April 15, 2013


Please take our survey on the KUSP FYI. There are 4 questions and it should take less than 1 minute. Thanks!!!

Congratulation to Malcolm Doupe and co-authors. Their article Frequent users of emergency departments: developing standard definitions and defining prominent risk factors. has been selected by CIHR as one of two articles receiving the IHSPR Article of the Year Awards. Way to go!!!!
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Doupe MB, Palatnick W, Day S, Chateau D, Soodeen RA, Burchill C, et al.
Annals of Emergency Medicine 2012 Jul;60(1):24-32

STUDY OBJECTIVE: We identify factors that define frequent and highly frequent emergency department (ED) users. METHODS: Administrative health care records were used to define less frequent (1 to 6 visits), frequent (7 to 17 visits), and highly frequent (≥18 visits) ED users. Analyses were conducted to determine the most unique demographic, disease, and health care use features of these groups. RESULTS: Frequent users composed 9.9% of all ED visits, whereas highly frequent users composed 3.6% of visits. Compared with less frequent users, frequent users were defined most strongly by their substance abuse challenges and by their many visits to primary care and specialist physicians. Substance abuse also distinguished highly frequent from frequent ED users strongly; 67.3% versus 35.9% of these patient groups were substance abusers, respectively. Also, 70% of highly frequent versus only 17.8% of frequent users had a long history of frequent ED use. Last, highly frequent users did not use other health care services proportionally more than their frequent user counterparts, suggesting that these former patients use EDs as a main source of care. CONCLUSION: This research develops objective thresholds of frequent and highly frequent ED use. Although substance abuse is prominent in both groups, only highly frequent users seem to visit EDs in place of other health care services. Future analyses can investigate these patterns of health care use more closely, including how timely access to primary care affects ED use. Cluster analysis also has value for defining frequent user subgroups who may benefit from different yet equally effective treatment options. Copyright © 2012. Published by Mosby, Inc.


Article recommended by Dr. Carole Estabrooks: Perspective: Entering uncharted waters: navigating the transition from trainee to career for the nonphysician clinician-scientist.
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MacDonald SE, Sharpe HM, Shikako-Thomas K, Larsen B, MacKay L.
Academic medicine : journal of the Association of American Medical Colleges 2013 Jan;88(1):61-66

The transition from trainee to career clinician-scientist can be a stressful and challenging time, particularly for those entering the less established role of nonphysician clinician-scientist. These individuals are typically PhD-prepared clinicians in the allied health professions, who have either a formal or informal joint appointment between a clinical institution and an academic or research institution. The often poorly defined boundaries and expectations of these developing roles can pose additional challenges for the trainee-to-career transition.It is important for these trainees to consider what they want and need in a position in order to be successful, productive, and fulfilled in both their professional and personal lives. It is also critical for potential employers, whether academic or clinical (or a combination of both), to be fully aware of the supports and tools necessary to recruit and retain new nonphysician clinician-scientists. Issues of relevance to the trainee and the employer include finding and negotiating a position; the importance of mentorship; the value of effective time management, particularly managing clinical and academic time commitments; and achieving work-life balance. Attention to these issues, by both the trainee and those in a position to hire them, will facilitate a smooth transition to the nonphysician clinician-scientist role and ultimately contribute to individual and organizational success.

CALL FOR ABSTRACTS: ANA 8th Annual Nursing Quality Conference
Phoenix AZ February 5 – 7, 2014
DEADLINE: May 10, 2013

The American Nurses Association is pleased to present its annual Nursing Quality Conference in Phoenix, Arizona. The theme for the 2014 conference is Advancing Nursing Outcomes: Research, Practice, Innovation. This unique conference provides opportunities to recognize quality issues that are influential to nursing practice and how it relates to addressing organizational performance to improve patient outcomes.


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

Dissemination and Implementation: INQRI’s Potential Impact.
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Titler MG, Wilson DS, Resnick B, Shever LL.
Medical care 2013 Apr;51 Suppl:S41-6

BACKGROUND: : Application of research evidence in care delivery improves patient outcomes. Large gaps still exist, however, between recommended care and that used in practice. To increase the understanding of implementation studies, and dissemination of research findings, we present the perspective of investigators from seven Interdisciplinary Nursing Quality Research Initiative (INQRI)-funded studies. OBJECTIVE: : To describe implementation strategies, challenges, and lessons learned from conducting 5 INQRI-funded implementation studies, and present 2 case examples of other INQRI studies to illustrate dissemination strategies. Potential impact of study findings are set forth. RESEARCH DESIGN: : Qualitative descriptive methods were used for the implementation studies. Case examples were set forth by investigators using reflection questions. RESULTS: : Four of the 5 implementation studies focused on clinical topics and 1 on professional development of nurse managers, 4 were multisite studies. Common implementation strategies used across studies addressed education, ongoing interaction with sites, use of implementation tools, and visibility of the projects on the study units. Major challenges were the Institutional Review Board approval process and the short length of time allocated for implementation. Successes and lessons learned included creating excitement about research, packaging of study tools and resources for use by other organizations, and understanding the importance of context when conducting this type of research. Case examples revealed that study findings have been disseminated to study sites and to the health care community through publications and presentations. The potential impact of all 7 studies is far reaching. CONCLUSIONS: : This study captures several nuanced perspectives from 5 Principal Investigators, who were completing INQRI-funded implementation studies. These nuanced perspectives are important lessons for other scientists embarking on implementation studies. The INQRI case examples illustrate important dissemination strategies and impact of findings on quality of care.

Methodology issues in implementation science
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Newhouse R, Bobay K, Dykes P, Stevens K, Titler M.
Medical care 2013;51(4 SUPPL. 2):S32-S40

BACKGROUND: Putting evidence into practice at the point of care delivery requires an understanding of implementation strategies that work, in what context and how. OBJECTIVE: To identify methodological issues in implementation science using 4 studies as cases and make recommendations for further methods development. RESEARCH DESIGN: Four cases are presented and methodological issues identified. For each issue raised, evidence on the state of the science is described. RESULTS: Issues in implementation science identified include diverse conceptual frameworks, potential weaknesses in pragmatic study designs, and the paucity of standard concepts and measurement. CONCLUSIONS: Recommendations to advance methods in implementation include developing a core set of implementation concepts and metrics, generating standards for implementation methods including pragmatic trials, mixed methods designs, complex interventions and measurement, and endorsing reporting standards for implementation studies. Copyright © 2013 by Lippincott Williams & Wilkins.

An infrastructure to advance the scholarly work of staff nurses.
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Parkosewich JA.
The Yale journal of biology and medicine 2013 Mar;86(1):63-77

The traditional role of the acute care staff nurse is changing. The new norm establishes an expectation that staff nurses base their practice on best evidence. When evidence is lacking, nurses are charged with using the research process to generate and disseminate new knowledge. This article describes the critical forces behind the transformation of this role and the organizational mission, culture, and capacity required to support practice that is based on science. The vital role of senior nursing leaders, the nurse researcher, and the nursing research committee within the context of a collaborative governance structure is highlighted. Several well-known, evidence-based practice models are presented. Finally, there is a discussion of the infrastructure created by Yale-New Haven Hospital to advance the scholarly work of the nursing staff.

Positioning continuing education: boundaries and intersections between the domains continuing education, knowledge translation, patient safety and quality improvement.
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Kitto S, Bell M, Peller J, Sargeant J, Etchells E, Reeves S, et al.
Advances in health sciences education : theory and practice 2013 Mar;18(1):141-156

Public and professional concern about health care quality, safety and efficiency is growing. Continuing education, knowledge translation, patient safety and quality improvement have made concerted efforts to address these issues. However, a coordinated and integrated effort across these domains is lacking. This article explores and discusses the similarities and differences amongst the four domains in relation to their missions, stakeholders, methods, and limitations. This paper highlights the potential for a more integrated and collaborative partnership to promote networking and information sharing amongst the four domains. This potential rests on the premise that an integrated approach may result in the development and implementation of more holistic and effective interdisciplinary interventions. In conclusion, an outline of current research that is informed by the preliminary findings in this paper is also briefly discussed. The research concerns a comprehensive mapping of the relationships between the domains to gain an understanding of potential dissonances between how the domains represent themselves, their work and the work of their ‘partner’ domains.

Psychometric evaluation of a questionnaire and primary healthcare nurses’ attitudes towards research and use of research findings.
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Nilsson Kajermo K, Alinaghizadeh H, Falk U, Wandell P, Tornkvist L.
Scandinavian journal of caring sciences 2013 Mar 20

AIM: This article investigates attitudes towards and awareness of research and use of research findings among primary healthcare nurses, determinants of attitudes and evaluation of psychometric properties of an instrument measuring nurses’ attitudes. BACKGROUND: The production of new knowledge is ongoing and the amount of research of relevance for health care has increased, but there remains a gap between what is known and what is done in practice. To enhance evidence-based practice and patient safety, the use of research findings needs to be encouraged and promoted. METHOD: An explanatory study using a cross-sectional survey was conducted in 2005-2006. The survey included items about background data and the instrument attitudes towards and awareness of research and development in nursing. 1054 nurses participated in the study. Factor analyses and Cronbach’s alpha were used to evaluate internal structure and internal consistency of the instrument. RESULT: The nurses generally held positive attitudes towards research. Although most of the nurses reported using research in practice, 37% claimed that they never or rarely used research findings. Half of the respondents perceived they had the ability to analyse scientific reports/articles. This ability and research use were significant determinants of attitudes. Factor analysis of the scale resulted in a three-factor solution, which differs from the seven-factor structure previously identified by the originators of the instrument. CONCLUSION: Our results support the view that implementation of research is a complex process involving several factors. The different factor structure identified suggests that further work is needed on this instrument. © 2013 Nordic College of Caring Science. Published by Blackwell Publishing Ltd.

