KUSP FYI will be back on January 6, 2014
News from KUSP Dr Diana Shaw has been appointed Managing Director for TREC
Diana has a strong science and business background and experience in university trust funded environments. She completed her PhD in Medical Genetics at the University of Calgary and two postdoctoral appointments at the University of Alberta; her undergraduate degree is from England and her MSc from Australia. While a long time Canadian citizen she is originally from England. Her first day at KUSP will be January 6, 2013. Welcome to the team Diana!!!
New article by Colin Reid, Greta Cummings, Carole Estabrooks, Sarah Cooper, Peter Norton The Older Persons’ Transitions in Care (OPTIC) study: pilot testing of the transition tracking tool
Reid R, Cummings G, Cooper S, Abel S, Bissell L, Estabrooks C, et al.
BMC Health Services Research 2013;13(1):515
OPTIC is a mixed method Partnership for Health System Improvement study focused on improving care for nursing home (NH) residents who are transferred to and from emergency departments (EDs) via emergency medical services (EMS). In the pilot study we tested feasibility of concurrently collecting individual resident data during transitions across settings using the Transition Tracking Tool (T3). Methods The pilot study tracked 54 residents transferred from NHs to one of two EDs in two western Canadian provinces over a three month period. The T3 is an electronic data collection tool developed for this study to record data relevant to describing and determining success of transitions in care. It comprises 800+ data elements including resident characteristics, reasons and precipitating factors for transfer, advance directives, family involvement, healthcare services provided, disposition decisions, and dates/times and timing. Results Residents were elderly (mean age = 87.1 years) and the majority were female (61.8%). Feasibility of collecting data from multiple sources across two research sites was established. We identified resources and requirements to access and retrieve specific data elements in various settings to manage data collection processes and allocate research staff resources. We present preliminary data from NH, EMS, and ED settings. Conclusions While most research in this area has focused on a unidirectional process of patient progression from one care setting to another, this study established feasibility of collecting detailed data from beginning to end of a transition across multiple settings and in multiple directions.
Article recommended by Dr. Carole Estabrooks
Implementation research: what it is and how to do it.
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Peters DH, Adam T, Alonge O, Agyepong IA, Tran N.
BMJ (Clinical research ed.) 2013 Nov 20;347:f6753
Implementation research is a growing but not well understood field of health research that can contribute to more effective public health and clinical policies and programmes. This article provides a broad definition of implementation research and outlines key principles for how to do it.
CALL FOR ABSTRACTS: 2014 Summer Institute for Informed Patient Choice (SIIPC)
25-27 June 2014 Dartmouth, Hanover, NH
DEADLINE: 28 February 2014
Proposals, protocols, works in progress, or unpublished work relating to informed patient choice, with relevance to law, ethics, and policy development are welcome. The 2014 Summer Institute for Informed Patient Choice will convene medical, legal, ethics, and policy professionals and patient advocates around the individual and systems-level consequences of the lack of transparency and patient involvement in health care (i.e, “keeping patients in the dark”). Aims include facilitating a deeper understanding of the importance of greater transparency in health care; engaging in joint learning about innovative health care delivery methods to promote patient-centered care; and spreading innovative solutions such as value-based purchasing.
CALL FOR ABSTRACTS: 2014 CAHSPR Conference
12-15 May 2014 Toronto ON
DEADLINE Thursday 9 January 2014
CAHSPR’s annual conference is Canada’s largest gathering of health care policy makers, managers, researchers, students and stakeholders. Held at a different location every year, it is attended by 600+ delegates annually. Don’t miss out on the chance to feature your work.
CALL FOR ABSTRACTS: 2nd Biennial Australian Implementation Conference (AIC): Solving complex implementation problems
17-18 September 2014, Sydney Aus
DEADLINE 4 May 2014
The goal of the conference is to help advance implementation science, practice, and policy to improve the implementation of policies and programs to more effectively deliver better health, education and wellbeing outcomes for individuals and families in Australia and our surrounding regions.
CALL FOR ABSTRACTS: 2014 Primary Health Care Research Conference: Integrating knowledge exchange to improve primary health care outcomes
23-25 July 2014 Canberra, Aus
DEADLINE 28 February 2013
This conference seeks to foster a culture in which knowledge exchange becomes automatic, a part of core business for everyone who wants to contribute to the improvement of primary health care outcomes. The value of any evidence is enhanced when the key stakeholders work together with a common purpose that encourages them to capitalise, from the outset, on their different perspectives, expertise and skills. Such a focus on partnerships and co-creation of knowledge can become a part of ‘the way we do things here’.
CALL FOR PAPERS: eGEMS: Sustaining the Effective Use of Health Care Data
DEADLINE 3 March 2014
Over the last few years, investment from care organizations, research institutes, and a significant one-time investment from the American Recovery and Reinvestment Act (ARRA) has created new infrastructure that leverages the use of electronic health data (particularly from electronic health records) to build “learning systems”. Developing sustainable business models to support ongoing maintenance and growth of these types of networks is now one of the most critical goals for these transformative projects. Concrete case examples of business models, lessons learned, and original research are needed to facilitate a broader conversation of promising practices.
Grants & Awards
CFHI: EXTRA Program
DEADLINE: 5 February 2013
As one of CFHI’s flagship programs, the EXTRA program for healthcare improvement develops capacity and leadership to optimize the use of research evidence in managing Canadian healthcare organizations. EXTRA gives health system managers across Canada the skills to better use research in their daily work, as a way to increase evidence-informed decision-making in the health system. The EXTRA program targets health service professionals in senior management positions – nurse leadersfellow, physician executives, and other health administration executives.Spread over three away-from-home residency sessions which incorporate curriculum modules, the program experience offers:
-knowledge of research evidence (its existence, location, and relevance/application)
-the capacity to draw on “system thinking”
-development of collaborative professional relationships
-the ability to introduce and manage evidence-informed change
TVN 2014 Summer Student Awards
A Pre-Application Indication of Intent is due by 10:00 MT on 28 February 2014
Applications are due 10 March 2014 by 10:00 MT
TVN’s Summer Student Program has been designed to provide students with an interdisciplinary summer experience, which will develop a frame of reference for participants in examining health care for Canada’s seriously ill, frail elderly. In the 2014 competition, funding of up to $6,000 each will be available to up to 10 students.
Current evidence on the attitudes, knowledge and perceptions of nurses regarding evidence-based practice implementation in European community settings: a systematic review.
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Patelarou AE, Patelarou E, Brokalaki H, Dafermos V, Thiel L, Melas CD, et al.
Journal of community health nursing 2013;30(4):230-244
Evidence-based practice (EBP) is an approach that influences healthcare worldwide. Systematic research in the relevant biomedical literature was conducted using the Medline-Pubmed interface until August 2012. Six studies were included in the review. All of these studies had a cross-sectional study design, and 4 of them conducted a postal survey, using different questionnaires for data collection purposes. This review supports previous literature suggesting that community nurses have a positive attitude toward EBP. However, although EBP implementation is considered to be a professional imperative, the integration of recent evidence into clinical practice seems to be a cumbersome process.
The impact of organizational information culture on information use outcomes in policing: an exploratory study
Abrahamson DE, Goodman-Delahunty J
Information Research; Dec 2013 18(4)
The information management practices of an organization along with the information behaviour and values of its personnel impact on organizational performance and the achievement of specific information use outcomes, positively and/or negatively. The aim of this study was to determine whether a theoretical model previously used in other fields to study the information management and information culture of organizations was applicable to policing, and examine which factors had the greatest impact on the achievement of the outcomes of problem solving, creating beneficial work, and information sharing within three Canadian police organizations. Method. A total of 134 sworn officers from various ranks across three Canadian police organizations completed an online survey. Analysis. Factor analysis and regression analysis were conducted using statistical analysis SPSS software. Results. Considering six information factors, regression analysis revealed that information pro-activeness and information management played significant roles in the achievement of the three information use outcomes. Factor analysis, using information management and five information behaviours, uncovered two new factors (information quality control and pro-active collaboration) that accounted for 71% of variance in the achievement of information use outcomes within this policing context. Conclusion. A conceptual framework for future police organization analysis is presented and the need for information use outcome scales is explored.
Public health research implementation and translation: evidence from practice-based research networks.
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Mays GP, Hogg RA, Castellanos-Cruz DM, Hoover AG, Fowler LC.
