Latest KUSP Publication
A protocol for advanced psychometric assessment of surveys.
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Squires JE, Hayduk L, Hutchinson AM, Cranley LA, Gierl M, Cummings GG, et al.
Nursing research and practice 2013;2013:156782
Background and Purpose. In this paper, we present a protocol for advanced psychometric assessments of surveys based on the Standards for Educational and Psychological Testing. We use the Alberta Context Tool (ACT) as an exemplar survey to which this protocol can be applied. Methods. Data mapping, acceptability, reliability, and validity are addressed. Acceptability is assessed with missing data frequencies and the time required to complete the survey. Reliability is assessed with internal consistency coefficients and information functions. A unitary approach to validity consisting of accumulating evidence based on instrument content, response processes, internal structure, and relations to other variables is taken. We also address assessing performance of survey data when aggregated to higher levels (e.g., nursing unit). Discussion. In this paper we present a protocol for advanced psychometric assessment of survey data using the Alberta Context Tool (ACT) as an exemplar survey; application of the protocol to the ACT survey is underway. Psychometric assessment of any survey is essential to obtaining reliable and valid research findings. This protocol can be adapted for use with any nursing survey.
New article by Kim Fraser, Hannah O’Rourke, and Anne-Marie Boström
Unregulated provider perceptions of audit and feedback reports in long-term care: cross-sectional survey findings from a quality improvement intervention.
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Fraser KD, O Rourke HM, Baylon MA, Bostrom AM, Sales AE.
BMC geriatrics 2013 Feb 13;13(1):15
BACKGROUND: Audit with feedback is a moderately effective approach for improving professional practice in other health care settings. Although unregulated caregivers give the majority of direct care in long-term care settings, little is known about how they understand and perceive feedback reports because unregulated providers have not been directly targeted to receive audit with feedback in quality improvement interventions in long-term care. The purpose of this paper is to describe unregulated care providers’ perceptions of usefulness of a feedback report in four Canadian long-term care facilities. METHODS: We delivered monthly feedback reports to unregulated care providers for 13 months in 2009–2010. The feedback reports described a unit’s performance in relation to falls, depression, and pain as compared to eight other units in the study. Follow-up surveys captured participant perceptions of the feedback report. We conducted descriptive analyses of the variables related to participant perceptions and multivariable logistic regression to assess the association between perceived usefulness of the feedback report and a set of independent variables. RESULTS: The vast majority (80%) of unregulated care providers (n = 171) who responded said they understood the reports. Those who discussed the report with others and were interested in other forms of data were more likely to find the feedback report useful for making changes in resident care. CONCLUSIONS: This work suggests that unregulated care providers can understand and feel positively about using audit with feedback reports to make changes to resident care. Further research should explore ways to promote fuller engagement of unregulated care providers in decision-making to improve quality of care in long-term care settings.
New article by Lars Wallin
Swedish Translation, Adaptation and Psychometric Evaluation of the Context Assessment Index (CAI).
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Nilsson Kajermo K, Boe H, Johansson E, Henriksen E, McCormack B, Gustavsson JP, et al.
Worldviews on evidence-based nursing, 2013 Feb;10(1):41-50
The strength of and relationship between the fundamental elements context, evidence and facilitation of the PARIHS framework are proposed to be key for successful implementation of evidence into healthcare practice. A better understanding of the presence and strength of contextual factors is assumed to enhance the opportunities of adequately developing an implementation strategy for a specific setting. A tool for assessing context-The Context Assessment Index (CAI)-was developed and published 2009. A Swedish version of the instrument was developed and evaluated among registered nurses. This work forms the focus of this paper. PURPOSE: The purpose of this study was to translate the CAI into Swedish, adapt the instrument for use in Swedish healthcare practice and assess its psychometric properties. METHODS: The instrument was translated and back-translated to English. The feasibility of items and response scales were evaluated through think aloud interviews with clinically active nurses. Psychometric properties were evaluated in a sample of registered nurses (n = 373) working in a variety of healthcare organisations in the Stockholm area. Item and factor analyses and Cronbach’s alpha were computed to evaluate internal structure and internal consistency. RESULT: Sixteen items were modified based on the think aloud interviews and to adapt the instrument for use in acute care. A ceiling effect was observed for many items and the originally identified 37 item five-factor model was not confirmed. Item analyses showed an overlap between factors and indicated a one-dimensional scale. DISCUSSION: The Swedish version of the CAI has a wider application than the original instrument. This might have contributed to the differences in factor structure. Different opportunities for further development of the scale are discussed. CONCLUSIONS: Further evaluation of the psychometric properties of the CAI is required. © 2012 The authors. World Views on Evidence-Based Nursing © Sigma Theta Tau International.
CALL FOR PAPERS: National Bureau of Economic Research: Hospital Organization and Productivity
Cape Cod, MA October 4-5, 2013
DEADLINE 28 February 2013
The NBER is organizing a conference on how organizational structure, management practices, and related innovations affect the costs and cost-effectiveness of health care, focusing on the hospital industry and health systems that have hospitals at their core.
CALL FOR ABSTRACTS:
The Art of Good Health and Wellbeing
DEADLINE Tuesday 30 April 2013
The Art of Good Health and Wellbeing, 5th Annual International Arts and Health Conference, will present best practice and innovative arts and health programs, effective health promotion and prevention campaigns, methods of project evaluation and scientific research.
CALL FOR PAPERS: Special Issue of Action Research: Action Research in Healthcare
DEADLINE: May 1, 2013
Action research as a broad approach to change has gained a growing legacy in the healthcare sector and this is the focus of this special issue. We see action research as representing a transformative orientation to knowledge creation for healthcare in that action researchers seek to take knowledge production beyond the gate-keeping of professional knowledge makers to empower all stakeholders in the healthcare arena.
Grants & Awards
CIHR: Dissemination Events Spring 2013 Competition
DEADLINE June 17, 2013
The specific objective of this funding opportunity is to support events/activities that contribute to the dissemination, exchange and uptake of research evidence.
Events/activities may focus on, but are not limited to, the following:
- Education of groups such as patients, health professionals, community organizations, policy-makers, the general public;
- Knowledge dissemination that will inform practice, clinical care, partnership best practices, policy and decision making;
- Dissemination and/or discussion of research findings at scientific meetings, workshops, conferences, congresses or symposia.
CIHR: Planning Grants Spring 2013 Competition
DEADLINE June 17, 2013
The specific objective of this funding opportunity is to provide support for planning activities, partnership development and/or increasing the team’s understanding of the health research landscape that will contribute to the advancement of research consistent with the mandate of CIHR.
Activities may focus on, but are not limited to, the following:
- Activities that assist potential teams of researchers, knowledge-users and/or partners in working together to identify research questions or emerging issues and priorities that could form the basis of a grant application;
- Stakeholder consultations, including citizen engagement activities, regarding needs, gaps and opportunities in the health research landscape, priority policy issues and/or priority research questions, where such common understanding is currently lacking or requires further development;
- Initial planning and discussion of a research project among potential team members including researchers, knowledge-users and/or partners to assess the viability of the research project and the partnership;
- Conducting an environmental scan or preliminary synthesis of relevant literature, activities or programs;
- Early-stage planning to determine possible commercial viability of a discovery;
- Opportunities for knowledge exchange involving stakeholder linkages (to inform practice, care, and/or policy) that could potentially lead to an application to a funding opportunity;
- Gatherings of partners, health researchers, and/or knowledge users where the main objective is to facilitate regional/national and/or international collaboration among individuals or groups from a variety of backgrounds (for example, building new and existing multi-sectored partnerships that include a significant number of participants from outside the conventional scientific community, consensus meetings, networking and partnership development events) interested in applying to a funding opportunity.
CIHR Barer-Flood Prize for Health Services and Policy Research
DEADLINE May 1, 2013
The CIHR Barer-Flood Prize for Health Services and Policy Research is a career achievement award that honours and recognizes an exceptional researcher in the area of health services and policy research who has created a seminal body of work that has had a substantial impact on health services and policy research, policy and/or care delivery.
Sigma Theta Tau International Global Research Grant
DEADLINE May 1, 2013
To be eligible for grant consideration, projects should focus on a global response to health disparities. Principal investigators should be registered nurses (or country equivalent) with current licenses and at least a master’s in nursing (or country equivalent).
