematic review.
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M. Pleasant, V. Molinari, D. Dobbs, H. Meng and K. Hyer.
Geriatr Nurs 2020 Jul 20
Over the next thirty years, Alzheimer’s disease rates will increase alongside global aging. With the anticipated increase in demand, knowledgeable and skilled dementia caregivers will be in need across the long-term care spectrum. This study is a systematic review of online dementia-based training programs for formal and informal caregivers conducted to analyze evidence for using online training programs. We used the Preferred Reporting Items for Systematic Reviews (PRISMA) method. Methodological quality was assessed by the Cochrane Collaboration Back Review Group criteria. No previously published systematic review has analyzed online dementia training programs among both formal and informal caregivers. A systematic search of Web of Science, PsychInfo, and PubMed resulted in a final sample of (N = 19) studies. Results suggest that online interventions improve the condition and preparedness of caregivers, but future evaluations should consider study designs with multiple time points, control groups, and content that is personalized and interactive.

Safety Climate Associated With Adverse Events in Nursing Homes: A National VA Study.
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E. D. Quach, L. E. Kazis, S. Zhao, et al.
J Am Med Dir Assoc 2020 Jul 19
Adverse events in nursing homes are leading causes of morbidity and mortality, prompting facilities to investigate their antecedents. This study examined the contribution of safety climate-how frontline staff typically think about safety and act on safety issues-to adverse events in Veterans Affairs (VA) nursing homes or Community Living Centers (CLCs). DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: A total of 56 CLCs nationwide, 1397 and 1645 CLC staff (including nurses, nursing assistants, and clinicians/specialists), respectively, responded to the CLC Employee Survey of Attitudes about Resident Safety (CESARS) in 2017 and 2018. METHODS: Adverse events (pressure ulcers, falls, major injuries from falls, and catheter use) were measured using the FY2017-FY2018 Minimum Data Set (MDS). Safety climate was defined as 7 CESARS domains (safety priorities, supervisor commitment to safety, senior management commitment to safety, personal attitudes toward safety, environmental safety, coworker interactions around safety, and global rating of CLC). The associations between safety climate domains and each adverse event were determined separately for each frontline group, using beta-logistic regression with random effects. RESULTS: Better ratings of supervisor commitment to safety were associated with lower rates of major injuries from falls [odds ratio (OR) 0.33, 95% confidence interval (CI) 0.11-0.97, clinicians] and catheter use (OR 0.42, 95% CI 0.21-0.85, nurses), and better ratings of environmental safety were associated with lower rates of pressure ulcers (OR 0.23, 95% CI 0.09-0.61, clinicians), major injuries from falls (OR 0.48, 95% CI 0.24-0.93, nurses), and catheter use (OR 0.55, 95% CI 0.32-0.93, nursing assistants). Better global CLC ratings were associated with higher rates of catheter use. No other safety climate domains had significant associations. CONCLUSIONS AND IMPLICATIONS: Nursing homes may reduce adverse events by fostering supportive supervision of frontline staff and a safer physical environment.

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Health Care Innovation and Quality Assurance

An evaluation of the clinical microsystems approach in general practice quality improvement.
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V. Abrahamson, S. Jaswal and P. M. Wilson.
Prim Health Care Res Dev 2020 Jun 23;21:e21
Changes to the general practice (GP) contract in England (April 2019) introduced a new quality improvement (QI) domain. The clinical microsystems programme is an approach to QI with limited evidence in primary care. AIM: To explore experiences of GP staff participating in a clinical microsystems programme. DESIGN AND SETTING: GPs within one clinical commissioning group (CCG) in South East England. Normalisation process theory informed qualitative approach. METHOD: Review of all CCG clinical microsystems projects using pre-existing data. The Diffusion of Innovation Cycle was used to inform the sampling frame and GPs were invited to participate in interviews or focus groups. Ten practices participated; 11 coaches and 16 staff were interviewed. RESULTS: The majority of projects were process-driven activities related to administrative systems. Projects directly related to health outputs were fewer and related to externally imposed targets. Four key elements facilitated practices to engage: feeling in control; receiving enhanced service payment; having a senior staff member championing the approach; and good practice-coach relationship. There appeared to be three key benefits in addition to project-specific ones: improved working relationships between CCG and practice; more cohesive practice team; and time to reflect. CONCLUSION: Small projects with clear parameters were more successful than larger ones or those spanning organisations. However, there was little evidence suggesting the key benefits were unique attributes of the microsystems approach and sustainability was problematic. Future research should focus on cross-organisational approaches to QI and identify what, if any, added value the approach provides.

