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Abstracts
New Report by Drs. Jennifer Baumbusch and Margaret McGregor
A Systematic Review of Research Evidence on: (a) 24-hour Registered Nurse Availability in Long-term Care, and (b) the Relationship between Nurse Staffing and Quality in Long-term Care 
Bryan S, Murphy JM, Doyle-Waters MM, Kuramoto L, Ayas N, Baumbusch J, Balka E, Mitton C, Gray J, Harrington C, Globerman J, McGregor MJ
Staff in LTC facilities include licensed nursing staff: registered nurses (RNs) registered psychiatric nurses (RPNs), and licensed practical nurses (LPNs), as well as unregulated nurse/care aides. RN/RPNs and LPNs are trained to assess residents and provide nursing care to promote health and prevent illness. The work presented in this report includes:
-a review of existing nurse staffing regulations relating to 24-hour nurse staffing in LTC facilities
-literature review relating to the 24-hour RN cover question
-the review of broader nurse staffing literature
Article recommended by Dr. Carole Estabrooks:
When do people with dementia die peacefully? An analysis of data collected prospectively in long-term care settings.
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De Roo ML, van der Steen JT, Galindo Garre F, Van Den Noortgate N, Onwuteaka-Philipsen BD, Deliens L, et al.
Palliative medicine 2013 Nov 29
Little is known about dying peacefully with dementia in long-term care facilities. Dying peacefully may be influenced by characteristics of the palliative care provided and characteristics of the long-term care setting. If so, dying peacefully may serve as a quality indicator for palliative care in dementia. Aim:This study aims to describe whether residents with dementia in Dutch long-term care facilities die peacefully and to assess which characteristics of the resident, the palliative care provided and the facilities are associated with dying peacefully.Design and Setting:We analysed existing data from the Dutch End of Life in Dementia study, collected between January 2007 and July 2010 in 34 long-term care facilities in the Netherlands. We used descriptive statistics and Generalised Estimating Equation models.Results:The sample consisted of 233 residents with dementia. Family members indicated that the resident died peacefully in 56% of cases. This percentage ranged from 17% to 80% across facilities. Residents were more likely to die peacefully if they had an optimistic attitude, if family found that there were enough nurses available and if residents died in facilities with a moderate (versus no) perceived influence of religious affiliation on end-of-life decision-making policies.Conclusions:Only half of the residents with dementia in Dutch long-term care facilities die peacefully, as perceived by relatives. In addition to residents’ optimistic attitude, facility characteristics are associated with dying peacefully, which suggests that ‘the percentage of relatives who indicate that the patient died peacefully’ can function as a quality indicator.
CALL FOR PAPERS: QHR Special Issue: Knowledge Translation
DEADLINE 1 June
Manuscripts are invited that explore any aspect of knowledge translation. Topics include but are not limited to: the use of qualitative methods in translating ideas from research into new approaches, interventions, programs, or other types of innovations; qualitative studies that explore how evidence-based practices develop and are taken up in health care settings, as well as problems encountered; qualitative studies that provide rich descriptions of perceptions, interactions, and social processes that influence knowledge translation in health care and health promotion from the perspective of health care providers as well as patients and families; and methodological issues and developments to advance the use of qualitative research methods in the field of knowledge translation and evidence-based practice.
CALL FOR ABSTRACTS: GSA 2014 Annual Scientific Meeting
5-9 November Washington DC
DEADLINE 5 March
The 2014 conference theme challenges researchers to present their best evidence on aging-related connections they investigate, ranging from the smallest particles examined in the lab to the most macro-level issues examined globally. It challenges educators to evaluate the ties they establish with students and community groups and the links they develop between aging-related research findings and effective pedagogy. It challenges practitioners and advocates to translate science into best practices for aging adults, their networks, and communities.
CALL FOR POSTERS & WORKSHOPS: TQ2U Australia Thinking Qualitatively Workshop Series
Various Australian Cities May 2014
TQ2U: Australia will allows participants to submit abstracts and present their posters at a world renowned workshop series to an international audience. This event will also allow participants to engage with experts in qualitative inquiry and learn about specific methods, techniques and approaches to qualitative research.
Grants & Awards
CAHSPR: Student Registration Waivers and Travel Bursaries
DEADLINE 14 March
In the interests of supporting students who might not be able to attend the 2014 CAHSPR Conference, CAHSPR is again this year offering registration waivers and travel bursaries for selected students. Available financial support from CAHSPR will be allocated on the basis of ranking in the abstract peer review process and on the basis of financial need.
CIHR: 2014 Summer Program in Aging (SPA) Training Program
DEADLINE 17 February
For 2014, the CIHR Institutes of Aging (IA), Gender and Health (IGH) and Musculoskeletal Health and Arthritis (IMHA) have partnered with the Institute for Work and Health to host this event. The Summer Program in Aging (SPA) 2014 partners have identified “Work and Health: The Aging Perspective” as the key theme for this year’s SPA Training Program. You need to apply separately for the CIHR-IA SPA 2014 Travel Grant.