American Journal of Preventive Medicine 2013 Dec;45(6):752-762
Research on how best to deliver efficacious public health strategies in heterogeneous community and organizational contexts remains limited. Such studies require the active engagement of public health practice settings in the design, implementation, and translation of research. Practice-based research networks (PBRNs) provide mechanisms for research engagement, but until now they have not been tested in public health settings. PURPOSE: This study uses data from participants in 14 public health PBRNs and a national comparison group of public health agencies to study processes influencing the engagement of public health settings in research implementation and translation activities. RESULTS: Among PBRN participants, both researchers and practice agencies reported high levels of engagement in research activities. Local public health agencies participating in PBRNs were two to three times more likely than nonparticipating agencies to engage in research implementation and translation activities (p<0.05). Participants in less densely connected PBRN networks and in more peripheral locations within these networks reported higher levels of research engagement, greater perceived benefits from engagement, and greater likelihood of continued participation.© 2013 Published by American Journal of Preventive Medicine on behalf of American Journal of Preventive Medicine.
Social-Interaction Knowledge Translation for In-Home Management of Urinary Incontinence and Chronic Care.
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Jansen L, McWilliam CL, Forbes D, Forchuk C.
Canadian journal on aging = La revue canadienne du vieillissement 2013 Sep 24:1-13
Although urinary incontinence (UI) can be managed conservatively, it is a principal reason for the breakdown of in-home family care. This study explored the social interaction processes of knowledge translation (KT) related to how UI management knowledge might be translated within in-home care. In-depth interview data were collected from a theoretical sample of 23 family caregivers, older home care recipients, and home care providers. Constant comparison and Glaser’s analysis criteria were used to create translating knowledge through relating, a substantive theory with 10 subthemes: living with the problem; building experiential knowledge; developing comfort; easing into a working relationship; nurturing mutuality; facilitating knowledge exchange; building confidence; fine-tuning knowledge; putting it all together; and managing in-home care. Findings inform both theory and practice of in-home UI KT, illuminating how intersubjectivity and bi-directional relational interactions are essential to translating in-home chronic care knowledge, which is largely tacit and experiential in nature.
Research utilization in baccalaureate-prepared registered nurses.
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Journal for nurses in professional development 2013 Sep-Oct;29(5):244-248
A focus group study was conducted to describe bachelor of science-prepared registered nurses’ (n = 10) use of research in their everyday practice. Results indicate that participants feel prepared to use research upon entry into the workforce and do so to better patient care. However, research use is both positively and negatively affected by nursing leadership and the research culture of the workplace. The author includes implications for nursing professional development specialists and educators.
Features of effective medical knowledge resources to support point of care learning: a focus group study.
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Cook DA, Sorensen KJ, Hersh W, Berger RA, Wilkinson JM.
PloS one 2013 Nov 25;8(11):e80318
Health care professionals access various information sources to quickly answer questions that arise in clinical practice. The features that favorably influence the selection and use of knowledge resources remain unclear. We sought to better understand how clinicians select among the various knowledge resources available to them, and from this to derive a model for an effective knowledge resource. METHODS: We conducted 11 focus groups at an academic medical center and outlying community sites. We included a purposive sample of 50 primary care and subspecialist internal medicine and family medicine physicians. We transcribed focus group discussions and analyzed these using a constant comparative approach to inductively identify features that influence the selection of knowledge resources. RESULTS: We identified nine features that influence users’ selection of knowledge resources, namely efficiency (with sub-features of comprehensiveness, searchability, and brevity), integration with clinical workflow, credibility, user familiarity, capacity to identify a human expert, reflection of local care processes, optimization for the clinical question (e.g., diagnosis, treatment options, drug side effect), currency, and ability to support patient education. No single existing resource exemplifies all of these features. CONCLUSION: The influential features identified in this study will inform the development of knowledge resources, and could serve as a framework for future research in this field.
Health Care Administration and Organization
Why do nurses intend to leave their organization? A large-scale analysis in long-term care.
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Tummers LG, Groeneveld SM, Lankhaar M.
Journal of advanced nursing 2013 Dec;69(12):2826-2838
AIM: To analyse the impact of six job characteristics on the intention of nurses to leave their organization, specifically focusing on long-term care settings: nursing homes, care homes and home care. BACKGROUND: When nurses leave their organization, this can negatively affect organizational performance. Organizations have to recruit new nurses and tacit knowledge is lost. Furthermore, organizational turnover could contribute to the nursing shortage, which will increasingly become a problem given the ageing population. This article adds to the literature, given: (a) its focus on long-term care; and (b) by explicating the differences between nursing and care homes (intramural) on one hand and home care (extramural) on the other. DESIGN: Survey. METHOD: Survey of 9982 nurses in 156 Dutch organizations in 2010-2011, 6321 nurses in nursing and care homes and 3661 nurses working in home care, based on the ActiZ Benchmark in Healthcare. RESULTS: First, the most important reason for nurses’ intention to leave is insufficient development and career opportunities. Secondly, a negative working atmosphere strongly influenced intention to leave. The impact of the working atmosphere is not often examined in the literature. However, this research shows that it is an important reason. Thirdly, intention to leave is partly context dependent. More specifically, when nurses in home care felt that their autonomy was reduced, this strongly influenced their intention to leave, although this was not the case for nurses working in nursing and care homes. CONCLUSION: This article provides guidelines for organizations on how to retain their nurses. © 2013 John Wiley & Sons Ltd.
Is the influence of nurse care practices and nursing home organization understood? A qualitative study.
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Palacios-Cena D, Cachon-Perez JM, Gomez-Perez D, Gomez-Calero C, Brea-Rivero M, Fernandez-DE-Las-Penas C.
Journal of nursing management 2013 Nov;21(8):1044-1052
Aim To describe residents’ experience of nursing home organization and nursing care practices in a region of Spain. Background Nursing home organization, nursing practices and rules within the institution may all influence residents’ daily living and their perception on the quality of care provided. Design A qualitative approach was conducted, using purposeful and theoretical sampling. Data were collected from nursing home residents, following unstructured and semi-structured interviews, researcher field notes and residents’ personal diaries and letters. Giorgi analysis was conducted. Results Two main themes emerged. (1) ‘Following nursing home rules’. Norms may be seen as boundaries, especially for those residents who were independent before admission. (2) ‘Prioritizing nursing care in residents’. Prioritizing the nursing care may limit the autonomy of residents because it does not meet their preferences and needs. Conclusion Understanding the meaning of nursing home organization and nursing care practices with nursing home residents might provide deeper insight into their expectations. Implications for nursing management Nursing staff should have greater involvement in the nursing home organization, as well as in prioritizing the care provision based on resident’s needs and preferences.© 2012 John Wiley & Sons Ltd.
Filipino Health Care Aides and the Nursing Home Labour Market in Winnipeg.
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Canadian journal on aging = La revue canadienne du vieillissement 2013 Sep 24:1-12
Canada’s nursing homes have become increasingly dependent on immigrant health care aides. More than any other ethnic group, Filipino women are over-represented among health care aides in the Canadian health care system. This qualitative study explored the employment experiences of Filipino health care aides in nursing homes from their own perspectives as well as those of policy stakeholders. Fourteen in-depth interviews were conducted with Filipino health care aides and long-term-care policy stakeholders in Winnipeg, Manitoba. The results indicated that migrant social networks act as pathways linking immigrant women with employment opportunities in nursing homes. The composition of the labour force is also shaped by management strategies and labour market accommodations that respond to, and reinforce, these social networks. These findings have implications for workforce planning and the quality of care provision in nursing homes.
Nurse retention: A review of strategies to create and enhance positive practice environments in clinical settings.
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Twigg D, McCullough K.
International journal of nursing studies 2014 Jan;51(1):85-92
This paper summarises and critically reviews strategies identified in the literature which support retention of nurses by the creation and enhancement of positive practice environments in the clinical setting. DESIGN: Literature review. DATA SOURCES: A literature search was undertaken in February 2012 of major healthcare-related databases, Cinahlplus, Medline, and Proquest. REVIEW METHODS: The keywords “nurs* AND practice AND environment” were used in the first instance. Additional keywords “retention strategies” were also searched. Abstracts were reviewed and articles which potentially outlined strategies were identified. Reference lists were scanned for other potential articles. Articles in languages other than English were excluded. Lake’s Practice Environment Scale of the Nursing Work Index provided a framework from which to assess the strategies. RESULTS: Thirty-nine papers reported strategies for creating a positive practice environment. Only two articles reported on a pre-test post-test evaluation of the proposed strategy. Strategies included: empowering work environment, shared governance structure, autonomy, professional development, leadership support, adequate numbers and skill mix and collegial relationships within the healthcare team. CONCLUSIONS: Creating positive practice environments enhances nurse retention and facilitates quality patient care. Managers and administrators should assess and manage their practice environments using a validated tool to guide and evaluate interventions. Copyright © 2013 Elsevier Ltd. All rights reserved.
