Article recommended by Dr. Carole Estabrooks
Place of death and health care utilization for people in the last 6 months of life in Switzerland: a retrospective analysis using administrative data.
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Reich O, Signorell A, Busato A.
BMC health services research 2013 Mar 25;13:116-6963-13-116
BACKGROUND: There is a growing interest in examining the current state of care and identifying opportunities for improving care and reducing costs at the end of life. The aim of this study is to examine patterns of health care use at the end of life and place of death and to describe the basic characteristics of the decedents in the last six months of their life. METHODS: The empirical analysis is based on data from 58,732 Swiss residents who died between 2007 and 2011. All decedents had mandatory health insurance with Helsana Group, the largest health insurer in Switzerland. Descriptive statistical techniques were used to provide a general profile of the study population and determinants of the outcome for place of death were analyzed with an econometric approach. RESULTS: There were substantial and significant differences in health care utilization in the last six months of life between places of death. The mean numbers of consultations with a general practitioner or a specialist physician as well as the number of different medications and the number of hospital days was consistently highest for the decedents who died in a hospital. We found death occurred in Switzerland most frequently in hospitals (38.4% of all cases) followed by nursing homes (35.1%) and dying at home (26.6%). The econometric analysis indicated that the place of death is significantly associated with age, sex, region and multiple chronic conditions. CONCLUSIONS: The importance of nursing homes and patients’ own homes as place of death will continue to grow in the future. Knowing the determinants of place of death and patterns of health care utilization of decedents can help decision makers on the allocation of these needed health care services in Switzerland.
CALL FOR ABSTRACTS: 2nd Annual NHMRC Symposium on Research Translation
October 2, 2013 Sydney Australia
DEADLINE May 13, 2013
The aim of this multi-disciplinary event is to showcase Australia’s talent and creativity across the entire spectrum of research translation: including advances from innovation and industry, through to clinical and public health practice and health policy. It will provide an opportunity for exchange about research translation across disciplines. This event will be the 2nd annual symposium of the NHMRC Research Translation Faculty. You do not need to be a Faculty member to submit an abstract and attend the symposium.
CALL FOR ABSTRACTS: AMDA’s 2014 Call for Presentations and Abstracts
February 27- March 2, 2014 Nashville, TN
DEADLINE Oral Presentation Submission July 16, 2013
DEADLINE Model Programs and Policies Swap September 16, 2013
DEADLINE Poster Submission October 28, 2013
The Program Committee invites you to submit program proposals and abstracts for AMDA Long Term Care Medicine. Submissions should be based on the learning objectives and areas of interest noted below and include current trends and best practices in long term care. Of special interest is emerging clinical information, research, innovations in non-pharmaceutical modification of challenging behaviors, emerging concepts in management and medical direction, and updates on approaches to regulatory compliance. AMDA also seeks proposals that emphasize strategies for successful cooperation with consultant pharmacists and administrators.
Grants & Awards
The Best Brains Exchange initiative is part of a larger CIHR provincial engagement strategy called Evidence on Tap. Evidence on Tap aims to produce high-quality, timely, and accessible evidence that responds to Ministry-identified health system priorities to help inform policy development, planning and program implementation. Evidence on Tap was developed to amplify CIHR’s capacity to engage with provincial and territorial ministries of health, and to generate applied and relevant research that is responsive to their priorities. The Best Brains Exchange is a one-day, in-camera meeting for decision makers and researchers with expertise on a topic deemed high priority by the Ministry. Specifically, it is a forum to highlight existing and relevant research evidence on the topic (and where the gaps in evidence lie), to bring together both decision maker and researcher expertise on the issue, and to candidly discuss the applicability of the research for the province. The Best Brains Exchange is an informal forum for interaction, exchange and mutual learning between researchers and decision makers in order to support and facilitate the sharing and use of information on a high priority topic.
Evidence-based practice in radiology: Knowledge, attitude and perceived barriers to practice among residents in radiology.
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Anuradha C, Jacob KS, Shyamkumar NK, Sridhar G.
European Journal of Radiology 2013 May;82(5):894-897
AIM: We examinted the attitude, knowledge and perceived barriers to evidence-based practice of radiology (EBPR) among residents in radiology. STUDY DESIGN AND SETTING: We used the McColl questionnaire (1) and the BARRIERS scale (2) to assess the issues among radiology trainees attending an annual refresher course. Ninety six residents from 32 medical colleges from Southern India attended the course. RESULTS: Eighty (83.3%) residents, 55 male and 25 female of age range 24-34 years, consented and returned the questionnaire. The majority of the participants had a positive attitude towards EBPR. However, 45% were unaware of sources for evidence based literature although many had access to Medline (45%) and the internet (80%). The majority (70%) were aware of the common technical terms (e.g. odds ratio, absolute and relative risk) but other complex details (e.g. meta-analysis, clinical effectiveness, confidence interval, publication bias and number needed to treat) were poorly understood. Though majority of residents (59%) were currently following guidelines and protocols laid by colleagues within their departments, 70% of residents were interested in learning the skills of EBPR and were willing to appraise primary literature or systematic reviews by themselves. Insufficient time on the job to implement new ideas (70.1%); relevant literature is not being complied in one place (68.9%); not being able to understand statistical methods (68.5%) were considered to be the major barriers to EBPR. Training in critical appraisal significantly influence usage of bibliographic databases (p<0.0001). Attitude of collegues (p=0.006) influenced attitude of the trainees towards EBPR. Those with higher knowledge scores (p=0.02) and a greater awareness of sources for seeking evidence based literature (p=0.05) held stronger beliefs that EBPR significantly improved patient care. CONCLUSIONS: The large knowledge gap related to EBPR suggests the need to incorporate structured training into the core-curriculum of training programmes in radiology. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Voicing the tensions of implementing research strategies: Implications for organizational leaders
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Billot J, Codling A.
Management in Education 2013;27(2):75-80
When higher education institutions seek to align their research goals with nationally driven imperatives, various members of the institutional community need to work in concert to achieve them. The identification of effective strategies and the development of a contextually appropriate research culture are fundamental elements to progressing institutional objectives and achieving planned performance outcomes. Because all parties frequently have differing motivations, there are obvious challenges for organizational leadership. This article examines some of the issues facing academic leaders in the changing research environment within New Zealand and links them to a research study of efforts made in two differing tertiary institutions to enhance research productivity. Data indicate that there is great complexity in integrating organizational purpose with academic staff aspirations and endeavours. Of necessity, strategy and initiatives need to be situated contextually and leadership becomes a crucial mechanism for dovetailing the institutional agenda with individual enterprise. © 2013 British Educational Leadership, Management & Administration Society (BELMAS).
Historical perspectives on evidence-based nursing.
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Beyea SC, Slattery MJ.
Nursing science quarterly 2013 Apr;26(2):152-155
The authors of this article offer a review and historical perspective on research utilization and evidence-based practice in nursing. They present the evolution of research utilization to the more contemporary framework of evidence-based nursing practice. The authors address the role of qualitative research in the context of evidence-based practice. Finally, some approaches and resources for learning more about the fundamentals of evidence-based healthcare are provided.
Implications of holding ideas of evidence-based practice in nursing.
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Nursing science quarterly 2013 Apr;26(2):143-151
The author of this paper examines emerging implications of holding ideas about evidence and evidence-based practice. Evidence has a very specific role in the delivery of safe clinical care, but it is creating a serious problematic for the practice of nursing. It is proposed that: evidence-based practice be re-situated or reconstructed as a collective and organizational responsibility and not the responsibility of individual nurses in practice; nurses re-focus on articulating a more ethical foundation for praxis, one that emerges from nursing philosophy and one that is co-constituted with persons/families/groups; and nurse leaders and educators establish teaching-learning and practice environments that enable a peer-to-peer process of critical review and curious inquiry of available evidence in the contexts of shared work.
Health Care Administration and Organization
Associations of patient safety outcomes with models of nursing care organization at unit level in hospitals.
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Dubois CA, D’amour D, Tchouaket E, Clarke S, Rivard M, Blais R.
International journal for quality in health care 2013 Apr;25(2):110-117
OBJECTIVE: To examine the associations of four distinct nursing care organizational models with patient safety outcomes. DESIGN: Cross-sectional correlational study. Using a standardized protocol, patients’ records were screened retrospectively to detect occurrences of patient safety-related events. Binary logistic regression was used to assess the associations of those events with four nursing care organizational models. SETTING: Twenty-two medical units in 11 hospitals in Quebec, Canada, were clustered into 4 nursing care organizational models: 2 professional models and 2 functional models. PARTICIPANTS: Two thousand six hundred and ninety-nine were patients hospitalized for at least 48 h on the selected units. MAIN OUTCOME MEASURE: Composite of six safety-related events widely-considered sensitive to nursing care: medication administration errors, falls, pneumonia, urinary tract infection, unjustified restraints and pressure ulcers. Events were ultimately sorted into two categories: events ‘without major’ consequences for patients and events ‘with’ consequences. RESULTS: After controlling for patient characteristics, patient risk of experiencing one or more events (of any severity) and of experiencing an event with consequences was significantly lower, by factors of 25-52%, in both professional models than in the functional models. Event rates for both functional models were statistically indistinguishable from each other. CONCLUSIONS: Data suggest that nursing care organizational models characterized by contrasting staffing, work environment and innovation characteristics may be associated with differential risk for hospitalized patients. The two professional models, which draw mainly on registered nurses (RNs) to deliver nursing services and reflect stronger support for nurses’ professional practice, were associated with lower risks than are the two functional models.