Oxford Evidence-Based Healthcare MSc Fellowships
As part of the Oxford AHSN’s Continuous Learning programme an Evidence-Based Healthcare MSc (EBHC MSc) Fellows programme has been established, in conjunction with The Centre for Evidence-Based Medicine (CEBM), and the Department of Continuing Education, University of Oxford. The Fellowships, funded through Health Education Thames Valley, are open to all doctors, nurses & midwives, allied health professionals, pharmacists and healthcare scientists working in the Oxford AHSN geography (Bedfordshire, Berkshire, Buckinghamshire and Oxfordshire). The funding for the EBHC MSc Course, covering the full three years
Publications
KT
Health Care Administration and Organization
Health Care Innovation and Quality Assurance
Organizational Change
Research Practice & Methodology
Healthcare in Canada
Aging
KT
Four factor Research Awareness Scale for Nurses in Japanese: Instrument development study.
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Watanabe Y, Oe M, Takemura Y, Sasaki M, Onishi M, Kanda K, et al.
Japan journal of nursing science 2013 Dec;10(2):232-241
Research awareness is an important consideration necessary for providing superior nursing care. However, a gap exists between research and clinical practice. A major obstacle to integrating research into clinical practice is the absence of research awareness among nurses. Studies on research awareness have focused primarily on three factors: attitude, competence, and encouragement for conducting research. The Research Awareness Scale for Nurses (RASN) in Japanese incorporates a critical, yet generally overlooked fourth factor of flexible structure for research. The aim of this study was to develop a nursing research awareness scale that could be used to determine the reasons for the lack of interest in research among nurses and to help nursing administrators take steps to integrate research into clinical practice. METHODS: The RASN was developed and tested in three stages. An item pool for the scale was generated from a published work review and focus group interviews. The scale was then tested in a pilot study, and finally in a main study. Reliability and validity were examined by exploratory and confirmatory factor analysis, Cronbach’s alpha, one-way anova and correlation analysis. RESULTS: The RASN exhibited good validity in the four factor structure (“attitude”, “competence”, “encouragement”, and “flexible structure”). Cronbach’s alpha exhibited good internal consistency. The RASN was significantly and positively correlated with research-related education and activities.
Knowledge transfer on complex social interventions in public health: a scoping study.
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Dagenais C, Malo M, Robert E, Ouimet M, Berthelette D, Ridde V.
PloS one 2013 Dec 4;8(12):e80233
Scientific knowledge can help develop interventions that improve public health. The objectives of this review are (1) to describe the status of research on knowledge transfer strategies in the field of complex social interventions in public health and (2) to identify priorities for future research in this field. METHOD: A scoping study is an exploratory study. After searching databases of bibliographic references and specialized periodicals, we summarized the relevant studies using a predetermined assessment framework. In-depth analysis focused on the following items: types of knowledge transfer strategies, fields of public health, types of publics, types of utilization, and types of research specifications. RESULTS: From the 1,374 references identified, we selected 26 studies. The strategies targeted mostly administrators of organizations and practitioners. The articles generally dealt with instrumental utilization and most often used qualitative methods. In general, the bias risk for the studies is high. CONCLUSION: Researchers need to consider the methodological challenges in this field of research in order to improve assessment of more complex knowledge transfer strategies (when they exist), not just diffusion/dissemination strategies and conceptual and persuasive utilization.
Patient-specific computer-based decision support in primary healthcare–a randomized trial
Kortteisto T, Raitanen J, Komulainen J, Kunnamo I, Makela M, Rissanen P, et al.
Implementation Science 2014;9(1):15
In Finland, we designed a trial where a set of evidence-based, patient-specific reminders was introduced into the local Electronic Patient Record (EPR) system. The aim was to measure the effects of such reminders on patient care. The hypothesis was that the total number of triggered reminders would decrease in the intervention group compared with the control group, indicating an improvement in patient care. Methods From July 2009 to October 2010 all the patients of one health center were randomized to an intervention or a control group. The intervention consisted of patient-specific reminders concerning 59 different health conditions triggered when the healthcare professional (HCP) opened and used the EPR. In the intervention group, the triggered reminders were shown to the HCP; in the control group, the triggered reminders were not shown. The primary outcome measure was the change in the number of reminders triggered over 12 months. We developed a unique data gathering method, the Repeated Study Virtual Health Check (RSVHC), and used Generalized Estimation Equations (GEE) for analysing the incidence rate ratio, which is a measure of the relative difference in percentage change in the numbers of reminders triggered in the intervention group and the control group. Results In total, 13,588 participants were randomized and included. Contrary to our expectation, the total number of reminders triggered increased in both the intervention and the control groups. The primary outcome measure did not show a significant difference between the groups. However, with the inclusion of patients followed up over only six months, the total number of reminders increased significantly less in the intervention group than in the control group when the confounding factors (age, gender, number of diagnoses and medications) were controlled for. Conclusions Computerized, tailored reminders in primary care did not decrease during the 12 months of follow-up time after the introduction of a patient-specific decision support system. Trial registration: ClinicalTrial.gov NCT00915304
Aspects of nursing with evidence-base when nursing frail older adults: a phenomenographic analysis of interviews with nurses in municipal care.
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Gustafsson LK, Mattsson K, Dubbelman K, Snoljung A.