Substance use treatment counselors’ attitudes toward evidence-based practice: the importance of organizational context.
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Smith BD.
Substance use & misuse 2013 Apr;48(5):379-390

This study addresses individual and organizational correlates of substance user treatment counselors’ attitudes toward evidence-based practice. Counselors (n = 293) from a probability sample of outpatient treatment organizations in a northeastern US state were surveyed in 2008. Multilevel [hierarchical linear model (HLM)] models address the nested sample. Attitudes toward evidence-based practice were measured with the Evidence-Based Practice Attitude Scale (Aarons). Study limitations and implications for the implementation of evidence-based practices in routine substance user treatment organizations are addressed.

Pandemic H1N1 in Canada and the use of evidence in developing public health policies – A policy analysis.
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Rosella LC, Wilson K, Crowcroft NS, Chu A, Upshur R, Willison D, et al.
Social science & medicine (1982) 2013 Apr;83:1-9

When responding to a novel infectious disease outbreak, policies are set under time constraints and uncertainty which can limit the ability to control the outbreak and result in unintended consequences including lack of public confidence. The H1N1 pandemic highlighted challenges in public health decision-making during a public health emergency. Understanding this process to identify barriers and modifiable influences is important to improve the response to future emergencies. The purpose of this study is to examine the H1N1 pandemic decision-making process in Canada with an emphasis on the use of evidence for public health decisions. Using semi-structured key informant interviews conducted after the pandemic (July-November 2010) and a document analysis, we examined four highly debated pandemic policies: use of adjuvanted vaccine by pregnant women, vaccine priority groups and sequencing, school closures and personal protective equipment. Data were analysed for thematic content guided by Lomas’ policy decision-making framework as well as indicative coding using iterative methods. We interviewed 40 public health officials and scientific advisors across Canada and reviewed 76 pandemic policy documents. Our analysis revealed that pandemic pre-planning resulted in strong beliefs, which defined the decision-making process. Existing ideological perspectives of evidence strongly influenced how information was used such that the same evidentiary sources were interpreted differently according to the ideological perspective. Participants recognized that current models for public health decision-making failed to make explicit the roles of scientific evidence in relation to contextual factors. Conflict avoidance theory explained policy decisions that went against the prevailing evidence. Clarification of roles and responsibilities within the public health system would reduce duplication and maintain credibility. A more transparent and iterative approach to incorporating evidence into public health decision-making that reflects the realities of the external pressures present during a public health emergency is needed. Copyright © 2013 Elsevier Ltd. All rights reserved.

Explaining the effects of two different strategies for promoting hand hygiene in hospital nurses: a process evaluation alongside a cluster randomised controlled trial.
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Huis A, Holleman G, van Achterberg T, Grol R, Schoonhoven L, Hulscher M.
Implementation science : IS 2013 Apr 8;8(1):41

BACKGROUND: There is only limited understanding of why hand hygiene improvement strategies are successful or fail. It is therefore important to look inside the ‘black box’ of such strategies, to ascertain which components of a strategy work well or less well. This study examined which components of two hand hygiene improvement strategies were associated with increased nurses’ hand hygiene compliance. METHODS: A process evaluation of a cluster randomised controlled trial was conducted in which part of the nursing wards of three hospitals in the Netherlands received a state-of-the-art strategy, including education, reminders, feedback, and optimising materials and facilities; another part received a team and leaders-directed strategy that included all elements of the state-of-the-art strategy, supplemented with activities aimed at the social and enhancing leadership. This process evaluation used four sets of measures: effects on nurses’ hand hygiene compliance, adherence to the improvement strategies, contextual factors, and nurses’ experiences with strategy components. Analyses of variance and multiple regression analyses were used to explore changes in nurses’ hand hygiene compliance and thereby better understand trial effects. RESULTS: Both strategies were performed with good adherence to protocol. Two contextual factors were associated with changes in hand hygiene compliance: a hospital effect in long term (p < 0.05), and high hand hygiene baseline scores were associated with smaller effects (p < 0.01). In short term, changes in nurses’ hand hygiene compliance were positively correlated with experienced feedback about their hand hygiene performance (p < 0.05). In the long run, several items of the components ‘social influence’ (i.e., addressing each other on undesirable hand hygiene behaviour p < 0.01), and ‘leadership’ (i.e., ward manager holds team members accountable for hand hygiene performance p < 0.01) correlated positively with changes in nurses’ hand hygiene compliance. CONCLUSION: This study illustrates the use of a process evaluation to uncover mechanisms underlying change in hand hygiene improvement strategies. Our study results demonstrate the added value of specific aspects of social influence and leadership in hand hygiene improvement strategies, thus offering an interpretation of the trial effects.Trial registration: The study is registered in ClinicalTrials.gov, dossier number: NCT00548015.

Playing with meaning: Using cartoons to disseminate research findings
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Bartlett R.
Qualitative Research 2013;13(2):214-227

Cartoons are a ubiquitous form of visual communication. Yet they are often overlooked in methodological debates about dissemination. In this article, the potential of cartoons as a vehicle for processing and transmitting qualitative research findings is explored and some methodological advantages and concerns of using cartoons in this way are outlined. Discussion stems from a small-scale, experimental ‘knowledge transfer’ project located within a larger qualitative study about higher functioning men and women with dementia who campaign for social change. It concludes that cartooning can bring to life in a playful way serious issues, but as form of visual communication, cartoons are not for everyone, and must therefore be used judiciously to disseminate research findings. © The Author(s) 2012.

Exploring the uptake and framing of research evidence on universal screening for intimate partner violence against women: a knowledge translation case study
Wathen C, MacGregor J, Sibbald S, MacMillan H.
Health Research Policy and Systems 2013;11(1):13

Background Significant emphasis is currently placed on the need to enhance health care decision-making with research-derived evidence. While much has been written on specific strategies to enable these “knowledge-to-action” processes, there is less empirical evidence regarding what happens when knowledge translation (KT) processes do not proceed as planned. The present paper provides a KT case study using the area of health care screening for intimate partner violence (IPV). Methods A modified citation analysis method was used, beginning with a comprehensive search (August 2009 to October 2012) to capture scholarly and grey literature, and news reports citing a specific randomized controlled trial published in a major medical journal on the effectiveness of screening women, in health care settings, for exposure to IPV. Results of the searches were extracted, coded and analysed using a multi-step mixed qualitative and quantitative content analysis process. Results The trial was cited in 147 citations from 112 different sources in journal articles, commentaries, books, and government and news reports. The trial also formed part of the evidence base for several national-level practice guidelines and policy statements. The most common interpretations of the trial were “no benefit of screening”, “no harms of screening”, or both. Variation existed in how these findings were represented, ranging from summaries of the findings, to privileging one outcome over others, and to critical qualifications, especially with regard to methodological rigour of the trial. Of note, interpretations were not always internally consistent, with the same evidence used in sometimes contradictory ways within the same source. Conclusions Our findings provide empirical data on the malleability of “evidence” in knowledge translation processes, and its potential for multiple, often unanticipated, uses. They have implications for understanding how research evidence is used and interpreted in policy and practice, particularly in contested knowledge areas.

Health Care Administration & Organization
The influence of individual and organisational factors on nurses’ behaviour to use lifting devices in healthcare.
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Koppelaar E, Knibbe JJ, Miedema HS, Burdorf A.
Applied Ergonomics 2013 Jul;44(4):532-537

AIMS: This study evaluates the influence of individual and organisational factors on nurses’ behaviour to use lifting devices in healthcare. METHODS: Interviews among nurses were conducted to collect individual characteristics and to establish their behaviour regarding lifting devices use. Organisational factors were collected by questionnaires and walk-through-surveys, comprising technical facilities, organisation of care, and management-efforts. Generalised-Estimating-Equations for repeated measurements were used to estimate determinants of nurses’ behaviour. RESULTS: Important determinants of nurses’ behaviour to use lifting devices were knowledge of workplace procedures (OR = 5.85), strict guidance on required lifting devices use (OR = 2.91), and sufficient lifting devices (OR = 1.92). Management-support and supportive-management-climate were associated with these determinants. CONCLUSION: Since nurses’ behaviour to use lifting devices is influenced by factors at different levels, studies in ergonomics should consider how multi-level factors impact each other. An integral approach, addressing individual and organisational levels, is necessary to facilitate appropriate implementation of ergonomic interventions, like lifting devices. Copyright © 2012 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Differences between certified and noncertified hospice and palliative nursing assistants
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Head BA, Myers J.
Journal of Hospice and Palliative Nursing 2013;15(2):89-98

The hospice and palliative nursing assistant is an essential member of the interdisciplinary caregiving team. In recognition of the important, specialized knowledge and skills required of these nursing assistants, the National Board for Certification of Hospice and Palliative Nurses established the first and only certification program for nursing assistants. Since 2002, more than 3852 nursing assistants have received designation as a Certified Hospice and Palliative Nursing Assistant. This study used two established instruments, the Better Jobs Better Care Survey of Direct Care Workers and the Perceived Value of Certification Tool, to ascertain the demographics and attitudes of hospice and palliative nursing assistants. A total of 795 nursing assistants (343 certified, 452 not certified) from across the nation participated. Data were analyzed to ascertain differences between the two groups. Those certified were older, made more per hour, had been nursing assistants longer, had been with their current employer longer, and were more likely to view their job as a long-term career when compared with the noncertified nurse. All study participants expressed high levels of regard for specialty certification; however, 25% of respondents were not aware of the Certified Hospice and Palliative Nursing Assistant program. Organizational support of certification was the factor most predictive of nursing assistant certification.

Work environment factors other than staffing associated with nurses’ ratings of patient care quality.
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Djukic M, Kovner CT, Brewer CS, Fatehi FK, Cline DD.
Health care management review 2013 Apr;38(2):105-114

BACKGROUND: The impact of registered nurse (RN) staffing on patient care quality has been extensively studied. Identifying additional modifiable work environment factors linked to patient care quality is critical as the projected shortage of approximately 250,000 RNs over the next 15 years will limit institutions’ ability to rely on RN staffing alone to ensure high-quality care. PURPOSE: We examined the association between RNs’ ratings of patient care quality and several novel work environment factors adjusting for the effects of two staffing variables: reported patient-to-RN ratios and ratings of staffing adequacy. METHODOLOGY:: We used a cross-sectional, correlational design and a mailed survey to collect data in 2009 from a national sample of RNs (n = 1,439) in the United States. A multivariate logistic regression was used to analyze the data. FINDINGS: Workgroup cohesion, nurse-physician relations, procedural justice, organizational constraints, and physical work environment were associated with RNs’ ratings of quality, adjusting for staffing. Furthermore, employment in a Magnet hospital and job satisfaction were positively related to ratings of quality, whereas supervisory support was not. PRACTICE IMPLICATIONS: Our evidence demonstrates the importance of considering RN work environment factors other than staffing when planning improvements in patient care quality. Health care managers can use the results of our study to strategically allocate resources toward work environment factors that have the potential to improve quality of care.