Factors influencing critical care nurses’ perception of their overall job satisfaction: an empirical study.
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Moneke N, Umeh OJ.
The Journal of nursing administration 2013 Apr;43(4):201-207
OBJECTIVE: : The aim of this study was to explore the factors influencing critical care nurses’ perception of their overall job satisfaction. BACKGROUND: : Nurses’ job satisfaction is a key issue to consider in the retention of critical care nurses. Shortages of nurses result in unsafe patient care, increased expense, and increased stress levels among other nurses. METHOD: : The Leadership Practices Inventory was used among a sample of critical care nurses to measure perceived leadership practices, the Organizational Commitment Questionnaire measured nurses commitment, and the Job in General scale was used to measure nurses’ overall job satisfaction. Four different hypotheses were tested using bivariate and multivariate statistical analytical techniques. RESULTS: : Statistically significant relationships were found among the following hypotheses: (a) perceived leadership and job satisfaction; (b) organizational commitment and job satisfaction; and (c) perceived leadership practices, organizational commitment, and job satisfaction. No significant relationships were found among critical care nurses’ demographic variables and job satisfaction. Organizational commitment was the strongest predictor of job satisfaction. Encourage the heart (B = 0.116, P = .035) and organizational commitment (B = 0.353, P = .000) were found to be significantly associated with job satisfaction. CONCLUSION: : These findings have implications for nurse educators, preceptors, administrators, recruiters, and managers in promoting satisfaction.
Nurse practitioner job satisfaction: looking for successful outcomes.
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Journal of clinical nursing 2013 Apr 3
AIMS AND OBJECTIVES: To examine overall job satisfaction and its association with extrinsic and intrinsic characteristics of job satisfaction among nurse practitioners at the chosen practice site. The objectives were to identify relevant retention and recruitment strategies, from the nurse practitioners perspective, by examining (1) what role aspects are most satisfying, and (2) approaches for successful, professional development and integration in the role. BACKGROUND: Supportive professional practice environments are particularly important to nurses’ satisfaction with their work and the quality of patient care provided. Hence, research that examines nurse practitioners practice implications and barriers in today’s healthcare system is essential. DESIGN/METHODS: A descriptive-correlational design using survey methodology. A nonprobability sample of convenience was used. The outcome measures were: The Misener Nurse Practitioner Job Satisfaction Scale and two investigator-developed surveys. RESULTS: Participants expressed dissatisfaction with professional and monetary recognition, assertive influence, administrative support and collegial relationships. CONCLUSIONS: Interaction of subscale factors on overall job satisfaction and demographic survey findings has important implications for health administrators and nurse practitioners in similar organisations. RELEVANCE TO CLINICAL PRACTICE: Stakeholders in healthcare milieus need to be fully engaged in the redesign of the American healthcare system heeding the recommendations of the Institute of Medicine to provide safer health systems to the public. By doing this, issues related to frustration by nurse practitioners related to job satisfaction will be addressed. The need for cooperation, participation, collaboration and instrumental communication are essential in the delivery of safe, quality patient care. A better understanding of intrinsic professional rewards needs to be learned by nurse practitioners who want to seek professional satisfaction and engage in the survival and growth of the profession. Nurse practitioners armed with this translational information have viable agenda items that can be negotiated into extrinsic rewards. © 2013 Blackwell Publishing Ltd.
Staff Ownership Would Revolutionize Patient Safety – If We Let It
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HealthcarePapers 2013 10/04;13(1):55-59
Healthcare has failed to make the same progress as other high-risk industries when it comes to creating safety – despite over a decade of research, education and implementation of safety systems in health services. Safe care is created by systems and standardization, and also by proactive, thinking staff working in partnership with consumers and each other; but the healthcare industry appears to struggle to reconcile these concepts. Even with our evolved knowledge of how human beings operate in organizations, and the best intentions, the dominant change paradigm in healthcare is still hierarchical, based on top-down policies implemented by managers and staff. Although the power spread in health services is being tested through generational change, we have a long way to go before proactivity and initiative at the front line are universally fostered and welcomed by healthcare managers and senior clinicians.
Hospital C-Suite Executives and Risk Managers agree that patient safety is their number one priority. They also agree that failing to maximize financial sustainability is their number one threat. By exploring the tension between these competing demands, as well as the environmental barriers toward progress to improve safety and reduce risk, this report provides actionable data and information to support continuous improvement. The purpose of this survey was to better understand:
• What drives hospital leaders’ main priority, patient safety?
• What are the barriers the healthcare system must overcome to improve patient safety?
• What can be done to keep patients safer in hospitals over the next three to five years?
The Health Foundation’s MAGIC (Making good decisions in collaboration) improvement programme aims to support clinical teams in primary and secondary care to embed shared decision making with patients in their everyday practice. The programme is developing and testing practical solutions that support patients to make informed and considered decisions about their own care and treatment.
University of Sheffield: A study to assess the impact of continuing professional development (CPD) on doctors’ performance and patient/service outcomes for the GMC
Professor Nigel Mathers, Dr Caroline Mitchell and Amanda Hunn
This study assesses the impact of continuing professional development on doctors’ performance and patient outcomes. The study makes a series of recommendations on CPD provision, content and process, and examines professional cultural environments and the role of organizations.
Health Care Innovation and Quality Assurance
Implementation evaluation of the Dutch national heat plan among long-term care institutions in Amsterdam: a cross-sectional study.
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Kunst AE, Britstra R.
BMC health services research 2013 Apr 11;13:135-6963-13-135
BACKGROUND: In 2007, a national heat plan was introduced in the Netherlands to effectively protect vulnerable populations (such as institutionalised elderly people) against heatwaves. The aim of this study was to assess the extent to which the measures recommended in this heat plan had been implemented, and could be implemented, in long-term care institutions in Amsterdam three years on. METHODS: Questionnaires were sent to the care managers of all 54 eligible long-term care institutions in Amsterdam. This included questions on the presence of a heat protocol and cooling facilities in the building. Furthermore, the care managers were asked to judge the importance of 23 of the cooling measures recommended by the National Heat Plan in the event of a heatwave, and to report on practical problems that may affect the implementation of these cooling measures. RESULTS: Of the 54 questionnaires sent, 27 were returned. Most institutions had a heat protocol, virtually all of which had been developed in the three years preceding the survey. Outdoor sunshades were used most often to protect residents against heat (93% of all institutions). Prevalence of cooling facilities such as air conditioning and rooftop cooling had increased, but remained low (41%). Care managers confirmed the importance of most of the 23 cooling measures recommended by the National Heat Plan, with some exceptions. Only 41% regarded consulting physicians on medication use to be ‘very important’. Most care managers did not foresee large problems with the implementation of the recommended cooling measures. Barriers mentioned related to shortage of and expertise among personnel, and residents’ independence. CONCLUSION: The results suggest that a national heat plan could be implemented in long-term care institutions with few problems. Possible areas of improvement include cooling of buildings and staff training.
Improving medication administration in nursing home residents with swallowing difficulties: sustainability of the effect of a multifaceted medication safety programme.
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Stuijt CC, Klopotowska JE, van Driel CK, Le N, Binnekade J, van der Kleij B, et al.
Pharmacoepidemiology and drug safety 2013 Apr;22(4):423-429
BACKGROUND: Crushing solid oral dosage forms is an important risk factor for medication administration errors (MAEs) in patients with swallowing difficulties. Nursing home (NH) residents, especially those on psychogeriatric wards, have a high prevalence of such difficulties. CONTEXT: Six different psychogeriatric wards in two Dutch NH facilities, participating over a total period of 1 year divided into preintervention, implementation, and the first and second evaluation period. KEY MEASURES FOR IMPROVEMENT: Number of MAEs per number of observed medication administrations calculated for all and three subtypes of MAEs: crushing-uncrushable-medication, inappropriate-technique, and food-drug interactions. STRATEGIES FOR CHANGE: The intervention included (i) education for nursing staff about crushing medication safely, (ii) a medication administration protocol for patients with swallowing difficulties, (iii) a ‘do-not-crush-medication’ pocket card for the nursing staff, (iv) screening of medication charts by pharmacy technicians on potential crushing problems, and (v) advices on medication charts on safe medication administration to residents with swallowing problems. EFFECTS OF CHANGE: The number of crushing uncrushable medication errors, an MAE subtype with the highest potential risk for patient harm, was reduced significantly from 19 (9.6%) to 7 (3.0%; first evaluation period), adjusted odds ratio 0.20 (OR = 95%CI, 0.07-0.55). During the second evaluation period, the proportion crushing uncrushable medications errors was the only outcome that remained significantly lower in comparison with the preintervention period (p = 0.045). LESSONS LEARNED: Introduction of a multifaceted medication safety programme in NH facilities by a pharmacy team is a tool towards safer medication administration practice in residents with swallowing difficulties. Commitment on organisational level is, however, vital to achieve sustainable improvements. Copyright © 2012 John Wiley & Sons, Ltd.
What, Why, and How Care Protocols are Implemented in Ontario Nursing Homes.
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Berta W, Ginsburg L, Gilbart E, Lemieux-Charles L, Davis D.