Scandinavian journal of caring sciences 2014 Jan 17
In earlier research as well as in political discussion and documents, the topic of evidence has been highlighted as one of the most important concerns in nursing care. This study focuses on understanding what lies behind nurses’ ways of acting regarding evidence-based nursing through an illumination of the way they perceive the phenomena. AIM: The aim was to identify and describe the different ways municipal care nurses perceive aspects of working with evidence when nursing frail older adults. METHODS: An explorative design with a phenomenographic approach based on interviews with nurses working with home-based care within the municipality was used in order to gain understanding of nurse’s perceptions of the phenomena. RESULTS: Findings revealed that the nurses perceived a variety of aspects when working with evidence when nursing frail older people. Aspects with a spectra of different perceptions shown in the analysis were as follows: Evidence-based nursing as a desired intention/mission, lack of practical supporting structures to apply evidence, lack of confidence in own capacity to apply evidence and a belief that it will work anyway. CONCLUSIONS: Findings reveal that it is a challenge to implement research both on an individual as well as on an organisational level. Understanding the contextual perceptions of evidence by nurses can cast light on the barriers as well as the prerequisites of working with evidence while caring for frail older adults in municipal care. © 2014 Nordic College of Caring Science.
Research utilization and evidence-based practice among Saskatchewan massage therapists.
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Gowan-Moody DM, Leis AM, Abonyi S, Epstein M, Premkumar K.
Journal of complementary & integrative medicine 2013 Jul 3;10:10.1515/jcim-2012-0044
While massage therapy (MT) is an increasingly used health care service with a growing evidence base, there is insufficient information about the extent to which MT practice is evidence-based. The purpose of this study was to provide a comprehensive view of Saskatchewan MT’s research utilization to inform the development of evidence-based massage therapy practice. The main objectives of the study were to describe MT’s perceptions of research, their appraised self-efficacy in research literacy and to identify the characteristic of practitioners who use research. Using a survey design all 815 registered members of the Massage Therapist Association of Saskatchewan were invited to complete a mail-out questionnaire. A total of 333 questionnaires were completed and returned for a 41% response rate. Univariate and logistic regression analysis was conducted using SPSS 17.0. While overall perceptions of research were positive, self-efficacy in research literacy was low and research utilization was limited. Characteristics associated with research use included referring to online research databases and peer-reviewed journals, belief that practice should be based on research, and 20 or greater hours per week of practice. Provincial regulatory status may be the first step to quality service delivery and research literacy training and support is needed for practitioners.
Analysis and implementation of a World Health Organization health report: methodological concepts and strategies.
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von Groote PM, Giustini A, Bickenbach JE.
American Journal of Physical Medicine & Rehabilitation 2014 Jan;93(1 Suppl 1):S12-26
A long-standing scientific discourse on the use of health research evidence to inform policy has come to produce multiple implementation theories, frameworks, models, and strategies. It is from this extensive body of research that the authors extract and present essential components of an implementation process in the health domain, gaining valuable guidance on how to successfully meet the challenges of implementation. Furthermore, this article describes how implementation content can be analyzed and reorganized, with a special focus on implementation at different policy, systems and services, and individual levels using existing frameworks and tools. In doing so, the authors aim to contribute to the establishment and testing of an implementation framework for reports such as the World Health Organization World Report on Disability, the World Health Organization International Perspectives on Spinal Cord Injury, and other health policy reports or technical health guidelines.
Primary health care staff’s opinions about changing routines in practice: a cross-sectional study
Carlfjord S, Festin K.
BMC Family Practice 2014;15(1):2
Efforts are made to translate new knowledge and evidence-based practices into routine care, but there are a number of obstacles to this translation process. Factors related to the new practice as well as factors related to the implementation process are important, but there is still a knowledge gap regarding how to achieve effective implementation. The aim of the present study was to assess opinions about practice change among staff in primary health care (PHC), focusing on factors related to a new practice and factors related to the implementation process. Four factors regarding the characteristics of the new practice were identified. Most important was Objective characteristics, followed by Evidence base, Subjectively judged characteristics and Organizational level characteristics. Two factors were identified regarding the implementation process: Bottom-up strategies were judged most important and Top-down strategies less important. The most important single items regarding characteristics were “easy to use” and “respects patient privacy”, and the most important implementation process item was “information about the new practice”. Nurses differed most from the other professionals, and judged the factors Evidence base and Organizational level characteristics more important than the others. Staff with more than 10 years experience in their profession judged the Evidence base factor more important than those who were less experienced.
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Health Care Administration and Organization
Developing the green house nursing care team: variations on development and implementation.
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Bowers BJ, Nolet K.
The Gerontologist 2014 Feb;54 Suppl 1:S53-64
A core component of the Green House nursing home model is an altered supervisory relationship between the nurse and direct care workers. Some have expressed concern that the Green House model might weaken professional nursing oversight, threatening the quality of clinical care. This qualitative research study explores the role of the nurse as implemented in the Green House model, focusing on how variations in the nursing team influence clinical care practices. DESIGN AND METHODS: Dimensional analysis, a “second generation” grounded theory methodology, was used to conduct this study. Data were collected through observations and interviews with 37 nurses, 68 CNAs, and 11 Guides working at 11 Green House sites. RESULTS: Implementation of the nursing role within the Green House model varied both within and across sites. Four nursing model types were identified: Traditional, Visitor, Parallel, and Integrated. Care processes, CNA/Shahbaz skill development, and worker stress varied with each nursing model. IMPLICATIONS: Government policies have been enacted to support culture change. However, there is currently little guidance for regulators, providers, or consumers regarding variability in how culture change practices are implemented and consequences of these variations. This article outlines the importance of understanding these practices at a level of detail that distinguishes and supports those that are most promising.