Nurse leaders’ perceptions of an approaching organizational change.
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Salmela S, Eriksson K, Fagerstrom L.
Qualitative health research 2013 May;23(5):689-699

The aim of the study was to achieve more profound understanding of nurse leaders’ perceptions of an approaching organizational change. We used a three-dimensional hermeneutical method of interpretation to analyze text from 17 interviews. The results suggest that nurse leaders were positive toward and actively engaged in continual change to their units, even though they perceived themselves as mere spectators of the change process. The nurse leaders believed that change might benefit patients and patient care, yet their adaptation lacked deeper engagement. The approaching merger affected the nurse leaders’ identities on a deeply personal level. They experienced uneasiness and anxiety with regard to being nurse leaders, the future of nursing care, and their mandate as patient advocates. Nurse leaders are in a critical position to influence the success of organizational change, but the organizations covered in this study were not incorporating their knowledge and experiences into the change.

Measuring influenza immunization coverage among health care workers in acute care hospitals and continuing care organizations in Canada.
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Quach S, Pereira JA, Hamid JS, Crowe L, Heidebrecht CL, Kwong JC, et al.
American Journal of Infection Control 2013 Apr;41(4):340-344

BACKGROUND: Immunizing health care workers against influenza is important for preventing and reducing disease transmission in health care environments. We describe the ability of Canadian health care organizations to measure influenza immunization coverage among health care workers and identify factors associated with comprehensive influenza immunization measurement. METHODS: A Web-based survey was distributed to influenza immunization campaign planners responsible for delivering the 2010-2011 influenza vaccine to health care workers working in acute care hospitals or long-term continuing care organizations. The primary outcome was the ability to comprehensively measure influenza immunization coverage. RESULTS: Of the 1,127 health care organizations approached, 721 (64%) responded. Ninety-one percent had incomplete immunization coverage measurement; 7% could not measure coverage among any personnel. After multivariable adjustment, organizations with a written influenza immunization implementation plan (odds ratio, 2.0; 95% confidence interval, 1.1-3.5) or a policy or procedure describing how to calculate or report immunization rates (odds ratio, 2.1; 95% confidence interval, 1.2-3.9) were more likely to have comprehensive measurement of influenza immunization coverage than organizations without these practices. CONCLUSION: Most organizations demonstrated incomplete measurement of influenza immunization among health care workers. Given the use of influenza immunization coverage as a measure of quality of care, further work is needed to develop a standardized approach to improve its measurement. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

A systematic review of the care coordination measurement landscape.
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Schultz EM, Pineda N, Lonhart J, Davies SM, McDonald KM.
BMC health services research 2013 Mar 28;13(1):119

BACKGROUND: Care coordination has increasingly been recognized as an important aspect of high-quality health care delivery. Robust measures of coordination processes will be essential tools to evaluate, guide and support efforts to understand and improve coordination, yet little agreement exists among stakeholders about how to best measure care coordination. We aimed to review and characterize existing measures of care coordination processes and identify areas of high and low density to guide future measure development. METHODS: We conducted a systematic review of measures published in MEDLINE through April 2012 and identified from additional key sources and informants. We characterized included measures with respect to the aspects of coordination measured (domain), measurement perspective (patient/family, health care professional, system representative), applicable settings and patient populations (by age and condition), and data used (survey, chart review, administrative claims). RESULTS: Among the 96 included measure instruments, most relied on survey methods (88%) and measured aspects of communication (93%), in particular the transfer of information (81%). Few measured changing coordination needs (11%). Nearly half (49%) of instruments mapped to the patient/family perspective; 29% to the system representative and 27% to the health care professionals perspective. Few instruments were applicable to settings other than primary care (58%), inpatient facilities (25%), and outpatient specialty care (22%). CONCLUSIONS: New measures are needed that evaluate changing coordination needs, coordination as perceived by health care professionals, coordination in the home health setting, and for patients at the end of life.

Health Care Innovation and Quality Assurance
Assessing quality improvement in health care: theory for practice.
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Kleinman LC, Dougherty D.
Pediatrics 2013 Mar;131 Suppl 1:S110-9

OBJECTIVES: To review the role of theory as a means to enhance the practice of quality improvement (QI) research and to propose a novel conceptual model focused on the operations of health care. METHODS: Conceptual model, informed by literature review. RESULTS: To optimize learning across QI studies requires the integration of small-scale theories (middle-range theories, theories of change) within the context of larger unifying theories. We propose that health care QI research would benefit from a theory that describes the operations of health care delivery, including the multiplicity of roles that interpersonal interactions play. The broadest constructs of the model are entry into the system, and assessment and management of the patient, with the subordinate operations of access; recognition, assessment, and diagnosis; and medical decision-making (developing a plan), coordination of care, execution of care, referral and reassessment, respectively. Interpersonal aspects of care recognize the patient/caregiver as a source of information, an individual in a cultural context, a complex human being, and a partner in their care. Impacts to any and all of these roles may impact the quality of care. CONCLUSIONS: Such a theory can promote opportunities for moving the field forward and organizing the planning and interpretation of comparable studies. The articulation of such a theory may simultaneously provide guidance for the QI researcher and an opportunity for refinement and improvement.

Hospital Fall Prevention: A Systematic Review of Implementation, Components, Adherence, and Effectiveness.
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Hempel S, Newberry S, Wang Z, Booth M, Shanman R, Johnsen B, et al.
Journal of the American Geriatrics Society 2013 Mar 25

OBJECTIVES: To systematically document the implementation, components, comparators, adherence, and effectiveness of published fall prevention approaches in U.S. acute care hospitals. DESIGN: Systematic review. Studies were identified through existing reviews, searching five electronic databases, screening reference lists, and contacting topic experts for studies published through August 2011. SETTING: U.S. acute care hospitals. PARTICIPANTS: Studies reporting in-hospital falls for intervention groups and concurrent (e.g., controlled trials) or historic comparators (e.g., before-after studies). INTERVENTION: Fall prevention interventions. MEASUREMENTS: Incidence rate ratios (IRR, ratio of fall rate postintervention or treatment group to the fall rate preintervention or control group) and ratings of study details. RESULTS: Fifty-nine studies met inclusion criteria. Implementation strategies were sparsely documented (17% not at all) and included staff education, establishing committees, seeking leadership support, and occasionally continuous quality improvement techniques. Most interventions (81%) included multiple components (e.g., risk assessments (often not validated), visual risk alerts, patient education, care rounds, bed-exit alarms, and postfall evaluations). Fifty-four percent did not report on fall prevention measures applied in the comparison group, and 39% neither reported fidelity data nor described adherence strategies such as regular audits and feedback to ensure completion of care processes. Only 45% of concurrent and 15% of historic control studies reported sufficient data to compare fall rates. The pooled postintervention incidence rate ratio (IRR) was 0.77 (95% confidence interval = 0.52-1.12, P = .17; eight studies; I2 : 94%). Meta-regressions showed no systematic association between implementation intensity, intervention complexity, comparator information, or adherence levels and IRR. CONCLUSION: Promising approaches exist, but better reporting of outcomes, implementation, adherence, intervention components, and comparison group information is necessary to establish evidence on how hospitals can successfully prevent falls. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

A multi-faceted tailored strategy to implement an electronic clinical decision support system for pressure ulcer prevention in nursing homes: A two-armed randomized controlled trial
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Beeckman D, Clays E, Van Hecke A, Vanderwee K, Schoonhoven L, Verhaeghe S.
International journal of nursing studies 2013 Apr;50(4):475-486

BACKGROUND: Frail older people admitted to nursing homes are at risk of a range of adverse outcomes, including pressure ulcers. Clinical decision support systems are believed to have the potential to improve care and to change the behaviour of healthcare professionals. OBJECTIVES: To determine whether a multi-faceted tailored strategy to implement an electronic clinical decision support system for pressure ulcer prevention improves adherence to recommendations for pressure ulcer prevention in nursing homes. DESIGN: Two-armed randomized controlled trial in a nursing home setting in Belgium. The trial consisted of a 16-week implementation intervention between February and June 2010, including one baseline, four intermediate, and one post-testing measurement. Primary outcome was the adherence to guideline-based care recommendations (in terms of allocating adequate pressure ulcer prevention in residents at risk). Secondary outcomes were the change in resident outcomes (pressure ulcer prevalence) and intermediate outcomes (knowledge and attitudes of healthcare professionals). SETTING: Random sample of 11 wards (6 experimental; 5 control) in a convenience sample of 4 nursing homes in Belgium. PARTICIPANTS: In total, 464 nursing home residents and 118 healthcare professionals participated. METHODS: The experimental arm was involved in a multi-faceted tailored implementation intervention of a clinical decision support system, including interactive education, reminders, monitoring, feedback and leadership. The control arm received a hard-copy of the pressure ulcer prevention protocol, supported by standardized 30min group lecture. RESULTS: Patients in the intervention arm were significantly more likely to receive fully adequate pressure ulcer prevention when seated in a chair (F=16.4, P=0.003). No significant improvement was observed on pressure ulcer prevalence and knowledge of the professionals. While baseline attitude scores were comparable between both groups [exp. 74.3% vs. contr. 74.5% (P=0.92)], the mean score after the intervention was 83.5% in the experimental group vs. 72.1% in the control group (F=15.12, P<0.001). CONCLUSION: The intervention was only partially successful to improve the primary outcome. Attitudes improved significantly while the knowledge of the healthcare workers remained unsatisfactorily low. Further research should focus on the underlying reasons for these findings. Copyright © 2012 Elsevier Ltd. All rights reserved.