Burnout intervention studies for inpatient elderly care nursing staff: Systematic literature review
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Westermann C, Kozak A, Harling M, Nienhaus A.
International journal of nursing studies 2014 Jan;51(1):63-71
The aim of this systematic review was to identify and analyse burnout intervention studies among nursing staff in the inpatient elderly and geriatric long-term care sector. METHODS: A systematic search of burnout intervention studies was conducted in the databases Embase, Medline and PsycNet published from 2000 to January 2012. RESULTS: We identified 16 intervention studies. Interventions were grouped into work-directed (n=2), person-directed (n=9) and combined approaches (work- and person-directed, n=5). Seven out of 16 studies observed a reduction in staff burnout. Among them are two studies with a work-directed, two with a person-directed and three with a combined approach. Person-directed interventions reduced burnout in the short term (up to 1 month), while work-directed interventions and those with a combined approach were able to reduce burnout over a longer term (from 1 month to more than 1 year). In addition to staff burnout, three studies observed positive effects relating to the client outcomes. Only three out of ten Randomised Control Trials (RCT) found that interventions had a positive effect on staff burnout. CONCLUSION: Work-directed and combined interventions are able to achieve beneficial longer-term effects on staff burnout. Person-directed interventions achieve short-term results in reducing staff burnout. However, the evidence is limited. Copyright © 2012 Elsevier Ltd. All rights reserved.
The impact of job stressors on health-related quality of life of nursing assistants in long-term care settings.
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Liang YW, Hsieh Y, Lin YH, Chen WY.
Geriatric nursing (New York, N.Y.) 2013 Nov 19
This study aimed to investigate the relationship between various job stressors and health-related quality of life among female nursing assistants working in long-term care facilities. A cross-sectional study was conducted in Taiwan. Data were collected using a structured, well-designed, pre-tested questionnaire with background questions and questions about job stressors and health-related quality of life as measured by SF-12. Our empirical results show that nursing assistants with higher scores for job control and work-related social support tend to enjoy better mental health, as indicated by higher mental component summary scores. Additionally, nursing assistants with higher psychological demand scores tend to have worse overall health, as indicated by lower physical component summary and mental component summary scores. We suggest reducing selected job stressors and enhancing job control to improve nursing assistants’ health-related quality of life. Copyright © 2013 Mosby, Inc. All rights reserved
Between surveillance and subjectification: Professionals and the governance of quality and patient safety in English hospitals.
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Martin GP, Leslie M, Minion J, Willars J, Dixon-Woods M.
Social science & medicine (1982) 2013 Dec;99:80-88
Two understandings of the dynamics of power developed by Foucault have been extensively used in analyses of contemporary healthcare: disciplinary power and governmentality. They are sometimes considered alternative or even contradictory conceptual frameworks. Here, we seek to deploy them as complementary ways of making sense of the complexities of healthcare organisation today. We focus on efforts to improve quality and safety in three UK hospitals. We find a prominent role for disciplinary power, including a panoptic gaze that is to some extent internalised by professionals. We suggest, however, that the role of disciplinary power relies for its impact on complementary strategies that are more akin to governmentality. These strategies foster organisational contexts that are receptive to disciplinary work. More fundamentally, we find that both disciplinary power and governmentality work on subjectivities in rather a different manner from that suggested by conventional accounts. We offer an alternative, less individualised and more socialised, understanding of the way in which power acts upon subjectivity and behaviour in professional contexts. Copyright © 2013 Elsevier Ltd. All rights reserved.
Health Care Innovation and Quality Assurance
Implementation strategies: recommendations for specifying and reporting.
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Proctor EK, Powell BJ, McMillen JC.
Implementation science 2013 Dec 1;8(1):139-5908-8-139
Implementation strategies have unparalleled importance in implementation science, as they constitute the ‘how to’ component of changing healthcare practice. Yet, implementation researchers and other stakeholders are not able to fully utilize the findings of studies focusing on implementation strategies because they are often inconsistently labelled and poorly described, are rarely justified theoretically, lack operational definitions or manuals to guide their use, and are part of ‘packaged’ approaches whose specific elements are poorly understood. We address the challenges of specifying and reporting implementation strategies encountered by researchers who design, conduct, and report research on implementation strategies. Specifically, we propose guidelines for naming, defining, and operationalizing implementation strategies in terms of seven dimensions: actor, the action, action targets, temporality, dose, implementation outcomes addressed, and theoretical justification. Ultimately, implementation strategies cannot be used in practice or tested in research without a full description of their components and how they should be used. As with all intervention research, their descriptions must be precise enough to enable measurement and ‘reproducibility.’ We propose these recommendations to improve the reporting of implementation strategies in research studies and to stimulate further identification of elements pertinent to implementation strategies that should be included in reporting guidelines for implementation strategies.
The effects of quality of care on costs: a conceptual framework.
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Nuckols TK, Escarce JJ, Asch SM.
The Milbank quarterly 2013 Jun;91(2):316-353
The quality of health care and the financial costs affected by receiving care represent two fundamental dimensions for judging health care performance. No existing conceptual framework appears to have described how quality influences costs. METHODS: We developed the Quality-Cost Framework, drawing from the work of Donabedian, the RAND/UCLA Appropriateness Method, reports by the Institute of Medicine, and other sources. FINDINGS: The Quality-Cost Framework describes how health-related quality of care (aspects of quality that influence health status) affects health care and other costs. Structure influences process, which, in turn, affects proximate and ultimate outcomes. Within structure, subdomains include general structural characteristics, circumstance-specific (e.g., disease-specific) structural characteristics, and quality-improvement systems. Process subdomains include appropriateness of care and medical errors. Proximate outcomes consist of disease progression, disease complications, and care complications. Each of the preceding subdomains influences health care costs. For example, quality improvement systems often create costs associated with monitoring and feedback. Providing appropriate care frequently requires additional physician visits and medications. Care complications may result in costly hospitalizations or procedures. Ultimate outcomes include functional status as well as length and quality of life; the economic value of these outcomes can be measured in terms of health utility or health-status-related costs. We illustrate our framework using examples related to glycemic control for type 2 diabetes mellitus or the appropriateness of care for low back pain. CONCLUSIONS: The Quality-Cost Framework describes the mechanisms by which health-related quality of care affects health care and health status-related costs. Additional work will need to validate the framework by applying it to multiple clinical conditions. Applicability could be assessed by using the framework to classify the measures of quality and cost reported in published studies. Usefulness could be demonstrated by employing the framework to identify design flaws in published cost analyses, such as omitting the costs attributable to a relevant subdomain of quality. © 2013 RAND Corporation. PMID: 23758513 [PubMed – indexed
Rates of medical errors and preventable adverse events among hospitalized children following implementation of a resident handoff bundle.
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Starmer AJ, Sectish TC, Simon DW, Keohane C, McSweeney ME, Chung EY, et al.
JAMA : the journal of the American Medical Association 2013 Dec 4;310(21):2262-2270
Handoff miscommunications are a leading cause of medical errors. Studies comprehensively assessing handoff improvement programs are lacking. OBJECTIVE: To determine whether introduction of a multifaceted handoff program was associated with reduced rates of medical errors and preventable adverse events, fewer omissions of key data in written handoffs, improved verbal handoffs, and changes in resident-physician workflow. INTERVENTIONS: Resident handoff bundle, consisting of standardized communication and handoff training, a verbal mnemonic, and a new team handoff structure. On one unit, a computerized handoff tool linked to the electronic medical record was introduced. MAIN OUTCOMES AND MEASURES: The primary outcomes were the rates of medical errors and preventable adverse events measured by daily systematic surveillance. The secondary outcomes were omissions in the printed handoff document and resident time-motion activity. RESULTS: Medical errors decreased from 33.8 per 100 admissions (95% CI, 27.3-40.3) to 18.3 per 100 admissions (95% CI, 14.7-21.9; P < .001), and preventable adverse events decreased from 3.3 per 100 admissions (95% CI, 1.7-4.8) to 1.5 (95% CI, 0.51-2.4) per 100 admissions (P = .04) following the intervention. There were fewer omissions of key handoff elements on printed handoff documents, especially on the unit that received the computerized handoff tool (significant reductions of omissions in 11 of 14 categories with computerized tool; significant reductions in 2 of 14 categories without computerized tool). Physicians spent a greater percentage of time in a 24-hour period at the patient bedside after the intervention (8.3%; 95% CI 7.1%-9.8%) vs 10.6% (95% CI, 9.2%-12.2%; P = .03). The average duration of verbal handoffs per patient did not change. Verbal handoffs were more likely to occur in a quiet location (33.3%; 95% CI, 14.5%-52.2% vs 67.9%; 95% CI, 50.6%-85.2%; P = .03) and private location (50.0%; 95% CI, 30%-70% vs 85.7%; 95% CI, 72.8%-98.7%; P = .007) after the intervention. CONCLUSIONS AND RELEVANCE: Implementation of a handoff bundle was associated with a significant reduction in medical errors and preventable adverse events among hospitalized children. Improvements in verbal and written handoff processes occurred, and resident workflow did not change adversely.
