Happy New Year!!!
New article by Diane Doran and Carole Estabrooks
The role of organizational context and individual nurse characteristics in explaining variation in use of information technologies in evidence based practice.
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Doran D, Haynes BR, Estabrooks CA, Kushniruk A, Dubrowski A, Bajnok I, et al.
Implementation science : IS 2012 Dec 31;7(1):122
BACKGROUND: There is growing awareness of the role of information technology in evidence-based practice. The purpose of this study was to investigate the role of organizational context and nurse characteristics in explaining variation in nurses’ use of personal digital assistants (PDAs) and mobile Tablet PCs for accessing evidence-based information. The Promoting Action on Research Implementation in Health Services (PARIHS) model provided the framework for studying the impact of providing nurses with PDA-supported, evidence-based practice resources, and for studying the organizational, technological, and human resource variables that impact nurses’ use patterns. METHODS: A survey design was used, involving baseline and follow-up questionnaires. The setting included 24 organizations representing three sectors: hospitals, long-term care (LTC) facilities, and community organizations (home care and public health). The sample consisted of 710 participants (response rate 58%) at Time 1, and 469 for whom both Time 1 and Time 2 follow-up data were obtained (response rate 66%). A hierarchical regression model (HLM) was used to evaluate the effect of predictors from all levels simultaneously. RESULTS: The Chi square result indicated PDA users reported using their device more frequently than Tablet PC users (p = 0.001). Frequency of device use was explained by ‘breadth of device functions’ and PDA versus Tablet PC. Frequency of Best Practice Guideline use was explained by ‘willingness to implement research,’ ‘structural and electronic resources,’ ‘organizational slack time,’ ‘breadth of device functions’ (positive effects), and ‘slack staff’ (negative effect). Frequency of Nursing Plus database use was explained by ‘culture,’ ‘structural and electronic resources,’ and ‘breadth of device functions’ (positive effects), and ‘slack staff’ (negative). ‘Organizational culture’ (positive), ‘breadth of device functions’ (positive), and ‘slack staff ‘(negative) were associated with frequency of Lexi/PEPID drug dictionary use. CONCLUSION: Access to PDAs and Tablet PCs supported nurses’ self-reported use of information resources. Several of the organizational context variables and one individual nurse variable explained variation in the frequency of information resource use.
New article by James W. Dearing and Carole Estabrooks
Designing for diffusion of a biomedical intervention.
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Dearing JW, Smith DK, Larson RS, Estabrooks CA.
American Journal of Preventive Medicine 2013 Jan;44(1 Suppl 2):S70-6.
The present article applies some of what is known about diffusion to the general case of biomedical interventions and specifically pre-exposure prophylaxis (PrEP). Designing for diffusion is the taking of strategic steps early in the process of creating and refining an evidence-based intervention to increase its chances of being noticed, positively perceived, accessed, and tried and then adopted, implemented, and sustained in practice.
New article by Greta Cummings
Older Persons’ Transitions in Care (OPTIC): a study protocol.
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Cummings GG, Reid RC, Estabrooks CA, Norton PG, Cummings GE, Rowe BH, Abel SL,
Bissell L, Bottorff JL, Robinson CA, Wagg A, Lee JS, Lynch SL, Masaoud E.
BMC Geriatr. 2012 Dec 14;12(1):75.
BACKGROUND: Changes in health status, triggered by events such as infections, falls, and geriatric syndromes, are common among nursing home (NH) residents and necessitate transitions between NHs and Emergency Departments (EDs). During transitions, residents frequently experience care that is delayed, unnecessary, not evidence-based, potentially unsafe, and fragmented. Furthermore, a high proportion of residents and their family caregivers report substantial unmet needs during transitions. This study is part of a program of research whose overall aim is to improve quality of care for frail older adult who reside in NHs. The purpose of this study is to identify successful transitions from multiple perspectives and to identify organizational and individual factors related to transition success, in order to inform improvements in care for frail elderly NH residents during transitions to and from acute care. Specific objectives are to:1. define successful and unsuccessful elements of transitions from multiple perspectives;2. develop and test a practical tool to assess transition success;3. assess transition processes in a discrete set of transfers in two study sites over a one year period;4. assess the influence of organizational factors in key practice locations, e.g., NHs, emergency medical services (EMS), and EDs, on transition success; and5. identify opportunities for evidence-informed management and quality improvement decisions related to the management of NH — ED transitions. METHODS: This is a mixed-methods observational study incorporating an integrated knowledge translation (IKT) approach. It uses data from multiple levels (facility, care unit, individual) and sources (healthcare providers, residents, health records, and administrative databases). DISCUSSION: Key to study success is operationalizing the IKT approach by using a partnership model in which the OPTIC governance structure provides for team decision-makers and researchers to participate equally in developing study goals, design, data collection, analysis and implications of findings. As preliminary and ongoing study findings are developed, their implications for practice and policy in study settings will be discussed by the research team and shared with study site administrators and staff. The study is designed to investigate the complexities of transitions and to enhance the potential for successful and sustained improvement of these transitions.
Another New article by Greta Cummings
The Context of Oncology Nursing Practice: An Integrative Review.
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Bakker D, Strickland J, Macdonald C, Butler L, Fitch M, Olson K, Cummings G.
Cancer Nurs. 2013 Jan;36(1):72-88.
BACKGROUND: In oncology, where the number of patients is increasing, there is a need to sustain a quality oncology nursing workforce. Knowledge of the context of oncology nursing can provide information about how to create practice environments that will attract and retain specialized oncology nurses. OBJECTIVE:: The aims of this review were to determine the extent and quality of the literature about the context of oncology nursing, explicate how “context” has been described as the environment where oncology nursing takes place, and delineate forces that shape the oncology practice environment. METHODS:: The integrative review involved identifying the problem, conducting a structured literature search, appraising the quality of data, extracting and analyzing data, and synthesizing and presenting the findings. RESULTS:: Themes identified from 29 articles reflected the surroundings or background (structural environment, world of cancer care), and the conditions and circumstances (organizational climate, nature of oncology nurses’ work, and interactions and relationships) of oncology nursing practice settings. CONCLUSIONS:: The context of oncology nursing was similar yet different from other nursing contexts. The uniqueness was attributed to the dynamic and complex world of cancer control and the personal growth that is gained from the intense therapeutic relationships established with cancer patients and their families. IMPLICATIONS FOR PRACTICE:: The context of healthcare practice has been linked with patient, professional, or system outcomes. To achieve quality cancer care, decision makers need to understand the contextual features and forces that can be modified to improve the oncology work environment for nurses, other providers, and patients.
CALL FOR ABSTRACTS: 2013 ARM AcademyHealth Annual Research Meeting
June 23-25, 2013 Baltimore, MD
DEADLINE January 17, 2012, 17:00 ET
This year’s ARM is organized around 18 themes. All individual abstracts and research panel submissions undergo blind peer review. The policy roundtable submissions will not be blinded. Abstracts selected for podium or poster presentation will be posted on the AcademyHealth website. Abstracts are invited for four categories: (1) call for papers, (2) call for posters, (3) call for research panels, and (4) call for policy roundtables. The Journal of the American Medical Association (JAMA) and Health Services Research (HSR) have again agreed to partner with AcademyHealth to select abstracts for full manuscript submission consideration in conjunction with the 2013 ARM
CALL FOR NEWSLETTER ARTICLES:
Newsletter of the International Society of Evidence-Based Health Care
DEADLINE January 18, 2013
Do you have an article – editorial, teaching tip, review, research piece, etc for the International Society of Evidence-Based Health Care? If so, send it in by the deadline.
CALL FOR ABSTRACTS: Advances in Qualitative Methods Conference
June 21-23, 2013 Edmonton, AB
DEADLINE February 21, 2013
Innovation matters. Contemporary societal issues demand more complex research. Mixed methods research is increasingly seen to provide these solutions. AQM is the premier interdisciplinary forum for innovation exchange in Qualitative Methods and 2013 will highlight innovations in Mixed Methods design.