NIH: 2013 Summer Institute on Aging Research
DEADLINE March 22, 2013. This award is only open to US citizens or permanent residents of the US.
This 6-day workshop for investigators new to the field is focused on current issues, research methodologies, and funding opportunities. The Summer Institute, one of the premier short-term training opportunities for new investigators, is scheduled to be held July 14-19, 2013 in Bethesda, Maryland, on the campus of the National Institutes of Health. Support is available for travel and living expenses.
An Overview of Practice Facilitation Programs in Canada: Current Perspectives and Future Directions
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Clare Liddy, Dianne Laferriere, Bruce Baskerville, Simone Dahrouge, Lyndee Knox and William Hogg.
Healthcare Policy 2013 01/02;8(3):58-68
Practice facilitation has proven to be effective in improving the quality of primary care. A practice facilitator is a health professional, usually external to the practice, who regularly visits the practice to provide support in change management that targets improvements in the delivery of care. Our environmental scan shows that several initiatives across Canada utilize practice facilitation as a quality improvement method; however, many are conducted in isolation as there is a lack of coordinated effort, knowledge translation and dissemination in this field across the country. We recommend that investments be made in capacity building, knowledge exchange and facilitator training, and that partnership building be considered a priority in this field.
Policy and practice impacts of applied research: a case study analysis of the New South Wales Health Promotion Demonstration Research Grants Scheme 2000–2006
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Milat AJ, Laws R, King L, Newson R, Rychetnik L, Rissel C, et al.
Health research policy and systems 2013 Feb 2;11(1):5
BACKGROUND: Intervention research provides important information regarding feasible and effective interventions for health policy makers, but few empirical studies have explored the mechanisms by which these studies influence policy and practice. This study provides an exploratory case series analysis of the policy, practice and other related impacts of the 15 research projects funded through the New South Wales Health Promotion Demonstration Research Grants Scheme between 2000–2006 and explored the factors mediating impacts. METHODS: Data collection included semi-structured interviews with the Chief Investigators (n=17) and end users (n=29) of each of the 15 projects to explore if, how, and under what circumstances the findings had been used, bibliometric analysis and verification using documentary evidence. Data analysis involved thematic coding of interview data and triangulation with other data sources to produce case summaries of impacts for each project. Case summaries were then individually assessed against four impact criteria and discussed at a verification panel meeting where final group assessments of the impact of research projects were made and key influences of research impact identified. RESULTS: Funded projects had variable impacts on policy and practice. Projects findings were used for agenda setting (raising awareness of issues), identifying areas and target groups for interventions, informing new policies and supporting and justifying existing policies and programs across sectors. Reported factors influencing the use of findings were: 1) nature of the intervention; 2) leadership and champions; 3) research quality; 4) effective partnerships; 5) dissemination strategies used, and 6) contextual factors. CONCLUSIONS: The case series analysis provides new insights into how and under what circumstances intervention research is used to influence real world policy and practice. The findings highlight that intervention research projects can achieve the greatest policy and practice impacts if they address proximal needs of the policy context by engaging end users from the inception of projects and utilising existing policy networks and structures, and using a range of strategies to disseminate findings that go beyond traditional peer review publications.
How hard can it be to include research evidence and evaluation in local health policy implementation? Results from a mixed methods study
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Evans BA, Snooks H, Howson H, Davies M.
Implementation science : IS 2013 Feb 12;8:17-5908-8-17
Although an evidence-based approach is the ideal model for planning and delivering healthcare, barriers exist to using research evidence to implement and evaluate service change. This paper aims to inform policy implementation and evaluation by understanding the role of research evidence at the local level through implementation of a national chronic conditions management policy. METHODS: We conducted a national email survey of health service commissioners at the most devolved level of decision-making in Wales (Local Health Boards – LHBs) followed by in-depth interviews with representatives of LHBs, purposively selecting five to reflect geographic and economic characteristics. Survey data were analysed descriptively; we used thematic analysis for interview data. RESULTS: All LHBs (n = 22) completed questionnaires. All reported they routinely assessed the research literature before implementing interventions, but free-text answers revealed wide variation in approach. Most commonly reported information sources included personal contacts, needs assessments, information or research databases. No consistent approach to evaluation was reported. Frequently reported challenges were: insufficient staff capacity (17/22); limited skills, cost, limited time, competing priorities (16/22); availability and quality of routine data (15/22). Respondents reported they would value central guidance on evaluation.Five interviews were held with managers from the five LHBs contacted. Service delivery decisions were informed by Welsh Government initiatives and priorities, budgets, perceived good practice, personal knowledge, and local needs, but did not include formal research evidence, they reported. Decision making was a collaborative process including clinical staff, patient representatives, and partner organization managers with varying levels of research experience. Robust evaluation data were required, but they were constrained by a lack of skills, time, and resources. They viewed evaluation as a means of demonstrating that targets had been met. CONCLUSIONS: There is a gap between evidence-based aims of national health policy and how health services are commissioned, implemented, and evaluated at local level. Commissioners and managers are unable to routinely incorporate research evidence. If health services research is to identify most effective ways to implement high quality care, it should be incorporated into commissioning and service delivery. Local commissioners and managers need to build the critical use of research evidence and evaluation into health policy implementation at local level in order to provide consistent and effective healthcare services.
Utilization of a population health survey in policy and practice: a case study.
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Laws R, King L, Hardy LL, Milat A, Rissel C, Newson R, et al.
Health research policy and systems 2013 Jan 30;11:4-4505-11-4
There is growing interest by funding bodies and researchers in assessing the impact of research on real world policy and practice. Population health monitoring surveys provide an important source of data on the prevalence and patterns of health problems, but few empirical studies have explored if and how such data is used to influence policy or practice decisions. Here we provide a case study analysis of how the findings from an Australian population monitoring survey series of children’s weight and weight-related behaviors (Schools Physical Activity and Nutrition Survey (SPANS)) have been used, and the key facilitators and barriers to their utilization. METHODS: Data collection included semi-structured interviews with the chief investigators (n = 3) and end-users (n = 9) of SPANS data to explore if, how and under what circumstances the survey findings had been used, bibliometric analysis and verification using documentary evidence. Data analysis involved thematic coding of interview data and triangulation with other data sources to produce case summaries of policy and practice impacts for each of the three survey years (1997, 2004, 2010). Case summaries were then reviewed and discussed by the authors to distil key themes on if, how and why the SPANS findings had been used to guide policy and practice. RESULTS: We found that the survey findings were used for agenda setting (raising awareness of issues), identifying areas and target groups for interventions, informing new policies, and supporting and justifying existing policies and programs across a range of sectors. Reported factors influencing use of the findings were: i) the perceived credibility of survey findings; ii) dissemination strategies used; and, iii) a range of contextual factors. CONCLUSIONS: Using a novel approach, our case study provides important new insights into how and under what circumstances population health monitoring data can be used to influence real world policy and practice. The findings highlight the importance of population monitoring programs being conducted by independent credible agencies, researchers engaging end-users from the inception of survey programs and utilizing existing policy networks and structures, and using a range of strategies to disseminate the findings that go beyond traditional peer review publications.
ABSTRACT: Understanding and evaluating the implementation of complex interventions in practice is an important problem for healthcare managers and policy makers, and for patients and others who must operationalize them beyond formal clinical settings. It has been argued that this work should be founded on theory that provides a foundation for understanding, designing, predicting, and evaluating dynamic implementation processes. This paper sets out core constituents of a general theory of implementation, building on Normalization Process Theory and linking it to key constructs from recent work in sociology and psychology. These are informed by ideas about agency and its expression within social systems and fields, social and cognitive mechanisms, and collective action. This approach unites a number of contending perspectives in a way that makes possible a more comprehensive explanation of the implementation and embedding of new ways of thinking, enacting and organizing practice.
Developing a measure of provider adherence to improve the implementation of behavioral health services in primary care: a Delphi study.
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Beehler GP, Funderburk JS, Possemato K, Vair CL.