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Health Care Innovation and Quality Assurance
Scaling up family medicine training in Gezira, Sudan – a 2-year in-service master programme using modern information and communication technology: a survey study.
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Mohamed KG, Hunskaar S, Abdelrahman SH, Malik EM.
Human resources for health 2014 Jan 21;12(1):3
In 2010 the Gezira Family Medicine Project (GFMP) was initiated in Gezira state, Sudan, designed as an in-service training model. The project is a collaboration project between the University of Gezira, which aims to provide a 2-year master’s programme in family medicine for practicing doctors, and the Ministry of Health, which facilitates service provision and funds the training programme. This paper presents the programme, the teaching environment, and the first batch of candidates enrolled. METHODS: In this study a self-administered questionnaire was used to collect baseline data at the start of the project from doctors who joined the programme. A checklist was also used to assess the health centres where they work. A total of 188 out of 207 doctors responded (91%), while data were gathered from all 158 health centres (100%) staffed by the programme candidates. RESULTS: The Gezira model of in-service family medicine training has succeeded in recruiting 207 candidates in its first batch, providing health services in 158 centres, of which 84 had never been served by a doctor before. The curriculum is community oriented. The mean age of doctors was 32.5 years, 57% were males, and 32% were graduates from the University of Gezira. Respondents stated high confidence in practicing some skills such as asthma management and post-abortion uterine evacuation. They were least confident in other skills such as managing depression or inserting an intrauterine device. The majority of health centres was poorly equipped for management of noncommunicable diseases, as only 10% had an electrocardiography machine (ECG), 5% had spirometer, and 1% had a defibrillator. CONCLUSIONS: The Gezira model has responded to local health system needs. Use of modern information and communication technology is used to facilitate both health service provision and training. The GFMP represents an example of a large-volume scaling-up programme of family medicine in Africa.
Effects of an advanced nursing assistant education program on job satisfaction, turnover rate, assistant education program on and clinical outcomes.
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Brown M, Redfern RE, Bressler K, Swicegood TM, Molnar M.
Journal of gerontological nursing 2013 Oct;39(10):34-43
Certified nursing assistants (CNAs) have become an integral part of the health care system, spend the most amount of time with residents, and yet have the least amount of training. Recent reports demonstrate that CNAs believe their salary is not commensurate with their workload, and turnover rates in this field have indicated low job satisfaction. In light of these issues, we developed an advanced training program for CNAs in our institution to determine whether investing in our employees would increase job satisfaction and therefore impact turnover rates and clinical outcomes. Although overall job satisfaction improved slightly during the study period, satisfaction with training offered was the only area significantly affected by the intervention; however, significant decreases in turnover rates were observed between the pre- and postintervention periods. Clinical indicators were slightly improved, and the number of resident urinary tract infections decreased significantly. Offering an advanced training program for CNAs may be an effective way to improve morale, turnover rates, and clinical outcomes.
Copyright 2013, SLACK Incorporated.
The effect of a national quality improvement collaborative on prehospital care for acute myocardial infarction and stroke in England.
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Siriwardena AN, Shaw D, Essam N, Togher FJ, Davy Z, Spaight A, et al.
Implementation science 2014 Jan 23;9(1):17
We used an interrupted time series design to investigate the effect of a national QIC on change in delivery of care bundles for AMI (aspirin, glyceryl trinitrate [GTN], pain assessment and analgesia) and stroke (face-arm-speech test, blood pressure and blood glucose recording) in all English ambulance services between January 2010 and February 2012. Key strategies for change included local quality improvement (QI) teams in each ambulance service supported by a national coordinating expert group that conducted workshops educating staff in QI methods to improve AMI and stroke care. Expertise and ideas were shared between QI teams who met together at three national workshops, between QI leads through monthly teleconferences, and between the expert group and participants. Feedback was provided to services using annotated control charts. RESULTS: We analyzed change over time using logistic regression with three predictor variables: time, gender, and age. There were statistically significant improvements in care bundles in nine (of 12) participating trusts for AMI (OR 1.04, 95% CI 1.04, 1.04), nine for stroke (OR 1.06, 95% CI 1.05, 1.07), 11 for either AMI or stroke, and seven for both conditions. Overall care bundle performance for AMI increased in England from 43 to 79% and for stroke from 83 to 96%. Successful services all introduced provider prompts and individualized or team feedback. Other determinants of success included engagement with front-line clinicians, feedback using annotated control charts, expert support, and shared learning between participants and organizations.
A comparison of home care quality indicator rates in two Canadian provinces
Mofina A, Guthrie D.