A theory-driven, longitudinal evaluation of the impact of team training on safety culture in 24 hospitals.
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Jones KJ, Skinner AM, High R, Reiter-Palmon R.
BMJ quality & safety 2013 Feb 23

BACKGROUND: Effective teamwork facilitates collective learning, which is integral to safety culture. There are no rigorous evaluations of the impact of team training on the four components of safety culture-reporting, just, flexible and learning cultures. We evaluated the impact of a year-long team training programme on safety culture in 24 hospitals using two theoretical frameworks. METHODS: We used two quasi-experimental designs: a cross-sectional comparison of hospital survey on patient safety culture (HSOPS) results from an intervention group of 24 hospitals to a static group of 13 hospitals and a pre-post comparison of HSOPS results within intervention hospitals. Dependent variables were HSOPS items representing the four components of safety culture; independent variables were derived from items added to the HSOPS that measured the extent of team training, learning and transfer. We used a generalised linear mixed model approach to account for the correlated nature of the data. RESULTS: 59% of 2137 respondents from the intervention group reported receiving team training. Intervention group HSOPS scores were significantly higher than static group scores in three dimensions assessing the flexible and learning components of safety culture. The distribution of the adoption of team behaviours (transfer) varied in the intervention group from 2.8% to 31.0%. Adoption of team behaviours was significantly associated with odds of an individual reacting more positively at reassessment than baseline to nine items reflecting all four components of safety culture. CONCLUSIONS: Team training can result in transformational change in safety culture when the work environment supports the transfer of learning to new behaviour.

Comparative effectiveness of implementing evidence-based education and best practices in nursing homes: Effects on falls, quality-of-life and societal costs.
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Teresi JA, Ramirez M, Remler D, Ellis J, Boratgis G, Silver S, et al.
International journal of nursing studies 2013 Apr;50(4):448-463

OBJECTIVES: The aim was to conduct a comparative effectiveness research study to estimate the effects on falls, negative affect and behavior, and the associated societal costs of implementing evidence-based education and best practice programs in nursing homes (NHs). DESIGN: A quasi-experimental design, a variant of a cluster randomized trial of implementation research examining transfer of research findings into practice, was used to compare outcomes among three groups of residents in 15 nursing homes per group. METHODS: Forty-five NHs participated in one of three conditions: (1) standard training, (2) training and implementation modules provided to facility staff, or (3) staff training and implementation modules augmented by surveyor training. After application of exclusion and matching criteria, nursing homes were selected at random within three regions of New York State. Outcomes were assessed using medical records and the Minimum Data Set (MDS). RESULTS: The main finding was of a significant reduction of between 5 and 12 annual falls in a typical nursing home. While both intervention groups resulted in fall reduction, the larger and significant reduction occurred in the group without surveyor training. A significant reduction in negative affect associated with training staff and surveyors was observed. Net cost savings from fall prevention was estimated. CONCLUSIONS: A low cost intervention targeting dissemination of evidence-based best practices in nursing homes can result in the potential for fall reduction, and cost savings. Copyright © 2011 Elsevier Ltd. All rights reserved.

Do implementation strategies increase adherence to pain assessment in hospitals? A systematic review.
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Ista E, van Dijk M, van Achterberg T.
International journal of nursing studies 2013 Apr;50(4):552-568

OBJECTIVES: Pain assessment and reassessment is an essential part of the treatment of hospitalised patients and must be integrated in pain management protocols. Yet nurses’ adherence to pain assessment recommendations is problematic. We sought to review the comparative evidence for implementation strategies aiming to improve nurses’ adherence to pain assessment recommendations in hospitalised patients. DESIGN: Systematic review using the narrative method. DATA SOURCES: PubMed (MEDLINE), CINAHL, Cochrane library and hand searching. REVIEW METHODS: Studies published since 1990, reporting implementation strategies that aimed to improve nurses’ adherence to pain assessment recommendations in hospitalised patients were included. According to the Cochrane Effective Practice and Organization of Care group (EPOC) classification system, strategies were categorized as directed at: health professionals, organizations, financing, or regulations. Given the heterogeneity in strategies, samples, outcomes and settings, evidence from the studies was synthesized using a narrative approach. RESULTS: From 743 initial citations, 23 studies were included. They reported a variety of implementation strategies, but only directed at health professionals and/or organizations. In seven studies, a single strategy was applied (e.g. education or feedback). The remaining 16 studies used multifaceted approaches. The effectiveness of the implementation strategies varied. In all studies but one, adherence rates had improved after implementation compared to the before measurement, by 9% up to 49%. These effects were measured at different time points after completion of the implementation, ranging from 2 weeks to 6 months. Half of the reviewed studies reported an adherence rate of 80% or higher after implementation activities; other reported rates ranging from 24 to 80%. In two controlled studies the adherence to pain assessment recommendations increased significantly when feedback was provided compared to no feedback. Sustained effects were reported in three studies. CONCLUSIONS: Based on this systematic review we conclude that implementation strategies to improve nurses’ adherence to pain assessment recommendations vary but generally address professionals and organizational aspects. Educational and feedback strategies are often used and seem largely effective. Due to the heterogeneity of the implementation strategies it is not possible to recommend one preferred strategy. The level of evidence for strategies to improve pain assessment recommendations is limited however, as well-conducted studies are lacking. Copyright © 2012 Elsevier Ltd. All rights reserved.

Feasibility of implementing a practice guideline for fall prevention on geriatric wards: A multicentre study.
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Milisen K, Coussement J, Arnout H, Vanlerberghe V, De Paepe L, Schoevaerdts D, et al.
International journal of nursing studies 2013 Apr;50(4):495-507

BACKGROUND: About 40% of all adverse events in hospital are falls, but only about one in three Belgian hospitals have a fall prevention policy in place. The implementation of a national practice guideline is urgently needed. OBJECTIVE AND DESIGN: This multicentre study aimed to determine the feasibility of a previously developed guideline. SETTING, PARTICIPANTS AND METHOD: Seventeen geriatric wards, selected at random out of 40 Belgian hospitals who agreed to take part in the study, evaluated the fall prevention guideline. After the one-month test period, 49 healthcare workers completed a questionnaire on the feasibility of the guideline. RESULTS: At the end of the study, 512 geriatric patients had been assessed using the practice guideline. The average time spent per patient on case finding, multifactorial assessment and initiating a treatment plan was 5.1, 76.1 and 30.6min, respectively. For most risk assessments and risk modifications, several disciplines considered themselves as being responsible and capable. The majority (more than 69%) of the respondents judged the practice guideline as useful, but only a small majority (62.3%) believed that the guideline could be successfully integrated into their daily practice over a longer period of time. Barriers for implementation included a large time investment (81.1%), lack of communication between the different disciplines (35.8%), lack of motivation of the patient (34.0%), lack of multidisciplinary teamwork (28.3%), and lack of interest from the hospital management (15.4%). CONCLUSION: Overall, the guideline was found useful, and for each risk factor (except for visual impairment), at least one discipline felt responsible and capable. Towards future implementation of the guideline, following steps should be considered: division of the risk-factor assessment duties and interventions among different healthcare workers; patient education; appointment of a fall prevention coordinator; development of a fall prevention policy with support from the management of the hospital. Copyright © 2012 Elsevier Ltd. All rights reserved.

Conceptual models to guide best practices in organization and development of State Action Coalitions.
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Cramer ME, Lazure L, Morris KJ, Valerio M, Morris R.
Nursing outlook 2013 Mar;61(2):70-77

The RWJF/AARP National Campaign for Action established a goal of establishing Action Coalitions in every state by 2012. Last year, a small Steering Committee formed in Nebraska and used two conceptual models to guide the organization and development of its Action Coalition. The purpose of this article is to present the Internal Coalition Outcome Hierarchy (ICOH) model that guided development of partnership and coalition building. The second model, Determining Program Feasibility, provided a framework for data collection and analysis to identify the opportunities and challenges for strategic program planning to accomplish identified key priorities for Nebraska. A discussion of the models’ applications is included and offered as best practices for others seeking to form partnership/coalitions and establish action plans and priorities. Copyright © 2013 Elsevier Inc. All rights reserved.

Development of a patient-centred care pathway across healthcare providers: a qualitative study.
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Rosstad T, Garasen H, Steinsbekk A, Sletvold O, Grimsmo A.
BMC health services research 2013 Apr 1;13:121-6963-13-121

BACKGROUND: Different models for care pathways involving both specialist and primary care have been developed to ensure adequate follow-up after discharge. These care pathways have mainly been developed and run by specialist care and have been disease-based. In this study, primary care providers took the initiative to develop a model for integrated care pathways across care levels for older patients in need of home care services after discharge. Initially, the objective was to develop pathways for patients diagnosed with heart failure, COPD and stroke. The aim of this paper is to investigate the process and the experiences of the participants in this developmental work. The participants were drawn from three hospitals, six municipalities and patient organizations in Central Norway. METHODS: This qualitative study used focus group interviews, written material and observations. Representatives from the hospitals, municipalities and patient organizations taking part in the development process were chosen as informants. RESULTS: The development process was very challenging because of the differing perspectives on care and different organizational structures in specialist care and primary care. In this study, the disease perspective, being dominant in specialist care, was not found to be suitable for use in primary health care because of the need to cover a broader perspective including the patient’s functioning, social situation and his or her preferences. Furthermore, managing several different disease-based care pathways was found to be unsuitable in home care services, as well as unsuitable for a population characterized by a substantial degree of comorbidity. The outcome of the development process was a consensus that outlined a single, common patient-centred care pathway for transition from hospital to follow-up in primary care. The pathway was suitable for most common diseases and included functional and social aspects as well as disease follow-up, thus merging the differing perspectives. The disease-based care pathways were kept for use within the hospitals. CONCLUSIONS: Disease-based care pathways for older patients were found to be neither feasible nor sustainable in primary care. A common patient-centred care pathway that could meet the needs of multi- morbid patients was recommended.