Implementation science : IS 2013 Feb 13;8(1):19
BACKGROUND: The integration of behavioral health services into primary care is increasingly popular, yet fidelity of implementation in this area has been infrequently assessed due to the few measurement tools available. A sentinel indicator of fidelity of implementation is provider adherence, or utilization of prescribed procedures and engagement in model-specific behaviors. This study aimed to develop the first self-report measure of behavioral health provider adherence for co-located, collaborative care, a commonly adopted model of behavioral health service delivery in primary care. METHODS: A preliminary 56-item measure was developed by the research team to represent critical components of adherence among behavioral health providers. To ensure the content validity of the measure, a modified Delphi study was conducted using a panel of co-located, collaborative care model experts. During three rounds of emailed surveys, panel members provided qualitative feedback regarding item content while rating each item’s relevance for behavioral health provider practice. Items with consensus ratings of 80% or greater were included in the final adherence measure. RESULTS: The panel consisted of 25 experts representing the Department of Veterans Affairs, the Department of Defense, and academic and community health centers (total study response rate of 76%). During the Delphi process, two new items were added to the measure, four items were eliminated, and a high level of consensus was achieved on the remaining 54 items. Experts identified 38 items essential for model adherence, six items compatible (although not essential) for model adherence, and 10 items that represented prohibited behaviors. Item content addressed several domains, but primarily focused on behaviors related to employing a time-limited, brief treatment model, the scope of patient concerns addressed, and interventions used by providers. CONCLUSIONS: This study yielded the first content valid self-report measure of critical components of collaborative care adherence for use by behavioral health providers in primary care. Although additional psychometric evaluation is necessary, this measure may assist implementation researchers in clarifying how provider behaviors contribute to clinical outcomes. This measure may also assist clinical stakeholders in monitoring implementation and identifying ways to support frontline providers in delivering high quality services.
Framework of policy recommendations for implementation of evidence-based practice: a systematic scoping review.
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Ubbink DT, Guyatt GH, Vermeulen H.
BMJ open 2013 Jan 24;3(1):10.1136/bmjopen-2012-001881.
Evidence-based practice (EBP) may help improve healthcare quality. However, not all healthcare professionals and managers use EBP in their daily practice. We systematically reviewed the literature to summarise self-reported appreciation of EBP and organisational infrastructure solutions proposed to promote EBP. DESIGN: Systematic review. Two investigators independently performed the systematic reviewing process. INFORMATION SOURCES: MEDLINE, EMBASE and Cochrane Library were searched for publications between 2000 and 2011. ELIGIBILITY CRITERIA FOR INCLUDED STUDIES: Reviews and surveys of EBP attitude, knowledge, awareness, skills, barriers and facilitators among managers, doctors and nurses in clinical settings. RESULTS: We found 31 surveys of fairly good quality. General attitude towards EBP was welcoming. Respondents perceived several barriers, but also many facilitators for EBP implementation. Solutions were proposed at various organisational levels, including (inter)national associations and hospital management promoting EBP, pregraduate and postgraduate education, as well as individual support by EBP mentors on the wards to move EBP from the classroom to the bedside. CONCLUSIONS: More than 20 years after its introduction, the EBP paradigm has been embraced by healthcare professionals as an important means to improve quality of patient care, but its implementation is still deficient. Policy exerted at microlevel , middlelevel and macrolevel, and supported by professional, educational and managerial role models, may further facilitate EBP.
The silent period of evidence integration in fast decision making.
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Ruter J, Sprekeler H, Gerstner W, Herzog MH.
PloS one 2013;8(1):e46525
In a typical experiment on decision making, one out of two possible stimuli is displayed and observers decide which one was presented. Recently, Stanford and colleagues (2010) introduced a new variant of this classical one-stimulus presentation paradigm to investigate the speed of decision making. They found evidence for “perceptual decision making in less than 30 ms”. Here, we extended this one-stimulus compelled-response paradigm to a two-stimulus compelled-response paradigm in which a vernier was followed immediately by a second vernier with opposite offset direction. The two verniers and their offsets fuse. Only one vernier is perceived. When observers are asked to indicate the offset direction of the fused vernier, the offset of the second vernier dominates perception. Even for long vernier durations, the second vernier dominates decisions indicating that decision making can take substantial time. In accordance with previous studies, we suggest that our results are best explained with a two-stage model of decision making where a leaky evidence integration stage precedes a race-to-threshold process.
Measuring factors affecting implementation of health innovations: A systematic review of structural, organizational, provider, patient, and innovation level measures.
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Chaudoir SR, Dugan AG, Barr CH.
Implementation science : IS 2013 Feb 17;8(1):22
BACKGROUND: Two of the current methodological barriers to implementation science efforts are the lack of agreement regarding constructs hypothesized to affect implementation success and identifiable measures of these constructs. In order to address these gaps, the main goals of this paper were to identify a multi-level framework that captures the predominant factors that impact implementation outcomes, conduct a systematic review of available measures assessing constructs subsumed within these primary factors, and determine the criterion validity of these measures in the search articles METHOD: We conducted a systematic literature review to identify articles reporting the use or development of measures designed to assess constructs that predict the implementation of evidence-based health innovations. Articles published through 12 August 2012 were identified through MEDLINE, CINAHL, PsycINFO and the journal Implementation Science. We then utilized a modified five-factor framework in order to code whether each measure contained items that assess constructs representing structural, organizational, provider, patient, and innovation level factors. Further, we coded the criterion validity of each measure within the search articles obtained. RESULTS: Our review identified 62 measures. Results indicate that organization, provider, and innovation-level constructs have the greatest number of measures available for use, whereas structural and patient-level constructs have the least. Additionally, relatively few measures demonstrated criterion validity, or reliable association with an implementation outcome (e.g., fidelity). DISCUSSION: In light of these findings, our discussion centers on strategies that researchers can utilize in order to identify, adapt, and improve extant measures for use in their own implementation research. In total, our literature review and resulting measures compendium increases the capacity of researchers to conceptualize and measure implementation-related constructs in their ongoing and future research.
Need to Knowledge (NtK) Model: an evidence-based framework for generating technological innovations with socio-economic impacts.
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Flagg JL, Lane JP, Lockett MM.
Implementation science 2013 Feb 15;8(1):21
BACKGROUND: Traditional government policies suggest that upstream investment in scientific research is necessary and sufficient to generate technological innovations. The expected downstream beneficial socio-economic impacts are presumed to occur through non-government market mechanisms. However, there is little quantitative evidence for such a direct and formulaic relationship between public investment at the input end and marketplace benefits at the impact end. Instead, the literature demonstrates that the technological innovation process involves a complex interaction between multiple sectors, methods, and stakeholders. DISCUSSION: The authors theorize that accomplishing the full process of technological innovation in a deliberate and systematic manner requires an operational-level model encompassing three underlying methods, each designed to generate knowledge outputs in different states: scientific research generates conceptual discoveries; engineering development generates prototype inventions; and industrial production generates commercial innovations. Given the critical roles of engineering and business, the entire innovation process should continuously consider the practical requirements and constraints of the commercial marketplace. The Need to Knowledge (NtK) Model encompasses the activities required to successfully generate innovations, along with associated strategies for effectively communicating knowledge outputs in all three states to the various stakeholders involved. It is intentionally grounded in evidence drawn from academic analysis to facilitate objective and quantitative scrutiny, and industry best practices to enable practical application. SUMMARY: The Need to Knowledge (NtK) Model offers a practical, market-oriented approach that avoids the gaps, constraints and inefficiencies inherent in undirected activities and disconnected sectors. The NtK Model is a means to realizing increased returns on public investments in those science and technology programs expressly intended to generate beneficial socio-economic impacts.
Developing leadership capacity for guideline use a pilot cluster randomized control trial
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Gifford WA, Davies BL, Graham ID, Tourangeau A, Woodend AK, Lefebre N.
Worldviews on evidence-based nursing 2013 Feb;10(1):51-65
The importance of leadership to influence nurses’ use of clinical guidelines has been well documented. However, little is known about how to develop and evaluate leadership interventions for guideline use. PURPOSE: The purpose of this study was to pilot a leadership intervention designed to influence nurses’ use of guideline recommendations when caring for patients with diabetic foot ulcers in home care nursing. This paper reports on the feasibility of implementing the study protocol, the trial findings related to nursing process outcomes, and leadership behaviors. METHODS: A mixed methods pilot study was conducted with a post-only cluster randomized controlled trial and descriptive qualitative interviews. Four units were randomized to control or experimental groups. Clinical and management leadership teams participated in a 12-week leadership intervention (workshop, teleconferences). Participants received summarized chart audit data, identified goals for change, and created a team leadership action. Criteria to assess feasibility of the protocol included: design, intervention, measures, and data collection procedures. For the trial, chart audits compared differences in nursing process outcomes. Primary outcome: 8-item nursing assessments score. Secondary outcome: 5-item score of nursing care based on goals for change identified by intervention participants. Qualitative interviews described leadership behaviors that influenced guideline use. RESULTS: Conducting this pilot showed some aspects of the study protocol were feasible, while others require further development. Trial findings observed no significant difference in the primary outcome. A significant increase was observed in the 5-item score chosen by intervention participants (p = 0.02). In the experimental group more relations-oriented leadership behaviors, audit and feedback and reminders were described as leadership strategies. CONCLUSIONS: Findings suggest that a leadership intervention has the potential to influence nurses’ use of guideline recommendations, but further work is required to refine the intervention and outcome measures. A taxonomy of leadership behaviors is proposed to inform future research. © 2012 The authors. World Views on Evidence-Based Nursing © Sigma Theta Tau International.