BMC Health Services Research 2014;14(1):37
A cross-sectional analysis of assessments completed for older (age 65+) home care clients in both Ontario (n = 102,504) and the Winnipeg Regional Health Authority (n = 9,250) of Manitoba, using the Resident Assessment Instrument for Home Care (RAI-HC). This assessment has been mandated for use in these two regions and the indicators are generated directly from items within the assessment. The indicators are expressed as rates of negative outcomes (e.g., falls, dehydration). Client-level risk adjustment of the indicator rates was used to enable fair comparisons between the regions. Results Clients had a mean age of 83.2 years, the majority were female (68.6%) and the regions were very similar on these demographic characteristics. Nearly all clients (92.4%) required full assistance with instrumental activities of daily living (IADLs), approximately 35% had activities of daily living (ADL) impairments, and nearly 50% had some degree of cognitive impairment, which was higher among clients in Ontario (48.8% vs. 37.0%). The highest quality indicator rates were related to clients who had ADL/rehabilitation potential but were not receiving therapy (range: 66.8%-91.6%) and the rate of cognitive decline (65.4%-76.3%). Ontario clients had higher unadjusted rates across 18 of the 22 indicators and the unadjusted differences between the two provinces ranged from 0.6% to 28.4%. For 13 of the 19 indicators that have risk adjustment, after applying the risk adjustment methodology, the difference between the adjusted rates in the two regions was reduced.
Reducing hospital admissions from nursing homes: a systematic review
Graverholt B, Forsetlund L, Jamtvedt G.
BMC Health Services Research 2014;14(1):36
The objective of this study is to summarise the effects of interventions to reduce acute hospitalisations from nursing homes. Five systematic reviews and five primary studies were included, evaluating a total of 11 different interventions. Fewer hospital admissions were found in four out of seven evaluations of structuring and standardising clinical practice; in both evaluations of geriatric specialist services, and in influenza vaccination of residents. The quality of the evidence for all comparisons was of low or very low quality, using the GRADE approach. Conclusions Overall, eleven interventions to reduce hospital admissions from nursing homes were identified. None of them were tested more than once and the quality of the evidence was low for every comparison. Still, several interventions had effects on reducing hospital admissions and may represent important aspects of nursing home care to reduce hospital admissions.
Are Nursing Home Survey Deficiencies Higher in Facilities With Greater Staff Turnover
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Lerner NB, Johantgen M, Trinkoff AM, Storr CL, Han K.
Journal of the American Medical Directors Association 2014;15(2):102-107
Objectives To examine CNA and licensed nurse (RN+LPN/LVN) turnover in relation to numbers of deficiencies in nursing homes. Design A secondary data analysis of information from the National Nursing Home Survey (NNHS) and contemporaneous data from the Online Survey, Certification and Reporting (OSCAR) database. Data were linked by facility as the unit of analysis to determine the relationship of CNA and licensed nurse turnover on nursing home deficiencies. Setting The 2004 NNHS used a multistage sampling strategy to generate a final sample of 1174 nursing homes, which represent 16,100 NHs in the United States. Participants This study focused on the 1151 NNHS facilities with complete deficiency data. Measurements Turnover was defined as the total CNAs/licensed nurse full-time equivalents (FTEs) who left during the preceding 3 months (full- and part-time) divided by the total FTE. NHs with high turnover were defined as those with rates above the 75th percentile (25.3% for CNA turnover and 17.9% for licensed nurse turnover) versus all other facilities. This study used selected OSCAR deficiencies from the Quality of Care, Quality of Life, and Resident Behavior categories, which are considered to be more closely related to nursing care. We defined NHs with high deficiencies as those with numbers of deficiencies above the 75th percentile versus all others. Using SUDAAN PROC RLOGIST, we included NNHS sampling design effects and examined associations of CNA/licensed nurse turnover with NH deficiencies, adjusting for staffing, skill mix, bed size, and ownership in binomial logistic regression models. Results High CNA turnover was associated with high numbers of Quality of Care (OR 1.53, 95% CI 1.10–2.13), Resident Behavior (OR 1.42, 95% CI 1.03–1.97) and total selected deficiencies (OR 1.54, 95% CI 1.12–2.12). Licensed nurse turnover was significantly related to Quality of Care deficiencies (OR 2.06, 95% CI 1.50–2.82) and total selected deficiencies (OR 1.71, 95% CI 1.25–2.33). When both CNA turnover and licensed nurse turnover were included in the same model, high licensed nurse turnover was significantly associated with Quality of Care and total deficiencies, whereas CNA turnover was not associated with that category of deficiencies. Conclusion Turnover in nursing homes for both licensed nurses and CNAs is associated with quality problems as measured by deficiencies.
Patient-centered innovation in health care organizations: a conceptual framework and case study application.
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Hernandez SE, Conrad DA, Marcus-Smith MS, Reed P, Watts C.