Considering context in quality improvement interventions and implementation: concepts, frameworks, and application.
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Academic pediatrics 2013 Nov-Dec;13(6 Suppl):S45-53
Growing consensus within the health care field suggests that context matters and needs more concerted study for helping those who implement and conduct research on quality improvement interventions. Health care delivery system decision makers require information about whether an intervention tested in one context will work in another with some differences from the original site. We aimed to define key terms, enumerate candidate domains for the study of context, provide examples from the pediatric quality improvement literature, and identify potential measures for selected contexts. Key sources include the organizational literature, broad evaluation frameworks, and a recent project in the patient safety area on context sensitivity. The article concludes with limitations and next steps for developments in this area. Copyright © 2013 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
Real teams and their effect on the quality of care in nursing homes.
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Havig AK, Skogstad A, Veenstra M, Romoren TI.
BMC health services research 2013 Dec 1;13:499-6963-13-499
Use of teams has shown to be an important factor for organizational performance. However, research has shown that a team has to meet certain criteria and operate in a certain way to realize the potential benefits of team organizing. There are few studies that have examined how teams operate in the nursing home sector and their effect on quality of care. This study investigates the relationship between teams that meet an academic definition of the team concept and quality of care in nursing homes. METHODS: A cross-sectional survey of forty nursing home wards throughout Norway was used to collect the data. Five sources of data were utilized to test our research question: (1) self-report questionnaires to 444 employees, (2) interviews with 40 ward managers, (3) self-report questionnaires to 40 ward managers, (4) telephone interviews with 378 relatives, and (5) 900 hours of field observations. Use of teams in nursing home wards was assessed by field observations and by interviews with ward mangers. Quality of care was assessed by data from surveys and interviews with relatives and staff and through field observations. All data were aggregated to the ward level and two-level analyses were used to assess the relationships. RESULTS: The multi-level analyses showed that teams – as operationalized in the present study – were significantly positively related to two out of the three quality of care indices when controlled for ward size, days of sick leave and care level. One significant interaction effect was found between teams and days of sick leave, implying that the effect of teams decreased with higher numbers of days of sick leave. CONCLUSIONS: The results suggest that teams are related to higher levels of quality of care in nursing homes. However, the study shows that there is a substantial difference between real, functional teams that meet an academic definition of the concept and quasi teams, the latter having a significantly lower effect on quality of care. Hence, nursing home leaders, directors and ward leaders should be aware of the substantial differences betweens dysfunctional – or quasi – teams and real teams, and encourage the development of real functional teams to take advantage of the potential benefits of team organizing.
Overcoming Resistance to Culture Change: Nursing Home Administrators’ Use of Education, Training, and Communication
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Tyler DA, Lepore M, Shield RR, Looze J, Miller SC.
Gerontology & geriatrics education 2013 Sep 24
Nursing home culture change is becoming more prevalent, and research has demonstrated its benefits for nursing home residents and staff-but little is known about the role of nursing home administrators in culture change implementation. The purpose of this study was to determine what barriers nursing home administrators face in implementing culture change practices, and to identify the strategies used to overcome them. The authors conducted in-depth individual interviews with 64 administrators identified through a nationally representative survey. Results showed that a key barrier to culture change implementation reported by administrators was staff, resident, and family member resistance to change. Most nursing home administrators stressed the importance of using communication, education and training to overcome this resistance. Themes emerging around the concepts of communication and education indicate that these efforts should be ongoing, communication should be reciprocal, and that all stakeholders should be included.
The Association Between Quality of Care and Quality of Life in Long-Stay Nursing Home Residents With Preserved Cognition.
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Kim SJ, Park EC, Kim S, Nakagawa S, Lung J, Choi JB, et al.
Journal of the American Medical Directors Association 2013 Dec 17
To assess the overall quality of life of long-stay nursing home residents with preserved cognition, to examine whether the Centers for Medicare and Medicaid Service’s Nursing Home Compare 5-star quality rating system reflects the overall quality of life of such residents, and to examine whether residents’ demographics and clinical characteristics affect their quality of life. DESIGN/MEASUREMENTS: Quality of life was measured using the Participant Outcomes and Status Measures-Nursing Facility survey, which has 10 sections and 63 items. Total scores range from 20 (lowest possible quality of life) to 100 (highest). SETTING/PARTICIPANTS: Long-stay nursing home residents with preserved cognition (n = 316) were interviewed. RESULTS: The average quality- of-life score was 71.4 (SD: 7.6; range: 45.1-93.0). Multilevel regression models revealed that quality of life was associated with physical impairment (parameter estimate = -0.728; P = .04) and depression (parameter estimate = -3.015; P = .01) but not Nursing Home Compare’s overall star rating (parameter estimate = 0.683; P = .12) and not pain (parameter estimate = -0.705; P = .47). CONCLUSION: The 5-star quality rating system did not reflect the quality of life of long-stay nursing home residents with preserved cognition. Notably, pain was not associated with quality of life, but physical impairment and depression were. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.
Research Practice & Methodology
Publication Bias in Recent Meta-Analyses
PLoS ONE 2013 11/27;8(11):e81823
Positive results have a greater chance of being published and outcomes that are statistically significant have a greater chance of being fully reported. One consequence of research underreporting is that it may influence the sample of studies that is available for a meta-analysis. Smaller studies are often characterized by larger effects in published meta-analyses, which can be possibly explained by publication bias. We investigated the association between the statistical significance of the results and the probability of being included in recent meta-analyses. Methods For meta-analyses of clinical trials, we defined the relative risk as the ratio of the probability of including statistically significant results favoring the treatment to the probability of including other results. For meta-analyses of other studies, we defined the relative risk as the ratio of the probability of including biologically plausible statistically significant results to the probability of including other results. We applied a Bayesian selection model for meta-analyses that included at least 30 studies and were published in four major general medical journals (BMJ, JAMA, Lancet, and PLOS Medicine) between 2008 and 2012. Results We identified 49 meta-analyses. The estimate of the relative risk was greater than one in 42 meta-analyses, greater than two in 16 meta-analyses, greater than three in eight meta-analyses, and greater than five in four meta-analyses. In 10 out of 28 meta-analyses of clinical trials, there was strong evidence that statistically significant results favoring the treatment were more likely to be included. In 4 out of 19 meta-analyses of observational studies, there was strong evidence that plausible statistically significant outcomes had a higher probability of being included. Conclusions Publication bias was present in a substantial proportion of large meta-analyses that were recently published in four major medical journals.
Barriers and Facilitators to Senior Centers Participating in Translational Research
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Felix HC, Adams B, Cornell CE, Fausett JK, Krukowski RA, Love SRJ, et al.
Research on aging 2014;36(1):22-39
Senior centers are ideal locations to deliver evidence-based health promotion programs to the rapidly growing population of older Americans to help them remain healthy and independent in the community. However, little reported research is conducted in partnership with senior centers; thus, not much is known about barriers and facilitators for senior centers serving as research sites. To fill this gap and potentially accelerate research within senior centers to enhance translation of evidence-based interventions into practice, the present study examined barriers and facilitators of senior centers invited to participate in a cluster-randomized controlled trial. Primary barriers to participation related to staffing and perceived inability to recruit older adult participants meeting research criteria. The primary facilitator was a desire to offer programs that were of interest and beneficial to seniors. Senior centers are interested in participating in research that provides benefit to older adults but may need assistance from researchers to overcome participation barriers. © The Author(s) 2012.
Frameworks for evaluating health research capacity strengthening: a qualitative study.
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Boyd A, Cole DC, Cho DB, Aslanyan G, Bates I.
