April 27, 2012

Grants & Awards

New Article by Susan Slaughter
Perceptions of family and staff on the role of the environment in long-term care homes for people with dementia
Garcia LJ, Hebert M, Kozak J, Senecal I, Slaughter SE, Aminzadeh F, et al.
International psychogeriatrics / IPA 2012 May;24(5):753-765

Background: Disruptive behaviors are frequent and often the first predictor of institutionalization. The goal of this multi-center study was to explore the perceptions of family and staff members on the potential contribution of environmental factors that influence disruptive behaviors and quality of life of residents with dementia living in long-term care homes.Methods: Data were collected using 15 nominal focus groups with 45 family and 59 staff members from eight care units. Groups discussed and created lists of factors that could either reduce disruptive behaviors and facilitate quality of life or encourage disruptive behaviors and impede the quality of life of residents. Then each participant individually selected the nine most important facilitators and obstacles. Themes were identified from the lists of data and operational categories and definitions were developed for independent coding by four researchers.Results: Participants from both family and staff nominal focus groups highlighted facility, staffing, and resident factors to consider when creating optimal environments. Human environments were perceived to be more important than physical environments and flexibility was judged to be essential. Noise was identified as one of the most important factors influencing behavior and quality of life of residents.Conclusion: Specialized physical design features can be useful for maintaining quality of life and reducing disruptive behaviors, but they are not sufficient. Although they can ease some of the anxieties and set the stage for social interactions, individuals who make up the human environment are just as important in promoting well-being among residents.

New article by Anne Marie Boström, Janet Squires, and Carole Estabrooks
Workplace aggression experienced by frontline staff in dementia care.
Bostrom AM, Squires JE, Mitchell A, Sales AE, Estabrooks CA.
Journal of clinical nursing 2012 May;21(9-10):1453-1465

Aim. To describe the frequency of aggressive acts experienced by frontline staff working in two models of dementia care: Residential Alzheimer’s Care Centers and Secured Dementia Units and to explore the associations between aggressive acts experienced by frontline staff and factors related to the work context and care providers. Background. Aggression towards healthcare providers in residential long-term care settings is well documented. However, few studies have examined associations between aggressive behaviours towards care providers and organisational factors. Design. A cross-sectional survey. Method. The survey included demographic items and questions about aggressive acts experienced by staff and contextual factors. Analyses included: (1) descriptive statistics, (2) tests of difference (i.e. Student’s t-test, Mann-Whitney U-test, chi-squared test and anova), (3) bivariate associations (i.e. Pearson and Spearman rank order correlations) and (4) multivariate linear regression. Results. Ninety-one health care aides and licensed practical nurses working in four nursing units using two models of dementia care participated (response rate 81%). The most frequently reported types of aggression were physical assault (50% of staff, n = 45) and emotional abuse (48% of staff, n = 44). Aggressive acts were significantly associated with working in Secured Dementia Units rather than Residential Alzheimer’s Care Centers. Conclusions. Frontline staff working in Secured Dementia Units were exposed to higher frequencies of various types of aggressive acts mainly initiated by residents. Future research needs to explore modifiable workplace factors associated with aggressive acts in a larger sample across a variety of long-term care settings. Relevance to clinical practice. To prevent staff perceived aggressive acts, leaders and managers in dementia care need to acknowledge the complex topic of workplace aggression and encourage an open discussion among frontline staff without assigning blame. Care provider strategies for dealing with aggressive behaviour have to be implemented in policies and clinical practice.

New article by Joanne Rycroft-Malone, Ali Hutchinson, and Lars Wallin
Realist synthesis: illustrating the method for implementation research.
Rycroft-Malone J, McCormack B, Hutchinson AM, Decorby K, Bucknall TK, Kent B, Schultz A, Snelgrove-Clarke E, Stetler CB, Titler M, Wallin L, Wilson V.
Implementation science : IS 2012 Apr 19;7(1):33