Canadian journal on aging 2013 Mar;32(1):73-85
The aim of this study was to better understand care protocol implementation, including the influence of organizational-contextual factors on implementation approaches, in long-term care homes operating in Ontario. We surveyed directors of care employed in all 547 Ontario LTC homes, and combined survey data with secondary organizational data on rural/urban location, nursing home size, chain membership, type of ownership, and accreditation status. Motivations for the use/selection of care protocols in nursing homes primarily derived from beliefs in continuous improvement and in evidence-based care. Protocol selection was largely participative, involving management and staff. External information sources were important for protocol implementation, and in-service education was the chief means of training and educating staff. Significant differences in approaches to implementation were evident in association with differences in ownership. Three key success factors for implementation were identified: contextualizing the practice change, adequately resourcing for implementation, and demonstrating connections between practice change and outcomes.
Helping primary care teams emerge through a quality improvement program.
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Hilts L, Howard M, Price D, Risdon C, Agarwal G, Childs A.
Family practice 2013 Apr;30(2):204-211
BACKGROUND: Approaches to improving the quality of health care recognize the need for systems and cultures that facilitate optimal care. Interpersonal relationships and dynamics are a key factor in transforming a system to one that can achieve quality. The Quality in Family Practice (QIFP) program encompasses clinical and practice management using a comprehensive tool of family practice indicators. OBJECTIVE: The objective of this study was to explore and describe the views of staff regarding changes in the clinical practice environment at two affiliated academic primary care clinics (comprising one Family Health Team, FHT) who participated in QIFP. METHODS: An FHT in Hamilton, Canada, worked through the quality tool in 2008/2009. A qualitative exploratory case study approach was employed to examine staff perceptions of the process of participating. Semi-structured interviews were conducted in early 2010 with 43 FHT staff with representation from physicians, nurses, allied health professionals, support staff and managers. Interviews were audio-taped and transcribed verbatim. A modified template approach was used for coding, with a complexity theory perspective of analysis. RESULTS: Themes included importance of leadership, changes to practice environment, changes to communication, an increased understanding of team roles and relationships, strengthened teamwork, flattening of hierarchy through empowerment, changes in clinical care and clinical impacts, challenges and rewards and sustainability. CONCLUSION: The program resulted in perceived changes to relationships, teamwork and morale. Addressing issues of leadership, role clarity, empowerment, flattening of hierarchy and teamwork may go a long way in establishing and maintaining a quality culture.
Patient Satisfaction as a Possible Indicator of Quality Surgical Care
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Lyu H, Housman M, Freischlag J, Makary MA, Wick EC
JAMA Surgery 2013 04/01;148(4):362-367
Importance In 2010, national payers announced they would begin using patient satisfaction scores to adjust reimbursements for surgical care. Objective To determine whether patient satisfaction is independent from surgical process measures and hospital safety. Design We compared the performance of hospitals that participated in the Patient Satisfaction Survey, the Centers for Medicare & Medicaid Services Surgical Care Improvement Program, and the employee Safety Attitudes Questionnaire. Setting Thirty-one US hospitals. Participants Patients and hospital employees. Interventions There were no interventions for this study. Main Outcomes and Measures Hospital patient satisfaction scores were compared with hospital Surgical Care Improvement Program compliance and hospital employee safety attitudes (safety culture) scores during a 2-year period (2009-2010). Secondary outcomes were individual domains of the safety culture survey. Results Patient satisfaction was not associated with performance on process measures (antibiotic prophylaxis, R = −0.216 [P = .24]; appropriate hair removal, R = −0.012 [P = .95]; Foley catheter removal, R = −0.089 [P = .63]; deep vein thrombosis prophylaxis, R = 0.101 [P = .59]). In addition, patient satisfaction was not associated with a hospital’s overall safety culture score (R = 0.295 [P = .11]). We found no association between patient satisfaction and the individual culture domains of job satisfaction (R = 0.327 [P = .07]), working conditions (R = 0.191 [P = .30]), or perceptions of management (R = 0.223 [P = .23]); however, patient satisfaction was associated with the individual culture domains of employee teamwork climate (R = 0.439 [P = .01]), safety climate (R = 0.395 [P = .03]), and stress recognition (R = −0.462 [P = .008]). Conclusions and Relevance Patient satisfaction was independent of hospital compliance with surgical processes of quality care and with overall hospital employee safety culture, although a few individual domains of culture were associated. Patient satisfaction may provide information about a hospital’s ability to provide good service as a part of the patient experience; however, further study is needed before it is applied widely to surgeons as a quality indicator. In 2011, the Centers for Medicare & Medicaid Services finalized details for a new reimbursement method that would adjust payments based on patient satisfaction scores—a trend that is also being adopted by private insurers.1 This new policy reflects the perception that patient satisfaction is an indicator of health care quality. Although this metric is easy to apply, making it highly attractive to payers, it may not be a comprehensive or even a reliable metric of quality, particularly for procedure-based medical care. Despite the widespread popularity of consumer satisfaction in other industries, patient satisfaction has not been evaluated as a metric of quality medical care. In fact, the ability of patient satisfaction scores to evaluate technical quality, particularly in the operating room, has been questioned for many reasons.2 Safety culture is increasingly recognized as a marker of safe practices on a local level. It measures the perception by health care workers of employee teamwork and satisfaction in the setting in which they work.3 A preliminary multicenter study has demonstrated that certain safety attitude scores were associated with patient outcomes.4 Specifically, poor perceptions of management were associated with higher hospital mortality, and low employee scores with regard to safety climate, perceptions of management, and job satisfaction were associated with increased hospital length of stay.4 Other studies that examined the relationship between the climate of patient safety and hospital outcomes have demonstrated associations between individual domains of safety attitudes and coordination of care, communication, and quality of care.5- 7We designed a study to evaluate the association between patient satisfaction and quality of care as defined by compliance with evidence-based processes of surgical care and employee attitudes of safety.
A controlled investigation of continuing pain education for long-term care staff.
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Ghandehari OO, Hadjistavropoulos T, Williams J, Thorpe L, Alfano DP, Dal Bello-Haas V, et al.
Pain research & management 2013 Jan-Feb;18(1):11-18f
BACKGROUND: The underassessment and undertreatment of pain in residents of long-term care (LTC) facilities has been well documented. Gaps in staff knowledge and inaccurate beliefs have been identified as contributors. OBJECTIVES: To investigate the effectiveness of an expert-based continuing education program in pain assessment⁄management for LTC staff. METHODS: Participants included 131 LTC staff members who were randomly assigned to either an interactive pain education (PE) program, which addressed gaps in knowledge such as medication management, or an interactive control program consisting of general dementia education without a specific clinical focus. Participants attended three sessions, each lasting 3 h, and completed measures of pain-related knowledge and attitudes⁄beliefs before, immediately after and two weeks following the program. Focus groups were conducted with a subset of participants to gauge perception of the training program and barriers to implementing pain-related strategies. RESULTS: Analysis using ANOVA revealed that PE participants demonstrated larger gains compared with control participants with regard to pain knowledge and pain beliefs. Barriers to implementing pain-related strategies certainly exist. Nonetheless, qualitative analyses demonstrated that PE participants reported that they overcame many of these barriers and used pain management strategies four times more frequently than control participants. CONCLUSIONS: Contrary to previous research, the present study found that the interactive PE program was effective in changing pain beliefs and improving knowledge. Continuing PE in LTC has the potential to address knowledge gaps among front-line LTC providers.
Clinical Supervision in Effectiveness and Implementation Research
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Schoenwald SK, Mehta TG, Frazier SL, Shernoff ES.
Clinical Psychology: Science and Practice 2013;20(1):44-59
The role of clinical supervision in the larger-scale implementation of effective mental health treatments has begun to attract attention in effectiveness research and implementation science. Clinical supervision approaches demonstrated to support the implementation of effective treatments could provide a fruitful basis for adaptation to the contours and implementation of other interventions. The adaptation of the Multisystemic Therapy supervision model to support the implementation of an innovative, experimental mental health service model called Links to Learning is described. An observational study provides the platform for consideration of the extent to which the Links supervision model was implemented as intended and of challenges to Links implementation illuminated by the supervision process. Implications are considered for research on supervision as a tool to effect the implementation and outcomes of effective treatment and service models in community practice contexts. © 2013 American Psychological Association.
A qualitative analysis of a consensus process to develop quality indicators of injury care.
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Bobrovitz N, Parrilla JS, Santana M, Straus SE, Stelfox HT.
Implementation science : IS 2013 Apr 18;8(1):45
BACKGROUND: Consensus methodologies are often used to create evidence-based measures of healthcare quality because they incorporate both available evidence and expert opinion to fill gaps in the knowledge base. However, there are limited studies of the key domains that are considered during panel discussion when developing quality indicators. METHODS: We performed a qualitative content analysis of the discussions from a two-day international workshop of injury control and quality-of-care experts (19 panel members) convened to create a standardized set of quality indicators for injury care. The workshop utilized a modified RAND/UCLA Appropriateness method. Workshop proceedings were recorded and transcribed verbatim. We used constant comparative analysis to analyze the transcripts of the workshop to identify key themes. RESULTS: We identified four themes in the selection, development, and implementation of standardized quality indicators: specifying a clear purpose and goal(s) for the indicators to ensure relevant data elements were included, and that indicators could be used for system-wide benchmarking and improving patient outcomes; incorporating evidence, expertise, and patient perspectives to identify important clinical problems and potential measurement challenges; considering context and variations between centers in the health system that could influence either the relevance or application of an indicator; and contemplating data collection and management issues, including availability of existing data sources, quality of data, timeliness of data abstraction, and the potential role for primary data collection. CONCLUSION: Our study provides a description of the key themes of discussion among a panel of clinical, managerial, and data experts developing quality indicators. Consideration of these themes could help shape deliberation of future panels convened to develop quality indicators.