Improving pediatric health care delivery by engaging residents in team-based quality improvement projects.
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Shaikh U, Natale JE, Nettiksimmons J, Li ST.
American Journal of Medical Quality 2013 Mar-Apr;28(2):120-126

The goal was to implement and evaluate an experimental and longitudinal team-based curriculum in quality improvement (QI) for pediatric residents that would increase their ability to apply QI methodology while improving clinical processes and outcomes. The curriculum evolved over 3 years based on resident feedback. Working in teams, residents and faculty apply QI principles to systematically design and implement QI projects. Residents increased their level of comfort with key QI concepts. They showed an increase in QI skills by meaningful integration of the following QI concepts into their projects: establishing the magnitude of the problem, developing focused aims for improvement, identifying areas to change, using QI tools, collecting data, and assessing if changes were successful. The 10 resident-led projects conducted over the past 3 years also resulted in improvements in measures of multiple clinical processes and outcomes. This curriculum was effective and feasible within the constraints of residency work hours.

A national study of nurse leadership and supports for quality improvement in rural hospitals.
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Paez K, Schur C, Zhao L, Lucado J.
American Journal of Medical Quality 2013 Mar-Apr;28(2):127-134

This study assessed the perceptions and actions of rural hospital nurse executives with regard to patient safety and quality improvement (QI). A national sample of rural hospital nurse executives (n = 300) completed a survey measuring 4 domains related to patient safety and QI: (a) patient “Safety Culture,” (b) adequacy of QI “Resources,” (c) “Barriers” related to QI, and (d) “Nurse Leader Engagement” in activities supporting QI. Perceptions of Safety Culture were strong but 47% of the Resources needed to carry out QI were inadequate, 29% of Barriers were moderate to major, and 25% of Nurse Leader Engagement activities were performed infrequently. Nurse Leader Engagement in quality-related activities was less frequent among nurses in isolated and small rural town hospitals compared with large rural city hospitals. To further QI, rural nurse executives may need to use their communications and actions to raise the visibility of QI.

Quality improvement needed in quality improvement randomised trials: systematic review of interventions to improve care in diabetes.
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Ivers NM, Tricco AC, Taljaard M, Halperin I, Turner L, Moher D, et al.
BMJ open 2013 Apr 9;3(4):10.1136/bmjopen-2013-002727

OBJECTIVE: Despite the increasing numbers of published trials of quality improvement (QI) interventions in diabetes, little is known about the risk of bias in this literature. DESIGN: Secondary analysis of a systematic review. DATA SOURCES: Medline, the Cochrane Effective Practice and Organisation of Care (EPOC) database (from inception to July 2010) and references of included studies. ELIGIBILITY CRITERIA: Randomised trials assessing 11 predefined QI strategies or financial incentives targeting health systems, healthcare professionals or patients to improve the management of adult outpatients with diabetes. ANALYSIS: Risk of bias (low, unclear or high) was assessed for the 142 trials in the review across nine domains using the EPOC version of the Cochrane Risk of Bias Tool. We used Cochran-Armitage tests for trends to evaluate the improvement over time. RESULTS: There was no significant improvement over time in any of the risk of bias domains. Attrition bias (loss to follow-up) was the most common source of bias, with 24 trials (17%) having high risk of bias due to incomplete outcome data. Overall, 69 trials (49%) had at least one domain with high risk of bias. Inadequate reporting frequently hampered the risk of bias assessment: allocation sequence was unclear in 82 trials (58%) and allocation concealment was unclear in 78 trials (55%). There were significant reductions neither in the proportions of studies at high risk of bias over time nor in the adequacy of reporting of risk of bias domains. CONCLUSIONS: Nearly half of the included QI trials in this review were judged to have high risk of bias. Such trials have serious limitations that put the findings in question and therefore inhibit evidence-based QI. There is a need to limit the potential for bias when conducting QI trials and improve the quality of reporting of QI trials so that stakeholders have adequate evidence for implementation.

Exploring the usefulness of two conceptual frameworks for understanding how organizational factors influence innovation implementation in cancer care.
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Urquhart R, Sargeant J, Grunfeld E.
The Journal of continuing education in the health professions 2013 Dec;33(1):48-58

Moving knowledge into practice and the implementation of innovations in health care remain significant challenges. Few researchers adequately address the influence of organizations on the implementation of innovations in health care. The aims of this article are to (1) present 2 conceptual frameworks for understanding the organizational factors important to the successful implementation of innovations in health care settings; (2) discuss each in relation to the literature; and (3) briefly demonstrate how each may be applied to 3 initiatives involving the implementation of a specific innovation-synoptic reporting tools-in cancer care. Synoptic reporting tools capture information from diagnostic tests, surgeries, and pathology examinations in a standardized, structured manner and contain only the information necessary for patient care. The frameworks selected were the Promoting Action on Research Implementation in Health Services framework and an organizational framework of innovation implementation; these frameworks arise from different disciplines (nursing and management, respectively). The constructs from each framework are examined in relation to the literature, with each construct applied to synoptic reporting tool implementation to demonstrate how each may be used to inform both practice and research in this area. By improving our understanding of existing frameworks, we enhance our ability to more effectively study and target implementation processes. Copyright © 2013 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

Comprehensive assessment of chronic pain management in primary care: a first phase of a quality improvement initiative at a multisite Community Health Center.
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Anderson D, Wang S, Zlateva I.
Quality in primary care 2013;20(6):421-433

BACKGROUND: The objective of this study was to conduct a comprehensive formative assessment of chronic pain management in a large, multisite community health centre and use the results to design a quality improvement initiative based on an evidence-based practice model developed by the Veterans Health Administration. Improving quality and safety by incorporating evidence-based practices (EBP) is challenging, particularly in busy clinical practices such as Federally Qualified Health Centers (FQHCs). FQHCs grapple with financial constraints, lack of resources and complex patient populations. METHODS: The Promoting Action on Research Implementation in Health Services (PARIHS) Framework served as a basis for the comprehensive assessment. We used a range of measures and tools to examine pain care from a variety of perspectives. Patients with chronic pain were identified using self-reported pain scores and opioid prescription records. We employed multiple data collection strategies, including querying our electronic health records system, manual chart reviews and staff surveys. RESULTS: We found that patients with chronic pain had extremely high primary care utilisation rates while referral rates to pain-related specialties were low for these patients. Large gaps existed in primary care provider adherence to standards for pain care documentation and practice. There was wide provider variability in the prescription of opioids to treat pain. Staff surveys found substantial variation in both pain care knowledge and readiness to change, as well as low confidence in providers’ ability to manage pain, and dissatisfaction with the resources available to support chronic pain care. CONCLUSIONS: Improving chronic pain management at this Community Health Center requires a multifaceted intervention aimed at addressing many of the problems identified during the assessment phase. During the intervention we will put a greater emphasis on increasing options for behavioural health and complementary medicine support, increasing access to specialty consultation, providing pain-specific CME for providers, and improving documentation of pain care in the electronic health records.

IBCD: Development and Testing of a Checklist to Improve Quality of Care for Hospitalized General Medical Patients
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Aspesi A, Kauffmann G, Davis A, Schulwolf E, Press V, Stupay K, et al.
Joint Commission Journal on Quality and Patient Safety 2013 04/01;39(4):147

Background: Several studies have demonstrated the usefulness of medical checklists to improve quality of care in surgery and the ICU. The feasibility, effectiveness, and sustainability of a checklist was explored. Methods: Literature on checklists and adherence to quality indicators in general medicine was reviewed to develop evidence-based measures for the IBCD checklist: (I) pneumococcal immunization, (B) pressure ulcers (bedsores), (C) catheter-associated urinary tract infections (CAUTIs), and (D) deep venous thrombosis (DVT) were considered conditions highly relevant to the quality of care in general medicine inpatients. The checklist was used by attending physicians during rounds to remind residents to perform four actions related to these measures. Charts were audited to document actions prompted by the checklist. Results: The IBCD checklist was associated with significantly increased documentation of and adherence to care processes associated with these four quality indicators. Seventy percent (46/66) of general medicine teams during the intervention period of July 2010-March 2011 voluntarily used the IBCD checklist for 1,168 (54%) of 2,161 patients. During the intervention period, average adherence for all four checklist items increased from 68% on admission to 82% after checklist use (p < .001). Average adherence after checklist use was also higher when compared to a historical control group from one year before implementation (82% versus 50%, p < .0001). In the six weeks after the checklist was transitioned to the electronic medical record, IBCD was noted in documentation of 133 (59%) of 226 patients admitted to general medicine. Conclusion: A checklist is a useful and sustainable tool to improve adherence to, and documentation of, care processes specific to quality indicators in general medicine.

Using a Hospital Quality Improvement Toolkit to Improve Performance on the AHRQ Quality Indicators
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Hussey P, Burns R, Weinick R, Mayer L, Cerese J, Farley D.
Joint Commission Journal on Quality and Patient Safety 2013 04/01;39(4):177.

As the recognition of variation in hospital quality has increased during the last decade, payers, accrediting agencies, Quality Improvement Organizations, and the US federal government have increasingly focused on monitoring, public reporting, and improvement initiatives to decrease variation and increase overall quality. In response, hospitals have increasingly focused on quality measurement and improvement. External incentive programs put increasing pressure on hospitals to mea – sure and improve their performance. If hospitals lack the knowledge, skills, or resources to improve performance, initiatives for improving hospital performance may be frustrating and have little effect on quality. Even hospitals with advanced quality improvement operations may face challenges in meeting the requirements of various external programs while also addressing their own priorities. In response, we developed a toolkit to support all phases of quality improvement, including preparation, measurement, priority setting, implementation, and monitoring progress for sustainable improvement.