BACKGROUND: Realist synthesis is an increasingly popular approach to the review and synthesis of evidence, which focuses on understanding the mechanisms by which an intervention works (or not). There are few published examples of realist synthesis. This paper therefore fills a gap by describing, in detail, the process used for a realist review and synthesis to answer the question ‘what interventions and strategies are effective in enabling evidence-informed healthcare?’ The strengths and challenges of conducting realist review are also considered. METHODS: The realist approach involves identifying underlying causal mechanisms and exploring how they work under what conditions. The stages of this review included: defining the scope of the review (concept mining and framework formulation); searching for and scrutinising the evidence; extracting and synthesising the evidence; and developing the narrative, including hypotheses. RESULTS: Based on key terms and concepts related to various interventions to promote evidenceinformed healthcare, we developed an outcome-focused theoretical framework. Questions were tailored for each of four theory/intervention areas within the theoretical framework and were used to guide development of a review and data extraction process. The search for literature within our first theory area, change agency, was executed and the screening procedure resulted in inclusion of 52 papers. Using the questions relevant to this theory area, data were extracted by one reviewer and validated by a second reviewer. Synthesis involved organisation of extracted data into evidence tables, theming and formulation of chains of inference, linking between the chains of inference, and hypothesis formulation. The narrative was developed around the hypotheses generated within the change agency theory area. CONCLUSIONS: Realist synthesis lends itself to the review of complex interventions because it accounts for context as well as outcomes in the process of systematically and transparently synthesising relevant literature. While realist synthesis demands flexible thinking and the ability to deal with complexity, the rewards include the potential for more pragmatic conclusions than alternative approaches to systematic reviewing. A separate publication will report the findings of the review.

Grants & Awards
Gerontological Society of America: Margret M. and Paul B. Baltes Award
Deadline May 1st, 2012

The Margret M. and Paul B. Baltes Foundation Award in Behavioral and Social Gerontology acknowledges outstanding early career contributions in behavioral and social gerontology. The award will be given to a person from any discipline in the social sciences. Eligible nominees must have the Ph.D. degree and must not be more than 10 years past the date the Ph.D. was awarded. Nominations are not restricted to GSA members. International participation is encouraged. Nominations made by others or self-nominations will be accepted. The award recipient will receive a plaque and a $1,000 cash award and is invited to present a lecture at the GSA Annual Scientific Meeting the following year.


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

Leadership, innovation climate, and attitudes toward evidence-based practice during a statewide implementation.
Aarons GA, Sommerfeld DH.
Journal of the American Academy of Child and Adolescent Psychiatry 2012 Apr;51(4):423-431

OBJECTIVE: Leadership is important in practice change, yet there are few studies addressing this issue in mental health and social services. This study examined the differential roles of transformational (i.e., charismatic) leadership and leader-member exchange (i.e., the relationship between a supervisor and their direct service providers) on team innovation climate (i.e., openness to new innovations) and provider attitudes toward adopting evidence-based practice (EBP) during a statewide evidence-based practice implementation (EBPI) of an intervention to reduce child neglect. METHOD: Participants were 140 case-managers in 30 teams providing home-based services to families in a statewide child-welfare system. Teams were assigned by region to EBPI or services as usual (SAU) conditions. Multiple group path analysis was used to examine associations of transformational leadership and leader-member exchange with innovation climate and attitudes toward adoption and use of EBP. RESULTS: Transformational leadership predicted higher innovation climate during implementation, whereas leader-member exchange predicted higher innovation climate during SAU. Innovation climate was, in turn, associated with more positive attitudes toward EBP for the EBPI group. CONCLUSIONS: Strategies designed to enhance supervisor transformational leadership have the potential to facilitate implementation efforts by promoting a strong climate for EBPI and positive provider attitudes toward adoption and use of EBP. Copyright © 2012 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Dynamic adaptation process to implement an evidence-based child maltreatment intervention.
Aarons GA, Green AE, Palinkas LA, Self-Brown S, Whitaker DJ, Lutzker JR, et al.
Implementation science : IS 2012 Apr 18;7(1):32

BACKGROUND: Adaptations are often made to evidence-based practices (EBPs) by systems, organizations, and/or service providers in the implementation process. The degree to which core elements of an EBP can be maintained while allowing for local adaptation is unclear. In addition, adaptations may also be needed at the system, policy, or organizational levels to facilitate EBP implementation and sustainment. This paper describes a study of the feasibility and acceptability of an implementation approach, the Dynamic Adaptation Process (DAP), designed to allow for EBP adaptation and system and organizational adaptations in a planned and considered, rather than ad hoc, way. The DAP involves identifying core elements and adaptable characteristics of an EBP, then supporting implementation with specific training on allowable adaptations to the model, fidelity monitoring and support, and identifying the need for and solutions to system and organizational adaptations. In addition, this study addresses a secondary concern, that of improving EBP model fidelity assessment and feedback in realworld settings. METHODS: This project examines the feasibility, acceptability, and utility of the DAP; tests the degree to which fidelity can be maintained using the DAP compared to implementation as usual (IAU); and examines the feasibility of using automated phone or internet-enabled, computer-based technology to assess intervention fidelity and client satisfaction. The study design incorporates mixed methods in order to describe processes and factors associated with variations in both how the DAP itself is implemented and how the DAP impacts fidelity, drift, and adaptation. The DAP model is to be examined by assigning six regions in California (USA) to either the DAP (n = 3) or IAU (n = 3) to implement an EBP to prevent child neglect. DISCUSSION: The DAP represents a data-informed, collaborative, multiple stakeholder approach to maintain intervention fidelity during the implementation of EBPs in the field by providing support for intervention, system, and organizational adaptation and intervention fidelity to meet local needs. This study is designed to address the real-world implications of EBP implementation in public sector service systems and is relevant for national, state, and local service systems and organizations.