National Partnership to Improve Dementia Care in Nursing Homes Campaign: State and Facility Strategies, Impact, and Antipsychotic Reduction Outcomes.
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S. Crystal, O. F. Jarrín, M. Rosenthal, R. Hermida and B. Angell.
Innov Aging 2020 Jun 2;4(3):igaa018
Antipsychotic medications have been widely used in nursing homes to manage behavioral and psychological symptoms of dementia, despite significantly increased mortality risk. Use grew rapidly during the 2000s, reaching 23.9% of residents by 2011. A national campaign for safer dementia care in U.S. nursing homes was launched in 2012, with public reporting of quality measures, increased regulatory scrutiny, and accompanying state and facility initiatives. By the second quarter of 2019, use had declined by 40.1% to 14.3%. We assessed the impact of state and facility initiatives during the Campaign aimed at encouraging more-judicious prescribing of antipsychotic medications. RESEARCH DESIGN AND METHODS: Our mixed-methods strategy integrated administrative and clinical data analyses with state and facility case studies. RESULTS: Results suggest that substantial change in prescribing is achievable through sustained, data-informed quality improvement initiatives integrating educational and regulatory interventions, supported by public quality reporting. Adequate staffing, particularly of registered nurses, is key to support individualized management of symptoms through nonpharmacological strategies. Case study results suggest that state and facility initiatives during the campaign achieved considerable buy-in for the goal of more conservative prescribing, through a social process of normalization. Reporting and reduction of antipsychotic use was not followed by increases in sedative-hypnotic medication use. Rather, sedative-hypnotic use declined in tandem with antipsychotic reduction, suggesting that increased attention to prescribing patterns led to more cautious use of other risky psychotropic medications. DISCUSSION AND IMPLICATIONS: Quality improvement initiatives to change entrenched but problematic clinical practices face many barriers to success, including provider-level inertia; perceptions that alternatives are not available; and family and staff resistance. Nevertheless, systemic change is possible through concerted, collaborative efforts that touch prescribing practices at multiple points; integrate educational and regulatory influences; activate local and state champions for improvement; foster reputational influences through public reporting and benchmarking; and support a social process of normalization of preferred care processes as a best practice that is in the interest of patients.

Transforming clients into experts-by-experience: A pilot in client participation in Dutch long-term elderly care homes inspectorate supervision.
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M. B. de Graaff, A. Stoopendaal and I. Leistikow.
Health Policy 2019 Mar;123(3):275-280
As experts-by-experience, clients are thought to give specific input for and legitimacy to regulatory work. In this paper we track a 2017 pilot by the Dutch Health and Youth Care Inspectorate that aimed to use experiential knowledge in risk regulation through engaging with clients of long-term elderly care homes. Through an ethnographic inquiry we evaluate the design of this pilot. We find how the pilot transforms selected clients into experts-by-experience through training and site visits. In this transformation, clients attempt, and fail, to bring to the fore their definitions of quality and safety, negating their potentially specific contributions. Paradoxically, in their attempts to expose valid new knowledge on the quality of care, the pilot constructs the experts-by-experience in such a way that this knowledge is unlikely to be opened up. Concurrently, we find that in their attempts to have their input seen as valid, experts-by-experience downplay the value of their experiential knowledge. Thus, we show how dominating, legitimated interpretations of (knowledge about) quality of care resonate in experimental regulatory practices that explicitly try to move beyond them, emphasizing the need for a pragmatic and reflexive engagement with clients in the supervision of long-term elderly care.