Leadership of healthcare commissioning networks in England: a mixed-methods study on clinical commissioning groups.
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Zachariadis M, Oborn E, Barrett M, Zollinger-Read P.
BMJ open 2013 Feb 20;3(2):10.1136/bmjopen-2012-002112.
To explore the relational challenges for general practitioner (GP) leaders setting up new network-centric commissioning organisations in the recent health policy reform in England, we use innovation network theory to identify key network leadership practices that facilitate healthcare innovation. DESIGN: Mixed-method, multisite and case study research. SETTING: Six clinical commissioning groups and local clusters in the East of England area, covering in total 208 GPs and 1 662 000 population. METHODS: Semistructured interviews with 56 lead GPs, practice managers and staff from the local health authorities (primary care trusts, PCT) as well as various healthcare professionals; 21 observations of clinical commissioning group (CCG) board and executive meetings; electronic survey of 58 CCG board members (these included GPs, practice managers, PCT employees, nurses and patient representatives) and subsequent social network analysis. MAIN OUTCOME MEASURES: Collaborative relationships between CCG board members and stakeholders from their healthcare network; clarifying the role of GPs as network leaders; strengths and areas for development of CCGs. RESULTS: Drawing upon innovation network theory provides unique insights of the CCG leaders’ activities in establishing best practices and introducing new clinical pathways. In this context we identified three network leadership roles: managing knowledge flows, managing network coherence and managing network stability. Knowledge sharing and effective collaboration among GPs enable network stability and the alignment of CCG objectives with those of the wider health system (network coherence). Even though activities varied between commissioning groups, collaborative initiatives were common. However, there was significant variation among CCGs around the level of engagement with providers, patients and local authorities. Locality (sub) groups played an important role because they linked commissioning decisions with patient needs and brought the leaders closer to frontline stakeholders. CONCLUSIONS: With the new commissioning arrangements, the leaders should seek to move away from dyadic and transactional relationships to a network structure, thereby emphasising on the emerging relational focus of their roles. Managing knowledge mobility, healthcare network coherence and network stability are the three clinical leadership processes that CCG leaders need to consider in coordinating their network and facilitating the development of good clinical commissioning decisions, best practices and innovative services. To successfully manage these processes, CCG leaders need to leverage the relational capabilities of their network as well as their clinical expertise to establish appropriate collaborations that may improve the healthcare services in England. Lack of local GP engagement adds uncertainty to the system and increases the risk of commissioning decisions being irrelevant and inefficient from patient and provider perspectives.
Barriers to research utilization by registered nurses in Taiwan.
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Chen SH, Shao JH, Hsiao YC, Lee HC.
Research in nursing & health 2013 Feb 13
This cross-sectional study was designed to identify barriers to research utilization among registered nurses (N = 510) in clinical settings in Taiwan. Data were collected by mailed survey. Barriers were measured by the Barriers to Research Utilization Scale-Chinese version, which has four subscales: characteristics of the adopter (nurse), organization (setting barriers and limitations), innovation (research qualities), and communication (presentation/accessibility of the research). Research utilization was predicted by frequency of reading professional literature, years of research experience, hospital classification, and the barriers of communication, innovation, and adopter characteristics. These findings indicate the need to enhance Taiwanese nurses’ research efficacy, research-based information, and research experiences. Nursing administrators should create a research-friendly climate and support implementing research findings. © 2013 Wiley Periodicals, Inc. Res Nurs Health. Copyright © 2013 Wiley Periodicals, Inc.
Knowledge exchange throughout the dementia care journey by Canadian rural community-based health care practitioners, persons with dementia, and their care partners: an interpretive descriptive study.
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Forbes DA, Finkelstein S, Blake CM, Gibson M, Morgan DG, Markle-Reid M, et al.
Rural and remote health 2012 Oct;12(4):2201
Accessing, assessing, exchanging, and applying dementia care information can be challenging in rural communities for healthcare practitioners (HCPs), persons with dementia (PWD), and their care partners. The overall purpose of this research was to enable HCPs, care partners, and PWD to use dementia care information more effectively by examining their information needs, how these change over time, and how they access, assess, and apply the knowledge. METHODS: A qualitative interpretive descriptive approach was used. A convenience sample was initially recruited through study collaborators in Southwestern Ontario, followed by purposive sampling. Nine rural dementia care networks consisting of PWD (n = 5), care partners (n = 14), and HCPs (n = 14) were recruited and 80 interviews were conducted at three time points. Transcripts were coded using Lubrosky’s thematic analysis. RESULTS: Six stages of the dementia care journey were identified: (1) recognizing the symptoms; (2) receiving a diagnosis; (3) loss of independence; (4) initiating and using home care and respite services; (5) long-term care (LTC) placement; and (6) decisions related to end-of-life care. Rural care partners identified the need for different types of knowledge during each of these critical decision points of the dementia care journey. They accessed information from family members, friends, local organizations, and dementia internet sites. Persons with dementia tended not to identify the need for dementia care information. The HCPs accessed dementia care information from their own organization, other organizations, and internet sites. Care partners and HCPs assessed the trustworthiness of the information based on whether the source was a well-known agency or their own organization. Barriers to knowledge exchange included: lack of rural community-based services for dementia care; care partners reluctant to seek help and had limited energy; and lack of integration of dementia-related services and supports. Facilitators of knowledge exchange included: rural care partners with healthcare experience who were actively seeking information; development of trusting relationships between HCPs, care partners, and PWD; and formal mechanisms for exchanging information within and across rural community-based organizations. METHODS: This research illustrates the stages of the dementia care journey, and the types of information typically needed, accessed, assessed, and applied at each stage. Healthcare practitioners can use these findings to support rural care partners in navigating their dementia care journey. Support is needed as care partners often do not have the time, energy, skills, or knowledge to seek out dementia care information independently. In addition, PWD typically do not recognize the need for this knowledge, leaving care partners potentially isolated in this journey. Developing formal linkages within and across rural organizations will facilitate knowledge exchange and the delivery of cost-effective, quality dementia care. However, additional rural community-based resources are urgently needed to implement these recommendations. This may require a redistribution of resources from acute care to rural community care
Factors influencing rural and urban emergency clinicians’ participation in an online knowledge exchange intervention.
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Curran JA, Murphy AL, Sinclair D, McGrath P.
Rural and remote health 2013 Jan;13(1):2175
Rural emergency departments (EDs) generally have limited access to continuing education and are typically staffed by clinicians without pediatric emergency specialty training. Emergency care of children is complex and the majority of children receive emergency care in non-pediatric tertiary care centers. In recent decades, there has been a call to action to improve quality and safety in the emergency care of children. Of the one million ED visits by children in Ontario in 2005-2006, one in three visited more than once in a year and one in 15 returned to the ED within 72 hours of the index visit. This study explored factors influencing rural and urban ED clinicians’ participation in a Web-based knowledge exchange intervention that focused on best practice knowledge about pediatric emergency care. The following questions guided the study: (i) What are the individual, context of practice or knowledge factors which impact a clinician’s decision to participate in a Web-based knowledge exchange intervention?; (ii) What are clinicians’ perceptions of organizational expectations regarding knowledge and information sources to be used in practice?; and (iii) What are the preferred knowledge sources of rural and urban emergency clinicians? METHODS: A Web-based knowledge exchange intervention, the Pediatric Emergency Care Web Based Knowledge Exchange Project, for rural and urban ED clinicians was developed. The website contained 12 pediatric emergency practice learning modules with linked asynchronous discussion forums. The topics for the modules were determined through a needs assessment and the module content was developed by known experts in the field. A follow-up survey was sent to a convenience sample of 187 clinicians from nine rural and two urban Canadian EDs participating in the pediatric emergency Web-based knowledge exchange intervention study. RESULTS: The survey response rate was 56% (105/187). Participation in the knowledge exchange intervention was related to individual involvement in research activities p=0.019), consultation with colleagues from other EDs p=0.01 and perception of organizational expectations to use research evidence to guide practice p=0.015). Most clinicians (95/105 or 92%) reported relying on colleagues from their own ED as a primary knowledge source. Urban clinicians were more likely than their rural counterparts to perceive that use of research evidence to guide practice was an expectation. Rural clinicians were more likely to rely on physicians from their own ED as a preferred knowledge source. CONCLUSIONS: The decision made by emergency clinicians to participate in a Web-based knowledge exchange intervention was influenced by a number of individual and contextual factors. Differences in these factors and preferences for knowledge sources require further characterization to enhance engagement of rural ED clinicians in online knowledge exchange interventions.