Healthcare collaborations for innovation and improvement in Canada
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Verma JY, Rossiter M, Kirvan K, Denis JL, Samis S, Phillips K, et al.
Int J of Healthcare Manag
Healthcare in Canada, as elsewhere, must adapt in order to better meet the needs of the chronically ill. Such adaptations are happening locally, but healthcare decision- and policy-makers require channels and mechanisms for sharing project outcomes and spreading or scaling up successful approaches. Without formal mechanisms, there is a risk of losing the rich knowledge produced by improvement projects; of compromising the efficient use of healthcare resources; and of negatively impacting the further distribution of potential outcomes and impacts. This paper profiles three Canadian collaborations, supported by the Canadian Foundation for Healthcare Improvement (CFHI), which supports healthcare leaders in working together to develop, share, implement, and sustain evidence-informed and systems solutions. The collaborations are team based and particularly relevant to patient engagement and chronic disease care. They illustrate early lessons on how collaborative partnerships, with a shared vision and ownership, can co-address multiple components, conditions and communities, using evidence-based approaches and embedding performance measurement and evaluation. They also demonstrate the role organizations such as CFHI can play in facilitating a collaborative approach to accelerating healthcare improvement within and across organizations or systems.
The calculation of quality indicators for long term care facilities in 8 countries (SHELTER project).
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Frijters DH, van der Roest HG, Carpenter IG, Finne-Soveri H, Henrard JC, Chetrit A, et al.
BMC health services research 2013 Apr 15;13(1):138
BACKGROUND: Performance indicators in the long term care sector are important to evaluate the efficiency and quality of care delivery. We are, however, still far from being able to refer to a common set of indicators at the European level.We therefore demonstrate the calculation of Long Term Care Facility Quality Indicators (LTCFQIs) from data of the European Services and Health for Elderly in Long TERm Care (SHELTER) project. We explain how risk factors are taken into account and show how LTC facilities at facility and country level can be compared on quality of care using thresholds and a Quality Indicator sum measure. METHODS: The indicators of Long Term Care Facility quality of care are calculated based on methods that have been developed in the US. The values of these Quality Indicators (QIs) are risk adjusted on the basis of covariates resulting from logistic regression analysis on each of the QIs. To enhance the comparison of QIs between facilities and countries we have used the method of percentile thresholds and developed a QI sum measure based on percentile outcomes. RESULTS: In SHELTER data have been collected with the interRAI Long Term Care Facility instrument (interRAI-LTCF). The data came from LTC facilities in 7 European countries and Israel. The unadjusted values of the LTCF Quality Indicators differ considerably between facilities in the 8 countries. After risk adjustment the differences are less, but still considerable. Our QI sum measure facilitates the overall comparison of quality of care between facilities and countries. CONCLUSIONS: With quality indicators based on assessments with the interRAI LTCF instrument quality of care between LTC facilities in and across nations can be adequately compared.
The effectiveness of computer reminders for improving quality assessment for point-of-care testing in general practice—a randomized controlled trial.
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Kousgaard MB, Siersma V, Reventlow S, Ertmann R, Felding P, Waldorff FB.
Implementation science : IS 2013 Apr 23;8(1):47
BACKGROUND: Computer reminders are increasingly being applied in efforts to improve quality and patient safety. However, research is still needed to establish the effectiveness of different kinds of reminders in various settings. This study aimed to evaluate the effectiveness of computer reminders for improving adherence to a quality assessment scheme for point-of-care testing in general practice. METHOD: The study was conducted as a randomized controlled crossover trial among general practices in the Capital Region of Denmark. The intervention consisted of sending computer reminders (ComRem) to practices not adhering to the guideline recommendations of split testing for hemoglobin and glucose. Practices were randomly allocated into two groups. During the first follow-up period, one of the groups received the ComRem intervention together with the general implementation activities (GIA), while the other group only received the GIA. For the second follow-up period, the intervention was switched between the two groups. Outcomes were measured as split test procedure adherence. RESULTS: A total of 142 practices were randomly allocated to the early intervention group and 144 practices to the late intervention group (the control group in the first follow-up period). In the first intervention period, the mean number of split tests performed in the group receiving ComRem group increased from 1.22 to 3.76 (out of eight possible tests) while the mean number of split tests increased from 1.11 to 2.35 in the group targeted by GIA only (p = 0.0059). After the crossover, a similar effect of reminders was observed. Furthermore, the developments in outcome measures over time showed a strong effect of computer reminders beyond the intervention periods. CONCLUSION: There was a significant effect of computer reminders on adherence to the quality assessment scheme for point-of-care testing. Thus, computer reminders seem to be useful for supporting the implementation of relatively simple procedures for quality and safety.Trial registrationClinicalTrials.gov: NCT01152177.
Front-Line Ownership: Generating a Cure Mindset for Patient Safety
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Brenda Zimmerman, Paige Reason, Liz Rykert, Leah Gitterman, Jennifer Christian and,Michael Gardam.
HealthcarePapers 2013 04/25;13(1):6-22
Great advances have been made in standardization and human factors engineering that have reduced variability and increased reliability in healthcare. As important as these advances are, the authors believe there is another important but largely ignored layer to the safety story in healthcare that has prevented us from progressing. In the field of infection prevention and control (IPAC), despite great attempts over several decades to improve compliance with hand hygiene, surveillance, environmental cleaning, isolation protocols and other control measures, very significant challenges remain. We believe this failure is in part due to the power gradients, often dysfunctional relationships and lack of safety mindfulness that exist in hospitals and healthcare more generally. Furthermore, safety culture requires different approaches and considerable ongoing attentiveness. If this is the case, and the authors contend in this paper that it is, then the role of the front line is much more important than many of our healthcare safety and IPAC approaches suggest.
Developing an Institute of Medicine–Aligned Framework for Categorizing Primary Care Indicators for Quality Assessment
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Cheryl Levitt, Xingchen Chen, Linda Hilts, Lisa Dolovich, David Price and,Kalpana Nair.
Healthcare Quarterly 2013 04/18;16(1):39-46
The Institute of Medicine (IOM) framework has been used frequently to assess and monitor quality in secondary and tertiary care, but not in primary care. This article describes and proposes a conceptual framework for categorizing primary care indicators that align with the IOM’s six aims for quality in healthcare performance (Safe, Effective, Patient-Centred, Timely, Efficient and Equitable.) Using an iterative process, the authors developed and compared a primary care framework for categorizing indicators in the Quality in Family Practice Book of Tools (QBT) with the IOM aims and other local healthcare systems frameworks (Integrated and Continuous, Appropriate Practice Resources). They also compared, cross-matched and analyzed their QBT categories and indicators with other international primary care assessment tools. And they compared the QBT titles and descriptions of groups of indicators with those published in the international tools.
Leadership, a Central Ingredient for a Successful Quality Agenda: A Qualitative Study of Canadian Leaders’ Perspectives
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Healthcare Quarterly 2013 04/18;16(1):62-67
Quality and safety (QS) teams have emerged as one strategy to improve the quality of care and safety. This article aims to enhance understanding of, and identify implications for, leaders in implementing successful QS teams. Research findings from the authors’ study that explored barriers and facilitators of Canadian QS teams highlight the need for delineated leadership and accountability, focused strategic plans, available data, dedicated resources and targeted messaging to engage staff and physicians. While top-down leadership strategies were predominantly reported, developing leaders at all organizational levels was acknowledged as key to sustaining a quality culture and advancing the quality agenda.
The purpose of this literature review was to synthesize the existing knowledge regarding physician engagement and leadership and to identify key recommendations to enhance physician leadership skills, physician alignment with other components of the healthcare system, and the capacity to foster and improve the accountability of physicians for improved organizational and system performance.
In “Making the Case for Continuous Learning from Routinely Collected Data,” the authors suggest that in order to achieve better health, patients and clinicians will need to view every health care encounter as providing an opportunity to improve outcomes. The paper cites widely-reported examples of routinely collected digital health data being applied to improve services, inform patients, avoid harm, and speed research. Developed by individual participants from the IOM’s Clinical Effectiveness Research Innovation Collaborative, it asserts that patients and the public are the most effective advocates for resetting expectations that their data be used to advance knowledge and support continuous learning. Citing examples of efforts to engage patients and clinicians in continuous learning efforts, the authors see broader application of these approaches as critical to ensuring the success of a learning health system in achieving better care, lower costs and improved health.
Evidence-based practice models for organizational change: overview and practical applications.
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Schaffer MA, Sandau KE, Diedrick L.