A need-based, multi-level, cross-sectoral framework to explain variations in satisfaction of care needs among people living with dementia.
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C. De Poli, J. Oyebode, M. Airoldi and R. Glover.
BMC Health Serv Res 2020 Jul 15;20(1):657-020-05416-x
Provision of care and support for people with dementia and family carers is complex, given variation in how dementia manifests, progresses and affects people, co-morbidities associated with ageing, as well as individual preferences, needs, and circumstances. The traditional service-led approach, where individual needs are assessed against current service provision, has been recognised as unfit to meet such complexity. As a result, people with dementia and family members often fail to receive adequate support, with needs remaining unmet. Current research lacks a conceptual framework for explaining variation in satisfaction of care needs. This work develops a conceptual framework mapped onto the care delivery process to explain variations in whether, when and why care needs of people with dementia are met and to expose individual-, service-, system-level factors that enable or hinder needs satisfaction. METHODS: Data collected through 24 in-depth interviews and two focus groups (10 participants) with people with dementia and family carers living in the North East of England (UK) were analysed thematically to develop a typology of care needs. The need most frequently reported for people with dementia (i.e. for support to go out and about) was analysed using themes stemming from the conceptual framework which combined candidacy and discrepancy theories. RESULTS: The operationalisation of the framework showed that satisfaction of the need to go out was first determined at the point of service access, affected by issues about navigation, adjudication, permeability, users’ resistance to offers, users’ appearance, and systems-level operating conditions, and, subsequently, at the point of service use, when factors related to service structure and care process determined (dis)satisfaction with service and, hence, further contributed to met or unmet need. CONCLUSION: The conceptual framework pinpoints causes of variations in satisfaction of care needs which can be addressed when designing interventions and service improvements.

What happens after James Lind Alliance Priority Setting Partnerships? A qualitative study of contexts, processes and impacts.
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K. Staley, S. Crowe, J. C. Crocker, M. Madden and T. Greenhalgh.
Res Involv Engagem 2020 Jul 11;6:41-020-00210-9. eCollection 2020
The James Lind Alliance (JLA) supports priority setting partnerships (PSPs) in which patients, carers and health professionals collaborate to identify a Top 10 list of research priorities. Few studies have examined how partnerships plan for the post-prioritisation phase, or how context and post-PSP processes influence the fortunes of priorities. This evaluation aimed to explore these questions. METHODS: We selected a diverse sample of 20 interviewees who had knowledge of 25 PSPs. Thirteen interviewees had led a PSP, either from a university, patient organisation or charity. Three were patients who had taken part in a PSP workshop. Four others, three researchers and one funder, had worked with JLA PSP priorities to develop research proposals. We analysed the data thematically, exploring how success was understood and achieved. RESULTS: The JLA PSPs had different histories, funding sources, goals and stakeholders. Whilst their focus was on generating priority research topics, PSPs’ wider impacts included enhanced status and greater confidence for individuals, as well as relationship-building and network strengthening for the organisations involved. To follow through on a Top 10, additional work was needed to refine broad priority topics into research questions and match them with appropriate funding sources. Commitment to post-PSP action from partners appeared to increase the chance that priority topics would be followed through to funded studies. Academic publications could alert researchers to a PSP’s outputs, but not all PSPs had the capacity to produce them. A Top 10 list potentially influences funding decisions through direct funding, themed calls or as a prompt in open calls. Influence on funders appears to depend on alignment between a priority and the funder’s remit, culture and values. CONCLUSION: The history and context of a JLA PSP have a major influence on its impact. Our findings suggest that there is no universal formula for success, but that greater resource and attention should be given to what happens after prioritisation. Further research is needed on what works best in what circumstances. Overall, we conclude that a wider cultural change in the research world is needed for JLA PSPs to achieve their goal of shaping the research agenda.