Development of quality of care indicators from systematic reviews: the case of hospital delivery.
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Bonfill X, Roque M, Aller MB, Osorio D, Foradada C, Vives A, et al.
Implementation science : IS 2013 Apr 10;8(1):42

BACKGROUND: The objective of this research is to generate quality of care indicators from systematic reviews to assess the appropriateness of obstetric care in hospitals. METHODS: A search for systematic reviews about hospital obstetric interventions, conducted in The Cochrane Library, clinical evidence and practice guidelines, identified 303 reviews. We selected 48 high-quality evidence reviews, which resulted in strong clinical recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The 255 remaining reviews were excluded, mainly due to a lack of strong evidence provided by the studies reviewed. RESULTS: A total of 18 indicators were formulated from these clinical recommendations, on antepartum care (8), care during delivery and postpartum (9), and incomplete miscarriage (1). Authors of the systematic reviews and specialists in obstetrics were consulted to refine the formulation of indicators. CONCLUSIONS: High-quality systematic reviews, whose conclusions clearly claim in favour or against an intervention, can be a source for generating quality indicators of delivery care. To make indicators coherent, the nuances of clinical practice should be considered. Any attempt made to evaluate the extent to which delivery care in hospitals is based on scientific evidence should take the generated indicators into account.

Nuffield Trust: Rating providers for quality: a policy worth pursuing?
March 2013

Should there be ‘Ofsted-style’ ratings for health and social care providers such as hospitals, GP practices and care homes? In November 2012, the Rt. Hon Jeremy Hunt MP, Secretary of State for Health, commissioned Dr Jennifer Dixon and the Nuffield Trust to consider this question as part of a review of whether aggregate ratings of provider performance should be used in health and social care in England. This report is the final output of the review process. It was presented to the Secretary of State for Health on 22 March 2013. Provider ratings were earlier published by various bodies from 2008 to 2010 in social care, and from 2001 to 2009 in the NHS. Early forms of the health rating (“star ratings”) were particularly visible to the public and professionals before being scrapped. Our analysis suggests that a clear gap has arisen in terms of the provision of comprehensive and trusted information on the quality of care of providers to inform the public and improve accountability. The report concludes that the costs and benefits in implementing a ratings system may be favourable for providers of social care and for general practices (given the potential for choice and the nature of care provided in those settings). The benefits are less certain for hospitals, given the way that ratings were designed and used in the past. The report lists a number of conditions that would have to be fulfilled for any potential benefits of hospital ratings to be fully realised.

National Patient Safety Foundation: Through the Eyes of the Workforce: Creating Joy, Meaning, and Safer Health Care

Workplace safety is inextricably linked to patient safety. Unless caregivers are given the protection, respect, and support they need, they are more likely to make errors, fail to follow safe practices, and not work well in teams. This report looks at the current state of health care as a workplace, highlights vulnerabilities common in health care organizations, discusses the costs of inaction, and outlines what a healthy and safe workplace would look like. The report concludes with seven recommendations for actions that organizations need to pursue to effect real change.

Research Methodology
Building research capital to facilitate research.
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Green G, Rein M.
Health research policy and systems 2013 Apr 4;11(1):12

The National Institute for Health Research, Research Design Service (NIHR RDS) was set up to increase the number and proportion of high quality applications for funding for applied and patient focused health and social care research. Access to specialist expertise and collaboration between researchers and health practitioners at the proposal development stage is crucial for high quality applied health research. In this essay we develop the concept of ‘research capital’ to describe the wide range of resources and expertise required to develop fundable research projects. It highlights the key role the RDS plays supporting researchers to broker relationships to access the requisite ‘research capital’.

An empirical investigation of the potential impact of selective inclusion of results in systematic reviews of interventions: study protocol.
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Page MJ, McKenzie JE, Green SE, Forbes AB.
Systematic reviews 2013 Apr 10;2(1):21

BACKGROUND: Systematic reviewers may encounter a multiplicity of outcome data in the reports of randomised controlled trials included in the review (e.g. multiple measurement instruments measuring the same outcome, multiple time points, and final and change from baseline values). The primary objectives of this study are to investigate in a cohort of systematic reviews of randomised controlled trials of interventions for rheumatoid arthritis, osteoarthritis, depressive disorders and anxiety disorders: (i) how often there is multiplicity of outcome data in trial reports; (ii) the association between selection of trial outcome data included in a meta-analysis and the magnitude and statistical significance of the trial result, and; (iii) the impact of the selection of outcome data on meta-analytic results.Methods/design: Forty systematic reviews (20 Cochrane, 20 non-Cochrane) of RCTs published from January 2010 to January 2012 and indexed in the Cochrane Database of Systematic Reviews (CDSR) or PubMed will be randomly sampled. The first meta-analysis of a continuous outcome within each review will be included. From each review protocol (where available) and published review we will extract information regarding which types of outcome data were eligible for inclusion in the meta-analysis (e.g. measurement instruments, time points, analyses). From the trial reports we will extract all outcome data that are compatible with the meta-analysis outcome as it is defined in the review and with the outcome data eligibility criteria and hierarchies in the review protocol. The association between selection of trial outcome data included in a meta-analysis and the magnitude and statistical significance of the trial result will be investigated. We will also investigate the impact of the selected trial result on the magnitude of the resulting meta-analytic effect estimates. DISCUSSION: The strengths of this empirical study are that our objectives and methods are pre-specified and transparent. The results may inform methods guidance for systematic review conduct and reporting, particularly for dealing with multiplicity of randomised controlled trial outcome data.

Should researchers use single indicators, best indicators, or multiple indicators in structural equation models?
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Hayduk LA, Littvay L.
BMC medical research methodology 2012 Oct 22;12:159-2288-12-159

BACKGROUND: Structural equation modeling developed as a statistical melding of path analysis and factor analysis that obscured a fundamental tension between a factor preference for multiple indicators and path modeling’s openness to fewer indicators. DISCUSSION: Multiple indicators hamper theory by unnecessarily restricting the number of modeled latents. Using the few best indicators – possibly even the single best indicator of each latent – encourages development of theoretically sophisticated models. Additional latent variables permit stronger statistical control of potential confounders, and encourage detailed investigation of mediating causal mechanisms. SUMMARY: We recommend the use of the few best indicators. One or two indicators are often sufficient, but three indicators may occasionally be helpful. More than three indicators are rarely warranted because additional redundant indicators provide less research benefit than single indicators of additional latent variables. Scales created from multiple indicators can introduce additional problems, and are prone to being less desirable than either single or multiple indicators.

Improving the normalization of complex interventions: measure development based on normalization process theory (NoMAD): study protocol.
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Finch TL, Rapley T, Girling M, Mair FS, Murray E, Treweek S, et al.
Implementation science : IS 2013 Apr 11;8(1):43

BACKGROUND: Understanding implementation processes is key to ensuring that complex interventions in healthcare are taken up in practice and thus maximize intended benefits for service provision and (ultimately) care to patients. Normalization Process Theory (NPT) provides a framework for understanding how a new intervention becomes part of normal practice. This study aims to develop and validate simple generic tools derived from NPT, to be used to improve the implementation of complex healthcare interventions.Objectives: The objectives of this study are to: develop a set of NPT-based measures and formatively evaluate their use for identifying implementation problems and monitoring progress; conduct preliminary evaluation of these measures across a range of interventions and contexts, and identify factors that affect this process; explore the utility of these measures for predicting outcomes; and develop an online users’ manual for the measures. METHODS: A combination of qualitative (workshops, item development, user feedback, cognitive interviews) and quantitative (survey) methods will be used to develop NPT measures, and test the utility of the measures in six healthcare intervention settings. DISCUSSION: The measures developed in the study will be available for use by those involved in planning, implementing, and evaluating complex interventions in healthcare and have the potential to enhance the chances of their implementation, leading to sustained changes in working practices.

AHRQ: Meta-Analytic Statistical Inferences for Continuous Measure Outcomes as a Function of Effect Size Metric and Other Assumptions
April 2013

This investigation provides guidance forstatistical practice in relation to meta-analysis of studies that compare two groups at one point in time, or that examine repeated measures for one or two groups. Simulations showed that neither standardized or unstandardized effect size indexes had an advantage in terms of bias or efficiency when distributions are normal, when there is no heterogeneity among effects, and when the observed variances of the experimental and control groups are equal. In contrast, when conditions deviate from these ideals, the SMD yields better statistical inferences than UMDs in terms of bias and efficiency. Under high skewness and kurtosis, neither metric has a marked advantage. In general, the standardized index presents the least bias under most conditions and is more efficient than the unstandardized index. Finally, the results comparing estimations of the SMD and its variance suggest that some are preferable to others under certain conditions. The current results imply that the choice of effect size metrics, estimators, and sampling variances can have substantial impact on statistical inferences even under such commonly observed circumstances as normal sampling distributions, large numbers of studies, and studies with large samples, and when effects exhibit vi heterogeneity. Although using the SMD may make clinical inferences more difficult, use of the SMD does permit inferences about effect size magnitude. The Discussion considers clinical interpretation of results using the SMD and addresses limitations of the current project.