CALL FOR SUBMISSIONS: InSight 2: Engaging the Health Humanities
May 14-June 8, 2013 Edmonton, AB
DEADLINE: January 25, 2013
We invite visual, textual, tactile, audio, or hybrid proposals for the InSight 2: Engaging the Health Humanities exhibition and publication that create opportunities for dialogue and debate regarding areas of practice and knowledge at the nexus of the health humanities, design and community engagement.
Grants & Awards
CIHR: China-Canada Joint Health Research Initiative
DEADLINE March 14, 2013
The specific objective of this funding opportunity is to promote the development of Canadian-Chinese scientific co-operation between researchers located at universities, hospitals, research institutes or affiliated research organizations in Canada and China through the support of collaborative research grants.
InnovateExchange (Ivey International Centre for Health Innovation): Colour Outside the Lines
The first place prize will be one $50,000 award. Second and third prizes are $25,000 each.
Colour Outside the Lines is an open challenge to inspire current and future leaders to become active participants in shaping the transformation of our health care system. We are calling on students, health care professionals, entrepreneurs, IT specialists, patients, development workers and innovators from around the world to generate reverse innovation projects that can address some of Canada’s biggest health challenges and drive transformational change. Colour Outside the Lines is focused on finding innovations that are being successfully applied in the developing world/emerging markets that offer potential solutions to some of the issues facing Canadian health systems. This challenge invites you to submit a reverse innovation idea that can work as a health care innovation business model in Canada. International and cross-sectoral collaboration is at the heart of this reverse innovation challenge. Colour Outside the Lines encourages you to form a team of innovators from around the globe, and across industry and academic lines, to help strengthen your idea for reverse innovation. Innovation can come from anywhere; so can submissions for this challenge.
Reflecting on nurses’ views on using research in practice.
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British journal of nursing 2012 Dec 13-26;21(22):1341-1346
This paper follows a previous paper (Hewitt-Taylor et al, 2012) in which the authors summarised their reflections on the literature relating to the application of research in practice. This paper builds on these reflections and reports on the findings from one aspect of a study that explored nurses’ views on using research in practice. Quantitative methods of data collection and analysis were used and data were gathered using questionnaires. The findings suggest that nurses generally value research, but this does not necessarily mean that they base individual decisions on particular research findings, or that research is considered the most important form of evidence in direct practice. In addition, the resources that enable nurses to find, appraise and make decisions about using research, are not always readily available in practice settings. From this part of the study, it can be concluded that for research utilisation to increase, time, resources, role models and environments that support this ethos are needed, and that an emphasis on research should not eclipse other key forms of nursing knowledge such as patient views and experiences, and professional expertise in the promotion of evidence-based practice.
SIMPLE: Implementation of recommendations from international evidence-based guidelines on caesarean sections in the Netherlands. Protocol for a controlled before and after study.
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Melman S, Schoorel EN, Dirksen C, Kwee A, Smits L, de Boer F, et al.
Implementation science : IS 2013 Jan 3;8(1):3
BACKGROUND: Caesarean section (CS) rates are rising worldwide. In the Netherlands, the most significant rise is observed in healthy women with a singleton in vertex position between 37 and 42 weeks gestation, whereas it is doubtful whether an improved outcome for the mother or her child was obtained. It can be hypothesized that evidence-based guidelines on CS are not implemented sufficiently.Therefore, the present study has the following objectives: to develop quality indicators on the decision to perform a CS based on key recommendations from national and international guidelines; to use the quality indicators in order to gain insight into actual adherence of Dutch gynaecologists to guideline recommendations on the performance of a CS; to explore barriers and facilitators that have a direct effect on guideline application regarding CS; and to develop, execute, and evaluate a strategy in order to reduce the CS incidence for a similar neonatal outcome (based on the information gathered in the second and third objectives). METHODS: An independent expert panel of Dutch gynaecologists and midwives will develop a set of quality indicators on the decision to perform a CS. These indicators will be used to measure current care in 20 hospitals with a population of 1,000 women who delivered by CS, and a random selection of 1,000 women who delivered vaginally in the same period. Furthermore, by interviewing healthcare professionals and patients, the barriers and facilitators that may influence the decision to perform a CS will be measured. Based on the results, a tailor-made implementation strategy will be developed and tested in a controlled before-and-after study in 12 hospitals (six intervention, six control hospitals) with regard to effectiveness, experiences, and costs. DISCUSSION: This study will offer insight into the current CS care and into the hindering and facilitating factors influencing obstetrical policy on CS. Furthermore, it will allow definition of patient categories or situations in which a tailor-made implementation strategy will most likely be meaningful and cost effective, without negatively affecting the outcome for mother and child.Trial registration: http://www.clinicaltrials.gov: NCT01261676.
A concept mapping approach to guide and understand dissemination and implementation.
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Green AE, Fettes DL, Aarons GA.
The journal of behavioral health services & research 2012 Oct;39(4):362-373
Many efforts to implement evidence-based programs do not reach their full potential or fail due to the variety of challenges inherent in dissemination and implementation. This article describes the use of concept mapping-a mixed method strategy-to study implementation of behavioral health innovations and evidence-based practice (EBP). The application of concept mapping to implementation research represents a practical and concise way to identify and quantify factors affecting implementation, develop conceptual models of implementation, target areas to address as part of implementation readiness and active implementation, and foster communication among stakeholders. Concept mapping is described and a case example is provided to illustrate its use in an implementation study. Implications for the use of concept mapping methods in both research and applied settings towards the dissemination and implementation of behavioral health services are discussed.
Knowledge brokers in a knowledge network: the case of Seniors Health Research Transfer Network knowledge brokers.
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Conklin J, Lusk E, Harris M, Stolee P.
Implementation science : IS 2013 Jan 9;8(1):7
BACKGROUND: The purpose of this paper is to describe and reflect on the role of knowledge brokers (KBs) in the Seniors Health Research Transfer Network (SHRTN). The paper reviews the relevant literature on knowledge brokering, and then describes the evolving role of knowledge brokering in this knowledge network. METHODS: The description of knowledge brokering provided here is based on a developmental evaluation program and on the experiences of the authors. Data were gathered through qualitative and quantitative methods, analyzed by the evaluators, and interpreted by network members who participated in sensemaking forums. The results were fed back to the network each year in the form of formal written reports that were widely distributed to network members, as well as through presentations to the network’s members. RESULTS: The SHRTN evaluation and our experiences as evaluators and KBs suggest that a SHRTN KB facilitates processes of learning whereby people are connected with tacit or explicit knowledge sources that will help them to resolve work-related challenges. To make this happen, KBs engage in a set of relational, technical, and analytical activities that help communities of practice (CoPs) to develop and operate, facilitate exchanges among people with similar concerns and interests, and help groups and individuals to create, explore, and apply knowledge in their practice. We also suggest that the role is difficult to define, emergent, abstract, episodic, and not fully understood. CONCLUSIONS: The KB role within this knowledge network has developed and matured over time. The KB adapts to the social and technical affordances of each situation, and fashions a unique and relevant process to create relationships and promote learning and change. The ability to work with teams and to develop relevant models and feasible approaches are critical KB skills. The KB is a leader who wields influence rather than power, and who is prepared to adopt whatever roles and approaches are needed to bring about a valuable result.
Developing and evaluating communication strategies to support informed decisions and practice based on evidence (DECIDE): protocol and preliminary results.
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Treweek S, Oxman AD, Alderson P, Bossuyt PM, Brandt L, Brozek J, et al.