How to define ‘best practice’ for use in Knowledge Translation research: a practical, stepped and interactive process.
Bosch M, Tavender E, Bragge P, Gruen R, Green S.
Journal of evaluation in clinical practice 2012 Apr 9

Objectives Defining ‘best practice’ is one of the first and crucial steps in any Knowledge Translation (KT) research project. Without a sound understanding of what exactly should happen in practice, it is impossible to measure the extent of existing gaps between ‘desired’ and ‘actual’ care, set implementation goals, and monitor performance. The aim of this paper is to present a practical, stepped and interactive process to develop best practice recommendations that are actionable, locally applicable and in line with the best available research-based evidence, with a view to adapt these into process measures (quality indicators) for KT research purposes. Methods Our process encompasses the following steps: (1) identify current, high-quality clinical practice guidelines (CPGs) and extract recommendations; (2) select strong recommendations in key clinical management areas; (3) update evidence and create evidence overviews; (4) discuss evidence and produce agreed ‘evidence statements’; (5) discuss the relevance of the evidence with local stakeholders; and (6) develop locally applicable actionable best practice recommendations, suitable for use as the basis of quality indicators. Conclusions Actionable definitions of local best practice are a prerequisite for doing KT research. As substantial resources go into rigorously synthesizing evidence and developing CPGs, it is important to make best use of such available resources. We developed a process for efficiently developing locally applicable actionable best practice recommendations from existing high-quality CPGs that are in line with current research evidence.

Developing theory-informed behaviour change interventions to implement evidence into practice: a systematic approach using the Theoretical Domains Framework.
French SD, Green SE, O’Connor DA, McKenzie JE, Francis JJ, Michie S, et al.
Implementation science : IS 2012 Apr 24;7(1):38

BACKGROUND: There is little systematic operational guidance about how best to develop complex interventions to reduce the gap between practice and evidence. This article is one in a Series of articles documenting the development and use of the Theoretical Domains Framework (TDF) to advance the science of implementation research. METHODS: The intervention was developed considering three main components: theory, evidence, and practical issues. We used a four-step approach, consisting of guiding questions, to direct the choice of the most appropriate components of an implementation intervention: Who needs to do what, differently? Using a theoretical framework, which barriers and enablers need to be addressed? Which intervention components (behaviour change techniques and mode(s) of delivery) could overcome the modifiable barriers and enhance the enablers? And how can behaviour change be measured and understood? RESULTS: A complex implementation intervention was designed that aimed to improve acute low back pain management in primary care. We used the TDF to identify the barriers and enablers to the uptake of evidence into practice and to guide the choice of intervention components. These components were then combined into a cohesive intervention. The intervention was delivered via two facilitated interactive small group workshops. We also produced a DVD to distribute to all participants in the intervention group. We chose outcome measures in order to assess the mediating mechanisms of behaviour change. CONCLUSIONS: We have illustrated a four-step systematic method for developing an intervention designed to change clinical practice based on a theoretical framework. The method of development provides a systematic framework that could be used by others developing complex implementation interventions. While this framework should be iteratively adjusted and refined to suit other contexts and settings, we believe that the four-step process should be maintained as the primary framework to guide researchers through a comprehensive intervention development process.