Journal of advanced nursing 2013 May;69(5):1197-1209
AIM: To provide an overview, summary of key features and evaluation of usefulness of six evidence-based practice models frequently discussed in the literature. BACKGROUND: The variety of evidence-based practice models and frameworks, complex terminology and organizational culture challenges nurses in selecting the model that best fits their practice setting. DATA SOURCES: The authors: (1) initially identified models described in a predominant nursing text; (2) searched the literature through CINAHL from 1998 to current year, using combinations of ‘evidence’, ‘evidence-based practice’, ‘models’, ‘nursing’ and ‘research’; (3) refined the list of selected models based on the initial literature review; and (4) conducted a second search of the literature on the selected models for all available years to locate both historical and recent articles on their use in nursing practice. DISCUSSION: Authors described model key features and provided an evaluation of model usefulness based on specific criteria, which focused on facilitating the evidence-based practice process and guiding practice change. IMPLICATIONS FOR NURSING: The evaluation of model usefulness can be used to determine the best fit of the models to the practice setting. CONCLUSION: The Johns Hopkins Model and the Academic Center for Evidence-Based Practice Star Model emphasize the processes of finding and evaluating evidence that is likely to appeal to nursing educators. Organizations may prefer the Promoting Action on Research Implementation in Health Services Framework, Advancing Research and Clinical Practice Through Close Collaboration, or Iowa models for their emphasis on team decision-making. An evidence-based practice model that is clear to the clinician and fits the organization will guide a systematic approach to evidence review and practice change. © 2012 Blackwell Publishing Ltd.
Dealing with the failure of many patient safety initiatives to positively impact patient safety is one of the most daunting issues healthcare systems now face. The concept of front-line ownership (FLO) and the research documenting the success of this approach is thus critical to all involved in the effort to make healthcare safer for patients. Focusing on why it is so important to involve front-line workers at every level in designing, implementing and evaluating patient safety initiatives is the subject of this commentary and, in the author’s view, the only way to move from theory to practice, and from exhortation to the kinds of changes in behaviour and attitudes upon which patient safety depends.
Doing the Dance of Culture Change: Complexity, Evidence and Leadership
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Allan Best, Jessie Saul and,Cameron Willis.
HealthcarePapers 2013 04/25;13(1):64-68
The challenge of culture change in hospitals must address three distinct but interwoven tensions: the need to shift paradigm and understand healthcare as a complex adaptive system; the challenge of knitting together the contributions of both evidence-based medicine and practice-based evidence; and the critical role of distributed, problem-focused leadership. The authors of the lead paper highlight five key issues in addressing this challenge: (1) the implementation of strategies like front-line ownership (FLO) in the context of macro-level social forces; (2) the central role of distributed leadership and its strengthening within the organization; (3) the need to attend to developing systems thinking skills at all levels; (4) the very significant challenge of how to scale up the labour-intensive change strategies within FLO, the role of “simple rules” and the potential for systems thinking tools such as concept mapping and dynamic modelling; and (5) the concurrent orchestration of not one culture change but three tensions in the challenge FLO represents to simpler versus complex adaptive systems, leadership and management and the balance between evidence-based medicine and practice-based evidence, at the clinical, organizational and macro-system levels.
Describing Mixed Methods Research An Alternative to Typologies
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Describing Mixed Methods Research: An Alternative to Typologies.
Journal of Mixed Methods Research 2013 04;7(2):141
Scholars have created a variety of typologies to describe and simplify mixed methods research designs. In this article, I review the rationale for using these typologies and discuss some shortcomings of the existing methods of classification. I argue that current systems of classification, although useful for simple and less fluid types of mixed methods research, are not capable of capturing the complexity and iterative nature of larger, more intricate research projects. I suggest an alternative way of viewing and describing mixed methods research for studies that resist simple classification. This alternative perspective shifts the unit of reference to the point of interface—where QUAL and QUAN data are integrated—and reduces the number of descriptive dimensions to two—the timing and the purpose of data integration.
Mandated data archiving greatly improves access to research data
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Vines TH, Andrew RL, Bock DG, Franklin MT, Gilbert KJ, Kane NC, et al.
FASEB Journal 2013;27(4):1304-1308
The data underlying scientific papers should be accessible to researchers both now and in the future, but how best can we ensure that these data are available? Here we examine the effectiveness of four approaches to data archiving: no stated archiving policy, recommending (but not requiring) archiving, and two versions of mandating data deposition at acceptance. We control for differences between data types by trying to obtain data from papers that use a single, widespread population genetic analysis, STRUCTURE. At one extreme, we found that mandated data archiving policies that require the inclusion of a data availability statement in the manuscript improve the odds of finding the data online almost 1000- fold compared to having no policy. However, archiving rates at journals with less stringent policies were only very slightly higher than those with no policy at all. We also assessed the effectiveness of asking for data directly from authors and obtained over half of the requested datasets, albeit with 8 d delay and some disagreement with authors. Given the long-term benefits of data accessibility to the academic community, we believe that journal-based mandatory data archiving policies and mandatory data availability statements should be more widely adopted
PRISMA for Abstracts: Reporting Systematic Reviews in Journal and Conference Abstracts
Beller EM, Glasziou PP, Altman DG, Hopewell S, Bastian H, Chalmers I, et al.
PLoS medicine 2013 Apr;10(4):e1001419
Elaine Beller and colleagues from the PRISMA for Abstracts group provide a reporting guidelines for reporting abstracts of systematic reviews in journals and at conferences.
The final report of the Strategic Review of Health and Medical Research (HMR) sets out a 10-year strategy to optimize government investment in research. The report calls for embedding research in the health system, supporting priority-driven research, and enhancing both non-commercial and commercial impact pathways.
Developed by the California HealthCare Foundation (CHCF), this needs assessment delineates state-level policymaker priorities for improving access to data and identifies factors that facilitate expanded access to data. It describes the methods used to elicit input from California policymakers and summarizes findings regarding data available from state agencies, policymakers’ use of that data, and barriers to expanded access.
Not just specific diseases: Systematic review of the association of geriatric syndromes with hospitalization or nursing home admission.
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Wang SY, Shamliyan TA, Talley KM, Ramakrishnan R, Kane RL.
Archives of Gerontology and Geriatrics 2013 Jul-Aug;57(1):16-26
To examine the association between geriatric syndromes with hospitalization or nursing home admission, we reviewed studies that examined hospitalization and nursing home admission in community-dwelling older adults with multiple morbidities, cognitive impairment, frailty, disability, sarcopenia, malnutrition, impaired homeostasis, and chronic inflammation. Studies published in English language were identified through MEDLINE (1990 through April 2010), Cochrane databases, the Centers for Disease Control and Prevention website and manual searches of reference lists from relevant publications. The study had to include general (non-disease specific) populations of adults aged 65 years or older. Using a standardized protocol, two investigators independently abstracted information on participant characteristics and adjusted measures of the association. Studies that controlled for the presence of specific diseases were further identified and analyzed. When the syndrome examined was similar from different studies, we computed the pooled risk estimates using a random-effects model. We assessed the strength of evidence following the recommended guidelines. We identified 47 eligible articles from 6 countries. Multiple morbidity, frailty, and disabilities were associated with hospitalization and nursing home admission (moderate evidence). Cognitive impairment was associated with hospitalization (low evidence) and nursing home admission (moderate evidence). Among these studies, 20 articles controlled for specific diseases. Limited evidence suggested that these geriatric syndromes are associated with hospitalization and institutionalization after controlling for the presence of specific diseases. We conclude that geriatric syndromes are associated with risk of hospitalization or nursing home admission. Efforts to prevent hospitalization or nursing home admission should target strategies to prevent and manage these syndromes. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
BACKGROUND: Dementia affects a large and growing number of older adults in the United States. The monetary costs attributable to dementia are likely to be similarly large and to continue to increase. METHODS: In a subsample (856 persons) of the population in the Health and Retirement Study (HRS), a nationally representative longitudinal study of older adults, the diagnosis of dementia was determined with the use of a detailed in-home cognitive assessment that was 3 to 4 hours in duration and a review by an expert panel. We then imputed cognitive status to the full HRS sample (10,903 persons, 31,936 person-years) on the basis of measures of cognitive and functional status available for all HRS respondents, thereby identifying persons in the larger sample with a high probability of dementia. The market costs associated with care for persons with dementia were determined on the basis of self-reported out-of-pocket spending and the utilization of nursing home care; Medicare claims data were used to identify costs paid by Medicare. Hours of informal (unpaid) care were valued either as the cost of equivalent formal (paid) care or as the estimated wages forgone by informal caregivers. RESULTS: The estimated prevalence of dementia among persons older than 70 years of age in the United States in 2010 was 14.7%. The yearly monetary cost per person that was attributable to dementia was either $56,290 (95% confidence interval [CI], $42,746 to $69,834) or $41,689 (95% CI, $31,017 to $52,362), depending on the method used to value informal care. These individual costs suggest that the total monetary cost of dementia in 2010 was between $157 billion and $215 billion. Medicare paid approximately $11 billion of this cost. CONCLUSIONS: Dementia represents a substantial financial burden on society, one that is similar to the financial burden of heart disease and cancer. (Funded by the National Institute on Aging.).
Person-centered care training in long-term care settings: usefulness and facility of transfer into practice.
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Viau-Guay A, Bellemare M, Feillou I, Trudel L, Desrosiers J, Robitaille MJ.