Implementation science : IS 2013 Jan 9;8(1):6
BACKGROUND: Healthcare decision makers face challenges when using guidelines, including understanding the quality of the evidence or the values and preferences upon which recommendations are made, which are often not clear. METHODS: GRADE is a systematic approach towards assessing the quality of evidence and the strength of recommendations in healthcare. GRADE also gives advice on how to go from evidence to decisions. It has been developed to address the weaknesses of other grading systems and is now widely used internationally. The Developing and Evaluating Communication Strategies to Support Informed Decisions and Practice Based on Evidence (DECIDE) consortium (http://www.decide-collaboration.eu/), which includes members of the GRADE Working Group and other partners, will explore methods to ensure effective communication of evidence-based recommendations targeted at key stakeholders: healthcare professionals, policymakers, and managers, as well as patients and the general public. Surveys and interviews with guideline producers and other stakeholders will explore how presentation of the evidence could be improved to better meet their information needs. We will collect further stakeholder input from advisory groups, via consultations and user testing; this will be done across a wide range of healthcare systems in Europe, North America, and other countries. Targeted communication strategies will be developed, evaluated in randomized trials, refined, and assessed during the development of real guidelines. DISCUSSION: Results of the DECIDE project will improve the communication of evidence-based healthcare recommendations. Building on the work of the GRADE Working Group, DECIDE will develop and evaluate methods that address communication needs of guideline users. The project will produce strategies for communicating recommendations that have been rigorously evaluated in diverse settings, and it will support the transfer of research into practice in healthcare systems globally.
This report summarizes lessons about a systems approach to knowledge mobilization, and identifies recommendations and strategies to inform how best to develop and support innovative knowledge mobilization approaches relevant to public health and health promotion. The intended uses of this report and its findings are to: 1) inform planning discussions for those involved in the Canadian Plan-Act-Learn System (PALS) for Chronic Disease Prevention partnership; and 2) inform the ongoing development of approaches for mobilizing knowledge and evidence that will better equip us to learn about what works in the dynamic and diverse environments within which chronic disease prevention efforts are currently being undertaken.
This report provides a summary analysis of:
- Features and characteristics found in the cases that reflect a systems approach and solutions to complex problems; and
- Key success factors drawn from the cross-case analysis, including lessons about creating conditions and appropriate business models, activities for knowledge mobilization in complexity, and the essential skills required.
- The Journey toward High Performance and Excellent Quality
Adalsteinn Brown, G. Ross Baker, Tom Closson and Terrence Sullivan
- Patient-and Family-Centredness: Growing a Sustainable Culture
- A Relentless Commitment to Improvement: The Guelph General Hospital Experience
Esther Green and Richard Ernst
- Public Engagement in Ontario’s Hospitals – Opportunities and Challenges
Karen Born and Andreas Laupacis
- Organization Culture and Managerial Discipline Key to Quality Improvement: The Mount Sinai Hospital Experience
Esther Green and Joe Mapa
- A Ten-Year History: The Cancer Quality Council of Ontario
Rebecca Anas, Robert Bell, Adalsteinn Brown, William Evans and Carol Sawka
- Aligning and Pursuing Quality Goals: The Role of Health Quality Ontario
Anthony Dale and Ben Chan
- It’s about the Relationships: Reflections from a Provincial Quality Council on Building a Better Healthcare System
- The Excellent Care for All Act’s Quality Improvement Plans: Reflections on the First Year
Sudha Kutty, Nizar Ladak, Cyrelle Muskat, Jillian Paul and Margo Orchard
- The Crucial Role of Clinician Engagement in System-Wide Quality Improvement: The Cancer Care Ontario Experience
Carol Sawka, Jillian Ross, John Srigley and Jonathan Irish
- Engaging Clinicians through Intrinsic Incentives
Chris Carruthers and Wendy Levinson
- Governance for Quality and Patient Safety: The Impact of the Ontario Excellent Care for All Act, 2010
G. Ross Baker and Anu MacIntosh-Murray
- Improving Care for British Columbians: The Critical Role of Physician Engagement
Julian Marsden, Marlies van Dijk, Peter Doris, Christina Krause and Doug Cochrane
- Clinicians as Designers and Leaders of Quality Improvement
Chris Carruthers and Ward Flemons
- Supporting the Use of Research Evidence in the Canadian Health Sector
Michael Wilson, John Lavis and Jeremy Grimshaw
- Bringing Evidence to Healthcare Decision Making
Charles Wright and Brian O’Rourke
- Evidence and Quality, Practicalities and Judgments: Some Experience from NICE
Anthony Culyer and Michael Rawlins
- Stronger Policy through Evidence
Charles Wright and Les Levin
- Who Doesn’t Deserve Excellent Care?
Sherri Huckstep, Debra Yearwood and Judith Shamian
- Building Better Healthcare Facilities through Evidence-Based Design: Breaking New Ground at Vancouver Island Health Authority
Howard Waldner, Bart Johnson and Blair Sadler
- Quality Legislation: Lessons for Ontario from Abroad
Jérémy Veillard, Brenda Tipper and Niek Klazinga
- Don Berwick, Former President and CEO, IHI
- Dame Ruth Carnall, Chief Executive, NHS London
- Robert Francis QC, Chair of the Mid-Staffordshire NHS Foundation Trust Inquiry
- Professor Lord Ara Darzi, Chair of Surgery, Chairman of the Institute for Global Health Innovation, Imperial College, Business Ambassador for the UK Maureen Bisognano, President and CEO, IHI
- Jason Leitch, National Clinical Lead for Quality, Scottish Government, Scotland
- Jim Livingstone, Former Director of Safety Quality and Standards, Department of Health, Northern Ireland
- Professor Sir Mansel Aylward CB, Chair, Public Health Wales and Director, Centre for Psychosocial and Disability Research
Health Care Administration & Organization
Burnout intervention studies for inpatient elderly care nursing staff: Systematic literature review.
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Westermann C, Kozak A, Harling M, Nienhaus A.
International journal of nursing studies 2012 Dec 26
Staff providing inpatient elderly and geriatric long-term care are exposed to a large number of factors that can lead to the development of burnout syndrome. Burnout is associated with an increased risk of absence from work, low work satisfaction, and an increased intention to leave. Due to the fact that the number of geriatric nursing staff is already insufficient, research on interventions aimed at reducing work-related stress in inpatient elderly care is needed. OBJECTIVE: The aim of this systematic review was to identify and analyse burnout intervention studies among nursing staff in the inpatient elderly and geriatric long-term care sector. METHODS: A systematic search of burnout intervention studies was conducted in the databases Embase, Medline and PsycNet published from 2000 to January 2012. RESULTS: We identified 16 intervention studies. Interventions were grouped into work-directed (n=2), person-directed (n=9) and combined approaches (work- and person-directed, n=5). Seven out of 16 studies observed a reduction in staff burnout. Among them are two studies with a work-directed, two with a person-directed and three with a combined approach. Person-directed interventions reduced burnout in the short term (up to 1 month), while work-directed interventions and those with a combined approach were able to reduce burnout over a longer term (from 1 month to more than 1 year). In addition to staff burnout, three studies observed positive effects relating to the client outcomes. Only three out of ten Randomised Control Trials (RCT) found that interventions had a positive effect on staff burnout. CONCLUSION: Work-directed and combined interventions are able to achieve beneficial longer-term effects on staff burnout. Person-directed interventions achieve short-term results in reducing staff burnout. However, the evidence is limited. Copyright © 2012 Elsevier Ltd. All rights reserved.
Better interprofessional teamwork, higher level of organized care, and lower risk of burnout in acute health care teams using care pathways: a cluster randomized controlled trial.
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Deneckere S, Euwema M, Lodewijckx C, Panella M, Mutsvari T, Sermeus W, et al.