 

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Organizational Culture and Change

Changing hospital organisational culture for improved patient outcomes: developing and implementing the leadership saves lives intervention.
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E. Linnander, Z. McNatt, K. Boehmer, E. Cherlin, E. Bradley and L. Curry.
BMJ Qual Saf 2020 Jul 16
Leadership Saves Lives (LSL) was a prospective, mixed methods intervention to promote positive change in organisational culture across 10 diverse hospitals in the USA and reduce mortality for patients with acute myocardial infarction (AMI). Despite the potential impact of complex interventions such as LSL, descriptions in the peer-reviewed literature often lack the detail required to allow adoption and adaptation of interventions or synthesis of evidence across studies. Accordingly, here we present the underlying design principles, overall approach to intervention design and core content of the intervention. METHODS OF INTERVENTION DEVELOPMENT: Hospitals were selected for participation from the membership of the Mayo Clinic Care Network using random sampling with a purposeful component. The intervention was designed based on the Assess, Innovate, Develop, Engage, Devolve model for diffusion of innovation, with attention to pressure testing of the intervention with user groups, creation of a think tank to develop a comprehensive assessment of the landscape, and early and continued engagement with strategically identified stakeholders in multiple arenas. RESULTS: We provide in-depth descriptions of the design and delivery of the three intervention components (three annual meetings of all hospitals, four rounds of in-hospital workshops and an online community), designed to equip a guiding coalition within each site to identify and address root causes of AMI mortality and improve organisational culture. CONCLUSIONS: This detailed practical description of the intervention may be useful for healthcare practitioners seeking to promote organisational culture change in their own contexts, researchers seeking to compare the results of the intervention with other leadership development and organisational culture change efforts, and healthcare professionals committed to understanding complex interventions across healthcare settings.

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Research Practice and Methodology

Cohort Profile: The Canadian Longitudinal Study on Aging (CLSA).
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P. Raina, C. Wolfson, S. Kirkland, et al.
Int J Epidemiol 2019 Dec 1;48(6):1752-1753j
The CLSA was designed to be a national, longitudinal research platform that includes participants from all 10 Canadian provinces, and collects comprehensive data and biological samples that will support a wide variety of aging-related research questions

Is authorship sufficient for today’s collaborative research? A call for contributor roles
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Nicole Vasilevsky A., Hosseini Mohammad, Teplitzky Samantha, et al.
Account Res.Jun 30 2020;1-21. doi:10.1080/08989621.2020.1779591
Assigning authorship and recognizing contributions to scholarly works is challenging on many levels. Here we discuss ethical, social, and technical challenges to the concept of authorship that may impede the recognition of contributions to a scholarly work. Recent work in the field of authorship shows that shifting to a more inclusive contributorship approach may address these challenges. Recent efforts to enable better recognition of contributions to scholarship include the development of the Contributor Role Ontology (CRO), which extends the CRediT taxonomy and can be used in information systems for structuring contributions. We also introduce the Contributor Attribution Model (CAM), which provides a simple data model that relates the contributor to research objects via the role that they played, as well as the provenance of the information. Finally, requirements for the adoption of a contributorship-based approach are discussed.

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Aging

Trends in Antipsychotic and Mood Stabilizer Prescribing in Long-Term Care in the U.S.: 2011-2014.
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L. B. Gerlach, H. C. Kales, H. M. Kim, et al.
J Am Med Dir Assoc 2020 Jul 18
The Centers for Medicare and Medicaid Services’ National Partnership to Improve Dementia Care in Nursing Homes focuses on but is not limited to long-term care (LTC) residents with dementia; the potential impact on residents with other diagnoses is unclear. We sought to determine whether resident subpopulations experienced changes in antipsychotic and mood stabilizer prescribing. DESIGN: Repeated cross-sectional analysis of a 20% Medicare sample, 2011-2014. SETTING AND PARTICIPANT: Fee-for-service Medicare beneficiaries with Part D coverage in LTC (n = 562,485) and a secondary analysis limited to persons with depression or bipolar disorder (n = 139,071). METHODS: Main outcome was quarterly predicted probability of treatment with an antipsychotic or mood stabilizer. RESULTS: From 2011 to 2014, the adjusted predicted probability (APP) of antipsychotic treatment fell from 0.120 [95% confidence interval (CI) 0.119-0.121] to 0.100 (95% CI 0.099-0.101; P < .001). Use decreased for all age, sex, and racial/ethnic groups; the decline was larger for persons with dementia (P < .001). The APP of mood stabilizer use grew from 0.140 (95% CI 0.139-0.141) to 0.185 (95% CI 0.184-0.186), growth slightly larger among persons without dementia (P < .001). Among persons with depression or bipolar disorder, the APP of antipsychotic treatment increased from 0.081 (95% CI 0.079-0.082) to 0.087 (95% CI 0.085-0.088; P < .001); APP of mood stabilizer treatment grew more, from 0.193 (95% CI 0.190-0.196) to 0.251 (0.248-0.253; P < .001). Quetiapine was the most commonly prescribed antipsychotic. The most widely prescribed mood stabilizer was gabapentin, prescribed to 70.5% of those who received a mood stabilizer by the end of 2014. CONCLUSIONS AND IMPLICATIONS: The likelihood of antipsychotic and mood stabilizer treatment did not decline for residents with depression or bipolar disorder, for whom such prescribing may be appropriate but who were not excluded from the Partnership’s antipsychotic quality measure. Growth in mood stabilizer use was widespread, and largely driven by growth in gabapentin prescribing.