Health research policy and systems / BioMed Central 2013 Dec 14;11(1):46
Health research capacity strengthening (RCS) projects are often complex and hard to evaluate. In order to inform health RCS evaluation efforts, we aimed to describe and compare key characteristics of existing health RCS evaluation frameworks: their process of development, purpose, target users, structure, content and coverage of important evaluation issues. A secondary objective was to explore what use had been made of the ESSENCE framework, which attempts to address one such issue: harmonising the evaluation requirements of different funders. METHODS: We identified and analysed health RCS evaluation frameworks published by seven funding agencies between 2004 and 2012, using a mixed methods approach involving structured qualitative analyses of documents, a stakeholder survey and consultations with key contacts in health RCS funding agencies. RESULTS: The frameworks were intended for use predominantly by the organisations themselves, and most were oriented primarily towards funders’ internal organisational performance requirements. The frameworks made limited reference to theories that specifically concern RCS. Generic devices, such as logical frameworks, were typically used to document activities, outputs and outcomes, but with little emphasis on exploring underlying assumptions or contextual constraints. Usage of the ESSENCE framework appeared limited. CONCLUSIONS: We believe that there is scope for improving frameworks through the incorporation of more accessible information about how to do evaluation in practice; greater involvement of stakeholders, following evaluation capacity building principles; greater emphasis on explaining underlying rationales of frameworks; and structuring frameworks so that they separate generic and project-specific aspects of health RCS evaluation. The third and fourth of these improvements might assist harmonisation.
Healthcare in Canada
The study identifies that the current processes in Alberta’s healthcare system for managing the complex dealings between referring physicians and specialists or clinics offering specialized healthcare services are variable and may not always be sufficiently reliable to protect patients’ continuity of care.
This report looks at how Canada performs compared with the other member countries of the Organisation for Economic Co-operation and Development (OECD) on a variety of indicators of health system performance, including measures of
-Non-medical determinants of health
-Quality of care
-Access to care
Physical activity for people with dementia: a scoping study
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Bowes A, Dawson A, Jepson R, McCabe L.
BMC geriatrics 2013 Nov 26;13(1):129-2318-13-129
This scoping study aimed to identify how physical activity may benefit people with dementia; how and/or if current service provide these benefits; and what support they need to do so. METHODS: Methods included an evidence review using literature; mapping current service provision through a survey; and in-depth interviews with a sample of service providers. RESULTS: The 26 studies included in the review indicated the potential effectiveness of physical activity for people with dementia, including improvements in cognition and mood, behaviour and physical condition. Mechanisms of action and the link with outcomes were poorly defined and implemented.The mapping survey and related interviews showed that service providers were delivering a range of services broadly consistent with the scientific evidence. They tended to take a holistic view of possible benefits, and focused on enjoyment and well-being, more than specific cognitive, physical and behavioural outcomes highlighted in literature. Service providers needed more evidence based information and resources to develop services and realise their potential. CONCLUSION: Despite potential benefits demonstrated in literature and practice, there is a need for further research to optimise interventions and to consider some neglected issues including delivery at home and in communities; impacts for carers; physical activities through ADLs; and individual needs. Studies are needed which take a more holistic approach to the effects of physical activity, and outcomes should be broader and include mental health and wellbeing.
Observer-rated depression in long-term care: Frequency and risk factors
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McCusker J, Cole MG, Voyer P, Monette J, Champoux N, Ciampi A, et al.
Archives of Gerontology and Geriatrics 2013 Dec 1
The objectives of this study were: (1) to describe the prevalence and 6-month incidence of observer-rated depression in residents age 65 and over of long-term care (LTC) facilities; (2) to describe risk factors for depression, at baseline and over time. A multisite, prospective observational study was conducted in residents aged 65 and over of 7 LTC facilities. The Cornell Scale for Depression in Dementia (CSDD) was completed by nurses monthly for 6 months. We measured demographic, medical, and functional factors at baseline and monthly intervals, using data from research assessments, nurse interviews, and chart reviews. 274 residents were recruited and completed baseline depression assessments. The prevalence of depression (CSDD score of 6+) was 19.0%. The incidence of depression among those without prevalent depression was 73.3 per 100 person-years. A delirium diagnosis, pain, and diabetes were independently associated with prevalent depression. CSDD score at baseline and development of severe cognitive impairment at follow-up were independent risk factors for incident depression. A diagnosis of delirium and uncorrected visual impairment at follow-up occurred concurrently with incident depression. The results of this study have implications for the detection and prevention of depression in LTC. Delirium diagnosis, pain and diabetes at baseline were associated with prevalent depression; depression symptoms at baseline and development of severe cognitive impairment at follow-up were risk factors for incident depression. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
The University of California at Los Angeles Alzheimer’s and Dementia Care Program for Comprehensive, Coordinated, Patient-Centered Care: Preliminary Data
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Reuben DB, Evertson LC, Wenger NS, Serrano K, Chodosh J, Ercoli L, et al.
Journal of the American Geriatrics Society 2013 Dec;61(12):2214-2218
Dementia is a chronic disease that requires medical and social services to provide high-quality care and prevent complications. As a result of time constraints in practice, lack of systems-based approaches, and poor integration of community-based organizations (CBOs), the quality of care for dementia is poorer than that for other diseases that affect older persons. The University of California at Los Angeles (UCLA) Alzheimer’s and Dementia Care (UCLA ADC) program partners with CBOs to provide comprehensive, coordinated, patient-centered care for individuals with Alzheimer’s disease and other dementias. The goals of the program are to maximize function, independence, and dignity; minimize caregiver strain and burnout; and reduce unnecessary costs. The UCLA ADC program consists of five core components: recruitment and a dementia registry, structured needs assessments of individuals in the registry and their caregivers, creation and implementation of individualized dementia care plans based on needs assessments and input from the primary care physicians, monitoring and revising care plans as needed, and around-the-clock access for assistance and advice. The program uses a comanagement model with a nurse practitioner Dementia Care Manager working with primary care physicians and CBOs. Based on the first 150 individuals served, the most common recommendations in the initial care plans were referrals to support groups (73%) and Alzheimer’s Association Safe Return (73%), caregiver training (45%), and medication adjustment (41%). The program will be evaluated on its ability to achieve the triple aim of better care for individuals, better health for populations, and lower costs. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.
Variability between nursing homes in prevalence of antipsychotic use in patients with dementia.
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Kleijer BC, van Marum RJ, Frijters DH, Jansen PA, Ribbe MW, Egberts AC, et al.
International psychogeriatrics / IPA 2013 Nov 20:1-9
Antipsychotic drugs (APD) are widely prescribed for people with dementia residing in long term care facilities (LTCFs). Concern has been expressed that such prescribing is largely inappropriate. The objective of this study is to examine if differences in facility-level prevalence of APD use in a sample of LTCFs for patients with dementia can be explained by patient and facility-related characteristics. Methods: A point prevalence study was conducted using data from the VU University Resident Assessment Instrument (VURAI) database from nursing homes and residential care facilities in the Netherlands. Patients were selected who had a diagnosis of dementia. LTCF and patient characteristics were extracted from the VURAI; facility-level resident satisfaction surveys were provided by the National Institute for Public Health. Results: In total, 20 LTCFs providing care for 1,090 patients with dementia were investigated. Overall, 31% of patients used an APD. In facilities with a high prevalence of APD use behavioral symptoms were present in 62% of their patients. In facilities with medium APD use behavioral problems remained frequent (57%), and in facilities with low prevalence of APD use 54% of the patients had behavioral symptoms. Facilities with a high prevalence of APD use were often large, situated in urban communities, and scored below average on staffing, personal care, and recreational activities. Conclusions: There was considerable variation between the participating LTCFs in the prevalence of APD use. Variability was related to LTCF characteristics and patient satisfaction. This indicates potential inappropriate prescribing because of differences in institutional prescribing culture.
Parkinson Disease in Long Term Care Facilities: A Review of the Literature.
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Weerkamp NJ, Tissingh G, Poels PJ, Zuidema SU, Munneke M, Koopmans RT, et al.
Journal of the American Medical Directors Association 2013 Dec 3
Parkinson disease (PD) is common in long term care (LTC) facilities. The number of institutionalized patients with PD will rise sharply in the coming decades because of 2 concurrent phenomena: aging of the population leads to an increased PD prevalence and improved quality of care has led to a prolonged survival in advanced disease stages. Only a few studies have investigated the prevalence and clinical characteristics of patients with PD in LTC facilities. Even fewer studies have addressed the treatment strategies used to support these institutionalized patients, who are mostly in advanced stages of the disease. The available evidence suggests that current management of patients with PD in LTC facilities is less than optimal. In the Netherlands, and we suspect in many other countries, there are no formal guidelines for treating patients with PD who have been admitted to a LTC facility. In this review, we describe the epidemiology, clinical characteristics, and clinical management of patients with PD in LTC settings. We also address potentially modifiable elements of care and provide several recommendations to improve the management of PD in these facilities. We conclude by suggesting a possible guide for future research in this area. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.