Translating evidence into practice: the role of health research funders.
Holmes B, Scarrow G, Schellenberg M.
Implementation science : IS 2012 Apr 24;7(1):39

BACKGROUND: A growing body of work on knowledge translation (KT) reveals significant gaps between what is known to improve health, and what is done to improve health. The literature and practice also suggest that KT has the potential to narrow those gaps, leading to more evidence-informed healthcare. In response, Canadian health research funders and agencies have made KT a priority. This article describes how one funding agency determined its KT role and in the process developed a model that other agencies could use when considering KT programs. DISCUSSION: While ‘excellence’ is an important criterion by which to evaluate and fund health research, it alone does not ensure relevance to societal health priorities. There is increased demand for return on investments in health research in the form of societal and health system benefits. Canadian health research funding agencies are responding to these demands by emphasizing relevance as a funding criterion and supporting researchers and research users to use the evidence generated. Based on recommendations from the literature, an environmental scan, broad circulation of an iterative discussion paper, and an expert working group process, our agency developed a plan to maximize our role in KT. Key to the process was development of a model comprising five key functional areas that together create the conditions for effective KT: advancing KT science; building KT capacity; managing KT projects; funding KT activities; and advocating for KT. Observations made during the planning process of relevance to the KT enterprise are: the importance of delineating KT and communications, and information and knowledge; determining responsibility for KT; supporting implementation and evaluation; and promoting the message that both research and KT take time to realize results. SUMMARY: Challenges exist in fulfilling expectations that research evidence results in beneficial impacts for society. However, health agencies are well placed to help maximize the use of evidence in health practice and policy. We propose five key functional areas of KT for health agencies, and encourage partnerships and discussion to advance the field.

A compilation of strategies for implementing clinical innovations in health and mental health.
Powell BJ, McMillen JC, Proctor EK, Carpenter CR, Griffey RT, Bunger AC, et al.
Medical care research and review : MCRR 2012 Apr;69(2):123-157

Efforts to identify, develop, refine, and test strategies to disseminate and implement evidence-based treatments have been prioritized in order to improve the quality of health and mental health care delivery. However, this task is complicated by an implementation science literature characterized by inconsistent language use and inadequate descriptions of implementation strategies. This article brings more depth and clarity to implementation research and practice by presenting a consolidated compilation of discrete implementation strategies, based on a review of 205 sources published between 1995 and 2011. The resulting compilation includes 68 implementation strategies and definitions, which are grouped according to six key implementation processes: planning, educating, financing, restructuring, managing quality, and attending to the policy context. This consolidated compilation can serve as a reference to stakeholders who wish to implement clinical innovations in health and mental health care and can facilitate the development of multifaceted, multilevel implementation plans that are tailored to local contexts.

AHRQ: Enabling Health Care Decisionmaking Through Clinical Decision Support and Knowledge Management
April 2012

Objectives: To catalogue study designs used to assess the clinical effectiveness of clinical decision support systems (CDSSs) and knowledge management systems (KMSs), to identify features that impact the success of CDSSs/KMSs, to document the impact of CDSSs/KMSs on outcomes, and to identify knowledge types that can be integrated into CDSSs/KMSs. We identified 15,176 articles, from which 323 articles describing 311 unique studies including 160 reports on 148 randomized control trials (RCTs) were selected for inclusion. RCTs comprised 47.5 percent of the comparative studies on CDSSs/KMSs. Both commercially and locally developed CDSSs effectively improved health care process measures related to performing preventive services (n = 25; OR 1.42, 95% confidence interval [CI] 1.27 to 1.58), ordering clinical studies (n = 20; OR 1.72, 95% CI 1.47 to 2.00), and prescribing therapies (n = 46; OR 1.57, 95% CI 1.35 to 1.82). Fourteen CDSS/KMS features were assessed for correlation with success of CDSSs/KMSs across all endpoints. Meta-analyses identified six new success features: integration with charting or order entry system, promotion of action rather than inaction, no need for additional clinician data entry, justification of decision support via research evidence, local user involvement, and provision of decision support results to patients as well as providers. Three previously identified success features were confirmed: automatic provision of decision support as part of clinician workflow, provision of decision support at time and location of decision making, and provision of a recommendation, not just an assessment. Only 29 (19.6%) RCTs assessed the impact of CDSSs on clinical outcomes, 22 (14.9%) assessed costs, and 3 assessed KMSs on any outcomes. The primary source of knowledge used in CDSSs was derived from structured care protocols. Conclusions: Strong evidence shows that CDSSs/KMSs are effective in improving health care process measures across diverse settings using both commercially and locally developed systems. Evidence for the effectiveness of CDSSs on clinical outcomes and costs and KMSs on any outcomes is minimal. Nine features of CDSSs/KMSs that correlate with a successful impact of clinical decision support have been newly identified or confirmed.