Research SnapShot: Were best practices recommendations adopted by needle and syringe programs?
Evidence Exchange Network
Needle and syringe programs (NSPs) provide a variety of formal and informal services including needle and syringe distribution and disposal, condom distribution, and HIV prevention education. These services reduce needle sharing which in turn reduces HIV transmission and saves money in healthcare. In 2006, a team of researchers and NSP managers developed a set of evidence-based best practice recommendations to ensure consistent, high-quality services across Ontario, Canada. This research is an examination of the changes that took place in NSPs’ policies and practices after the release of the recommendations, and the role they had in influencing such changes.
Today’s health policy‑makers need a clear understanding both of the innovation processes that lead to new technologies and of the ways in which these technologies are disseminated in health systems. This study captures a broad range of experience and data in dealing with the interplay between intellectual property, trade rules and the dynamics of access to, and innovation in, medical technologies.
Making better use of evidence is essential if public services are to deliver more for less. Central to this challenge is the need for a clearer understanding about standards of evidence that can be applied to the research informing social policy. This paper reviews the extent to which it is possible to reach a workable consensus on ways of identifying and labelling evidence. It does this by exploring the efforts made to date and the debates that have ensued. Throughout, the focus is on evidence that is underpinned by research, rather than other sources of evidence such as expert opinion or stakeholder views.
Health Care Administration & Organization
Improving Collaboration between Public Health and Family Health Teams in Ontario
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Michael E Green, Erica Weir, William Hogg, Vera Etches, Kieran Moore and,Richard Birtwhistle.
Healthcare Policy 2013 02/18;8(3):e93-e104
Objectives: To identify and explore areas where responsibilities may overlap between family health teams (FHTs) and public health units (PHUs); to identify facilitators or barriers to collaboration; and to identify priority areas for increased collaboration. Design and context: Cross-sectional mixed-methods study of FHTs and PHUs in Ontario, Canada, consisting of a postal survey, key informant interviews and a roundtable meeting. Results: The survey response rate was 46%. Direct client-based services such as giving immunizations, promoting prenatal health and nutrition, and counselling related to smoking cessation were identified as the top three areas of perceived overlap. The greatest interest in collaboration was expressed in the areas of emergency planning and preparedness, immunization, and prenatal health and nutrition. Good communication with a clear understanding of roles and functions was the most important facilitator, and lack of resources and absence of a clear provincial mandate and direction to collaborate were identified as significant barriers. Conclusions: Small, simple client-based projects of interest to both kinds of organization would be the best way to move forward in the short term. Improving communication between FHTs and PHUs, understanding of roles and functions, the use of shared or interoperable information systems and greater clarity from government on the ways in which these two key sectors of the healthcare system are intended to work together were identified as important for the success of increased collaboration.
Inter-professional Collaboration as a Health Human Resources Strategy: Moving Forward with a Western Provinces Research Agenda
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Grace Mickelson, Esther Suter, Siegrid Deutschlander, Lesley Bainbridge, Liz Harrison, Ruby Grymonpre and Shelanne Hepp.
Healthcare Quarterly 2012 10/29;15(4):41-46
The current gap in research on inter-professional collaboration and health human resources outcomes is explored by the Western Canadian Interprofessional Health Collaborative (WCIHC). In a recent research planning workshop with the four western provinces, 82 stakeholders from various sectors including health, provincial governments, research and education engaged with WCIHC to consider aligning their respective research agendas relevant to inter-professional collaboration and health human resources. Key research recommendations from a recent knowledge synthesis on inter-professional collaboration and health human resources as well as current provincial health priorities framed the discussions at the workshop. This knowledge exchange has helped to consolidate a shared current understanding of inter-professional education and practice and health workforce planning and management among the participating stakeholders. Ultimately, through a focused research program, a well-aligned approach between sectors to finding health human resources solutions will result in sustainable health systems reform.
Over the past decade, many OECD countries have introduced new policies to tackle excessive waiting times for elective surgery with some success. However, in the wake of the recent economic downturn and severe pressures on public budgets, waiting times times may rise again, and it is important to understand which policies work. In addition, the European Union has introduced new regulations to allow patients to seek care in other member states, if there are long delays in treatment. This book provides a framework to understand why there are waiting lists for elective surgery in some OECD countries and not in others. It also describes how waiting times are measured in OECD countries, which differ widely, and makes recommendations for best practice. Finally, it reviews different policy approaches to tackling excessive waiting times. Some countries have introduced guarantees to patients that they will not wait too long for treatment. These policies work only if they are accompanied by sanctions on health providers to ensure the guarantee is met or if they allow greater choice of health-care providers including the private sector. Many countries have also introduced policies to expand supply of surgical services, but these policies have generally not succeeded in the long-term in bringing down waiting times. Given the increasing demand for elective surgery, some countries have experimented with policies to improve priorisation of who is entitled to elective surgery. These policies are promising, but difficult to implement.
In October 2010, Alberta Health Services (AHS) successfully completed phase one of its journey to accreditation, meeting 683 of 774 criteria and earning Accreditation with Condition. AHS entered accreditation during its infancy (18 months, to be exact) in an environment shaped by seismic organizational and structural changes. In this article, the authors share some of the successes, challenges and ongoing opportunities that have emerged during the first years of AHS’s accreditation journey, as well as details of the strong collaborative relationship between AHS and Accreditation Canada.
Measuring team factors thought to influence the success of quality improvement in primary care: a systematic review of instruments.
Non UofA Access
Brennan SE, Bosch M, Buchan H, Green SE.
Implementation science : IS 2013 Feb 14;8(1):20
BACKGROUND: Measuring team factors in evaluations of Continuous Quality Improvement (CQI) may provide important information for enhancing CQI processes and outcomes; however, the large number of potentially relevant factors and associated measurement instruments makes inclusion of such measures challenging. This review aims to provide guidance on the selection of instruments for measuring team-level factors by systematically collating, categorizing, 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: To determine the scope of the review, we developed and used a conceptual framework designed to capture factors relevant to evaluating CQI in primary care (the InQuIRe framework). We included papers reporting development or use of an instrument measuring factors relevant to teamwork. 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 summarizing and comparing instruments. Instrument content was categorized 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 192 potentially relevant instruments, 170 of which were analyzed to develop the taxonomy. Eighty-one instruments measured constructs relevant to CQI teams in primary care, with content covering teamwork context (45 instruments measured enabling conditions or attitudes to teamwork), team process (57 instruments measured teamwork behaviors), and team outcomes (59 instruments measured perceptions of the team or its effectiveness). Forty instruments were included for full review, many with a strong theoretical basis. Evidence supporting measurement properties was limited. CONCLUSIONS: Existing instruments cover many of the factors hypothesized to contribute to QI success. With further testing, use of these instruments measuring team factors in evaluations could aid our understanding of the influence of teamwork on CQI outcomes. Greater consistency in the factors measured and choice of measurement instruments is required to enable synthesis of findings for informing policy and practice.
Do patients’ reports of their health care experiences reflect the quality of care? Despite the increasing role of such measures in research and policy, there’s no consensus regarding their legitimacy in quality assessment. Indeed, as physician and hospital compensation becomes increasingly tied to patient feedback, health care providers and academics are raising strong objections to the use of patient-experience surveys. These views are fueled by studies indicating that patient-experience measures at best have no relation to the quality of delivered care and at worst are associated with poorer patient outcomes. Conversely, other studies have found that better patient experiences — even more than adherence to clinical guidelines — are associated with better outcomes. Which conclusion is correct? We believe that when designed and administered appropriately, patient-experience surveys provide robust measures of quality, and our efforts to assess patient experiences should be redoubled.