Medical care 2013 Jan;51(1):99-107
Effective interprofessional teamwork is an essential component for the delivery of high-quality patient care in an increasingly complex medical environment. The objective is to evaluate whether the implementation of care pathways (CPs) improves teamwork in an acute hospital setting. DESIGN AND MEASURES: A posttest-only cluster randomized controlled trial was performed in Belgian acute hospitals. Teams caring for patients hospitalized with a proximal femur fracture and those hospitalized with an exacerbation of chronic obstructive pulmonary disease, were randomized into intervention and control groups. The intervention group implemented a CP. The control group provided usual care. A set of team input, process, and output indicators were used as effect measures. To analyze the results, we performed multilevel statistical analysis. RESULTS: Thirty teams and a total of 581 individual team members participated. The intervention teams scored significantly better in conflict management [β=0.30 (0.11); 95% confidence interval (CI), 0.08 to 0.53]; team climate for innovation [β=0.29 (0.10); 95% CI, 0.09 to 0.49]; and level of organized care [β=5.56 (2.05); 95% CI, 1.35 to 9.76]. They also showed lower risk of burnout as they scored significantly lower in emotional exhaustion [β=-0.57 (0.21); 95% CI, -1.00 to -0.14] and higher in the level of competence (β=0.39; 95% CI, 0.15 to 0.64). No significant effect was found on relational coordination. CONCLUSIONS: CPs are effective interventions for improving teamwork, increasing the organizational level of care processes, and decreasing risk of burnout for health care teams in an acute hospital setting. Through this, high-performance teams can be built.
Experience and education of home health administrators and nursing home administrators and the relationship to establishment ownership.
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Decker FH, Decker SL.
Journal of health and human services administration 2012 Fall;35(2):149-169
Administrators in long-term care may have an important influence on quality of care. Limited prior research has described the characteristics of nursing home administrators. Despite growing emphasis on home health care as an alternative to nursing homes, almost no research has described the characteristics of administrators of home health agencies. Using the 2004 National Nursing Home Survey and the 2007 National Home and Hospice Care Survey, we describe the career experience of administrators, and examine the relationship between experience and education of administrators both within and across the nursing home and home health sectors. We also explore the characteristics of nursing homes and home health agencies, including establishment ownership (e.g., nonchain not-for-profit), that are associated with being able to attract administrators with the most experience. We find that home health administrators have, on average, less experience than nursing home administrators. Among home health agencies, administrators with the least experience also tend to have less education. In nursing homes, administrators with less experience tend to have more education. Results from multivariate analysis suggest that chain for-profits may be the least able to attract experienced administrators. More research on the effects of different levels of experience and education among administrators is needed.
Context, culture and (non-verbal) communication affect handover quality.
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Frankel RM, Flanagan M, Ebright P, Bergman A, O’Brien CM, Franks Z, et al.
BMJ quality & safety 2012 Dec;21 Suppl 1:i121-8
BACKGROUND: Transfers of care, also known as handovers, remain a substantial patient safety risk. Although research on handovers has been done since the 1980s, the science is incomplete. Surprisingly few interventions have been rigorously evaluated and, of those that have, few have resulted in long-term positive change. Researchers, both in medicine and other high reliability industries, agree that face-to-face handovers are the most reliable. It is not clear, however, what the term face-to-face means in actual practice. OBJECTIVES: We studied the use of non-verbal behaviours, including gesture, posture, bodily orientation, facial expression, eye contact and physical distance, in the delivery of information during face-to-face handovers. METHODS: To address this question and study the role of non-verbal behaviour on the quality and accuracy of handovers, we videotaped 52 nursing, medicine and surgery handovers covering 238 patients. Videotapes were analysed using immersion/crystallisation methods of qualitative data analysis. A team of six researchers met weekly for 18 months to view videos together using a consensus-building approach. Consensus was achieved on verbal, non-verbal, and physical themes and patterns observed in the data. RESULTS: We observed four patterns of non-verbal behaviour (NVB) during handovers: (1) joint focus of attention; (2) ‘the poker hand’; (3) parallel play and (4) kerbside consultation. In terms of safety, joint focus of attention was deemed to have the best potential for high quality and reliability; however, it occurred infrequently, creating opportunities for education and improvement. CONCLUSIONS: Attention to patterns of NVB in face-to-face handovers coupled with education and practice can improve quality and reliability.
Innovations in major system reconfiguration in England: a study of the effectiveness, acceptability and processes of implementation of two models of stroke care.
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Fulop N, Boaden R, Hunter R, McKevitt C, Morris S, Pursani N, et al.
Implementation science : IS 2013 Jan 5;8(1):5
BACKGROUND: Significant changes in provision of clinical care within the English National Health Service (NHS) have been discussed in recent years, with proposals to concentrate specialist services in fewer centres. Stroke is a major public health issue, accounting for over 10% of deaths in England and Wales, and much disability among survivors. Variations have been highlighted in stroke care, with many patients not receiving evidence-based care. To address these concerns, stroke services in London and Greater Manchester were reorganised, although different models were implemented. This study will analyse processes involved in making significant changes to stroke care services over a short time period, and the factors influencing these processes. We will examine whether the changes have delivered improvements in quality of care and patient outcomes; and, in light of this, whether the significant extra financial investment represented good value for money.Methods/design: This study brings together quantitative data on ‘what works and at what cost?’ with qualitative data on ‘understanding implementation and sustainability’ to understand major system change in two large conurbations in England. Data on processes of care and their outcomes (e.g. morbidity, mortality, and cost) will be analysed to evidence services’ performance before and after reconfiguration. The evaluation draws on theories related to the dissemination and sustainability of innovations and the ‘social matrix’ underlying processes of innovation We will conduct a series of case studies based on stakeholder interviews and documentary analysis. These will identify drivers for change, how the reconfigurations were governed, developed, and implemented, and how they influenced service quality. DISCUSSION: The research faces challenges due to: the different timings of the reconfigurations; the retrospective nature of the evaluation; and the current organisational turbulence in the English NHS. However, these issues reflect the realities of major systems change and its evaluation. The methods applied in the study have been selected to account for and learn from these complexities, and will provide useful lessons for future reconfigurations, both in stroke care and other specialties.
Measuring organizational and individual factors thought to influence the success of quality improvement in primary care: a systematic review of instruments.
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Brennan SE, Bosch M, Buchan H, Green SE.
Implementation science : IS 2012 Dec 17;7(1):121
BACKGROUND: Continuous quality improvement (CQI) methods are widely used in healthcare; however, the effectiveness of the methods is variable, and evidence about the extent to which contextual and other factors modify effects is limited. Investigating the relationship between these factors and CQI outcomes poses challenges for those evaluating CQI, among the most complex of which relate to the measurement of modifying factors. We aimed to provide guidance to support the selection of measurement instruments by systematically collating, categorising, and reviewing quantitative self-report instruments. METHODS: Data sources: We searched MEDLINE, PsycINFO, and Health and Psychosocial Instruments, reference lists of systematic reviews, and citations and references of the main report of instruments. Study selection: The scope of the review was determined by a conceptual framework developed to capture factors relevant to evaluating CQI in primary care (the InQuIRe framework). Papers reporting development or use of an instrument measuring a construct encompassed by the framework were included. Data extracted included instrument purpose; theoretical basis, constructs measured and definitions; development methods and assessment of measurement properties. Analysis and synthesis: We used qualitative analysis of instrument content and our initial framework to develop a taxonomy for summarising and comparing instruments. Instrument content was categorised using the taxonomy, illustrating coverage of the InQuIRe framework. Methods of development and evidence of measurement properties were reviewed for instruments with potential for use in primary care. RESULTS: We identified 186 potentially relevant instruments, 152 of which were analysed to develop the taxonomy. Eighty-four instruments measured constructs relevant to primary care, with content measuring CQI implementation and use (19 instruments), organizational context (51 instruments), and individual factors (21 instruments). Forty-one instruments were included for full review. Development methods were often pragmatic, rather than systematic and theory-based, and evidence supporting measurement properties was limited. CONCLUSIONS: Many instruments are available for evaluating CQI, but most require further use and testing to establish their measurement properties. Further development and use of these measures in evaluations should increase the contribution made by individual studies to our understanding of CQI and enhance our ability to synthesise evidence for informing policy and practice.