WHO: Knowledge translation on ageing and health. A framework for policy development 2012
April 2012

The objective of the document is to assist policy- and decision -makers in integrating evidence-based approaches to ageing in national health policy development processes, specific policies or programmes addressing older population needs and other health programmes concerned with such issues as HIV, reproductive health, chronic diseases.

Health Care Administration & Organization
Determining a set of measurable and relevant factors affecting nursing workload in the acute care hospital setting: A cross-sectional study.
Myny D, Van Hecke A, De Bacquer D, Verhaeghe S, Gobert M, Defloor T, et al.
International journal of nursing studies 2012 Apr;49(4):427-436

BACKGROUND: While there has been great interest in the effect of nurse staffing levels have on the quality of care in hospitals, less attention has been given to determining the factors that affect the nursing workload. There are no existing studies that help define measurable factors that have a clear relation to nursing workload. OBJECTIVES: The aim of this study was to determine the most important and measurable factors, other than patient acuity, that influence nursing workload. DESIGN: A cross-sectional design. SETTINGS: Hospitals within the acute hospital care setting. PARTICIPANTS: Persons with a nursing educational background, working in Belgian acute care hospitals. METHODS: A self-administered questionnaire was developed based on the results of an integrative review, the use of focus groups and a survey on measurability and relevance of the included factors. The questionnaire listed relevant and measurable factors related to nursing workload. Weight and frequency of each factor was assessed. RESULTS: The initial list consisted of 94 factors. These factors were regrouped and organised into a questionnaire of 28 measurable and sufficiently relevant factors affecting the nursing workload. More than half of the initial factors seemed to be relevant, but hard to measure on a daily basis. Based on the impact of each factor, the number of work interruptions was the most important factor related to nursing workload. CONCLUSIONS: It is unlikely that a workload instrument will ever be able to take into account all possible factors affecting the nursing workload. Nevertheless, the number of work interruptions, the patient turnover rate and the number of mandatory registrations should be included in the development or revision of a workload measurement tool. Copyright © 2011 Elsevier Ltd. All rights reserved.

Health Care Innovation & Quality Assurance
Implementation outcomes of evidence-based quality improvement for depression in VA community based outpatient clinics.
Fortney J, Enderle M, McDougall S, Clothier J, Otero J, Altman L, et al.
Implementation science : IS 2012 Apr 11;7(1):30

BACKGROUND: Collaborative-care management is an evidence-based practice for improving depression outcomes in primary care. The Department of Veterans Affairs (VA) has mandated the implementation of collaborative-care management in its satellite clinics, known as Community Based Outpatient Clinics (CBOCs). However, the organizational characteristics of CBOCs present added challenges to implementation. The objective of this study was to evaluate the effectiveness of evidence-based quality improvement (EBQI) as a strategy to facilitate the adoption of collaborative-care management in CBOCs. METHODS: This nonrandomized, small-scale, multisite evaluation of EBQI was conducted at three VA Medical Centers and 11 of their affiliated CBOCs. The Plan phase of the EBQI process involved the localized tailoring of the collaborative-care management program to each CBOC. Researchers ensured that the adaptations were evidence based. Clinical and administrative staff were responsible for adapting the collaborative-care management program for local needs, priorities, preferences and resources. Plan-Do-Study-Act cycles were used to refine the program over time. The evaluation was based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) Framework and used data from multiple sources: administrative records, web-based decision-support systems, surveys, and key-informant interviews. RESULTS: Adoption: 69.0% (58/84) of primary care providers referred patients to the program. Reach: 9.0% (298/3,296) of primary care patients diagnosed with depression who were not already receiving specialty care were enrolled in the program. Fidelity: During baseline care manager encounters, education/activation was provided to 100% (298/298) of patients, barriers were assessed and addressed for 100% (298/298) of patients, and depression severity was monitored for 100% (298/298) of patients. Less than half (42.5%, 681/1603) of follow-up encounters during the acute stage were completed within the timeframe specified. During the acute phase of treatment for all trials, the Patient Health Questionnaire (PHQ9) symptom-monitoring tool was used at 100% (681/681) of completed follow-up encounters, and self-management goals were discussed during 15.3% (104/681) of completed follow-up encounters. During the acute phase of treatment for pharmacotherapy and combination trials, medication adherence was assessed at 99.1% (575/580) of completed follow-up encounters, and side effects were assessed at 92.4% (536/580) of completed follow-up encounters. During the acute phase of treatment for psychotherapy and combination trials, counseling session adherence was assessed at 83.3% (239/287) of completed follow-up encounters. Effectiveness: 18.8% (56/298) of enrolled patients remitted (symptom free) and another 22.1% (66/298) responded to treatment (50% reduction in symptom severity). Maintenance: 91.9% (10/11) of the CBOCs chose to sustain the program after research funds were withdrawn. CONCLUSIONS: Provider adoption was good, although reach into the target population was relatively low. Fidelity and maintenance were excellent, and clinical outcomes were comparable to those in randomized controlled trials. Despite the organizational barriers, these findings suggest that EBQI is an effective facilitation strategy for CBOCs. Trial registration Clinical trial # NCT00317018.