Canadian journal on aging = La revue canadienne du vieillissement 2013 Mar;32(1):57-72
The person-centered approach is increasingly recommended in long-term care facilities to increase quality of care. In Quebec, Canada,. caregivers were specifically trained in “relationship-based care. “This study analyzed caregivers’ assessment of this approach’s usefulness and their capacity, after training, to apply it to care practices. Questionnaires with open-ended questions were administered to caregivers (n= 392) one month after training. Caregivers’ answers were categorized using a qualitative approach. Respondents perceive some features of this approach are beyond their reach or in opposition to their beliefs. They reported feeling pressure related to time constraints, their peers and the families of residents. These results indicate that training itself is insufficient to transform practice. Institutions wishing to implement such an approach must also act upon the beliefs of individuals, as well as upon work situations.
Clinical Changes in Older Adults During Hospitalization: Responsiveness of the interRAI Acute Care Instrument.
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Wellens NI, Verbeke G, Flamaing J, Moons P, Boonen S, Tournoy J, et al.
Journal of the American Geriatrics Society 2013 Apr 16
OBJECTIVES: To evaluate the responsiveness of the Minimum Data Set interRAI Acute Care (AC), a comprehensive geriatric assessment system, to detect clinical changes in patient status during hospital stays. DESIGN: An explorative secondary data-analysis comparing prospectively collected data with the interRAI AC before hospitalization, upon admission, and at discharge. SETTING: Clinicians from multiple disciplines in nine geriatric and eight nongeriatric wards of nine acute hospitals performed the assessment. PARTICIPANTS: The interRAI AC was administered serially to 256 geriatric inpatients (aged 83.2 ± 5.2; 60% female). MEASUREMENTS: Responsiveness (capacity to detect changes in patients) was calculated for the output scales on five domains: activities of daily living (ADLs), cognition, communication, depressive symptoms, and pain. Internal responsiveness was evaluated using the Friedman test and Guyatt technique. RESULTS: Significant differences in clinical status were found for all five domains, based on the Friedman test. Post hoc tests revealed differences between each assessment period, except for cognition and communication from admission to discharge and for depressive symptoms from before admission to discharge. The Guyatt Responsiveness Index showed good to excellent capacity to detect longitudinal changes during hospitalization for cognition, communication, and pain and substantial performance for ADLs and depressive symptoms. CONCLUSION: In older inpatients, fluctuations in ADLs, cognition, communication, depressive symptoms, and pain can be captured using the interRAI AC output scales, enabling clinicians to evaluate longitudinal changes from admission to discharge and to provide a comparison with patient status before the acute onset of the illness. These results support the use of these scales in geriatric and nongeriatric wards. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.
A controlled trial of an intervention to increase resident choice in long term care.
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Schnelle JF, Rahman A, Durkin DW, Beuscher L, Choi L, Simmons SF.
Journal of the American Medical Directors Association 2013 May;14(5):345-351
OBJECTIVE: The purpose of this study was to evaluate an intervention to improve staff offers of choice to nursing home residents during morning care. DESIGN: A controlled trial with a delayed intervention design. SETTING: Four community, for-profit nursing homes. PARTICIPANTS: A total of 169 long-stay nursing home residents who required staff assistance with morning care and were able to express their care preferences. INTERVENTION: Research staff held weekly training sessions with nurse aides (NAs) for 12 consecutive weeks focused on how to offer choice during four targeted morning care areas: when to get out of bed, when to get dressed/what to wear, incontinence care (changing and/or toileting), and where to dine. Training sessions consisted of brief video vignettes illustrating staff-resident interactions followed by weekly feedback about how often choice was being provided based on standardized observations of care conducted weekly by research staff. MEASUREMENTS: Research staff conducted standardized observations during a minimum of 4 consecutive morning hours per participant per week for 12 weeks of baseline and 12 weeks of intervention. RESULTS: There was a significant increase in the frequency that choice was offered for 3 of the 4 targeted morning care areas from baseline to intervention: (1) out of bed, 21% to 33% (P < .001); dressing, 20% to 32% (P < .001); incontinence care, 18% to 23%, (P < .014). Dining location (8% to 13%) was not significant. There was also a significant increase in the amount of NA staff time to provide care from baseline to intervention (8.01 ± 9.0 to 9.68 ± 9.9 minutes per person, P < .001). CONCLUSION: A staff training intervention improved the frequency with which NAs offered choice during morning care but also required more time. Despite significant improvements, choice was still offered one-third or less of the time during morning care. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.
Evaluating the impact of computer-generated rounding reports on physician workflow in the nursing home: a feasibility time-motion study.
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Thorpe-Jamison PT, Culley CM, Perera S, Handler SM.
Journal of the American Medical Directors Association 2013 May;14(5):358-362
OBJECTIVES: To determine the feasibility and impact of a computer-generated rounding report on physician rounding time and perceived barriers to providing clinical care in the nursing home (NH) setting. SETTING: Three NHs located in Pittsburgh, PA. PARTICIPANTS: Ten attending NH physicians. MEASUREMENTS: Time-motion method to record the time taken to gather data (pre-rounding), to evaluate patients (rounding), and document their findings/develop an assessment and plan (post-rounding). Additionally, surveys were used to determine the physicians’ perception of barriers to providing optimal clinical care, as well as physician satisfaction before and after the use of a computer-generated rounding report. RESULTS: Ten physicians were observed during half-day sessions both before and 4 weeks after they were introduced to a computer-generated rounding report. A total of 69 distinct patients were evaluated during the 20 physician observation sessions. Each physician evaluated, on average, four patients before implementation and three patients after implementation. The observations showed a significant increase (P = .03) in the pre-rounding time, and no significant difference in the rounding (P = .09) or post-rounding times (P = .29). Physicians reported that information was more accessible (P = .03) following the implementation of the computer-generated rounding report. Most (80%) physicians stated that they would prefer to use the computer-generated rounding report rather than the paper-based process. CONCLUSIONS: The present study provides preliminary data suggesting that the use of a computer-generated rounding report can decrease some perceived barriers to providing optimal care in the NH. Although the rounding report did not improve rounding time efficiency, most NH physicians would prefer to use the computer-generated report rather than the current paper-based process. Improving the accuracy and harmonization of medication information with the electronic medication administration record and rounding reports, as well as improving facility network speeds might improve the effectiveness of this technology. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.
A Hospital-to-Nursing Home Transfer Process Associated With Low Hospital Readmission Rates While Targeting Quality of Care, Patient Safety, and Convenience: A 20-Year Perspective.
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Sandvik D, Bade P, Dunham A, Hendrickson S.
Journal of the American Medical Directors Association 2013 May;14(5):367-374
BACKGROUND: Safe patient transfer from hospitals to skilled nursing facilities (SNFs) is one of the most logistically challenging safety problems in the US medical system. PROBLEM: The authors describe a community that experienced inefficient transfers in the 1990s, spurring development of continuous quality improvement (CQI) methods to develop transfer forms and processes to improve efficiency. METHODS: The community established a Geriatric Forum for educational and process improvement purposes. Attendees consist of anyone involved with care of older patients in the community. Over the years, minor environmental changes forced periodic adjustments to transfer processes. The need for adjustment is identified by asking the simple question, “Have any problems occurred with transfers lately?” When problems are identified, forum attendees make process changes. The current forms and processes are discussed in detail. RESULTS: Initial improvement in efficiency of transfers also produced improvements in patient safety and quality of medical care according to periodic internal surveys. During 2009, this community’s 30-day rehospitalization rate of patients discharged to a SNF was 14.75%, lower than any national or state average reported rate. CONCLUSIONS: Developing hospital-to-SNF transfer methods focusing on the traditional CQI goals of efficiency, patient safety, and quality of care also yields lower hospital readmission rates. Because the methodology is that of CQI, a widely taught skill, similar programs could be established between any hospital and the SNFs to which it discharges patients. The particular examples of transfer forms and processes described might be helpful to other programs. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.
The Development and Test of an Intervention to Improve ADR Screening in Nursing Homes.
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Dilles T, Vander Stichele RH, Van Bortel LM, Elseviers MM.
Journal of the American Medical Directors Association 2013 May;14(5):379.e1-379.e6
OBJECTIVES: The aim of this study was to develop and test the effect of an instrument, Pharmanurse, to facilitate nurse-driven adverse drug reaction (ADR) screening as an input for interdisciplinary medication review in nursing homes. DESIGN: Intervention study with a pre-posttest design PARTICIPANTS: All residents of a convenience sample of 8 nursing homes of more than 80 beds were eligible if they resided at least 1 month in the nursing home and took 4 or more different medications. Residents receiving palliative care were excluded. INTERVENTION: The intervention consisted of interdisciplinary medication review, prepared by nurse observations of potential ADRs using personalized screening lists generated by the Pharmanurse software. Pharmanurse is specifically adapted to use by nurses and to use in nursing homes. MEASUREMENTS: Outcome parameters were the number of ADRs detected by nurses, ADRs confirmed by general practitioners, and medication changes. After the intervention, health care professionals involved completed a questionnaire to evaluate the value and the feasibility of the intervention. RESULTS: Nurses observed 1527 potential ADRs in 81% of the 418 residents (mean per resident 3.7). Physicians confirmed 821 ADRs in 60% of the residents (mean per resident 2.0). As a result, 214 medication changes were planned in 21% of the residents (mean per resident 0.5) because of ADRs. Health care professionals gave the Pharmanurse intervention a score of 7 of 10 for the potential to improve pharmacotherapy and 83% of the physicians were satisfied about nurses’ screening for ADRs. CONCLUSIONS: The Pharmanurse intervention supports nurses in ADR screening and may have the potential to improve pharmacotherapy. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.