Innovative Health & Wealth set out a delivery agenda for spreading innovation at pace and scale throughout the NHS. This report outlines the results so far.
Background. The United States devotes significant resources for the provision of health care, yet quality is often elusive or lacking. In 2004, the Agency for Healthcare Research and Quality launched a collection of evidence reports to bring data to bear on quality improvement (QI) opportunities. This new series, Closing the Quality Gap: Revisiting the State of the Science, consists of eight reports that continue the focus on improving the quality of health care through critical assessment of relevant evidence for selected settings, interventions, and clinical conditions. This report is an introduction to the Executive Summaries of the eight reports in the series and summarizes elements across the series for readers. Overview. The topics are effectiveness of bundled payment programs, effectiveness of the patient-centered medical home, QI strategies to address health disparities, effectiveness of medication adherence interventions, effectiveness of public reporting, prevention of healthcare associated infections, QI measurement of outcomes for people with disabilities, and health care and palliative care for patients with advanced and serious illness. The overview describes the scope of the eight reports; describes the scope of the series by summarizing the quality levers, populations, interventions, outcomes, and other features across the reports; and discusses key messages by audience (patient/consumer/caregiver, health care professional, health care delivery organization, policymaker, and research community). Conclusions. The series covers many important aspects of quality improvement in health care. This Summary is intended to show how topics relate and complement each other, and how together they provide a picture of the state of the science. It will help readers, as they read the Executive Summaries for the individual topics, to gain a deeper understanding of the nature and extent of quality gaps across health care, as well as the systemic changes necessary to close them.
Health Care Innovation and Quality Assurance in Long Term Care
Minimum data set 3.0: a giant step forward.
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Journal of the American Medical Directors Association 2013 Jan;14(1):1-3.
Over the last year, the Journal has published a series of articles on the validation of the Minimum Data Set 3.0 (MDS 3.0) and its utility. We have now had a year using the MDS 3.0 in nursing homes in the United States, and so it is an appropriate time to reflect on its functioning in real life.
A survey-based study of knowledge of Alzheimer’s disease among health care staff.
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Smyth W, Fielding E, Beattie E, Gardner A, Moyle W, Franklin S, et al.
BMC geriatrics 2013 Jan 2;13:2-2318-13-2
Continued aging of the population is expected to be accompanied by substantial increases in the number of people with dementia and in the number of health care staff required to care for them. Adequate knowledge about dementia among health care staff is important to the quality of care delivered to this vulnerable population. The purpose of this study was to assess knowledge about dementia across a range of health care staff in a regional health service district. METHODS: Knowledge levels were investigated via the validated 30-item Alzheimer’s Disease Knowledge Scale (ADKS). All health service district staff with e-mail access were invited to participate in an online survey. Knowledge levels were compared across demographic categories, professional groups, and by whether the respondent had any professional or personal experience caring for someone with dementia. The effect of dementia-specific training or education on knowledge level was also evaluated. RESULTS: A diverse staff group (N = 360), in terms of age, professional group (nursing, medicine, allied health, support staff) and work setting from a regional health service in Queensland, Australia responded. Overall knowledge about Alzheimer’s disease was of a generally moderate level with significant differences being observed by professional group and whether the respondent had any professional or personal experience caring for someone with dementia. Knowledge was lower for some of the specific content domains of the ADKS, especially those that were more medically-oriented, such as ‘risk factors’ and ‘course of the disease.’ Knowledge was higher for those who had experienced dementia-specific training, such as attendance at a series of relevant workshops. CONCLUSIONS: Specific deficits in dementia knowledge were identified among Australian health care staff, and the results suggest dementia-specific training might improve knowledge. As one piece of an overall plan to improve health care delivery to people with dementia, this research supports the role of introducing systematic dementia-specific education or training.
The Influence of Teams to Sustain Quality Improvement in Nursing Homes that “Need Improvement”.
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Rantz MJ, Zwygart-Stauffacher M, Flesner M, Hicks L, Mehr D, Russell T, et al.
Journal of the American Medical Directors Association 2013 Jan;14(1):48-52
Qualitatively describe the use of team and group processes in intervention facilities participating in a study targeted to improve quality of care in nursing homes “in need of improvement.” DESIGN/SETTING/PARTICIPANTS: A randomized, two-group, repeated-measures design was used to test a 2-year intervention for improving quality of care and resident outcomes. Intervention group (n = 29) received an experimental multilevel intervention designed to help them: (1) use quality improvement methods, (2) use team and group process for direct-care decision-making, (3) focus on accomplishing the basics of care, and (4) maintain more consistent nursing and administrative leadership committed to communication and active participation of staff in decision-making. RESULTS: The qualitative analysis revealed a subgroup of homes (“Full Adopters”) likely to continue quality improvement activities that were able to effectively use teams. “Full Adopters” had either the nursing home administrator or director of nursing who supported and were actively involved in the quality improvement work of the team. “Full Adopters” also selected care topics for the focus of their quality improvement team, instead of “communication” topics of the “Partial Adopters” or “Non-Adopters” in the study who were identified as unlikely to continue to continue quality improvement activities after the intervention. “Full Adopters” had evidence of the key elements of complexity science: information flow, cognitive diversity, and positive relationships among staff; this evidence was lacking in other subgroups. All subgroups were able to recruit interdisciplinary teams, but only those that involved leaders were likely to be effective and sustain team efforts at quality improvement of care delivery systems. CONCLUSIONS: Results of this qualitative analysis can help leaders and medical directors use the key elements and promote information flow among staff, residents, and families; be inclusive as discussions about care delivery, making sure diverse points of view are included; and help build positive relationships among all those living and working in the nursing home. Wide-spread adoption of the intervention in the randomized study is feasible and could be enabled by nursing home Medical Directors in collaborative practice with Advanced Practice Nurses. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.
Implementation of quality assurance and performance improvement programs in nursing homes: a brief report.
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Smith KM, Castle NG, Hyer K.
Journal of the American Medical Directors Association 2013 Jan;14(1):60-61
The purpose of this article was to investigate nursing homes’ (NHs’) readiness to implement a quality assurance and performance improvement (QAPI) program as required by Section 6102 of the Affordable Care Act. Nursing home administrators (NHAs) in 3000 NHs (response rate, 67%) were surveyed using a 70-item questionnaire to assess: (1) current facility approaches to quality, (2) NHA’s self-assessed knowledge of QAPI techniques; and (3) the use of QAPI techniques. The Online Survey, System for Certification and Administrative Reporting data and the Area Resource File were also used to examine and compare facility and market characteristics. As rated on a scale of 1 to 10, NHs are more likely to use quality assurance (rating, 7.2) and least likely to use total quality management (rating, 4.1). Few NHAs use tools for QAPI such as flow charts (23%), Plan-Do-Check-Act cycles (13%), or run charts (9%). A gap in knowledge of quality improvement tools has been identified signifying that the new QAPI regulations may pose an issue for NHAs who possibly lack the knowledge and technical expertise to implement a comprehensive QAPI program. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.
Transitions in care among older adults receiving long-term services and supports.
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Toles MP, Abbott KM, Hirschman KB, Naylor MD.
Journal of gerontological nursing 2012 Nov;38(11):40-47
Recipients of long-term services and supports (LTSS) frequently transition between LTSS settings (e.g., assisted living facilities, nursing homes) and hospitals for acute changes in health. In this qualitative study, we analyzed findings from interviews with 57 recently hospitalized LTSS recipients and their family caregivers and described barriers and facilitators to high-quality care to support older adults through these care transitions. The themes that emerged strongly suggest that LTSS recipients and family caregivers do not receive needed information about the reasons for their transfers to hospitals, medical diagnoses, and planned treatments to address acute changes in health. Our findings indicate an urgent need for nurses and other health care team members to talk with LTSS recipients (and family caregivers) and ensure they are engaged and informed participants in care. We also found the need for research to test evidence-based transitional care for high-risk LTSS recipients and their family caregivers. Copyright 2012, SLACK Incorporated.