Unmet Needs of Community-Residing Persons with Dementia and Their Informal Caregivers: Findings from the Maximizing Independence at Home Study
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Black BS, Johnston D, Rabins PV, Morrison A, Lyketsos C, Samus QM.
Journal of the American Geriatrics Society 2013;61(12):2087-2095
To determine the prevalence and correlates of unmet needs in a sample of community-residing persons with dementia (PWD) and their informal caregivers. Design Analysis of cross-sectional, baseline participant characteristics before randomization in a care coordination intervention trial. Setting Baltimore, Maryland. Participants Community-residing PWD (n = 254) and their informal caregivers (n = 246). Measurements In-home assessments of dementia-related needs based on the Johns Hopkins Dementia Care Needs Assessment. Bivariate and multivariate regression analyses were conducted to identify demographic, socioeconomic, clinical, functional, and quality-of-life correlates of unmet needs. Results The mean number of unmet needs was 7.7 ± 4.8 in PWD and 4.6 ± 2.3 in caregivers, with almost all PWD (99%) and caregivers (97%) having one or more unmet needs. Unmet needs in PWD were significantly greater in those with higher cognitive function. Ninety percent of PWD had unmet safety needs, more than half had unmet needs for meaningful activities, and almost one-third had not received a prior evaluation or diagnosis. Higher unmet needs in PWD was significantly associated with nonwhite race, lower income, less impairment in activities of daily living, and more symptoms of depression. For caregivers, more than 85% had unmet needs for resource referrals and caregiver education. Higher unmet caregiver needs was significantly associated with nonwhite race, less education, and more symptoms of depression. Conclusion Many community-residing PWD and their caregivers have unmet dementia-related needs for care, services, and support. Providers should be aware that unmet needs may be higher in minority and low-income community residents, caregivers with lower education, and individuals with early-stage dementia. Identifying and treating symptoms of depression in PWD and caregivers may enable them to address their other unmet needs.
The frailty phenotype and the frailty index: different instruments for different purposes.
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Cesari M, Gambassi G, van Kan GA, Vellas B.
Age and Ageing 2014 Jan;43(1):10-12
The integration of frailty measures in clinical practice is crucial for the development of interventions against disabling conditions in older persons. The frailty phenotype (proposed and validated by Fried and colleagues in the Cardiovascular Health Study) and the Frailty Index (proposed and validated by Rockwood and colleagues in the Canadian Study of Health and Aging) represent the most known operational definitions of frailty in older persons. Unfortunately, they are often wrongly considered as alternatives and/or substitutables. These two instruments are indeed very different and should rather be considered as complementary. In the present paper, we discuss about the designs and rationals of the two instruments, proposing the correct ways for having them implemented in the clinical setting.
Do people with dementia die at their preferred location of death? A systematic literature review and narrative synthesis.
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Badrakalimuthu V, Barclay S.
Age and Ageing 2014 Jan;43(1):13-19
Place of death is an important component of the quality of a person’s death. The aim of this study was to undertake a systematic review and narrative synthesis of the literature concerning place of death of people with dementia and the preferences for location of death of people with dementia as well as family carers and healthcare providers preferred location of death for patients with dementia. Methods and results: studies relying on death certificate data show that patients with dementia die more commonly in care homes than other locations contrasting with prospective studies which show that death is more common in own residence and hospital. Age (older), gender (male), availability of hospital and nursing home beds and enrolment in hospice, influence place of death. There is very limited evidence of patients, family carers and healthcare providers’ views on preferred location of death for patients with dementia and the only study included reported that, family carers views are more agreed to rather than patients own views regarding place of death. CONCLUSION: this study on place of death raises exploratory questions on end-of-life care for patients with dementia which has implications on health and social care policies related to dementia.
Health status of UK care home residents: a cohort study.
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Gordon AL, Franklin M, Bradshaw L, Logan P, Elliott R, Gladman JR.
Age and Ageing 2014 Jan;43(1):97-103
UK care home residents are often poorly served by existing healthcare arrangements. Published descriptions of residents’ health status have been limited by lack of detail and use of data derived from surveys drawn from social, rather than health, care records. AIM: to describe in detail the health status and healthcare resource use of UK care home residents Design and setting: a 180-day longitudinal cohort study of 227 residents across 11 UK care homes, 5 nursing and 6 residential, selected to be representative for nursing/residential status and dementia registration. Method: Barthel index (BI), Mini-mental state examination (MMSE), Neuropsychiatric index (NPI), Mini-nutritional index (MNA), EuroQoL-5D (EQ-5D), 12-item General Health Questionnaire (GHQ-12), diagnoses and medications were recorded at baseline and BI, NPI, GHQ-12 and EQ-5D at follow-up after 180 days. National Health Service (NHS) resource use data were collected from databases of local healthcare providers. RESULTS: out of a total of 323, 227 residents were recruited. The median BI was 9 (IQR: 2.5-15.5), MMSE 13 (4-22) and number of medications 8 (5.5-10.5). The mean number of diagnoses per resident was 6.2 (SD: 4). Thirty per cent were malnourished, 66% had evidence of behavioural disturbance. Residents had contact with the NHS on average once per month. CONCLUSION: residents from both residential and nursing settings are dependent, cognitively impaired, have mild frequent behavioural symptoms, multimorbidity, polypharmacy and frequently use NHS resources. Effective care for such a cohort requires broad expertise from multiple disciplines delivered in a co-ordinated and managed way.
Physical performance and quality of life of nursing-home residents with mild and moderate dementia.
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Telenius EW, Engedal K, Bergland A.
International journal of environmental research and public health 2013 Dec 2;10(12):6672-6686
The aims of this study were to describe the quality of life (QoL) of nursing-home residents with dementia and their balance, mobility, muscle strength and daily life activity, as well as to examine the associations between QoL and levels of balance, mobility, muscle strength and daily life activity. Methods: The study is cross sectional, and 170 nursing-home residents with dementia were included. Tests: “The quality of life in late-stage dementia scale” (QUALID), Berg Balance Scale, comfortable walking speed, maximum walking speed, 30-s sit-to-stand, Barthel Index, Clinical Dementia Rating Scale, the Clock Drawing Test and the Mini-Mental State Examination (MMSE) were used. Results: Our study showed that nursing-home residents with dementia are a heterogeneous group regarding registrations of QUALID and physical function measures. The scores on the QUALID ranged from 11 to 41 points. Higher scores on the 30-s sit-to-stand and Berg Balance Scale were associated with a better QUALID. For comfortable, as well as maximum, walking speed there was a trend towards better QUALID results for those participants with higher walking speed. Conclusions: Good muscle strength and balance were the most important physical performance variables significantly associated with a good QUALID score.
Health-related profile and quality of life among nursing home residents: does pain matter?
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Tse MM, Wan VT, Vong SK.
Pain management nursing 2013 Dec;14(4):e173-84
The purpose of this exploratory cross-sectional study was to explore the health-related profile and quality of life among older persons living with and without pain in nursing homes. Ten nursing homes were approached, and 535 older persons were invited to join the study from 2009 to 2011. The nursing home residents’ demographic information and information regarding their pain situation and the use of oral analgesic drug and nondrug therapy among the older residents with chronic pain were also collected. Residents’ physical health (using the Barthel Activities of Daily Living (ADL) and Elderly Mobility Scores); psychologic health, including happiness, life satisfaction, depression, and loneliness (using the Happiness Scale, the Life Satisfaction Scale, the Geriatric Depression Scale, and the UCLA Loneliness Scale); and quality of life were investigated. Among the 535 nursing home residents, 396 (74%) of them suffered from pain, with mean pain scores of 4.09 ± 2.19, indicating medium pain intensity a remaining 139 (26%) reported no pain. The location of pain was mainly in the knees, back and shoulders. Our results demonstrated that, with the exception of the no-pain group (p < .05), nursing home residents’ pain affected both their psychologic health, including happiness, life satisfaction, and depression, and their physical quality of life. Nevertheless, only one-half of the older persons with pain used oral analgesic drug or nondrug therapy to relieve their pain. Pain had a significant impact on their mobility and ADL, was positively correlated with happiness and life satisfaction, and was negatively correlated with loneliness and depression. Pain management is a high priority in elderly care; as such, innovative and interdisciplinary strategies are necessary to enhance quality of life particularly for older persons living in nursing homes. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
Pain management education in long-term care: it can make a difference.