The Institute for Clinical Evaluative Sciences: 20 Years and Counting
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Doug Dolan, James Grainger, Nancy MacCallum, Deborah Creatura, Jacqueline Forrester and,Susan Shiller.
Healthcare Quarterly 2012 10/29;15(4):19-21.
In the early 1990s, as the quality and efficiency of healthcare in Ontario were coming under increased scrutiny, provincial officials saw the value of a new type of research institute that would provide evidence-based insights on system performance. But before the government could give its full support to the Institute for Clinical Evaluative Sciences (ICES), there were two hurdles to overcome: First, ICES scientists needed to explain precisely what kind of data they were seeking, and why. Second, the new organization had to formulate a set of privacy protective ground rules – at a time when jurisdictions around the globe were taking the first steps toward creating regulatory frameworks to safeguard personal data.
Getting more generous with the truth: clinical trial reporting in 2013 and beyond.
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PLOS Medicine Editors.
PLoS medicine 2013 Jan;10(1):e1001379
The PLOS Medicine editors discuss the recent initiative from the European Medicines Agency to commit to releasing clinical-trial data and how important such moves are for rebuilding trust between the pharmaceutical companies and society.
Community research partnerships: underappreciated challenges, unrealized opportunities.
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Kulynych J, Heffernan KG.
JAMA : the journal of the American Medical Association 2013 Feb 13;309(6):555-556.
Thousands of physicians, predominantly in primary care and oncology, participate in community research networks sponsored by federal entities, industry, and academia. These numbers, however, are insufficient to achieve the goals of translational research or to realize the potential of ambitious new proposals to fully integrate research and clinical care.3 As attorneys representing academic medical centers (AMCs) that are building research networks, we know that physicians value participation but are deterred by the uncompensated time, uncertain liability, and regulatory complexity of research. Existing network models provide community physicians access to clinical trials but often little help managing research risk or building compliance infrastructure.
In pursuit of certainty: can the systematic review process deliver?
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Saltman D, Jackson D, Newton PJ, Davidson PM.
BMC medical informatics and decision making 2013 Feb 20;13(1):25
BACKGROUND: There has been increasing emphasis on evidence-based approaches to improve patient outcomes through rigorous, standardised and well- validated approaches. Clinical guidelines drive this process and are largely developed based on the findings of systematic reviews (SRs). This paper presents a discussion of the SR process in providing decisive information to shape and guide clinical practice, using a purpose-built review database: the Cochrane reviews; and focussing on a highly prevalent medical condition: hypertension. METHODS: We searched the Cochrane database and identified 25 relevant SRs incorporating 443 clinical trials. Reviews with the terms ‘blood pressure’ or ‘hypertension’ in the title were included. Once selected for inclusion, the abstracts were assessed independently by two authors for their capacity to inform and influence clinical decision-making. The inclusions were independently audited by a third author. RESULTS: Of the 25 SRs that formed the sample, 12 provided conclusive findings to inform a particular treatment pathway. The evidence-based approaches offer the promise of assisting clinical decision-making through clarity, but in the case of management of blood pressure, half of the SRs in our sample highlight gaps in evidence and methodological limitations. Thirteen reviews were inconclusive, and eight, including four of the 12 conclusive SRs, noted the lack of adequate reporting of potential adverse effects or incidence of harm. CONCLUSIONS: These findings emphasise the importance of distillation, interpretation and synthesis of information to assist clinicians. This study questions the utility of evidence-based approaches as a uni-dimensional approach to improving clinical care and underscores the importance of standardised approaches to include adverse events, incidence of harm, patient’s needs and preferences and clinician’s expertise and discretion.
Methodological quality in clinical trials and bibliometric indicators: no evidence of correlations
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Akcan D, Axelsson S, Bergh C, Davidson T, Rosén M.
Citation frequencies and journal impact factors (JIFs) are being used more and more to assess the quality of research and allocate research resources. If these bibliometric indicators are not an adequate predictor of research quality, there could be severe negative consequences for research. To analyse to which extent citation frequencies and journal impact factors correlate with the methodological quality of clinical research articles included in an SBU systematic review of antibiotic prophylaxis in surgery. All 212 eligible original articles were extracted from the SBU systematic review “Antibiotic Prophylaxis in Surgery” and categorized according to their methodological rigourness as high, moderate or low quality articles. Median of citation frequencies and JIFs were compared between the methodological quality groups using Kruskal-Wallis non-parametric test. An in-depth study of low-quality studies with higher citation frequencies/JIFs was also conducted. No significant differences were found in median citation frequencies (p = 0.453) or JIFs (p = 0.185) between the three quality groups. Studies that had high citation frequencies/JIFs but were assessed as low-quality lacked control groups, had high dropout rates or low internal validity. This study of antibiotic prophylaxis in surgery does not support the hypothesis that bibliometric indicators are a valid instrument for assessing methodological quality in clinical trials. This is a worrying observation, since bibliometric indicators have a major influence on research funding. However, further studies in other areas are needed. © 2013 Akadémiai Kiadó, Budapest, Hungary.
Many grant proposals identify the use of a given evaluation model or framework but offer little about how such models are implemented. The authors discuss what it means to employ a specific model, RE-AIM, and key dimensions from this model for program planning, implementation, evaluation, and reporting. The authors report both conceptual and content specifications for the use of the RE-AIM model and a content review of 42 recent dissemination and implementation grant applications to National Institutes of Health that proposed the use of this model. Outcomes include the extent to which proposals addressed the overall RE-AIM model and specific items within the five dimensions in their methods or evaluation plans. The majority of grants used only some elements of the model (less than 10% contained thorough measures across all RE-AIM dimensions). Few met criteria for “fully developed use” of RE-AIM and the percentage of key issues addressed varied from, on average, 45% to 78% across the RE-AIM dimensions. The results and discussion of key criteria should help investigators in their use of RE-AIM and illuminate the broader issue of comprehensive use of evaluation models.
As they age, many seniors develop a progressively more complex mix of health conditions. Multiple prescription medications are often required to help manage these conditions and control symptoms, with the goal of maintaining seniors’ health for as long as possible. This article explores trends in the number and types of medications used by seniors on public drug programs in Canada. Our findings suggest that a high proportion of Canadian seniors are taking several medications, highlighting the need for medication management systems focusing on this population.
Alzheimer’s disease and mortality in traditional long-term care facilities.
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Cereda E, Pedrolli C, Zagami A, Vanotti A, Piffer S, Faliva M, et al.
Archives of Gerontology and Geriatrics 2013 May;56(3):437-441
Although there is evidence that different types of dementia share similar pathophysiologic mechanisms, research studies support the concept that dementia of the Alzheimer type (AD) is a distinct clinical entity, which may differ in terms of disease progression and outcome. We assessed whether a diagnosis of probable AD in elderly patients admitted to traditional long-term care facilities results in different mortality rates. We analyzed data belonging to a prospective, multi-center (n=4) cohort study involving 378 long-term care facility residents. In our population the prevalence of dementia (any-type) and AD were 46.3% and 11.9%, respectively. During a median follow-up of 5.7 years [25-75th percentile, 2.6-6.9], 262 (69.3%) elderly died. Compared to other admission diagnoses, AD was characterized by lower mortality rates: all-cause hazard risk (HR), 0.64 [95% CI, 0.41-0.99] (P=0.048); HR for cardiovascular (CV) causes, 0.40 [95% CI, 0.20-0.78] (P=0.008). Pre-specified subgroup analyses restricted to patients with dementia (n=175) provided similar results. HRs for AD were: all-cause, 0.60 [95% CI, 0.35-1.00] (P=0.049); CV, 0.43 [95% CI, 0.20-0.91] (P=0.028). However, any-type dementia did not show any difference in risk when compared to other admission diagnosis. In conclusion, probable AD was associated with reduced mortality risk in traditional long-term care facilities. The reasons for these findings deserve further investigation; peculiar pathophysiological features could not be excluded. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
Clinician roles and responsibilities during care transitions of older adults.
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Schoenborn NL, Arbaje AI, Eubank KJ, Maynor K, Carrese JA.