An internet training to reduce assaults in long-term care.
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Toles MP, Abbott KM, Hirschman KB, Naylor MD.
Journal of gerontological nursing 2012 Nov;38(11):40-47
Physical and verbal assaults by residents on care staff are not uncommon in long-term residential care facilities (LTCs). This research evaluated an Internet training designed to teach nurse aides (NAs) strategies to work with aggressive resident behaviors. Six LTCs were randomized in an immediate treatment (IT) and delayed treatment (DT) design, and NAs were recruited in each (IT: n = 58; DT; n = 45). The treatment involved 2 weekly visits to the online training. Hard copy assessments collected participant responses at baseline (T1), 8 weeks (T2), and at 16 weeks (T3). The DT group viewed the program after T2. Hierarchical linear models showed significant group differences at T2 in knowledge, and these levels were maintained at T3. The number of aggressive incidents reported per day by the IT group were nonsignificant at T2 but decreased significantly from T1 to T3 with a large effect size. The program was well received by users. These results suggest that the Internet training was an effective tool to reduce assaults in LTCs, and training effects may improve over time as NAs gain experience using the techniques. Copyright © 2012 Mosby, Inc. All rights reserved.
Director of nursing current job tenure and past experience and quality of care in nursing homes.
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Health care management review 2012 Jan-Mar;37(1):98-108
Directors of nursing (DONs) are central to quality of care in nursing homes (NHs) because of their role in coordinating and overseeing nursing care. Research is needed to test the association between DON characteristics and quality using large, representative samples of NHs and global measures of quality. One such measure is the quality measure (QM) rating from the Centers for Medicare & Medicaid Services’ Five-Star Quality Rating, which aggregates 10 individual QMs into a single rating. PURPOSE: This study examined whether DON current job tenure or past experience (a) differed across levels of the QM rating, (b) was associated with QM ratings, and (c) was associated with any of the individual 10 QM scores that comprise QM ratings. METHODOLOGY: Data for a nationally representative sample of 1,174 NHs were obtained from the 2004 National Nursing Home Survey, publicly reported QMs, and an Area Resource File. Wald tests were used to test differences in mean DON current job tenure and past experience across levels of the QM rating. Multinomial logistic and Poisson regression analyses were used to examine the association between DON current job tenure and past experience and QM ratings and QM scores, respectively, controlling for selected market and organizational characteristics. FINDINGS: Nursing homes with longer DON current job tenure tended to have higher QM ratings. Longer DON current job tenure was associated with higher QM ratings and lower QM scores for several individual QMs, suggesting higher quality. The past experience of the DON did not differ across levels of the QM rating and was not associated with QM ratings or QM scores. PRACTICE IMPLICATIONS: This study highlights the need for owners and administrators to support DONs as they either the transition into the role of the DON for the first time or learn to effectively fulfill their role in a new NH.
Implementation of geriatric assessment and decision support in residential care homes: facilitating and impeding factors.
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Boorsma M, Langedijk E, Frijters DH, Nijpels G, Elfring T, van Hout HP.
BMC health services research 2013 Jan 5;13(1):8
BACKGROUND: Successfully introducing and maintaining care innovations may depend on the interplay between care setting, the intervention and specific circumstances. We studied the factors influencing the introduction and maintenance of a Multidisciplinary Integrated Care model in 10 Dutch residential care homes. METHODS: Facilitating and impeding factors were studied and compared at the time of introduction of the interRAI-LTCF assessment method in residential care homes as well as three years later, by surveys and semi structured interviews among nurse staff, managers, and physicians. RESULTS: Facilitating factors at introduction were positive opinions of staff and family physicians about the changes of the process of care and the anticipated improvement of quality of care. Staff was positive about the applicability of the software to support the interRAI-LTCF assessments. Impeding factors were time constraints to complete interRAI-LTCF assessments and insufficient computer equipment.In the maintenance phase, the positive attitude of the manager and the perceived benefits of the care model and the interRAI-LTCF assessment method were most important. Impeding factors after 3 years remained the lack of time to complete the assessments and lack of sufficient computer equipment. CONCLUSIONS: Impeding and facilitating factors were comparable in the initial and maintenance phase. Adoption of the interRAI-LTCF assessment method depended on positive opinions of staff and management, continuing support of staff and the availability of sufficient computer equipment.
Shrinkage estimators for a composite measure of quality conceptualized as a formative construct.
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Shwartz M, Pekoz EA, Christiansen CL, Burgess JF,Jr, Berlowitz D.
Health services research 2013 Feb;48(1):271-289
To demonstrate the value of shrinkage estimators when calculating a composite quality measure as the weighted average of a set of individual quality indicators. DATA SOURCES: Rates of 28 quality indicators (QIs) calculated from the minimum dataset from residents of 112 Veterans Health Administration nursing homes in fiscal years 2005-2008. STUDY DESIGN: We compared composite scores calculated from the 28 QIs using both observed rates and shrunken rates derived from a Bayesian multivariate normal-binomial model. PRINCIPAL FINDINGS: Shrunken-rate composite scores, because they take into account unreliability of estimates from small samples and the correlation among QIs, have more intuitive appeal than observed-rate composite scores. Facilities can be profiled based on more policy-relevant measures than point estimates of composite scores, and interval estimates can be calculated without assuming the QIs are independent. Usually, shrunken-rate composite scores in 1 year are better able to predict the observed total number of QI events or the observed-rate composite scores in the following year than the initial year observed-rate composite scores. CONCLUSION: Shrinkage estimators can be useful when a composite measure is conceptualized as a formative construct. © Health Research and Educational Trust.
Sampling challenges in nursing home research.
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Tilden VP, Thompson SA, Gajewski BJ, Buescher CM, Bott MJ.
Journal of the American Medical Directors Association 2013 Jan;14(1):25-28
Research on end-of-life care in nursing homes is hampered by challenges in retaining facilities in samples through study completion. Large-scale longitudinal studies in which data are collected on-site can be particularly challenging. OBJECTIVES: To compare characteristics of nursing homes that dropped from the study to those that completed the study. METHODS: One hundred two nursing homes in a large geographic 2-state area were enrolled in a prospective study of end-of-life care of residents who died in the facility. The focus of the study was the relationship of staff communication, teamwork, and palliative/end-of-life care practices to symptom distress and other care outcomes as perceived by family members. Data were collected from public data bases of nursing homes, clinical staff on site at each facility at 2 points in time, and from decedents’ family members in a telephone interview. RESULTS: Seventeen of the 102 nursing homes dropped from the study before completion. These non-completer facilities had significantly more deficiencies and a higher rate of turnover of key personnel compared to completer facilities. A few facilities with a profile typical of non-completers actually did complete the study after an extraordinary investment of retention effort by the research team. CONCLUSION: Nursing homes with a high rate of deficiencies and turnover have much to contribute to the goal of improving end-of-life care, and their loss to study is a significant sampling challenge. Investigators should be prepared to invest extra resources to maximize retention. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.
Applying factor analysis and analytic hierarchy process to evaluate innovation of nonprofit organizations
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Advances in Information Sciences and Service Sciences 2012;4(22):365-373
Although innovation is a critical success factor for any organization, its measurement and evaluation still has not been fully addressed especially in the context of nonprofit organizations (NPOs). This paper aims at integrating factor analysis and analytic hierarchy process (AHP) to evaluate innovation of NPOs. As a result of our literature review, three types of NPOs’ innovation, namely climate for innovation, service innovation, and management innovation were identified. Factor analysis techniques were then performed based on survey data from Chinese NPOs to establish the measurement scale of NPOs’ innovation. Finally, AHP together with a case study was carried out to clarify how to evaluate the proposed measurement scale of NPOs’ innovation.