The relationship between care dependency and pain in nursing home residents.
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M. Hoedl and S. Bauer.
Arch Gerontol Geriatr 2020 Jun 29;90:104166
Pain is a common health problem experienced by up to 57 % of nursing home residents which has many negative side effects, including a reduced quality of life. Several studies have been carried out on the prevalence of pain and pain management. However, these study findings remain controversial. OBJECTIVES: Therefore, the aim of this study was to compare care dependent and care independent nursing home residents with regard to their (1) pain prevalence and levels and (2) their pain management. METHODS: This cross-sectional study is conducted annually in Austrian nursing homes. We measured pain prevalence and levels by asking questions about the pain experienced and pain level measured in the seven days prior to the interview, as well as the pain experienced at the time of this interview. RESULTS: The study sample comprised 81.1 % of the 1528 residents of Austrian nursing homes. Overall, pain prevalence was higher in care dependent residents than in care independent residents. Care dependent residents experienced more often mild/moderate pain than care independent residents. Both, prevalence and levels of pain were not statistically significant different between the levels of care dependency. Care dependent residents who suffered from pain received a statistically significantly higher number of non-pharmacological interventions as compared to care independent residents who suffered from pain. CONCLUSIONS: We identified a higher prevalence of pain among care dependent residents. Furthermore, the found differences in pain relief seem to be correlated with different degrees of care dependency, an aspect that requires further investigation.

Association between poor sleep quality and depression symptoms among the elderly in nursing homes in Hunan province, China: a cross-sectional study
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Z. Hu, X. Zhu, A. C. Kaminga, T. Zhu, Y. Nie and H. Xu.
BMJ Open 2020 Jul 13;10(7):e036401-2019-036401
To examine the association between the prevalence of poor sleep quality and depression symptoms among the elderly in the nursing homes of Hunan province in China. DESIGN, SETTING AND PARTICIPANTS: This was a cross-sectional study investigating 817 elderly people from 24 nursing homes in China’s Hunan province. MAIN OUTCOME MEASURES: Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) such that poor sleep quality was defined as PSQI Score >5. In addition, depression symptoms were assessed using the Geriatric Depression Scale (GDS). Linear regression models and binary logistic regression models were used to analyse the relationship between the prevalence of poor sleep quality and depression symptoms. RESULTS: The mean PSQI Score was 8.5±4.9, and the prevalence of poor sleep quality was 67.3%. Additionally, the mean GDS Score was 9.8±7.5, and the prevalence of depression symptoms was 36.0%. Elderly people with poor sleep quality had increased GDS Score (mean difference=2.54, 95% CI 1.66 to 3.42) and increased risk of depression symptoms (OR=3.19, 95% CI 2.04 to 4.98) after controlling for demographics, chronic disease history, lifestyle behaviours, social support, activities of daily living and negative life events. CONCLUSIONS: The prevalence of poor sleep quality was relatively high, and this was associated with increased depression symptoms. Therefore, poor sleep quality could be speculated as a marker of current depression symptoms in the elderly.