“Can this care be provided at home?” This basic question is a powerful instrument for change in the healthcare system. The fundamental shift required for healthcare is from the current system, where home care is designed to accommodate and respond to pressures in acute care or long-term care, to a system where home care considerations actually drive practice. This article describes how a philosophical change accompanied by the measurement of “system shift indicators” can achieve the move to effective person-centred and home-based healthcare. By changing the approach and the measures for evaluating effectiveness, the health system changes sought by all jurisdictions across Canada and recommended by Drummond for Ontario will be sustainable.
Enhancing Quality and Safety Standards for Older People in Canadian Hospitals: A National Collaboration
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Belinda Parke, Barbara Liu, Angela Juby and Craig Jamieson.
Healthcare Quarterly 2013 04/18;16(1):23-29
In this article, the authors present quality and safety standards for older people in hospital, derived from a national dialogue involving inter-professional experts, key stakeholders and opinion leaders. They report the consensus process and present the standard statements with corresponding operational definitions, along with relevant clinical topics. This work can serve as a platform for service planners, evaluators and policy makers who are endeavouring to ensure that older people receive quality care and service when admitted to a Canadian hospital.
Care relationships, quality of care and migrant workers caring for older people
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Walsh K, Shutes I.
Ageing & Society 2013 04;33(3):393-420
Migrant care workers make a substantial contribution to older adult care in Ireland and the United Kingdom (UK). However, little is known about the relational aspects of care involving migrant care workers and older people. Given that the care relationship is closely linked to quality of care, and that the Irish and UK sectors are increasingly restricted by economic austerity measures, this lack of information is a concern for care practice and policy. Our paper explores the relationship between migrant care workers and older people in Ireland and the UK and draws on data collected in both countries, including focus groups with older people (N = 41), interviews with migrant care workers (N = 90) and data from a survey of and interviews with employers. The findings illustrate the complexity of the migrant care worker–older person relationship; the prevalence of need orientated, friendship and familial-like, reciprocal, and discriminatory interlinking themes; and the role of individual, structural and temporal factors in shaping these relationships.
This paper explores wellbeing among senior Australians. The report examines how wellbeing differs between seniors in a variety of demographic groups; levels and patterns of social activity and engagement with family members and with friends. Results are based on data from the Social Activity and Wellbeing of Older Australians survey. Also considered are the context for social engagement, including paid work and retirement, volunteer work, household composition and caring. The report also focuses on issues on differences between older adults in their fifties, sixties, and seventies and eighties.
This report, released April, 2013, summarizes the results of a national survey conducted by Associated Press-NORC Center for Public Affairs (University of Chicago). The research focused on understanding experiences and attitudes of older Americans as they begin to plan for their own care and interact with the long-term care system. The survey asked Americans 40 years or older what they believe about their need for long-term care, the costs of this service, and how these issues fit into their concerns about growing older.
Health Systems AoE Brown Bag Series: Budgeting in Complex and Straight-Forward Grants
Wednesday May 8, 2013 ECHA 5-140, 12:00-13:00
Presenter: Dr. Carole Estabrooks
WCHRI: Sleep, Breathing, and Heart Health
Monday April 29, 2013 ECHA 4-036 11:30
Presenters: Dr. Lawrence Richer & Dr. Joanna MacLean
Goal: To enhance opportunities for collaboration and team building between research pillars, and increase opportunities for knowledge translation and transfer.
Assisted suicide in Canada: Why clinicians should not kill their patients
Thursday May 2, 2013 12:00-13:00 1J2.13 WMC
Presented by Brendan Leier, Assistant Professor, John Dossetor Health Ethics Centre.
Wed, 8 May, 10:00 – 12:00 3-001 ECHA
All students, staff, and faculty members in health sciences are welcome to join us for a spell-binding and truly amazing discussion of the social construction of chronicity, based on a paper by Martin and Peterson. Coffee and snacks provided! Please RSVP to firstname.lastname@example.org
Event recommended by Dr. Carole Estabrooks Statistics Coffee Time – A CIHR Funded Collaboration Event
May 29 09:30-10:00 Location TBD at a later date
Advanced registration is required by 8am April 30, 2013
Hundreds of statisticians will be travelling to Edmonton this May! With funding received from a Canadian Institutes of Health Research Dissemination Events grant, a Statistics Coffee Time has been created as part of the 41st Annual Meeting of the Statistical Society of Canada. In an informal setting, participating health researchers and statistics and probability experts will socialize and discuss potential collaborations for health research projects. The emphasis is on fostering collaborations and not statistical consultations. To date, we have 8 statisticians registered from multiple institutions with the following areas of expertise/interest: adaptive designs of clinical trials, applied statistics, biostatistics, classification models, cluster randomized trials, data visualization, generalized linear models, inter-observer agreement, longitudinal data analysis, meta-analysis, mixed models, multivariate analysis, robust statistics, survey methodology, and survival analyses.
Geriatric Medicine 2013: Successful Healthy Aging One Day Conference
June 15, 2013 Lister Conference Centre
This is a one day meeting for internists, geriatricians, family physicians and allied health professionals with an interested in geriatrics. This course is designed to be interactive with workshops and debates covering some of the challenging areas in the clinical management of geriatric patients.
Health Services Research Network (HSRN) Symposium
17-18 June 2013 Nottingham UK
The Health Services Research Network (HSRN) Symposium, now in its sixth year, presents the leading edge of health services research. A multidisciplinary programme includes plenaries from research and service leaders, presentations and posters, interactive art and technology and commissioned themes.
Ways & Means to Make Health Links Work
Wednesday 15 May 2013 08:15-17:00 Toronto ON
Join Longwoods Publishing with Co-Chairs Leslee Thompson, President and CEO of Kingston General Hospital and Will Falk, Managing Partner, Healthcare PwC as we bring together key stakeholders from across Ontario to explore the Ministry of Health and Long-Term Care’s primary care initiative Health Links.
Center on Knowledge Translation for Disability and Rehabilitation Research (KTDRR): Knowledge Translation From Research to Vocational Rehabilitation Service Delivery
Tuesday April 30, 2013, 13:00-14:00 MT
Presenters: Tamara Bushnick, Robert Stensrud, John Connelly
The Center on KTDRR is collaborating with the American Institutes for Research to support webcasts and a Community of Practice to examine issues around evidence-based practice and vocational rehabilitation (VR). Practice guidelines are a strategy used in systems similar to VR to help identify and implement evidence-based practices to promote successful outcomes. Should practice guidelines be developed for VR service delivery? This webcast will be a discussion with a rehabilitation researcher, a VR educator, and a VR practitioner around practice guidelines: what they are, how they are developed in other disciplines, and if they could be helpful to VR counselors and consumers.
Webinar: the steps of a Cochrane Review: an overview
13 June 2013 10:00-11:00
What makes Cochrane Reviews different from other systematic reviews? Who – and what – is involved in the process? We will introduce you to the steps of a Cochrane Review and give you some practical tips for getting a review underway.
NICHE: Integrative Healing Arts and the Geriatric Patient Webinar
Thursday May 9, 2013 11:00-12:00 MT Cost: Free for NICHE sites, $99 Non-NICHE site
Presenters: Brenda Belbot, RN-BC, MSN, MHA and Jenna Godfryd, RN-BC, BSN St. John Hospital and Medical Center
This webinar will provide an introduction to the integrative healing arts and their value in the care of the geriatric population, particularly the management of dementia and delirium. The discussion will also include the importance of the RN caregiver using the integrative healing arts to help center herself and effectively deliver care. The webinar will also showcase how and when to use aromatherapy, music therapy and hand massage in the dementia and delirium geriatric patient, with a focus on decreasing medication use for this population.
AMDA: Diabetic Care in Nursing Homes
Tuesday June 11, 2013 17:00-18:30
Presenter: Michele F. Bellantoni, MD
This live webinar will begin by addressing the prevalence of diabetes in nursing home residents and introduce the challenges of co-morbidity, functional debility, prognosis, and risks of mortality associated with tight glucose control in this population. The concept of individualized diabetes management will be introduced to include the resident and family in setting goals for diabetes management. Secondly, this activity will provide a consensus on appropriate targets for hemoglobin A1C to prevent symptomatic diabetes such as acute metabolic complications and infections while minimizing hypoglycemia. This webinar will conclude with a discussion on facility policies and procedures established by the medical director, and relevant quality assurance, performance improvement practices appropriate for diabetes management in the nursing home.
inspirenet: Mapping the types of literature reviews
Monday April 29, 2013 11:00-12:00
Presenter: Dr. Anastasia Mallidou, Assistant Professor, School of Nursing, University of Victoria
A new initiative from the KTA team for all members is the launching of a webinar series focused on knowledge translation. All are welcome; no need to RSVP.
BC Patient Safety and Quality Council: Quality Café – Is there an elephant hiding in your QI or evaluation project?