Hospital innovation portfolios: key determinants of size and innovativeness.
Schultz C, Zippel-Schultz B, Salomo S.
Health care management review 2012 Apr-Jun;37(2):132-143

BACKGROUND: Health care organizations face an increasing demand for strategic change and innovation; however, there are also several barriers to innovation that impede successful implementation. PURPOSES: We aimed to shed light on key issues of innovation management in hospitals and provide empirical evidence for controlling the size and innovativeness of a hospital’s new health service and process portfolio. We show how health care managers could align the need for exploration and exploitation by applying both informal (e.g., employee encouragement) and formal (e.g., analytical orientation and reward systems) organizational mechanisms. METHODOLOGY: To develop hypotheses, we integrated the innovation management literature into the hospital context. Detailed information about the innovation portfolio of 87 German hospitals was generated and combined with multirespondent survey data using ratings from management, medical, and nursing directors. Multivariate regression analysis was applied. FINDINGS: The empirical results showed that an analytical approach increased the size of innovation portfolios. Employee encouragement amplified the degree of innovativeness of activities in the portfolio. Reward systems did not have direct effects on the composition of innovation portfolios. However, they adjusted bottom-up employee and top-down strategic initiatives to match with the existing organization, thereby decreasing the degree of innovativeness and enforcing exploitation. PRACTICE IMPLICATIONS: Hospitals should intertwine employee encouragement, analytical approaches, and formal reward systems depending on organizational goals.

Quality measures for medication continuity in long-term care facilities, using a structured panel process.
Bell CM, Brener SS, Comrie R, Anderson GM, Bronskill SE.
Drugs & aging 2012 Apr 1;29(4):319-327

Patient transitions, such as transfers between acute and long-term care (LTC), aposare times when the likelihood of communication failure between healthcare providers is increased. Employing appropriate health quality indicators helps support improvement efforts. To date, few quality indicators that evaluate the continuity of medication use between acute and LTC facilities have been described. Objective: The aim of the study was to develop quality indicators signalling the potential discontinuation of previously prescribed medications for chronic diseases when residents return to LTC following an acute-care hospitalization. Methods: A literature review for the selection of potential indicators was conducted, followed by a three-step process: (i) initial screening round that rated the indicators; (ii) a 1-day in-person consensus meeting in which the panel refined the parameters regarding the proposed quality indicators; and (iii) a final anonymous survey that assessed consensus among panel members. The study setting was a survey and consensus meeting with national representation, held in Toronto, ON, Canada. A ten-member expert panel with broad geographical and clinical representation participated and was made up of registered nurses, physicians, pharmacists, policy makers and academic researchers. A 75% agreement threshold was required for consensus, as measured on a 9-point Likert-type scale. The panel evaluated quality indicators for effectiveness, relevance and feasibility, using currently available healthcare administrative data. Results: The panel reached consensus on four quality indicators to assess the unintentional discontinuation of medications prescribed to LTC residents for chronic diseases upon return to LTC after an acute-care admission. The selected indicators were (i) HMG-CoA reductase inhibitors (statins) for all indications; (ii) anticoagulants (e.g. warfarin) for the indication of atrial fibrillation; (iii) proton-pump inhibitors for the indication of post-gastrointestinal haemorrhage; and (iv) thyroxine for all indications. The panel identified three additional treatment groups for future consideration as quality indicators: anti-Parkinson’s disease, anti-diabetes and antidepressant medications. Conclusion: A novel set of quality indicators has been developed to evaluate medication continuity between acute and LTC facilities. The adoption and implementation of these indicators in clinical practice can help inform quality improvement efforts at various local and regional levels.