Journal of the American Geriatrics Society 2013 Feb;61(2):231-236
To identify the perceived roles and responsibilities of clinicians during care transitions of older adults. DESIGN: Qualitative study involving 1-hour in-depth semistructured interviews. Audiotapes of interviews were transcribed, coded, and analyzed, and themes and subthemes were generated. SETTING: An acute care hospital, a skilled nursing facility, two community-based outpatient practices, and one home healthcare agency. PARTICIPANTS: Forty healthcare professionals directly involved in care transitions of older adults (18 physicians, 11 home healthcare administrative and field staff, four social workers, three nurse practitioners, three physician assistants, and one hospital case manager). MEASUREMENTS: Perspectives of healthcare professionals regarding clinicians’ roles and responsibilities during care transitions were examined and described. RESULTS: Content analysis revealed several themes: components of clinicians’ roles during care transitions; congruence between self- and others’ perceived ideal roles but incongruence between ideal and routine roles; ambiguity in accountability in the postdischarge period; factors prompting clinicians to act closer to ideal roles; and barriers to performing ideal roles. A conceptual framework was created to summarize clinicians’ roles during care transitions. CONCLUSION: This study reports differences between what healthcare professionals perceive as ideal roles of clinicians during care transitions and what clinicians actually do routinely. Certain patient and clinician factors prompt clinicians to act closer to the ideal roles. Multiple barriers interfere with consistent practice of ideal roles. Future investigations could evaluate interventions targeting various components of the conceptual framework and relevant outcomes. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.
Collaborative care management reduces disparities in dementia care quality for caregivers with less education.
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Brown AF, Vassar SD, Connor KI, Vickrey BG.
Journal of the American Geriatrics Society 2013 Feb;61(2):243-251
To examine educational gradients in dementia care and whether the effect of a dementia collaborative care management intervention varied according to the educational attainment of the informal caregiver. DESIGN: Analysis of data from a cluster-randomized controlled trial. SETTING: Eighteen clinics in three healthcare organizations in southern California. PARTICIPANTS: Dyads of Medicare recipients aged 65 and older with a diagnosis of dementia and an eligible caregiver. INTERVENTION: Collaborative care management for dementia. MEASUREMENTS: Caregiver educational attainment, adherence to four dimensions of guideline-recommended processes of dementia care (assessment, treatment, education and support, and safety) before and after the intervention, and the adjusted intervention effect (IE) for each dimension stratified according to caregiver education. Each IE was estimated by subtracting the difference between pre- and postintervention scores for the usual care participants from the difference between pre- and postintervention scores in the intervention participants. RESULTS: At baseline, caregivers with lower educational attainment provided poorer quality of dementia care for the Treatment and Education dimensions than those with more education, but less-educated caregivers had significantly more improvement after the intervention on the assessment, treatment, and safety dimensions. The IEs for those who had not graduated from high school were 44.4 for the assessment dimension, 36.9 for the treatment dimension, and 52.7 for the safety dimension, versus 29.5, 15.7, and 40.9 respectively, for college graduates (P < .001 for all three). CONCLUSIONS: Collaborative care management was associated with smaller disparities in dementia care quality between caregivers with lower educational attainment and those with more education. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.
The relationship between pain and disruptive behaviors in nursing home resident with dementia.
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Ahn H, Horgas A.
BMC geriatrics 2013 Feb 11;13:14-2318-13-14
Nursing home residents with dementia gradually lose the ability to process information so that they are less likely to express pain in typical ways. These residents may express pain through disruptive behaviors because they cannot appropriately verbalize their pain experience. The objective of this study was to investigate the effect of pain on disruptive behaviors in nursing home residents with dementia. METHODS: This is a secondary analysis of the Minimum Data Set (MDS 2.0) assessment data on long-term care from the state of Florida. The data used in this study were the first comprehensive assessment data from NH residents with dementia aged 65 and older (N = 56,577) in Medicare- or Medicaid-certified nursing homes between January 1, 2009 and December 31, 2009. Variables examined were pain, wandering, aggression, agitation, cognitive impairment, activities of daily living impairments, and demographic characteristics. Ordinal logistic regression was used to evaluate the effect of pain on disruptive behaviors. RESULTS: Residents with more severe pain are less likely to display wandering behaviors (OR = .77, 95% CI for OR = [0.73, 0.81]), but more likely to display aggressive and agitated behaviors (OR = 1.04, 95% CI for OR = [1.01, 1.08]; OR = 1.17, 95% CI for OR = [1.13, 1.20]). CONCLUSIONS: The relationship between pain and disruptive behaviors depends on the type of behaviors. Pain is positively correlated with disruptive behaviors that do not involve locomotion (e.g., aggression and agitation), but negatively related to disruptive behaviors that are accompanied by locomotion (e.g., wandering). These findings indicate that effective pain management may help to reduce aggression and agitation, and to promote mobility in persons with dementia.
“It says fat free so you won’t get fat”: Children, media literacy and the challenge of packaged foods
Wednesday, February 27, 2013 12:00 – 13:00 L1-430 ECHA
The Alberta Institute for Human Nutrition presents “It says fat free so you won’t get fat”: Children, media literacy and the challenge of packaged foods with Charlene Elliott PhD, Associate Professor, Department of Communication and Culture at the University of Calgary.
2nd Biennial Seattle Implementation Research Conference (2013): Solving Implementation Research Dilemmas
Seattle, WA May 16-17, 2013
This conference is for researchers who have developed or are interested in:
- models of training, supervision, or implementation
- quantitative or qualitative research designs
- sampling frames or statistical methodology
- community participation strategies
The 2nd Biennial Global Implementation Conference (GIC)
August 19-21, 2013 Washington DC
In 2011, the first Global Implementation Conference (GIC) brought together more than 750 scientists, policy makers, practitioners, and community and organizational leaders from around the world for an unprecedented focus on how evidence-based practices can be implemented effectively to improve outcomes for people and organizations.
CDRAKE: Falls Prevention: Dual-Task Training and Balance Rehabilitation
Wednesday February 27, 2013 10:00-11:00 MT
Presenter: Susan Muir, PhD & Luke Denommé, BSc
Susan will present a novel exercise program that combines physical and cognitive exercises (dual-task training) for community-dwelling older adults with dementia. Training with both physical and cognitive exercises has the potential to prevent falls, decrease loss of function, ease caregiver burden and improve quality of life in this vulnerable group of older adults. Luke’s presentation will focus on a series of experiments which have focused on balance rehabilitation using the Nintendo Wii Fit with various populations whom experience sensory related balance impairments. Luke’s experiments are novel in that he uses a series of clinical and biomechanical analyses to assess: 1) if the Nintendo Wii Fit is in fact an effective training tool to improve the mechanical components associated with balance; and 2) if improvements in balance following training can be translated to balance during dynamic situations
NCCMT and UofA School of Public Health: Policy Readiness Tool
March 19 11:00-12:30 MT
Are you working to create policy change at the local level? Trying to engage several groups to support policy change in your community? Unsure which strategies could help you gain support for the policies you propose? An initial step might be to assess the level of readiness of your municipality for policy change. The Policy Readiness Tool: Understanding a Municipality’s Readiness for Policy Change and Strategies for Taking Action can help you determine your municipality’s level of readiness. The tool is appropriate for municipalities, organizations, and other government bodies, such as school boards. Developed by the School of Public Health, University of Alberta, with support from the Alberta Policy Coalition for Chronic Disease Prevention, the toolkit includes a number of strategies and resources for policy change, such as:
• Providing supportive evidence
• Using media advocacy
• Building relationships with local champions
• Working with decision-makers.
NICHE: Geriatric Education for Nursing Assistants: An Organizational Strategy
March 6, 2013 11:00 MT, Cost Free for NICHE members, $99 for non-members
Presenter: Barb Seliger, BSN, RN-BC
This webinar will feature the history and implementation of specialized education in geriatrics for the certified nursing assistants at Aspirus Wausau Hospital. As the hospital progressed with its NICHE journey, it was understood it needed to impart a basic knowledge and utilize evidence-based practice to encourage the nursing assistants to help avoid functional decline in older adult patients. Join us to learn more about Aspirus Wausau Hospital’s NICHE journey.
Propensity Score Analysis
Taught by Shenyang Guo, Ph.D.