Wednesday May 22, 2013 13:00-14:00 MT
Presenters: Jody Pistak Quality Improvement and Patient Safety Consultant for Interior Health, Nicole Elliot Leader for Enterprise Risk Management at Interior Health, Geoff Schierbeck Quality Improvement Consultant with Interior Health
This is the question posed in the ARECCI Project Ethics course, How to Integrate an Ethical Approach in Quality Improvement and Evaluation, developed by Alberta Innovates-Health Solutions (AIHS). The elephant refers to the ethical issues that are present in the QI and evaluation projects we do but are not necessarily acknowledged. Interior Health has recently trained close to 40 people in 2 cohorts of the Level 1 Project Ethics course, using ARECCI (A pRoject Ethics Community Consensus Initiative) Guidelines and Screening tools. These online tools have been designed to help ensure that all QI and Evaluation projects that involve people or their information have appropriate ethics consideration integrated into the project.
KT Canada Seminar Series: John Lavis
May 9, 2013 10:00-11:00 MT 3-001 ECHA
Dr. John Lavis is the Director of the McMaster Health Forum, Associate Director of the Centre for Health Economics and Policy Analysis, and a Professor (in both the Department of Clinical Epidemiology and Biostatistics and the Department of Political Science) at McMaster University. He is also Adjunct Professor of Global Health, Department of Global Health and Population, Harvard School of Public Health. His principal research interests include knowledge transfer and exchange in public policymaking environments and the politics of health systems. He led the creation and oversees the continuous updating of Health Systems Evidence.
CFHI Webinar: How do we plan for meaningful, effective, and appropriate patient engagement?
May 23, 2013 10:00-11:30 MT Cost: $99
Presenters: Mireille Brosseau, Stephani Roy McCallum, Mary Elizabeth Snow
How do we plan for meaningful, effective, and appropriate patient engagement? will introduce participants to the essential steps in planning their engagement processes: identifying the goals and objectives; ensuring representation and inclusion; and building capacity for engagement. Participants will gain an understanding of what makes patient engagement meaningful, effective and appropriate – for both patients AND providers. Hear how the Centre for Addiction and Mental Health in Toronto and the Fraser Health Authority in British Columbia developed and implemented a model to engage voices not traditionally heard in healthcare improvement. We will discuss their lessons learned, successes, as well as the challenges they met and overcame along the way.
A special report from CBC’s the fifth estate ranking Canadian hospitals is receiving a mixed reaction from hospital officials and medical associations, but many experts are saying measuring success matters for hospital improvement.
This hot new field promises to revolutionize industries from business to government, health care to academia.
Who will take care of us in our frail, declining years? Most of us hope that our family will step up and help out. But for an increasing number of seniors, that option isn’t there. Whether they’re estranged from family or have never married or had children, more and more people will find themselves alone as they age and their health declines.
The Conservative government has informed the Health Council of Canada that its funding will be discontinued with next year’s expiry of the intergovernmental health accords.
Nurses are “drowning in a sea of paperwork” with more than one-sixth of the working week taken up doing non-essential paperwork, a survey suggests. The Royal College of Nursing poll of 6,000 nurses found 17.3% of their hours were spent on tasks such as filing, photocopying and ordering supplies.
Change can be both painful and good. And depending on who’s talking about it, the Ontario Ministry of Health plan to revamp its funding of physiotherapy services is either great news or the beginning of rehabilitation doom.
Ontario is taking action to safeguard care for hospital patients and improve the oversight of drugs purchased by hospitals, including chemotherapy drugs. The government is posting a new regulation under the Public Hospitals Act to ensure that hospitals purchase drugs only from accredited, licensed or otherwise approved suppliers.
A Nova Scotia health official is defending his decision not to release data to the CBC about the province’s hospitals, but critics say more transparency could make the health care system safer.
Health officials say surgical waiting times at two major Vancouver hospitals have been cut by 21 per cent in the last year. They also say the number of patients waiting more than a year for surgery at Vancouver General and UBC Hospitals has dropped by 69 per cent.
The cost of long-term care in nursing homes and assisted-living sites is increasing at a dramatic pace compared with the cost of in-home care, an annual industry survey finds.
Waiting times for lung cancer patients have been slashed from about 190 days to 45 days thanks to patient navigators at Surrey Memorial Hospital.
A Post-Doctoral Fellow from McMaster University, Kristine Newman, who is being supervised by Maureen Dobbins, is investigating public health professionals’ perceptions of their information-seeking behaviours and problem solving abilities, and perceptions of how evidence is used in the practice environment. Follow the link to the survey. It takes 30 min.
About a decade ago, anesthesiologists at The Ottawa Hospital were working out what they could do to help reduce wait times for surgery. Prompted by an initiative of the anesthesiology section of the Ontario Medical Association, the Ottawa anesthesiologists created an “anesthesia care team” (ACT) for cataract surgery.
In the Waterloo Wellington Local Health Integration Network, three projects will receive support through the province’s Small and Rural Hospital Transformation Fund. Initiatives include standardizing care co-ordination and implementing integrated health delivery while optimizing the use of technology
THE NDP’s new budget has $2.1 million to create more nurse training positions, which the province says it needs to address a higher number of baby-boomer retirements in the nursing field and to meet the growing aging population, the so-called silver tsunami.
The new Ontario government wants more people to receive timely access to home and community care.
The IHI, a leader innovator in health and health care improvement worldwide, has launched a suite of Improvement Blogs that capture fresh ideas and new thinking from the frontlines of patient care and population health. The blogs address the most current and challenging topics facing health care quality improvement in the US and globally — from the innovation process itself, to important topics such as patient safety, reducing infant and maternal mortality, and preventing unnecessary hospital readmissions.
Leuphana University Lueneburg will apply for an EU Innovation Project, with an investment volume of up to EUR 1.6 billion.
The Cochrane Collaboration formalized its commitment to the AllTrial initiative to campaign for the registration and reporting of all clinical trials.
Former Assistant Editor is now the Editor-in-Chief.
This online database to help scholars, policy analysts, and advocates stay on top of the latest research and innovations in aging care, including health care and social services.
The UK Database of Uncertainties about the Effects of Treatments (UK DUETs) publishes treatment uncertainties from patients, carers, clinicians, and from research recommendations, covering a wide variety of health problems.
People living in the most disease prone and poorest countries of the world are developing new ideas and practices in health from which we can all learn, wherever we live. Turning the World Upside Down showcases some extraordinary examples and provides the space for discussion and debate. Please share your experiences and insights – add to the case studies – and comment on those you read here, just as global health leaders from around the world are already doing.
The Canadian Public Health Association has launched a new platform to facilitate the exchange of real-life experiences, tools and resources about initiatives implemented by communities and their health and social service organizations to improve health and address health equity through the social determinants of health.
This fact sheet outlines how to assign DOIs to datasets. There is also a series of fact sheets on data available here.
This toolbox of novel and underused methods can equip evaluators and implementers to better assess and refine PCMH models and to meet the evidence needs of PCMH stakeholders more effectively. Each of the briefs describes a method and how PCMH researchers have used it or could do so, discusses advantages and limitations of the methods, and provides resources for researchers to learn more about the method. Methods included are: Anthropological Approaches, Cognitive Task Analysis, Efficient Orthogonal Designs, Formative Evaluation, Fuzzy-Set Qualitative Comparative Analysis and Configurational Comparative Methods, Implementation Research, Mixed Methods, Optimal Use of Logic Models, Pragmatic Clinical Trials, Statistical Process Control.
Living Words is an artistic program, based in the UK, creating art and poetry from the words of Dementia patients. It aims to empower creative communication between people living with Dementia and those who are not, as well as work with family caregivers and staff at Personal Care Homes to improve patient wellbeing.
Thinking about moving to the US when you retire? Check out the Age-Friendly America database
Interested in learning about more about age-friendly initiatives? Looking for peers across the country to share ideas and resources? This database has brief descriptions about and contact information for more than 200 age-friendly programs across the United States.
The NICE Digital Tool site, created by the National Initiative for the Care of the Elderly, organizes assessment tools and information packages for healthcare professionals, families and patients on age-related topics. These information packages are a quick reference tool on topics like: Caregiving; Dementia Care; Elder Abuse; End-of-Life Issues; Financial Literacy and Mental Health. The tools are available online, and can be easily accessed on a smart phone or tablet for easy access and referral. They can also be ordered in print for a cost.
Research Fellow in Clinical Diabetes Nursing
King’s College London, UK
DEADLINE: 13 May 2013
The FEND Post-Doctoral Fellowship has been created to give a diabetes nurse the opportunity undertake a clinical research project to generate important knowledge that will improve the care provided to people with diabetes. The Fellow will work with the support of the current FEND Chair in Clinical Diabetes Nursing Professor Angus Forbes and the wider diabetes research team at King’s College London. A training and development package will be constructed to help the post-holder fulfil their potential as a leading researcher.
Senior Research Fellow/Research Fellow in Healthcare Modelling
University of Southhampton, Chilworth UK
DEADLINE: May 1, 2013
We are looking for people to join a cohesive research team working on economic evaluations and evidence synthesis/primary research to address major policy questions concerning the use of drugs, devices, procedures, diagnostics, public health programmes and other health interventions. You will also work with colleagues on a programme of research on methodological developments related to health technology assessment.
ICES Toronto ON
DEADLINE: May 3, 2013
ICES is seeking two (2) SAS Analyst/Biostatisticians to work collaboratively with ICES researchers, applying research methodology in the context of health services administrative data.