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Pain management nursing 2013 Dec;14(4):220-227
Acute and chronic pain management for persons residing in long-term care settings is a serious problem. In an effort to change practice in pain management and improve resident outcomes, the Campaign Against Pain education program was instituted at Beatitudes Health Care Center in Phoenix, Arizona. In this pilot study, professional and certified nursing assistant (CNA) staff were surveyed before and after the training program to ascertain change in knowledge, attitudes, and barriers about pain. After the intensive training program and onsite consultation with the concomitant changes in policies, procedures, and documentation, professional and CNA staff knowledge improved after 6 months (F = 6.273; p = .02), attitudes changed (F = 12.26; p = .002), and barriers were mitigated. With a comprehensive quality improvement pain plan in place, the findings suggest that education in pain management in long-term care and program changes that adopt best practices in pain can make a difference. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
Empowering certified nurse’s aides to improve quality of work life through a team communication program.
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Geriatric nursing (New York, N.Y.) 2013 Nov 19
The purpose of this pilot study was to explore the impact of a certified nurse’s aide (CNA)-led interdisciplinary teamwork and communication intervention on perceived quality of work environment and six-month job intentions. CNAs are frequently excluded from team communication and decision-making, which often leads to job dissatisfaction with high levels of staff turnover. Using a mixed quantitative and qualitative approach with pre- post-program design, the intervention utilized the strategy of debriefing from the national patient safety initiative, TeamSTEPPS. Inherent in the program design, entitled Long Term Care (LTC) Team Talk, was the involvement of the CNAs in the development of the intervention as an empowering process on two wings of a transitional care unit in a long-term care facility in upstate NY. CNAs’ perceptions of work environment quality were measured using a Quality of Work Life (QWL) instrument. Additionally, job turnover intent within six months was assessed. Results indicated improved scores on nearly all QWL subscales anticipated to be impacted, and enhanced perceived empowerment of the CNAs on each wing albeit through somewhat different experiential processes. The program is highly portable and can potentially be implemented in a variety of long-term care settings. Copyright © 2013 Mosby, Inc. All rights reserved.
Thriving in long-term care facilities: instrument development, correspondence between proxy and residents’ self-ratings and internal consistency in the Norwegian version.
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Bergland A, Kirkevold M, Sandman PO, Hofoss D, Vassbo T, Edvardsson D.
Journal of advanced nursing 2013 Dec 8
To develop an instrument for measuring thriving among residents in long-term care facilities, to assess the correspondence between proxy ratings and self-report and the internal consistency of the Norwegian version. BACKGROUND: The instrument was developed from the life-world concept of thriving and thereby has a different theoretical basis than existing ‘dementia related’ quality-of-life instruments. Thriving relates the experience of older persons to the place where they live. Proxy instruments need to be developed for residents in long-term care facilities who are not able to report their subjective experiences. DESIGN: Instrument development using cross-sectional survey design. METHODS: The instrument was developed in three versions (resident, family and staff) from a theory on thriving. Forty-eight triads consisting of a resident, family member and primary nurse from 12 Norwegian nursing homes participated. Data collection took place between March-December 2011. Inter-rater agreement between the groups was assessed by Cohen’s kappa coefficient (weighted). Internal consistency was evaluated by Cronbach’s alpha. Homogeneity was explored through item-total correlations. RESULTS: Agreement between residents, family members and staff was poor or fair (<0·41) in six of 38 items. These items were excluded. The 32-items instrument had satisfactory Cronbach’s alpha values in each of the three samples and satisfactory homogeneity as item-total correlations was substantial without being excessive and thus indicated that items were measuring the same construct. CONCLUSION: The instrument appears to have internal consistency and enable reliable proxy measures of the thriving construct. Further psychometric assessment including checking for possible item redundancy is needed. © 2013 John Wiley & Sons Ltd.
The Costs of Dementia From the Societal Perspective: Is Care Provided in the Community Really Cheaper than Nursing Home Care?
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Konig HH, Leicht H, Brettschneider C, Bachmann C, Bickel H, Fuchs A, et al.
Journal of the American Medical Directors Association 2013 Dec 6
To compare the costs of care for community-dwelling dementia patients with the costs of care for dementia patients living in nursing homes from the societal perspective. DESIGN: Cross-sectional bottom-up cost of illness study nested within the multicenter German AgeCoDe-cohort. SETTING: Community and nursing homes. PARTICIPANTS: One hundred twenty-eight community-dwelling dementia patients and 48 dementia patients living in nursing homes. INTERVENTION: None. MEASUREMENTS: Utilization and costs of medical care and long term care, including formal and informal social and nursing care based on proxy interviews. Informal care was valued using the replacement cost method. RESULTS: Unadjusted mean annual total costs including informal care were €29,930 ($43,997) for community-dwelling patients and €33,482 ($49,218) for patients living in nursing homes. However, multiple regression analysis controlling for age, sex, deficits in basic and instrumental activities of daily living and comorbidity showed that living in the community significantly increased total costs by €11,344 ($16,676; P < .01) compared with living in a nursing home, mainly due to higher costs of informal care (+€20,585; +$30,260; P < .001). CONCLUSION: From the societal perspective care for dementia patients living in the community tends to cost more than care in nursing homes when functional impairment is controlled for. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.
Feasibility and Acceptability of a Delirium Prevention Program for Cognitively Impaired Long Term Care Residents: A Participatory Approach
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Voyer P, McCusker J, Cole MG, Monette J, Champoux N, Vu M, et al.
Journal of the American Medical Directors Association 2013 Oct 2
In this participatory action research study, researchers conducted a total of 3 implementation cycles to evaluate the feasibility and acceptability of a new delirium prevention program (DPP) for cognitively impaired residents in long term care (LTC) settings. Researchers interviewed 95 health care staff to obtain feedback on their use of the DPP and then modified the DPP and tested the changes in the next implementation cycle. Our results indicated that the DPP was feasible and that health care staff would accept it under certain conditions. We found there were 4 keys to successful implementation of the DPP: support for the program from both the administration and the users; effective clinician leadership to ensure proper delivery of the DPP (format, content and values) and its appropriate adaptation to the LTC facility’s internal culture and policies; a sense of ownership among the DPP users; and, last, practical hands-on training as well as theoretical training for staff. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.
Needs of People With Dementia in Long-Term Care A Systematic Review
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Cadieux MA, Garcia LJ, Patrick J.
American Journal of Alzheimer’s Disease and Other Dementias 2013 Sep 4
With the aging of the population and the projected increase of dementia in the coming years, it is crucial that we understand the needs of people with dementia (PWD) in order to provide appropriate care. The aim of this study is to determine, using the best evidence possible, the care needs of PWD living in long-term care (LTC). A total of 68 studies, published between January 2000 and September 2010, were identified from six databases. From the selected studies, 19 needs of PWD were identified. The existing evidence suggests that psychosocial needs such as the need to engage in daily individualized activities and care must not be ignored in LTC. This review aims to provide a clearer picture of the needs of this growing patient population.
A new report by the Health Council of Canada says that governments must make a greater effort to collaborate to improve health care for First Nations, Inuit, and Métis seniors. The report, Canada’s most vulnerable: Improving health care for First Nations, Inuit, and Métis seniors, shows they often do not receive the same level of health care as non-Aboriginal Canadians because of poor communication, collaboration, and disputes between governments about who is responsible for the care of Aboriginal people.
OECD countries account for nearly half the global cases of dementia today and have a particular responsibility in addressing this challenge. Our hope is that international dialogue will help mobilise knowledge that will benefit millions of people globally. We look forward to working with international leaders, the research community and business, so that in the future Alzheimer and other dementias are no longer a disease we need to fear.
This is a policy brief for heads of government, updating ADI’s prevalence figures published in the World Alzheimer Report 2009. The new estimates are an increase of 17% on the figures published in 2009, with data showing that the number of people with dementia will increase from 115 to 135 million by 2050. The report also predicts a shift in the distribution of the global burden of dementia. By 2050, 71% of all people with dementia will live in low or middle income countries. The briefing has been released ahead of the first G8 Dementia Summit, which will take place in London, UK, on 11 December 2013. The update focused on the new evidence emerging from China and the sub-Saharan African region, applying the new prevalence rates to the latest (2012) UN population projections.
Alberta Centre on Aging Nibble, Nosh & Network 2014
Friday 17 January 2014 13:30-16:00-Lister Centre
Our poster presentations enable researchers to present results, significant work in progress, or recent work that is best communicated in coversation. Poster presentations allow attento exchange ideas one-on-one with authors and others interested in the topic. Meet faculty, students and research staff to identify others with similar interests for possible collaboration.