Philadelphia, PA March 22-23, 2013
Propensity score analysis is a relatively new and innovative class of statistical methods that has proven useful for evaluating the effects of treatments or interventions when using nonexperimental or observational data. Although regression analysis is most often used to adjust for potentially confounding variables, propensity score analysis is an attractive alternative. Results produced by propensity score methods are typically easier to communicate to lay audiences. And propensity score estimates are often more robust to differences in the distributions of the confounding variables across the groups being compared.
UCL Institute of Child Health: How to Practise Evidence-Based Child Health
London, UK 19th – 21st June 2013, Costs £450
A 3-day course for health professionals who want to enhance their clinical or research skills, learn more about how to use the best available evidence in their everyday practice and examine evidence underpinning guidelines.
Aims of the course
The course introduces health professionals to the skills required for Evidence-based Practice including:
- framing answerable questions from practice or policy problems
- finding the best available evidence to answer the question
- critically appraising research for its validity and usefulness
- incorporating the findings into decisions
- understanding the process involved in developing guidelines
The course involves a mix of interactive plenary and facilitated small group sessions, combined with training in searching and support for self-directed searching. Key features are an emphasis on multi professional groups and a high tutor-participant ratio.
What is public health surveillance? If public health is about promoting and protecting the health of people, then surveillance is one of the main ways we continuously gather, analyze and interpret health relevant data to achieve this end. Surveillance can warn us about impending public health emergencies. It can reveal how well an intervention has worked. And, with surveillance, we are better positioned to anticipate and respond to public health threats with effective policies and strategies.
Who should attend?
These courses are ideal for practitioners, clinicians and policy developers working in health services, health systems, government and non-governmental organizations. If you have experience in one or more of these areas – but have limited exposure to the theory and practice of surveillance – the knowledge you gain will broaden your understanding and influence how you approach your work. Learn from leading experts in public health surveillance and expand your tool box of skills. Register to learn how you can use surveillance to be more effective in your job.
4 courses are being offered:
- Infectious Disease Outbreak Investigations May 27-28, 2013 Kim Simmonds (Instructor) $550
- Evidence for Decision Making May 2-3, 2013 Suzanne Tough, Nancy Raynolds (Instructors) $550/li>
- Geographic Information Science in Public Health May 30-31, 2013 Erik Ellehoj (Instructor) $550
- Data Analysis for Public Health Surveillance May 23-24, 2013 Lisa Lix(Instructor) $550
A quarter of home-care services provided to the elderly in England are failing to meet quality and safety standards, inspectors say.
Big Data, open access peer-reviewed journal, provides a forum for world-class research exploring the challenges and opportunities in collecting, analyzing, and disseminating vast amounts of data, including data science, big data infrastructure and analytics, and pervasive computing.
Scientists don’t always report everything they discover. Sometimes loose bits of data can be packed up in a box with a bunch of old books and research papers and left in a garage in Sydney, Australia. And that means intriguing, puzzling findings that didn’t make sense back in the day, can slowly retreat into scientific oblivion, about to be lost to humankind for all eternity.
TVO Program on Aging
The Agenda with Steve Paikin: The Week in Review: Aging in Ontario
From planning for retirement to the social costs of aging, The Agenda brings you a review of our Aging in Ontario series. You can watch this online–just follow the link.
The Chief Executive Officer of the Alzheimer Society of Canada is Mrs. Mimi Lowi-Young whose term of office commences on December 17, 2012.
The BC Health Coalition says that the 2013 budget does not take the necessary steps toward improving seniors’ care nor ensuring the long term sustainability of the public health care system.
A new journal seeks to rethink how science communication among the masses gets done.
National Resource Center on LGBT Aging
The National Resource Center on LGBT Aging is America’s first and only technical assistance resource center aimed at improving the quality of services and supports offered to lesbian, gay, bisexual and/or transgender older adults.
The ConsultGeriRN App
The ConsultGeriRN app from the Hartford Institute for Geriatric Nursing is designed to help healthcare professionals with their decision making in providing the best quality care for older adults without needing to leave their side. This mobile reference provides information and tools to treat common problems encountered in the health care of older adults. It is a powerful and readily accessible tool for healthcare professionals as they meet new situations in everyday practice. It was developed based on the most current evidence based practice standards for the care of older adults. Current topics include Delirium, Agitation, Confusion, Fall Prevention and Post Fall.
The PEDE database contains detailed information on 2,363 full economic evaluation citations published from January 1, 1980 to December 31, 2011. It also contains 1,193 health state utility weights which have been collected from the cost-utility analyses included in PEDE.
A “cohort” is any group of people with a shared characteristic. For example, in a birth cohort, what’s common to all individuals is their birth year.
The Policy Readiness Tool was created to increase local capacity for healthy policy change. It is designed for use by individuals, organizations and municipalities interested in creating healthier communities. The Tool consists of a short questionnaire to assess a municipality’s readiness for healthy public policy change. Coupled with the questionnaire are a series of policy change strategies and advocacy resources for working with municipalities at different stages of policy readiness.
INQRI grantees Patti Dykes, Blackford Middleton and colleagues created a tool designed to prevent patient falls by translating an individual patient’s fall risk assessment into a decision support intervention that communicates fall risk status, and creates a tailored plan that is accessible to care team members (including patients and family members) to prevent falls. The team constructed the Fall Prevention Toolkit (FPTK), or Fall TIPS Toolkit, and conducted a randomized controlled trial to examine whether the FPTK led to a decrease in the incidence of patient falls and a decrease in the incidence of patient falls with injury. The use of their toolkit did significantly lower the incidence of falls in the intervention units and several units wished to continue using the tool after the conclusion of the study.
From the Australian Centre of Excellence for Local Government. This Guide offers tools, tips and Thinklists to help you develop credible, robust, and logical writing to share with the local government sector.
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I came across this website through twitter. It’s from Sweden and unfortunately my Swedish doesn’t go beyond hej. But based on google translate and their English site, it looks like this group is focused on quality improvement in healthcare. They also seem VERY involved in using clinical microsystems for QI.
Research Associate in Statistics and Epidemiology
Warwick Medical School, Division of Health Sciences
Salary in the Range: £24,049 – £27,047 pa, Fixed Term Contract until March 2016
DEADLINE: Thursday 14 March 2013
You will join Warwick Medical School, Division of Health Sciences to support the expanding work programme of Warwick Evidence, one of nine health technology appraisal and evidence synthesis teams in the UK. You will provide statistical and epidemiological research support to health technology appraisal reviews. You will work with a multidisciplinary team of information specialists, modellers and systematic reviewers in appraising evidence on the clinical and cost-effectiveness of health technologies. You will contribute to methodological research in epidemiology and medical statistics and progress the development of the field through evidence synthesis and research. There will be opportunities for assisting in teaching activities.
The Pew Research Center has an immediate need for a Research Associate to support the Global Attitudes Project. The Research Associate assists in the design and drafting of poll questionnaires, creates toplines and tables for survey reports, performs statistical analysis, assists with fact-checking and other aspects of report production, and helps to write and review survey reports. The Research Associate is also responsible for managing projects and fielding requests for information from the press, government officials and other target audiences.
Doctoral Fellowship: Equity Lens in Public Health (ELPH), University of Victoria
DEADLINE March 15, 2013
Applications are invited for a 2-year doctoral fellowship with the Equity Lens in Public Health (ELPH) Program of Research at the University of Victoria. ELPH is a Core Public Health Functions Research Initiative (CPHFRI) program of research and is housed in the University of Victoria School of Nursing and Centre for Addictions Research of BC (CARBC). The ELPH Program of Research is seeking highly qualified candidates to engage in research related to health equity in public health and application of an equity lens in BC public health policy related to mental health promotion and preventing the harms of substance use. We are specifically looking for someone interested in knowledge translation and exchange research.
Evidence Based Medicine Mentor
Volunteer position in Namibia, 3-6 month assignment
Polytechnic of Namibia (PoN) and University of Namibia (UNAM)
Volunteer Healthcare Corps is actively recruiting for an Evidence-Based Medicine Mentor to serve in a 6-month placement in Windhoek, Namibia. The mentor will be working with the Polytechnic of Namibia and University of Namibia to help integrate EBM in their health education and teaching as well as develop the universities’ capacity to perform systematic literature reviews for the Cochrane Center in South Africa. This is an unique opportunity for highly skilled health professionals to directly apply their skills and expertise in a place that desperately needs it.