Qualitative analyses of nursing home residents’ quality of life from multiple stakeholders’ perspectives.
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J. L. Johs-Artisensi, K. E. Hansen and D. M. Olson.
Qual Life Res 2020 May;29(5):1229-1238
Quality of life has been defined in various ways by nursing home stakeholders over the years. As such, analyzing the levels of agreement or disagreement among these stakeholders to ascertain if staff and leadership align with resident-identified factors for “good” quality of life has become important to include in the literature. This study sought to identify contributory factors to resident quality of life, as well as analyze areas of commonality in qualitative responses. METHODS: Semi-structured interviews were conducted at 46 Midwestern nursing homes, with residents (n = 138), nursing assistants (n = 138), social workers (n = 46), activities directors (n = 46), and administrators (n = 46), on whether each stakeholder felt residents had a good quality of life and the factors contributing to resident quality of life. RESULTS: Overall, the majority of residents perceived their quality of life as “good,” though differences were noted in their main contributing factors when compared to staff members’ and management’s perspectives. Findings also demonstrated that nursing assistants most closely aligned with resident perspectives. CONCLUSIONS: Given the implications of resident satisfaction with quality of life on multiple facets of a nursing home (e.g., survey process, financial reimbursement), it remains ever critical for management to engage residents and to truly listen to resident perspectives to enhance and ensure an optimal quality of life.

Changes over Time in Racial/Ethnic Differences in Quality of Life for Nursing Home Residents: Patterns within and between Facilities.
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T. T. Shippee, W. Ng, Y. Duan, et al.
J Aging Health 2020 Jul 10:898264320939006
To investigate trends in racial/ethnic differences in nursing home (NH) residents’ quality of life (QoL) and assess these patterns within and between facilities. Method: Data include resident-reported QoL surveys (n = 60,093), the Minimum Data Set, and facility-level characteristics (n = 376 facilities) for Minnesota. Hierarchical linear models were estimated to identify differences in QoL by resident race/ethnicity and facility racial/ethnic minority composition for 2011-2015. Results: White residents in low-proportion racial/ethnic minority facilities reported higher QoL than both minority and white residents in high-proportion minority facilities. While the year-to-year differences were not statistically significant, the point estimates for white-minority disparity widened over time. Discussion: Racial/ethnic differences in QoL are persistent and may be widening over time. The QoL disparity reported by minority residents and all residents in high-proportion minority facilities underscores the importance of examining NH structural characteristics and practices to ultimately achieve the goal of optimal, person-centered care in NHs.

A comparative analysis of prophylactic antimicrobial use in long-term care facilities in Ireland, 2013 and 2016.
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M. Tandan, R. O’Connor, K. Burns, et al.
Euro Surveill 2019 Mar;24(11):1800102. doi: 10.2807/1560
Long-term care facilities (LTCFs) are important locations of antimicrobial consumption. Of particular concern is inappropriate prescribing of prophylactic antimicrobials. AimWe aimed to explore factors related to antimicrobial prophylaxis in LTCFs in Ireland. MethodsThe point prevalence surveys of Healthcare-Associated Infections in Long-Term Care Facilities (HALT) were performed in Ireland in May 2013 and 2016. Data were collected on facility (type and stewardship initiatives) and resident characteristics (age, sex, antimicrobial and indication) for those meeting the surveillance definition for a HAI and/or prescribed an antimicrobial. ResultsIn 2013, 9,318 residents (in 190 LTCFs) and in 2016, 10,044 residents (in 224 LTCFs) were included. Of the 10% of residents prescribed antimicrobials, 40% were on prophylaxis, most of which was to prevent urinary tract infection. The main prophylactic agents were: nitrofurantoin (39%) and trimethoprim (41%) for urinary tract (UT); macrolides (47%) for respiratory tract and macrolides and tetracycline (56%) for skin or wounds. More than 50% of the prophylaxis was prescribed in intellectual disability facilities and around 40% in nursing homes. Prophylaxis was recorded more often for females, residents living in LTCFs for more than 1 year and residents with a urinary catheter. No difference in prophylactic prescribing was observed when comparing LTCFs participating and not participating in both years. ConclusionsForty per cent of antimicrobial prescriptions in Irish LTCFs were prophylactic. This practice is not consistent with national antimicrobial prescribing guidelines. Addressing inappropriate prophylaxis prescribing in Irish LTCFs should be a key objective of antimicrobial stewardship initiatives.