Health care management review 2013 Apr-Jun;38(2):166-175
Patient-centered innovation is spreading at the federal and state levels. A conceptual framework can help frame real-world examples and extract systematic learning from an array of innovative applications currently underway. The statutory, economic, and political environment in Washington State offers a special contextual laboratory for observing the interplay of these factors. PURPOSE: We propose a framework for understanding the process of initiating patient-centered innovations-particularly innovations addressing patient-centered goals of improved access, continuity, communication and coordination, cultural competency, and family- and person-focused care over time. The framework to a case study of a provider organization in Washington State actively engaged in such innovations was applied in this article. METHODS: We conducted a selective review of peer-reviewed evidence and theory regarding determinants of organizational change. On the basis of the literature review and the particular examples of patient-centric innovation, we developed a conceptual framework. Semistructured key informant interviews were conducted to illustrate the framework with concrete examples of patient-centered innovation. FINDINGS: The primary determinants of initiating patient-centered innovation are (a) effective leadership, with the necessary technical and professional expertise and creative skills; (b) strong internal and external motivation to change; (c) clear and internally consistent organizational mission; (d) aligned organizational strategy; (e) robust organizational capability; and (f) continuous feedback and organizational learning. The internal hierarchy of actors is important in shaping patient-centered innovation. External financial incentives and government regulations also significantly shape innovation. PRACTICE IMPLICATIONS: Patient-centered care innovation is a complex process. A general framework that could help managers and executives organize their thoughts around innovation within their organization is presented.
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Organizational Change
Who are the innovators? Nursing homes implementing culture change.
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Grabowski DC, Elliot A, Leitzell B, Cohen LW, Zimmerman S.
The Gerontologist 2014 Feb;54 Suppl 1:S65-75
A key directive of the Affordable Care Act of 2010 is to transform both institutional and community-based long-term care into a more person-centered system. In the nursing home industry, the culture change movement is central to this shift in philosophy. If policymakers are to further encourage implementation of culture change, they need to better understand the factors associated with implementation. DESIGN AND METHODS: Using logistic regression (N = 16,835), we examined the extent to which resident, facility, and state characteristics relate to a nursing home being identified by experts as having implemented culture change over the period 2004 through 2011. RESULTS: At baseline, the 291 facilities that were later identified by experts to have implemented culture change were more often nonprofit-owned, larger in size, and had fewer Medicaid and Medicare residents. Implementers also had better baseline quality with fewer health-related survey deficiencies and greater licensed practical nurse and nurse aide staffing. States experienced greater culture change implementation when they paid a higher Medicaid per diem. IMPLICATIONS: To date, nursing home culture change has been implemented differentially by higher resource facilities, and nursing homes have been responsive to state policy factors when implementing culture change.
What does the evidence really say about culture change in nursing homes?
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Shier V, Khodyakov D, Cohen LW, Zimmerman S, Saliba D.
The Gerontologist 2014 Feb;54 Suppl 1:S6-S16
Although nursing home culture change efforts are becoming more widespread, there have been few efforts to systematically compile the evidence related to the efficacy of culture change. This study uses an analytic framework to evaluate the existing evidence for the impact of culture change on nursing home quality. We focus on the nature and scope of culture change interventions, measurement of culture change and adherence to interventions, measurement of culture change outcomes, and the relationship between culture change and its outcomes. DESIGN AND METHODS: We conducted a comprehensive review of peer-reviewed and gray literature published between 2005 and 2012 to identify intervention evaluations that addressed at least one culture change domain. Of 4,982 identified publications, 625 underwent full review; 27 peer-reviewed and 9 gray literature studies met inclusion criteria. RESULTS: Studies varied widely in scope and outcomes. Most addressed more than one culture change domain; resident direction, home environment, and close relationships were most common. Few studies measured culture change implementation, but most used validated tools to measure outcomes. Although few studies reported negative outcomes, there was little consistent evidence of positive effects. IMPLICATIONS: Nursing home culture change remains an evolving field. Although culture change has clear face validity, the current evidence does not give providers sufficient information for selecting interventions based on the expectation of improving outcomes. Rigorous research on implementation and outcomes of culture change is needed to determine the specific impact of culture change on quality and to provide guidance to providers and policy makers.
Culture change and nursing home quality of care.
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Grabowski DC, O’Malley AJ, Afendulis CC, Caudry DJ, Elliot A, Zimmerman S.
The Gerontologist 2014 Feb;54 Suppl 1:S35-45
Culture change models are intended to improve the quality of life for nursing home residents, but the impact of these models on quality of care is unknown. We evaluated the impact of the implementation of nursing home culture change on the quality of care, as measured by staffing, health-related survey deficiencies, and Minimum Data Set (MDS) quality indicators. DESIGN AND METHODS: From the Pioneer Network, we have data on whether facilities were identified by experts as “culture change” providers in 2004 and 2009. Using administrative data, we employed a panel-based regression approach in which we compared pre-post quality outcomes in facilities adopting culture change between 2004 and 2009 against pre-post quality outcomes for a propensity score-matched comparison group of nonadopters. RESULTS: Nursing homes that were identified as culture change adopters exhibited a 14.6% decrease in health-related survey deficiency citations relative to comparable nonadopting homes, while experiencing no significant change in nurse staffing or various MDS quality indicators. IMPLICATIONS: This research represents the first large-scale longitudinal evaluation of the association of culture change and nursing home quality of care. Based on the survey deficiency results, nursing homes that were identified as culture change adopters were associated with better care although the surveyors were not blind to the nursing home’s culture change efforts. This finding suggests culture change may have the potential to improve MDS-based quality outcomes, but this has not yet been observed.
Changing the culture of mouth care: mouth care without a battle.
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Zimmerman S, Sloane PD, Cohen LW, Barrick AL.