Between and within-site variation in qualitative implementation research.
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Benzer JK, Beehler S, Cramer IE, Mohr DC, Charns MP, Burgess JF,Jr.
Implementation science : IS 2013 Jan 3;8(1):4
BACKGROUND: Multisite qualitative studies are challenging in part because decisions regarding within-site and between-site sampling must be made to reduce the complexity of data collection, but these decisions may have serious implications for analyses. There is not yet consensus on how to account for within-site and between-site variations in qualitative perceptions of the organizational context of interventions. The purpose of this study was to analyze variation in perceptions among key informants in order to demonstrate the importance of broad sampling for identifying both within-site and between-site implementation themes. METHODS: Case studies of four sites were compared to identify differences in how Department of Veterans Affairs (VA) medical centers implemented a Primary Care/Mental Health Integration (PC/MHI) intervention. Qualitative analyses focused on between-profession variation in reported referral and implementation processes within and between sites. RESULTS: Key informants identified co-location, the consultation-liaison service, space, access, and referral processes as important topics. Within-site themes revealed the importance of coordination, communication, and collaboration for implementing PC/MHI. The between-site theme indicated that the preexisting structure of mental healthcare influenced how PC/MHI was implemented at each site and that collaboration among both leaders and providers was critical to overcoming structural barriers. CONCLUSIONS: Within- and between-site variation in perceptions among key informants within different professions revealed barriers and facilitators to the implementation not available from a single source. Examples provide insight into implementation barriers for PC/MHI. Multisite implementation studies may benefit from intentionally eliciting and analyzing variation within and between sites. Suggestions for implementation research design are presented.
Protocol for a systematic review on the extent of non-publication of research studies and associated study characteristics.
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Portalupi S, von Elm E, Schmucker C, Lang B, Motschall E, Schwarzer G, et al.
Systematic reviews 2013 Jan 9;2(1):2
BACKGROUND: Methodological research has found that non-published studies often have different results than those that are published, a phenomenon known as publication bias. When results are not published, or are published selectively based on the direction or the strength of the findings, healthcare professionals and consumers of healthcare cannot base their decision-making on the full body of current evidence. METHODS: As part of the OPEN project (www.open-project.eu) we will conduct a systematic review with the following objectives:1.To determine the proportion and/or rate of non-publication of studies by systematically reviewing methodological research projects that followed up a cohort of studies that a. received research ethics committee (REC) approval, b. were registered in trial registries, orc.were presented as abstracts at conferences.2.To assess the association of study characteristics (for example, direction and/or strength of findings) with likelihood of full publication.To identify reports of relevant methodological research projects we will conduct electronic database searches, check reference lists, and contact experts. Published and unpublished projects will be included. The inclusion criteria are as follows: a.RECs: methodological research projects that examined the subsequent proportion and/or rate of publication of studies that received approval from RECs; b.Trial registries: methodological research projects that examine the subsequent proportion and/or rate of publication of studies registered in trial registries; c.Conference abstracts: methodological research projects that examine the subsequent proportion and/or rate of full publication of studies which were initially presented at conferences as abstracts.Primary outcomes: Proportion/rate of published studies; time to full publication (mean/median; cumulative publication rate by time).Secondary outcomes: Association of study characteristics with full publication.The different questions (a, b, and c) will be investigated separately. Data synthesis will involve a combination of descriptive and statistical summaries of the included methodological research projects. DISCUSSION: Results are expected to be publicly available in mid 2013.
Participant recruitment in sensitive surveys: a comparative trial of ‘opt in’ versus ‘opt out’ approaches.
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Hunt KJ, Shlomo N, Addington-Hall J.
BMC medical research methodology 2013 Jan 11;13(1):3
BACKGROUND: Although in health services survey research we strive for a high response rate, this must be balanced against the need to recruit participants ethically and considerately, particularly in surveys with a sensitive nature. In survey research there are no established recommendations to guide recruitment approach and an ‘opt-in’ system that requires potential participants to request a copy of the questionnaire by returning a reply slip is frequently adopted. However, in observational research the risk to participants is lower than in clinical research and so some surveys have used an ‘opt-out’ system. The effect of this approach on response and distress is unknown. We sought to investigate this in a survey of end of life care completed by bereaved relatives. METHODS: Out of a sample of 1422 bereaved relatives we assigned potential participants to one of two study groups: an ‘opt in’ group (n=711) where a letter of invitation was issued with a reply slip to request a copy of the questionnaire; or an ‘opt out’ group (n=711) where the survey questionnaire was provided alongside the invitation letter. We assessed response and distress between groups. RESULTS: From a sample of 1422, 473 participants returned questionnaires. Response was higher in the ‘opt out’ group than in the ‘opt in’ group (40% compared to 26.4%: chi2 =29.79, p-value<.01), there were no differences in distress or complaints about the survey between groups, and assignment to the 'opt out' group was an independent predictor of response (OR=1.84, 95% CI: 1.45-2.34). Moreover, the 'opt in' group were more likely to decline to participate (chi2=28.60, p-value<.01) and there was a difference in the pattern of questionnaire responses between study groups. CONCLUSION: Given that the 'opt out' method of recruitment is associated with a higher response than the 'opt in' method, seems to have no impact on complaints or distress about the survey, and there are differences in the patterns of responses between groups, the 'opt out' method could be recommended as the most efficient way to recruit into surveys, even in those with a sensitive nature.
Tool for evaluating research implementation challenges: A sense-making protocol for addressing implementation challenges in complex research settings.
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Simpson KM, Porter K, McConnell ES, Colon-Emeric C, Daily KA, Stalzer A, et al.
Implementation science : IS 2013 Jan 2;8(1):2
BACKGROUND: Many challenges arise in complex organizational interventions that threaten research integrity. This article describes a Tool for Evaluating Research Implementation Challenges (TECH), developed using a complexity science framework to assist research teams in assessing and managing these challenges. METHODS: During the implementation of a multi-site, randomized controlled trial (RCT) of organizational interventions to reduce resident falls in eight nursing homes, we inductively developed, and later codified the TECH. The TECH was developed through processes that emerged from interactions among research team members and nursing home staff participants, including a purposive use of complexity science principles. RESULTS: The TECH provided a structure to assess challenges systematically, consider their potential impact on intervention feasibility and fidelity, and determine actions to take. We codified the process into an algorithm that can be adopted or adapted for other research projects. We present selected examples of the use of the TECH that are relevant to many complex interventions. CONCLUSIONS: Complexity theory provides a useful lens through which research procedures can be developed to address implementation challenges that emerge from complex organizations and research designs. Sense-making is a group process in which diverse members interpret challenges when available information is ambiguous; the groups’ interpretations provide cues for taking action. Sense-making facilitates the creation of safe environments for generating innovative solutions that balance research integrity and practical issues. The challenges encountered during implementation of complex interventions are often unpredictable; however, adoption of a systematic process will allow investigators to address them in a consistent yet flexible manner, protecting fidelity. Research integrity is also protected by allowing for appropriate adaptations to intervention protocols that preserve the feasibility of ‘real world’ interventions.
Twenty-five years of Australian nursing and allied health professional journals: Bibliometric analysis from 1985 through 2010
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Wiles L, Olds T, Williams M.