IRISS: Understanding and measuring outcomes: The role of qualitative data

This guide has been developed to support the collection and use of personal outcomes data. Personal outcomes data refers to information gathered from people supported by health and social services and their unpaid carers about what’s important to them in their lives and the ways in which they would like to be supported. The guide is divided into three parts.
Part 1 explores the links between an outcomes approach and qualitative data, why qualitative data is important and what it can achieve
Part 2 outlines a practical approach exploring collecting, recording, analysing and reporting qualitative data about personal outcomes
Part 3 highlights different approaches to qualitative analysis through case studies of people using qualitative data about outcomes for the first time

Publication efficiency among the higher impact factor nursing journals in 2009: A retrospective analysis.
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Palese A, Coletti S, Dante A.
International journal of nursing studies 2013 Apr;50(4):543-551

BACKGROUND: Knowledge translation is attracting different professional, educational and institutional strategies mainly focused on how new knowledge should be tailored and transferred at bedside. Less attention is dedicated to the antecedent of knowledge translation, which is the availability of the knowledge itself. Knowledge diffusion is a process by which an innovation is communicated through certain channels among members of a social system over time. Publishing in peer review journals is recognised as the main method for knowledge diffusion: nevertheless publication efficiency has received little attention to date. OBJECTIVES: Describing publication efficiency via nursing journals as the time occurring between data collection and manuscript publication was the main aim of the study. The secondary aim was to discover the differences, if any, in publication efficiency within manuscripts reporting results from different study designs. DESIGN: A retrospective study design was adopted in 2010. METHODS: The 2009 Impact Factor List of Nursing Journals published by the ISI web of Knowledge in 2010 was obtained. The first top ten IF Nursing Journals available as a full text and for which the overall ISI 5-Year Impact Factor was also available, was eligible. The articles published on paper by the selected journals, from 1st January to 31st December 2009, were then included. Commentaries, editorials and book reviews were excluded. For each article included, the following were evaluated: (a) the time occurring between each step of publication, from data collection to article submission, acceptance and publication online and on paper; and (b) the differences in the publication efficiency within articles reporting different study designs. RESULTS: 1152 articles were included. From the end of data collection to manuscript publication online/on paper it takes an average of 981 days [CI95% 929-1032] (2.5-3 years). Meta-analysis and systematic reviews have demonstrated the fastest process, requiring an average 1.3 years and 1.9 years respectively. Case-control, cohort and quasi-experimental studies have required more time to enjoy publication in nursing journals, 4 years, 3.5 years and 3.2 years respectively. CONCLUSIONS: The production time of an article from its data collection involves significant processes and skills. However, the time may also be lengthened by factors not related to the processes of research, such as the time available to researchers. The scientific world needs to reflect on publication efficiency because lateness can potentially have a negative impact on patients and on further research. In the future, the same emphasis given to the evaluation of knowledge translation effectiveness should be given also to the complex process of knowledge diffusion, discovering facilitators and barriers. Copyright © 2012 Elsevier Ltd. All rights reserved.

Patient safety culture and the association with safe resident care in nursing homes.
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Thomas KS, Hyer K, Castle NG, Branch LG, Andel R, Weech-Maldonado R.
The Gerontologist 2012 Dec;52(6):802-811

PURPOSE OF THE STUDY: Studies have shown that patient safety culture (PSC) is poorly developed in nursing homes (NHs), and, therefore, residents of NHs may be at risk of harm. Using Donabedian’s Structure-Process-Outcome (SPO) model, we examined the relationships among top management’s ratings of NH PSC, a process of care, and safety outcomes. DESIGN AND METHODS: Using top management’s responses from a nationally representative sample of 3,557 NHs on the 2008 Nursing Home Survey on PSC, the Online Survey, Certification, and Reporting Database, and the Minimum Data Set, we examined the relationships among the three components of Donabedian’s SPO model: structure (PSC), a process of care (physical restraints), and patient safety outcomes (residents who fell). RESULTS: Results from generalized estimating equations indicated that higher ratings of PSC were significantly related to lower prevalence of physical restraints (odds ratio [OR] = 0.997, 95% confidence interval [CI] = 0.995-0.999) and residents who fell (OR = 0.999, 95% CI = 0.998-0.999). Physical restraint use was related to falls after controlling for structural characteristics and PSC (OR = 1.698, 95% CI = 1.619-1.781). IMPLICATIONS: These findings can contribute to the development of PSC in NHs and promote improvements in health care that can be measured by process of care and resident outcomes.

Review of current conceptual models and frameworks to guide transitions of care in older adults.
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Enderlin CA, McLeskey N, Rooker JL, Steinhauser C, D’Avolio D, Gusewelle R, et al.
Geriatric nursing (New York, N.Y.) 2013 Jan;34(1):47-52

Older adults are at high risk for gaps in care as they move between health care providers and settings during the course of illness, such as following hospital discharge. These gaps in care may result in unnecessary re-hospitalization and even death. Nurses can assist older adults to achieve successful transitions of care by taking a systematic approach and individualizing care to meet patient and family health literacy, cognitive, and sensory needs. This article reviews trends in transitions of care, models, partnerships, and health literacy. Models described include the Transitional Care Model, Care Transitions Program, Project BOOST (Better Outcomes for Older adults through Safe Transitions), Project RED (Re-engineered Discharge), Chronic Care Model, and INTERACT(II) (Interventions to Reduce Acute Care Transfers). Approaches to transitions of care are discussed, and resources for geriatric nurses are provided. Copyright © 2013 Mosby, Inc. All rights reserved.

Common factors that enhance the quality of life for women living in their own homes or in aged care facilities.
Non UofA Access
Chin L, Quine S.
Journal of women & aging 2012;24(4):269-279

A qualitative study of older women living in their own homes and older women living in aged care facilities found that the concerns of the women living in their own homes were the realities of life for the residents in the aged care facilities. Twenty-five female residents across two facilities and 11 older women living in their own homes were interviewed. The positive outcomes of aging at home are relevant and desirable for residents of aged care facilities. A smooth transition from community living to residential aged care involves retaining some of these positive aspects of their lives.

Systematic Review of Interdisciplinary Interventions in Nursing Homes.
Non UofA Access
Nazir A, Unroe K, Tegeler M, Khan B, Azar J, Boustani M.
Journal of the American Medical Directors Association 2013 Apr 6

BACKGROUND: The role of interdisciplinary interventions in the nursing home (NH) setting remains unclear. We conducted a systematic evidence review to study the benefits of interdisciplinary interventions on outcomes of NH residents. We also examined the interdisciplinary features of successful trials, including those that used formal teams. DATA SOURCES: Medline was searched from January 1990 to August 2011. Search terms included residential facilities, long term care, clinical trial, epidemiologic studies, epidemiologic research design, comparative study, evaluation studies, meta-analysis and guideline. STUDY SELECTION: We included randomized controlled trials (RCTs) evaluating the efficacy of interdisciplinary interventions conducted in the NH setting. MEASUREMENTS: We used the Cochrane Collaboration tools to appraise each RCT, and an RCT was considered positive if its selected intervention had a significant positive effect on the primary outcome regardless of its effect on any secondary outcome. We also extracted data from each trial regarding the participating disciplines; for trials that used teams, we studied the reporting of various team elements, including leadership, communication, coordination, and conflict resolution. RESULTS: We identified 27 RCTs: 7 had no statistically significant effect on the targeted primary outcome, 2 had a statistically negative effect, and 18 demonstrated a statistically positive effect. Participation of residents’ own primary physicians (all 6 trials were positive) and/or a pharmacist (all 4 trials were positive) in the intervention were common elements of successful trials. For interventions that used formal team meetings, presence of communication and coordination among team members were the most commonly observed elements. CONCLUSION: Overall interdisciplinary interventions had a positive impact on resident outcomes in the NH setting. Participation of the residents’ primary physician and/or a pharmacist in the intervention, as well as team communication and coordination, were consistent features of successful interventions. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

AHRQ: Comparison of Characteristics of Nursing Homes and Other Residential Long- Term Care Settings for People With Dementia
October 2012

Objectives: To compare characteristics and related outcomes of nursing homes (NHs) and other residential long-term care settings for people with dementia so as to reduce uncertainty when choosing a setting of care for someone with dementia. Data Sources: We searched MEDLINE®, Embase®, the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL®), AgeLine®, and PsycINFO® from 1990 through March 23, 2012. We identified additional studies from reference lists and experts. Review methods: Two people independently selected, abstracted data from, and rated the quality of relevant studies. Given that quantitative analyses were inappropriate because of clinical heterogeneity, insufficient numbers of similar studies, or insufficient or variation in outcome reporting, we synthesized the data qualitatively. Two reviewers graded the strength of evidence (SOE) using established criteria. Results: We identified 14 studies meeting our inclusion criteria. Generally, studies examined characteristics, structures, and process of care for populations with mild to severe dementia. Ten studies addressed health outcomes (Key Question [KQ] 1), and 10 examined psychosocial outcomes (KQ 2) for people with dementia. No eligible studies examined health or psychosocial outcomes for informal caregivers (KQ 3 and KQ 4, respectively). The studies included four prospective cohort studies, nine randomized controlled trials (RCTs), and one non-RCT. Two studies showed that the use of pleasant sensory stimulation reduces agitation. We found limited evidence on a number of interventions, including protocols for individualized care to reduce pain/discomfort and agitation/aggression and functional skill training to improve function. We found largely no differences across outcomes including function, cognition, depressive symptoms, pain, morbidity, behavioral symptoms, engagement, and quality of life based on residence in an NH or residential care/assisted living (RC/AL), other than increased hospitalization for people with mild dementia in RC/AL compared with NHs and increased restraint use in NHs compared with RC/AL for imminently dying residents. Conclusions: Overall, we found low or insufficient SOE regarding the effect of organizational characteristics, structures, and processes of care on health and psychosocial outcomes for people with dementia and no evidence for informal caregivers. Findings of moderate SOE indicate that pleasant sensory stimulation reduces agitation. Also, although the SOE is low, protocols for individualized care and to improve function result in better outcomes. Finally, outcomes do not differ between NHs and RC/AL except when medical care is indicated. Additional research is needed to develop a sufficient evidence base to support decisionmaking.


Health Systems AoE Brown Bag: Governance in the Context of Research Studies
April 24 12:00-13:00, ECHA 5-140
Presenter: Dr. Carole Estabrooks

Focuses on the context of research studies, as well as individual research studies.

Faculty of Nursing breakfast meeting with Dr. John Fletcher, Editor in Chief of the Canadian Medical Journal (CMAJ)
Tuesday 23rd April, 08:30-09:20 ECHA 5-001

Please come for breakfast and hear of new developments at CMAJ and bring your questions about publishing your work in CMAJ or CMAJ Open.

Non UofA
Conference Board of Canada: Western Summit on Sustainable Health
Edmonton, AB May 22-23, 2013

The Conference Board of Canada’s Canadian Alliance for Sustainable Health Care (CASHC) is pleased to present the Western Summit on Sustainable Health. This insightful forum will provide an opportunity for all health stakeholders from across the West to connect, share ideas, and discuss how to transform the health care system and improve the health of Canadians.