The Gerontologist 2014 Feb;54 Suppl 1:S25-34
Culture change aims to fundamentally improve care provision in a manner consistent with individual preferences. However, few studies of culture change have focused on the quality of daily care, despite the fact that system-wide efforts are important to assure the effectiveness, adoption, and sustainability of person-centered care to meet daily needs. This paper describes a new culture change practice, Mouth Care Without a Battle. The focus on mouth care is predicated on the important association between person-centered support for oral hygiene and quality of life. DESIGN AND METHODS: Mouth Care Without a Battle is a person-centered approach to quality mouth care for persons with cognitive and physical impairment. It was developed by an interdisciplinary team of clinician researchers based on literature review, consultation with experts, environmental scan of existing programs, and testing in nursing homes. Building from the success of Bathing Without a Battle, Mouth Care Without a Battle was evaluated in terms of changed care practices and outcomes, developed into a training program, and packaged for dissemination as a digital video disk (DVD) and website. RESULTS: The development and evaluation of Mouth Care Without a Battle demonstrate attention to the areas necessary to establish the evidence-base for culture change, to ultimately empower and support staff to provide care to achieve quality outcomes. IMPLICATIONS: As illustrated in this paper, it is beneficial to build the evidence base for culture change by attending to care processes and outcomes benefiting all residents, ability to implement culture change, and costs of implementation.
A “Recipe” for Culture Change? Findings From the THRIVE Survey of Culture Change Adopters.
Non UofA Access
Elliot A, Cohen LW, Reed D, Nolet K, Zimmerman S.
The Gerontologist 2014 Feb;54 Suppl 1:S17-24
Descriptions of culture change adoption are often complex and varied, creating a challenge for those seeking guidance about which of the many components of culture change to adopt and in what order and combination. DESIGN AND METHODS: To begin to address this question, members of The Research Initiative Valuing Eldercare (THRIVE) developed and distributed an online survey to 327 known culture change adopters. Of these, 164 (50%) completed the survey. Data were analyzed to identify adopted components, co-occurrence of adopted components, and differences in these across various types of nursing home models (i.e., traditional unit, household, and small house). RESULTS: Our findings support unique co-occurrence of components across nursing home models. Results also show that homes with more traditional environments have been able to implement certain culture change components without large capital investments required by renovations. IMPLICATIONS: The adoption patterns suggest that the co-occurrence of components should be considered when pursuing organizational transformations to support culture change. KEYWORDS: Autonomy and self-efficacy, Consumer-directed care, Institutional care/residential care, Long-term care, Nursing homes, Organizational and institutional issues, Person-centered care.
Transforming nursing home culture: evidence for practice and policy.
Non UofA Access
Zimmerman S, Shier V, Saliba D.
The Gerontologist 2014 Feb;54 Suppl 1:S1-5
The nursing home culture change movement aims to improve resident quality of life and quality of care by emphasizing the deinstitutionalization of nursing home culture and focusing on person-centered care. This article briefly reviews the history of culture change, discusses some of the challenges related to culture change in nursing homes, and overviews the conceptualization and select models of culture change. Building from this background, it critiques current understanding, identifies critical research questions, and notes key issues arising during a workshop that addressed existing and emerging evidence in the field. This review and analysis provide a context for how 9 accompanying papers in this supplemental issue of The Gerontologist fill identified evidence gaps and provide evidence for future practice and policies that aim to transform nursing home culture.
Implementing Culture Change in Nursing Homes: An Adaptive Leadership Framework
Non UofA Access
Corazzini K, Twersky J, White HK, Buhr GT, McConnell ES, Weiner M, et al.
The Gerontologist 2014 Jan 22
To describe key adaptive challenges and leadership behaviors to implement culture change for person-directed care. DESIGN AND METHODS: The study design was a qualitative, observational study of nursing home staff perceptions of the implementation of culture change in each of 3 nursing homes. We conducted 7 focus groups of licensed and unlicensed nursing staff, medical care providers, and administrators. Questions explored perceptions of facilitators and barriers to culture change. Using a template organizing style of analysis with immersion/crystallization, themes of barriers and facilitators were coded for adaptive challenges and leadership. RESULTS: Six key themes emerged, including relationships, standards and expectations, motivation and vision, workload, respect of personhood, and physical environment. Within each theme, participants identified barriers that were adaptive challenges and facilitators that were examples of adaptive leadership. Commonly identified challenges were how to provide person-directed care in the context of extant rules or policies or how to develop staff motivated to provide person-directed care. IMPLICATIONS: Imple- menting culture change requires the recognition of adaptive challenges for which there are no technical solutions, but which require reframing of norms and expectations, and the development of novel and flexible solutions. Managers and administrators seeking to implement person-directed care will need to consider the role of adaptive leadership to address these adaptive challenges.
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Research Practice & Methodology
Investigating complexity in systematic reviews of interventions by using a spectrum of methods.
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Anderson LM, Oliver SR, Michie S, Rehfuess E, Noyes J, Shemilt I.