The generation of research involves producers (study authors and funders), products (studies and arising publications) and consumption (measured through readership and citation). Bibliometric analyses of research producers, products and consumption over time can be used to describe the evolution of health professions as captured in professional journal publications. Numerous bibliometric studies have been conducted however few have sampled nursing and allied health professional journals. This is despite a growing health workforce and socioeconomic pressures. The aim of this study was to use bibliometric analyses to track change in the producers, products and consumption of seven Australian nursing and allied health professional journals from 1985 through 2010. An analysis of all original research articles published in these journals was performed using a reliable bibliometric audit tool. Articles were sampled every 3 months and at 5 year intervals over a 25 year period. Information relating to authorship, the research methods used and citation patterns was collected. Data were analysed descriptively. Over the study period, all journals shifted towards publishing research that used higher study designs, reported more quantitative data, and were authored by larger research teams. The rate at which this transition occurred (greater evidence base, quantitation and collaboration) differed among the journals sampled. The changes seen in the research published in these journals are likely to be a function of the strategic purpose of each publication (to its professional readership) as well as reflect wider socioeconomic phenomena. Therefore these trends are likely to continue in the future. © 2012 Akadémiai Kiadó, Budapest, Hungary.
The urban-rural disparity in nursing home quality indicators: the case of facility-acquired contractures.
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Bowblis JR, Meng H, Hyer K.
Health services research 2013 Feb;48(1):47-69
To identify and quantify the sources of the urban-rural disparity in facility-acquired contracture rates in nursing homes. DATA SOURCES: Survey inspection data of U.S. nursing homes from 1999 to 2008 and standardized national rural definition file from the Rural-Urban Commuting Area Codes. STUDY DESIGN: We estimated regressions of facility-level contracture rate as a function of urban-rural categories (urban, micropolitan, small rural town, and isolated small rural town) and other related facility characteristics to identify size of the urban-rural disparity. We used Blinder-Oaxaca decomposition techniques to determine the extent to which the disparity is attributable to the differences in facility and aggregate resident characteristics. PRINCIPAL FINDINGS: Rural nursing homes have higher contracture rates than urban nursing homes. About half of the urban-rural disparity is explained by differences in observable characteristics among urban and rural nursing homes. Differences in staffing levels explain less than 5 percent of the disparity, case-mix explains 6-8 percent, and structure and operational characteristics account for 10-22 percent of the disparity. CONCLUSION: While a lower level and quality of staffing are a concern for rural nursing homes, facility structure and funding sources explain a larger proportion of the urban-rural disparity in the quality of care. © Health Research and Educational Trust.
The effects of evacuation on nursing home residents with dementia.
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Brown LM, Dosa DM, Thomas K, Hyer K, Feng Z, Mor V.
American Journal of Alzheimer’s Disease and Other Dementias 2012 Sep;27(6):406-412
BACKGROUND: In response to the hurricane-related deaths of nursing home residents, there has been a steady increase in the number of facilities that evacuate under storm threat. This study examined the effects of evacuation during Hurricane Gustav on residents who were cognitively impaired. METHODS: Nursing homes in counties located in the path of Hurricane Gustav were identified. The Minimum Data Set resident assessment files were merged with the Centers for Medicare enrollment file to determine date of death for residents in identified facilities. Difference-in-differences analyses were conducted adjusting for residents’ demographic characteristics and acuity. RESULTS: The dataset included 21,255 residents living in 119 at risk nursing homes over three years of observation. Relative to the two years before the storm, there was a 2.8 percent increase in death at 30 days and a 3.9 percent increase in death at 90 days for residents with severe dementia who evacuated for Hurricane Gustav, controlling for resident demographics and acuity. CONCLUSIONS: The findings of this research reveal the deleterious effects of evacuation on residents with severe dementia. Interventions need to be developed and tested to determine the best methods for protecting this at risk population when there are no other options than to evacuate the facility.
Older people leaving hospital: a statistical overview of the transition care program 2009-10 and 2010-11 presents key statistics about transition care services provided to older people directly after discharge from hospital. The Transition Care Program aims to improve recipients’ independence and functioning, and has assisted nearly 52,000 people since it started in 2005-06, including 18,000 individuals who received just under 20,300 episodes of transition care in 2010-11. The report includes for the first time an analysis of trends since the program’s establishment, and an examination of the final outcomes of people receiving consecutive episodes of care.
2013 CADTH Symposium
St. John’s, NL May 5-7, 2013
This year’s event, themed Evidence in Context, will have both Canadian and International presenters and attendees discussing and exchanging thoughts on how the role of evidence, context, and other factors are integral to decisions made regarding health technologies.
IHI/BMJ International Forum on Quality & Safety in Healthcare
16-19 April, 2013 London, UK
Join 3,000 of your colleagues from 90 countries in London on April 16-19, 2013. Improve Quality, Reduce Costs, Save Lives is the theme for the 2013 IHI/BMJ International Forum on Quality and Safety in Healthcare which continues to build upon previous Forums’ commitment to excellent, safe, and affordable health care.
Learn from the following health care leaders at the 2013 International Forum:
2nd Biennial SIRC (2013): Solving Implementation Research Dilemmas
May 16-17. 2013 Seattle, WA
SIRC is a conference series that brings together implementation stakeholders committed to the rigorous evaluation of implementation of evidence based psychosocial interventions. Conferences occur biennially; our next conference will be May 16-17, 2013.
Dr. Cy Frank will become the corporation’s Chief Executive Officer (CEO) on April 1, 2013. Dr. Frank currently holds a number of leadership positions in the academic, clinical, health services, administrative, and medical device sectors, including senior roles at Alberta Health Services, the Alberta Bone and Joint Health Institute (ABJHI), the University of Calgary (U of C), and with the recently sold TENET Medical Engineering, a Calgary based company. He was the Scientific Director of the Institute of Musculoskeletal Health and Arthritis (IMHA) at the Canadian Institutes of Health Research (CIHR) for six years. Dr. Frank has had a long association with AIHS (formerly AHFMR) as a recipient of research and innovation funding over three decades.
There is a “disgraceful” variation in the number of proportion with dementia being diagnosed across the UK, according to the Alzheimer’s Society. About 800,000 people in the UK have some form of dementia, but most have not been diagnosed. Estimates by the charity suggest 32% were diagnosed in the East Riding of Yorkshire compared with 76% in Belfast. The government said the variation was “unacceptable” and caused “unnecessary suffering”.
Residents of Quebec and Ontario receive better value for money from their public health care systems than other Canadians, concludes a new report from the Fraser Institute, one of Canada’s public policy think-tank.
More than 360,000 regulated nurses were employed in Canada in 2011, representing an increase of more than 8% since 2007. This growth rate was nearly twice the rate of population growth, according to the Canadian Institute for Health Information (CIHI) annual report on the nursing workforce. However, the number of registered nurses per 100,000 remains below the peak reached in the early 1990s. For more information, read the report: Regulated Nurses: Canadian Trends, 2007 to 2011
Time for something fun Future of the Hospital: A Game
You are invited to join the Future of the Hospital a one-of-a-kind, 24-hour collaborative forecasting game designed and run by the Institute for the Future, a game designed to provoke and inspire a range of possibilities for the future of the community hospital. Created and produced by Institute for the Future , the goal of the Future of the Hospital is to inspire a conversation about a new 21st century role for community hospitals.
Call for Nominations for Editorship of the American Journal of Evaluation (2014-16)
DEADLINE: February 1, 2013
The Editor Selection Task Force of the Board of Directors of the American Evaluation Association invites nominations for the editorship of the American Journal of Evaluation (AJE).AJE publishes original papers about the methods, theory, practice, and findings of evaluation. The general goal of AJE is to present the best work in and about evaluation, in order to improve the knowledge base and practice of its readers. Because the field of evaluation is diverse, with different intellectual traditions, approaches to practice, and domains of application, the papers published in AJE reflect this diversity. Nevertheless, preference is given to papers that are likely to be of interest to a wide range of evaluators and that are written to be accessible to most readers.
Journal of Clinical Nursing seeks Editor
DEADLINE February 28, 2013
The successful candidate for the position of Editor will: be recognized internationally for the quality of her or his academic and research achievements; have worked at a strategic level within academia or healthcare; and have an impressive track record of publications and presentations at conferences.