Organizational Change
Building a culture of learning through organizational development: the experiences of the Marin County Health and Human Services Department.
Lindberg A, Meredith L.
Journal of evidence-based social work 2012;9(1-2):27-42

After determining a need for organizational change informed by changes in workforce demographics, community demographics, the socio-political and economic environment, and constraints on resources, one agency sought to transform its organizational culture into that of a learning organization. An external organizational development consultant was hired to work with agency leadership to identify ways that would help move the agency’s culture towards one that was conducive to learning. Specifically, the agency director sought to create a culture where communication is encouraged both vertically and horizontally, frontline level workers are engaged and their voices heard, cross-departmental problem solving is practiced, innovative ideas are supported, and evidence-informed practice regularly implemented. This case study describes the experiences of this agency and the process taken toward engaging an external consultant and moving towards the development of a culture of learning.

Organizational learning measurement and the effect on firm innovation.
Tohidi H, Seyedaliakbar SM, Mandegari M.
Journal of Enterprise Information Management 2012;25(3):219-245

The purpose of this paper is to propose and validate a measurement scale to capture organizational learning capabilities (OLC) and examine how OLC affects innovation. There are several models in the literature that have been generated by statistical data from manufacturing firms. This paper presents a structural equation model in order to measure OLC in Iranian ceramic tile manufacturers. The proposed model has five dimensions – i.e. managerial commitment and empowerment, experimentation, risk taking, interaction with the external environment and openness and knowledge transfer and integration – and is evaluated by 23 items. Design/methodology/approach: Data were collected from 18 Iranian ceramic tile manufacturers. The survey was sent to employees of the business section of each factory and a total of 173 valid questionnaires were obtained and used to test the research model, employing confirmatory factor analysis (CFA), a particular analysis of structural equation modeling methods. Findings: In the validation process, both the principal components and the confirmatory factor analyses clearly corroborate the existence of the five dimensions mentioned in the theoretical work. Likewise, the scale provides information that could be used by those managers wishing to improve learning capability in their firms. In addition, the results show that the OLC has a positive impact on innovation. Originality/value – This research suggests that that organizational environments that facilitate learning are more innovative. In addition, the OLC literature shows that OLC has a significant impact on the effectiveness and performance of the organization. Therefore, it is essential to find a valid measurement that can evaluate OLC in an organization. The five-factor model introduced in this paper is a practical way to measure OLC. As a result, managers can determine which organizational learning issues are strong and which are weak; this is a hint for improvement. © Emerald Group Publishing Limited.

Research Methodology
The conundrum of sharing research data
Borgman CL.
Journal of the American Society for Information Science and Technology 2012

We must all accept that science is data and that data are science, and thus provide for, and justify the need for the support of, much-improved data curation. (Hanson, Sugden, & Alberts, ) Researchers are producing an unprecedented deluge of data by using new methods and instrumentation. Others may wish to mine these data for new discoveries and innovations. However, research data are not readily available as sharing is common in only a few fields such as astronomy and genomics. Data sharing practices in other fields vary widely. Moreover, research data take many forms, are handled in many ways, using many approaches, and often are difficult to interpret once removed from their initial context. Data sharing is thus a conundrum. Four rationales for sharing data are examined, drawing examples from the sciences, social sciences, and humanities: (1) to reproduce or to verify research, (2) to make results of publicly funded research available to the public, (3) to enable others to ask new questions of extant data, and (4) to advance the state of research and innovation. These rationales differ by the arguments for sharing, by beneficiaries, and by the motivations and incentives of the many stakeholders involved. The challenges are to understand which data might be shared, by whom, with whom, under what conditions, why, and to what effects. Answers will inform data policy and practice. © 2012 ASIS&T.

Decisions about lumping vs. splitting of the scope of systematic reviews of complex interventions are not well justified: A case study in systematic reviews of health care professional reminders.
Weir MC, Grimshaw JM, Mayhew A, Fergusson D.
Journal of clinical epidemiology 2012 Apr 11

OBJECTIVES: Lumping and splitting refer to the scope of a systematic review question, where lumped reviews are broad and split are narrow. The objective was to determine the frequency of lumping and splitting in systematic reviews of reminder interventions, assess how review authors justified their decisions about the scope of their reviews, and explore how review authors cited other systematic reviews in the field. STUDY DESIGN AND SETTING: A descriptive approach involving a content analysis and citation bibliometric study of an overview of 31 systematic reviews of reminder interventions. RESULTS: Twenty-four of 31 reminder reviews were split, most frequently across one category (population, intervention, study design, outcome). Review authors poorly justified their decisions about the scope of their reviews and tended not to cite other similar reviews. CONCLUSION: This study demonstrates that for systematic reviews of reminder interventions, splitting is more common than lumping, with most reviews split by condition or targeted behavior. Review authors poorly justify the need for their review and do not cite relevant literature to put their reviews in the context of the available evidence. These factors may have contributed to a proliferation of systematic reviews of reminders and an overall disorganization of the literature.