Alberta Association on Gerontology (Edmonton Chapter) and the Alberta Gerontological Nurses Association (Edmonton Chapter) Annual Networking Dinner
Thursday 23 January 2014 17:15 MT Faculty Club, University of Alberta—Windsor Room
Register before 17 January 2014
Guest Speaker The Honourable Fred Horne, Minister of Health “Preparing for the Future Service Needs of Seniors— A Plan for Action”
CFHI: Improving Care – Avoiding Hospitalization for Long-Term Care Residents
29 January 2014 10:00-11:00 MT
Join CFHI and guest speakers Marilyn El Bestawi, senior healthcare executive and Dr. Joy Richards, Vice President Health Professions and Chief Nursing Executive at University Health Network, for this session of On Call, where participants will hear about and discuss:
-how to reduce preventable ED visits from long-term care
-why this initiative was important to the University Health Network (UHN)
-factors that have promoted successful implementation and sustainability of the PREVIEWED-ED™ model within a major health sciences centre
-how this initiative is being spread at the organizational and provincial levels
Assessing the Quality and Applicability of Systematic Reviews (AQASR)
Starting 8 January 2014
SEDL’s Center on KTDRR is sponsoring a realtime online workshop to make disability and rehabilitation practitioners and researchers familiar with AQASR, an instrument to help assess systematic reviews and consider their relevance for use. The workshop will consist of seven sessions, to be conducted by Dr. Marcel Dijkers, and tentatively scheduled to begin January 8, 2014. In each 60-90 minute session, a small group of participants together with the instructor will review and discuss the checklist and apply it to a few systematic reviews chosen by the group. Practice assignments will make it possible for participants to have a hands-on experience to apply what they are learning.
CDRAKE All About Me: Person-Centred Care
6 March 2014 10:00-11:00
Christene Gordon will be addressing person-centred care in reference to All about Me, a booklet about a person living with Alzheimer’s disease or other dementias.
KT Canada: The potential of knowledge translation tools to improve chronic disease management: An interrupted time series analysis of an osteoporosis tool in primary care
Thursday 9 January 2013 10:00-11:00 with Monika Kastner
-To understand how the complete knowledge-to-action cycle can be applied in the development and evaluation of a KT tool
-To understand how to conduct an interrupted time series study across multiple settings
-To highlight the potential of chronic disease management tools in primary care
CFHI: Patient and Family Engagement Series
Begins 14 January 2014
CFHI’s On Call: Patient and Family Engagement Series is an interactive four-part webinar series, dedicated to supporting organizations in advancing the practice of patient- and family-centred care to improve quality. The series will cover:
-Jan. 14, 2014: What is patient and family engagement and why do it?
-Feb. 20, 2014: How do we plan for meaningful, effective, and appropriate patient and family engagement?
-Apr. 15, 2014: Who needs to be engaged? The staff, patient/family and leadership trilogy
-May 2014: How do you measure patient engagement and capture its impact?
IHI: Taking a Fresh Look at Getting Results at Scale
Begins 13 February 2014 Fee $595
Over the course of four virtual sessions, you will have a unique opportunity learn from leaders of large-scale spread efforts as they share the stories of their successes and how they overcame barriers. This program will use these case examples to bring concepts to life and provide step-by-step guidance on how to successfully spread and scale-up your improvement activities. Our expert faculty will provide you with:
-Cutting-edge theory and practice about moving improvements from pilot areas to entire organizations, systems, regions, or countries
-The tools and tactics that contribute to successful spread efforts
-Proven methods for how to implement projects so that they are scalable beyond a pilot area
-Ways to identify and address infrastructure issues that enable large-scale adoption of improvements
-Case examples that illustrate the relationship between pilot projects and successful large-scale implementation of improvements
-Guidance on the day-to-day management of large-scale spread efforts
The framework aligns priorities at the system level with those at the hospital level and is consistent with the recently developed Health System Performance Measurement Framework. The new framework represents the hospital production process—that is, the inputs of hospital production as well as the outputs and outcomes they are intended to produce—within the health system and wider demographic, economic and political contexts. Feedback on the framework is required by December 23, 2013, via email to email@example.com.
The Nova Scotia Health Research Foundation (NSHRF) is pleased to announce that Krista Connell, NSHRF CEO, was revealed as a recipient of the Women’s Executive Network’s (WXN) 2013 Canada’s Most Powerful Women: Top 100 Awards. Co-Presented by Scotiabank and KPMG, these Awards celebrate and highlight the professional achievements of women across the country in the private, public and not-for-profit sectors at a time when corporate Canada is under growing pressure to promote more female leaders into senior management and corporate director roles.
Assurance autonomie will not be introduced in Quebec before April 2015, Health Minister Réjean Hébert admits.
Randy Schekman says his lab will no longer send papers to Nature, Cell and Science as they distort scientific process.
The Care Quality Commission (CQC) has today revealed plans for unannounced, focused and detailed inspections of 150 care homes and acute hospitals, in order to lay out a positive working blueprint for dementia care.
Ontario has not met its goal of having the right number, mix and distribution of health-care professionals to meet its needs, Auditor General Bonnie Lysyk said in her 2013 annual report released this week.
Canada was a signatory to a 12-point Declaration coming out of the G8 Dementia Summit held in London Wednesday. It includes a call for greater innovation to improve the quality of life for people with dementia and their caregivers while reducing emotional and financial burden.
Sullivan said the program will start as a pilot project in the spring of 2014, with 250 places, some earmarked for seniors, and others for those caring for people with disabilities. “We’ll take them on a first come, first served basis and then we’ll establish a waitlist after that,” said Sullivan.
The new data policy will be launched in March 2014. They now welcome input from the larger community of authors, researchers, patients, and others, and invite comments before March.
The Alzheimer Society of Canada (ASC) has been working with the help of many partners to better understand how a person centred approach to care can be experienced in long term care (LTC) homes by people living with dementia and their families. This work has included visiting LTC homes across Canada to learn about the key elements that can make a person centred approach a reality. In February, we will be releasing practical information sheets on each of these key elements in both English and French along with the full reports from each of the homes that kindly agreed to share their work with us. All this information will be available from the link above.
Just before the Quebec National Assembly adjourned for the holidays, Health Minister Réjean Hébert tabled Bill 67, the proposed “autonomy insurance” law. On the surface, the legislation would provide an additional $100-million a year for home care and home support services for seniors. Given that Quebec already spends $4.3-billion annually on long-term care for seniors, the new monies are modest, not nearly enough to keep pace with burgeoning demand.
From Britain’s Health Foundation, this resource centre website is designed to help UK healthcare professionals implement a more patient-focused healthcare service. The site has two priority areas, patient safety and person-centred care, and features links to many studies, reports and policy tools.
This library brings together metadata for health indicators in one convenient location on CIHI’s website. For each indicator, definitions, methodology and characteristics such as reporting level are summarized in one standard template. Indicator results can also be accessed from hyperlinks provided in the library. Currently, the library includes information on 60 indicators; additional indicators will be regularly included over the next two years.
The University of Alberta expresses its strong support for the draft Tri-Agency Open Access Policy.
The Panel on Research Ethics has produced new materials to facilitate the consultation process for proposed changes to the 2nd edition of the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS 2): – an additional set of proposed changes to TCPS 2 Article 3.7 – a new webinar for consultation participants. Written comments on the proposed changes will continue to be accepted until January 15, 2014.
Senior Health Research Evaluator
AIHS Edmonton, AB
Position open until suitable candidate is found
This position is responsible for applying research and evaluation methodology in the assessment of health research and innovation programs and corporate services. Reporting to the Director, Performance Management & Evaluation, you will support the planning, design, data collection, analysis and reporting of AIHS programs and services.
School of Public Health, University of Alberta
DEADLINE 31 January 2014
The Knowledge Broker will support the research and knowledge translation activities of PRISM (Promoting Rare-disease Innovations through Sustainable Mechanisms). PRISM is a CIHR-funded research team focussed on developing effective policies for managing technologies for rare diseases. PRISM’s research and knowledge translation (KT) program covers a number of content domains and a knowledge integration hub, and involves researchers from 8 universities in Canada, US and Europe.
Neurobiology of Aging is seeking an Editor-in-Chief
DEADLINE: 31 January 2014
Neurobiology of Aging, published by Elsevier, is a leading journal in the fields of neurology and gerontology. Published monthly, the journal seeks to provide the most exciting new content to an international audience of researchers and clinicians. Neurobiology of Aging has an Impact Factor of 6.166.