CFHI: What is Patient Engagement and Why Do It?
Tuesday April 23, 2013 10-11:30 MT, Costs $99

What is Patient Engagement and Why Do It?, will provide a practical introduction to patient engagement. Participants will gain an understanding of the concept of patient- and family-centred care, the benefits of patient engagement, and the foundational elements essential to working with patients and families in meaningful and effective ways. Hear how Cancer Care Ontario and Alberta Health Services incorporated the foundations of patient and family engagement into their work and reflect on the opportunities that exist in your context for partnering with patients for quality improvement.

AHRQ: Fuzzy Set Analysis Webinar
Monday April 15, 2012 10:00–11:00 (MT)

Fuzzy set analysis is a mode of analyzing data using set membership and configurational analysis. The mode allows researchers to calibrate partial membership in sets using values in the interval between 0 (non-membership) and 1 (full membership), without abandoning core set theoretic principles. The presenters are Marcus Thygeson, M.D., associate medical director, Health Partners, and Jodi Holtrop, associate professor, Department of Family Medicine, Michigan State University. The moderator is Michael Harrison, Ph.D., senior social scientist, AHRQ. Four other webinars will be held on May 14, June 4, July 15, and a yet to-be-determined date in December. The webinars will focus on planning, executing, analyzing, and reporting research on delivery system improvement.

How Funders Can Help Spread Ideas and Innovation Webinar
Tuesday April 23 12:00-13:00

From Grantmakers for Effective Organizations. By advancing the spread of an idea or an innovation, nonprofits and funders are able to extend their reach, transform how they respond to persistent social problems and increase participation from partners with shared missions. Join this webinar to hear David Colby, vice president of research and evaluation at the Robert Wood Johnson Foundation, talk about the foundation’s innovative responses to addressing complex social issues, such as childhood obesity, end-of-life care and teen tobacco use. Additionally, Becky Kanis, director of the 100,000 Homes Campaign will talk about their work to spread the “housing first” model as a way to end permanent homelessness. Join us to hear about the skills that enable organizations to spread ideas effectively as well as what grantmakers can do to help.

NICHE: ‘Uh-Oh’ to ‘Oh-Yeah!’: A Nurse Driven Urinary Catheter Removal Protocol
Wednesday April 24, 2013 11:00-12:00 (MT) Costs NICHE Site Free, Non-NICHE site $99

This webinar will discuss the inappropriate use of urinary catheters as associated with negative patient outcomes: urinary tract infections (UTIs), patient discomfort and dignity issues, impediment of mobility, restraint issues, increased healthcare costs, morbidity and mortality. An overall increase in staff knowledge will result in a decrease of catheter associated urinary tract infections (CAUTIs). Join us for this webinar to learn how to positively impact quality patient outcomes through an evidence-based, nurse-driven urinary catheter removal protocol.

CFHI: Mapping the Chronic Care Experience and Applying Theory of Change Thinking for Healthcare Improvement
Wednesday April 17, 2013, 10:00-11:15 MT Costs: $99
Presenters: Prof. Francois Champagne & France Laframboise

This session of Improvement On Call will introduce an approach to mapping the current chronic care experience and applying theory of change thinking toward healthcare improvement. It will also share the experience of a healthcare leader who has undertaken this approach in the redesign of the CSSS des Sommets service delivery model toward a population based approach to improve quality of life for “chronically ill” patients – 5% of the population, consuming 85% of all healthcare resources – and, ultimately to improve how they use health services in the region.

CPSI: STOP! Clean Your Hands Day Webinar Series

Each week, you’ll hear from experts in the field and learn how to improve hand hygiene practices in your organization. Each Webinar will run for one hour starting at 10 am MT.

  • Ten barriers to hand hygiene April 15, 2013
  • ​Patient and Visitor Involvement: The Hand Hygiene Missing Link? April 18, 2013
  • ​Patient Involvement in Hand Hygiene April 24, 2013
  • ​Hand Hygiene Measurement and Patient Safety Metrics May 1, 2013

ANA: Innovation in Nursing Practice: Are You Leading the Charge? Webinar
Thursday, May 9 11:00-12:00 MT

Innovation in nursing practice harnesses processes, technologies and best practices to improve patient outcomes and satisfaction. In addition, innovation in nursing practice can increase effectiveness, reduce stress, and provide more satisfaction for a nurse in her/his career. Today, innovation is often driven by applying technology and processes creatively to practice. Nurses have to channel continuously the information, initiative, and imagination necessary to support and sustain innovation.


NICE: Dementia care ‘patchy’

The standard of care provided for people with dementia is “patchy”, the National Institute for Health and Care Excellence (NICE) has said.

NY Times: Dementia Care Cost Is Projected to Double by 2040

The most rigorous study to date of how much it costs to care for Americans with dementia found that the financial burden is at least as high as that of heart disease or cancer, and is probably higher. And both the costs and the number of people with dementia will more than double within 30 years, skyrocketing at a rate that rarely occurs with a chronic disease.

CBC Rate My Hospital site flooded with rankings

The online hospital ranking tool by CBC’s the fifth estate — the first rating system of its kind in Canada — has already amassed more than 23,000 responses from across the country since its launch on April 10, 2013.

Boston Globe: Brigham and Women’s airing medical mistakes-Hospital reports errors to staff in drive for improvement

Brigham openly recounted a communication error that led to a misdiagnosis, and the improvements it led to, in a monthly online newsletter for its 16,000 employees. Brigham leaders started the publication to encourage staff to talk openly about their mistakes and propose solutions, and help make sure errors are not repeated.

Saskatchewan Seniors’ Home-Care Pilot Program Allocated $2 million

Seniors may soon have a new service available to help them stay in their homes longer. The province announced that it has allocated $2 million for a new Home First/ Quick Response Home Care two-year pilot program in the Regina Qu’Appelle Health Region (RQHR).

figshare partners with Nature on their Scientific Data journal

Scientific Data is a new open-access, online-only publication for descriptions of scientifically valuable datasets from Nature Publishing Group.

NY Times: The Dark Side of Open Access Publishing

Some researchers (and librarians) are now raising the alarm about what they see as the proliferation of online journals that will print seemingly anything for a fee.

ResearchImpact chooses The role of evidence, context, and facilitation in an implementation trial: implications for the development of the PARIHS framework for it’s online journal club

There’s an easy to read summary and some questions intended for knowledge brokers.

Toronto Star: Three ways to bridge Canada’s innovation gap

University innovation, access to capital and basic research are the keys to fixing Canada’s dismal research and innovation record.

Healthcare assistants’ in the UK want professional register’

Most healthcare assistants in the UK want to see tougher regulation of the profession, a survey suggests.


2013 Tri-Agency Financial Administration Guide Now Available

The three federal granting agencies—the Canadian Institutes of Health Research, the Natural Sciences and Engineering Research Council of Canada, and the Social Sciences and Humanities Research Council of Canada—have posted the 2013 Tri-Agency Financial Administration Guide on their respective Web sites. The guide is effective April 1, 2013 and supersedes all previous versions.


Myclinicaltriallocator.com permits patients to learn about clinical trials, search for clinical trials, clinical research, and observational studies by disease, condition or location in the United States and around the world. The site lists all existing clinical trials, regardless of whether they are open or closed, and provides information on eligibility and contact information. The site is comprehensive and includes clinical trials for drugs/medications; medical devices; medical procedures and interventions; and studies that look at lifestyle or behavioral changes, such as nutrition, diet or exercise. Patients can view clinical trials on a map and sign up for “push notification” to find out about new clinical trials.

Ontario Centre for Excellence on Child and Youth Mental Health: Implementing an evidence-informed practice modules

This website contains learning modules to support agencies that are implementing evidence-based practices. Modules on organizational change, teamwork and collaboration, needs assessment, and practical implementation are offered, and can be completed individually or as a team.

Long-Term Care & Residential Care: Evidence-Based Resources

These resources are the result of a collaboration between RxFiles and CADTH. Included are resources for providers, LTC administration, and family members/informal caregivers.

The A to Z of Social Media for Academia

An index of social media tools that may be useful for academics.


CFHI: Communications Officer (Program Officer II)
DEADLINE: April 22, 2012

Under the guidance and direction of the Senior Communications Specialist, the Communications Officer is responsible for a wide range of communications services that support the planning and delivery of CFHI’s programs. These services include the writing, editing and preparation of a variety of communications products, and a range of creative services, including support to CFHI’s social media and media relations strategy, website, corporate events and promotional activities.

World Economic Forum: Senior Project Manager Health Systems Transformation

As Senior Project Manager for the Health Systems Transformation project, you will:
• Lead on content, identifying opportunities for undertaking country deep dives in emerging economies and engaging relevant stakeholders
• Manage the country work envisioned for different locations (3-5 low-middle income countries) by developing content and know-how from needs assessments undertaken in each country; follow through with planning potential implementation of recommendations; and derive overall conclusions that are applicable to different situations and a set of principles/methodology that can be scaled up
• Be responsible for setting up country deep dive sessions and private sessions during World Economic Forum events
• Manage the project’s working group of senior leaders, helping them deliver concrete inputs to the work
• Be responsible for the outputs of the project, including leading on reports and other deliverables
• Any other ad hoc needs for the project and related work within the Health Team

Departmental Lecturer in Evidence-Based Social Intervention
Department of Social Policy and Intervention, University of Oxford
DEADLINE: 19 April 2013

The department wishes to appoint a full-time Departmental Lecturer in Evidence-Based Social Intervention from 1 October 2013 or as soon as possible thereafter. This is an excellent opportunity to join a vibrant research centre and contribute to the continuing growth of teaching and research in evidence-based social intervention. The Departmental Lecturer will be involved in teaching, supervision and examining on the MPhil and MSc courses in Evidence-Based Social Intervention, and will also conduct a programme of research within the Centre for Evidence-Based Intervention (CEBI).

Systematic Reviewer The National Collaborating Centre for Mental Health (NCCMH)
University College London, UK
DEADLINE Friday May 3, 2013

The post holder will undertake and oversee systematic reviews in aspects of mental health practice, present findings to an expert development group, assist with developing evidence based recommendations and prepare guidelines and papers for publication. There will be close work with other reviewers and methodologists, with access to a full range of academic resources at both UCL and the Royal College of Psychiatrists.

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