 

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Events & Training Opportunities

Nursing Home Staffing – Research Highlights Relationship Between COVID and Staffing

Available on demand
Consumers have long believed that adequate numbers of well trained staff are essential to quality of care and quality of life. Their advocacy has focused for many years on a staffing standard and the importance of RN coverage. Sadly, COVID-19 has shown the disparities between facilities in alarming ways, and the factors in COVID-19’s spread are being examined by researchers. Two studies by Dr. Charlene Harrington and Dr. Yue Li look carefully at the relationship between staffing and COVID-19 spread. The research findings also address the importance of RN staffing and point out racial disparities in nursing home care.

Harrington and Li will explain their recent findings and what they tell us about COVID-19, facilities and residents. There will be discussion on how these findings can be applied to consumer advocacy on the state and national level. The importance of additional consumer driven research will be highlighted.

Parliament for Researchers (UK)

Various dates and times in October & November
We offer free online training events for academic researchers and knowledge mobilisers. These focused, practical webinars are 45 minutes long, and give an insight into how to use research to engage with Parliament. There are webinars available for researchers at different career stages, as well as knowledge mobilisers (those working in roles focused on sharing research from their institution with other sectors). Dates and booking details for the Autumn 2020 series can be found below.

The role of philosophy in the development and practice of nursing

27 August, 10:00-11:30 MT
This mini-seminar was originally planned as part of the International Philosophy of Nursing Society (IPONS) annual conference held in conjunction with the University of Gothenberg, Sweden. This meeting was postponed due to the COVID-19 pandemic. It is now a co-sponsored event between IPONS and the Center for Nursing Philosophy at the University of California, Irvine.

During the seminar, there will be a series of short presentations tracing the history of IPONS and highlighting the importance of philosophy to the nursing profession, ultimately for the good of individuals and the societies served.

Looking to the future, we emphasize the critical importance of incorporating philosophy and philosophical inquiry if we are to continue to question received views and oppose negative influences on our ability to practice well and anticipate future needs for nursing.

The second half of the seminar will consist of a discussion with attendees to brainstorm ways to continue to incorporate philosophy and philosophical thinking into education and research for the purpose of informing practice.

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Resources

Care homes strategy for Infection Prevention & Control of Covid-19 based on clear delineation of risk zones

Dementia Connections: a website and magazine that aims to connect people with dementia, their families, health-care workers and anybody interested in learning more about dementia to information and resources about how to live well with dementia.

The question you need to ask to focus and engage your team

Tackling High-Priority COVID-19 Challenges for Nursing Homes

Alliance to Improve Dementia Care

Finding the Right Balance: Guidance to Support the Re-Opening of Canadian Long-Term Care Homes to Family Caregivers and Visitors during the COVID-19 Pandemic

How to Use Value Stream Maps in Healthcare

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News

FEMA Sends Faulty Protective Gear to Nursing Homes Battling Virus

Here’s what we’ve learned in 6 months of COVID-19 — and what we still don’t know

Trump Administration Announces Initiative for More and Faster COVID-19 Testing in Nursing Homes

A Nursing Home Alternative

A nursing home in England recreates famous album covers using its residents as models

New country report: The COVID-19 Long-Term Care situation in Sweden

Research in the Context of a Pandemic

Building Better Communities for Older Adults

Death by download: the problem of misguided bureaucracy

MPs hear why Hong Kong had no Covid-19 care home deaths

How can the scientific community ensure the integrity of
COVID-19 research?

Face coverings for the public: Laying straw men to rest

States Allow In-Person Nursing Home Visits As Families Charge Residents Die ‘Of Broken Hearts’

Less than 5% of papers on the use of research in health policymaking tested interventions to see what worked. But those studies reveal a number of strategies for improvement

We must act now to prevent the loss of an entire generation
in long-term care

Social Isolation-the Other COVID-19 Threat in Nursing Homes.

Reflections from health systems researchers on nursing practices in dementia care
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Opportunities

Canadian Journal on Aging Editorial Board

DEADLINE:4 September
The Canadian Journal on Aging / La Revue canadienne du vieillissement is seeking nominations or applications to fill several positions on the Editorial Board. These include: Health Sciences and Biological Sciences, Psychology, Social Sciences and Social Policy and Practice Section Editors.

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