Pressure ulcers: knowledge and attitude of nurses and nursing assistants in Belgian nursing homes.
Demarre L, Vanderwee K, Defloor T, Verhaeghe S, Schoonhoven L, Beeckman D.
Journal of clinical nursing 2012 May;21(9-10):1425-1434

Aims. To gain insight into the knowledge and attitudes of nurses and nursing assistants and to study the correlation between knowledge, attitudes and the compliance with the pressure ulcer prevention guidelines provided to residents at risk of pressure ulcers in nursing homes. Background. There is a lack of evidence on knowledge and attitudes of nurses and nursing assistants towards pressure ulcer prevention in nursing homes. Design. A cross-sectional multi-centre study. Methods. A convenience sample of nine Belgian nursing homes, representing 18 wards was chosen in the study. In total, 145 nurses and nursing assistants were included. The compliance with the guidelines was evaluated in 615 residents, and data were collected using validated instruments. Results. Fully compliant prevention was found in only 6.9% of the residents at risk. The mean knowledge score of the nurses was 29.3 vs. 28.7% for the nursing assistants. The overall attitude score was 74.5%, and attitude scores were significantly different between nurses and nursing assistants. Nurses showed to have a more positive attitude towards pressure ulcer prevention than nursing assistants, respectively 78.3 and 72.3%. A more positive attitude was a significant predictor of pressure ulcer prevention compliance with the guidelines provided to residents at risk of pressure ulcers in nursing homes. Conclusions. Knowledge about pressure ulcer prevention of both nurses and nursing assistants in nursing homes was low. Attitudes were a significant predictor of the application of fully compliant prevention in residents at risk. Relevance to clinical practice. Pressure ulcer prevention is an important aspect in daily care for residents at risk in nursing homes. These insights will contribute to evidence-based practice in this area of care and will form the basis for the development of an education strategy for pressure ulcer prevention and management in nursing homes.

The relationship between care providers’ relational behaviors and residents mood and behavior in long-term care settings.
McGilton KS, Sidani S, Boscart VM, Guruge S, Brown M.
Aging & mental health 2012 May;16(4):507-515

Care providers’ interactions with residents are an important element in long-term care settings. This study aimed at examining the association between care providers’ relational behaviors and affect and mood of residents with dementia over different caregiving situations and with different residents. Methods: This study utilized a repeated-measures design. Thirty-eight residents with a diagnosis of dementia and 35 care providers from three nursing homes in Ontario, Canada, participated in the study. Care providers’ relational behaviors and residents’ mood and affect were assessed using direct observation methods and self-rating scales. Results: The care providers’ relational behavior varied according to the caregiving situation, with the most effective relational behaviors observed during interpersonal interactions and the least effective during mealtimes. Less effective relational behaviors were observed between care providers and residents that were perceived as more resistive to care. In addition, effective relational behaviors were associated with positive mood and affect of the residents. Conclusion: These findings emphasize the importance of acknowledging and enhancing care providers’ relational behaviors when caring for persons with dementia living in long-term care settings.

Webinar: Dementia Research and Care in Social Media: Creating New KT Opportunities

This event provided an overview of social media concepts, the importance thereof and will discuss how social media can be applied in the context of dementia research and care.

UBC: Visiting Scholar Position at CDKTN open

The Education and Training theme of Canadian Dementia Knowledge Translation Network is seeking visiting scholars whose interests are dementia and knowledge translation. The program funds 2-6 month fellowships for investigators, academic faculty and clinicians to conduct research, deliver other scholarly products, such as case reviews and books, or produce innovative multimedia in dementia or knowledge translation research in Canada.

New Issue of AHRQ’s Innovation Exchange

Includes a report on AHRQ’s Health Care Innovations Exchange Report on Scale Up and Spread Activities 2011 and a new section of their website dedicated to scaling up innovations.

New CAHPS Podcast: Practical Strategies for Gathering Feedback Directly from Patients

The seventh podcast in a series focused on quality improvement features Susan Edgman-Levitan, executive director of the Stoeckle Center for Primary Care Innovation at Massachusetts General Hospital and co-principal investigator on the Yale CAHPS Team. In this podcast, Susan discusses the importance of getting patient feedback to help you better understand and improve your CAHPS scores. Additionally, the podcast highlights various methods for collecting patient feedback.

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