Journal of clinical epidemiology 2013 Nov;66(11):1223-1229
Systematic reviews framed by PICOS (Populations, Interventions, Comparisons, Outcomes, and Study designs) have been valuable for synthesizing evidence about the effects of interventions. However, this framework is limited in its utility for exploring the influence of variations within populations or interventions, or about the mechanisms of action or causal pathways thought to mediate outcomes, other contextual factors that might similarly moderate outcomes, or how and when these mechanisms and elements interact. Valuable insights into these issues come from configurative as well as aggregative methods of synthesis. This article considers the range of evidence that can be used in systematic reviews of interventions to investigate complexity in terms of potential sources of variation in interventions and their effects, and presents a continuum of purposes for, and approaches to, evidence synthesis. Choosing an appropriate synthesis method takes into account whether the purpose of the synthesis is to generate, explore, or test theories. Taking complexity into account in a synthesis of economic evidence similarly shifts emphasis from evidence synthesis strategies focused on aggregation toward configurative strategies that aim to develop, explore, and refine (in advance of testing) theories or explanations of how and why interventions are more or less resource intensive, costly or cost-effective in different settings, or when implemented in different ways. Copyright © 2013 Elsevier Inc. All rights reserved.
Comparison of two data collection processes in clinical studies: electronic and paper case report forms.
Non UofA Access
Le Jeannic A, Quelen C, Alberti C, Durand-Zaleski I.
BMC medical research methodology 2014 Jan 17;14(1):7
Electronic Case Report Forms (eCRFs) are increasingly chosen by investigators and sponsors of clinical research instead of the traditional pen-and-paper data collection (pCRFs). Previous studies suggested that eCRFs avoided mistakes, shortened the duration of clinical studies and reduced data collection costs. METHODS: Our objectives were to describe and contrast both objective and subjective efficiency of pCRF and eCRF use in clinical studies. A total of 27 studies (11 eCRF, 16 pCRF) sponsored by the Paris hospital consortium, conducted and completed between 2001 and 2011 were included. Questionnaires were emailed to investigators of those studies, as well as clinical research associates and data managers working in Paris hospitals, soliciting their level of satisfaction and preferences for eCRFs and pCRFs. Mean costs and timeframes were compared using bootstrap methods, linear and logistic regression. RESULTS: The total cost per patient was 374[euro sign] +/-351 with eCRFs vs. 1,135[euro sign] +/-1,234 with pCRFs. Time between the opening of the first center and the database lock was 31.7 months Q1 = 24.6; Q3 = 42.8 using eCRFs, vs. 39.8 months Q1 = 31.7; Q3 = 52.2 with pCRFs (p = 0.11). Electronic CRFs were globally preferred by all (31/72 vs. 15/72 for paper) for easier monitoring and improved data quality. CONCLUSIONS: This study found that eCRFs and pCRFs are used in studies with different patient numbers, center numbers and risk. The first ones are more advantageous in large, low-risk studies and gain support from a majority of stakeholders.
Effect of numbering of return envelopes on participation, explicit refusals, and bias: experiment and meta-analysis
Non UofA Access
Perneger TV, Cullati S, Rudaz S, Agoritsas T, Schmidt RE, Combescure C, et al.
BMC medical research methodology 2014 Jan 15;14(1):6-2288-14-6
Tracing mail survey responses is useful for the management of reminders but may cause concerns about anonymity among prospective participants. We examined the impact of numbering return envelopes on the participation and the results of a survey on a sensitive topic among hospital staff. METHODS: In a survey about regrets associated with providing healthcare conducted among hospital-based doctors and nurses, two randomly drawn subsamples were provided numbered (N = 1100) and non-numbered (N = 500) envelopes for the return of completed questionnaires. Participation, explicit refusals, and item responses were compared. We also conducted a meta-analysis of the effect of questionnaire/envelope numbering on participation in health surveys. RESULTS: The participation rate was lower in the “numbered” group than in the “non-numbered” group (30.3% vs. 35.0%, p = 0.073), the proportion of explicit refusals was higher in the “numbered” group (23.1% vs 17.5%, p = 0.016), and the proportion of those who never returned the questionnaire was similar (46.6% vs 47.5%, p = 0.78). The means of responses differed significantly for 12 of 105 items (11.4%), which did not differ significantly from the expected frequency of type 1 errors, i.e., 5% (permutation test, p = 0.078). The meta-analysis of 7 experimental surveys (including this one) indicated that numbering is associated with a 2.4% decrease in the survey response rate (95% confidence interval 0.3% to 4.4%). CONCLUSIONS: Numbered return envelopes may reduce the response rate and increase explicit refusals to participate in a sensitive survey. Reduced participation was confirmed by a meta-analysis of randomized health surveys. There was no strong evidence of bias.
IOM: Discussion Framework for Clinical Trial Data Sharing: Guiding Principles, Elements, and Activities (US)
January 2014
Clinical trials are crucial to determining the safety of medical interventions and their ability to achieve particular health outcomes and represent a significant investment from all involved — patients and others who volunteer to participate, organizations that sponsor trials, and the researchers who conduct a study and analyze the data. Clinical trial data represent potential resources that, if shared, could facilitate new analyses and a deeper understanding of a particular therapy or condition. However, much of the data generated by clinical trials is not public or shared beyond the data holder, and significant barriers to sharing these data exist. In follow up to an October 2012 workshop at the IOM, the IOM is conducting a consensus study to recommend guiding principles and a framework for the responsible sharing of clinical trial data. A final report will be released in December 2014.
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Healthcare in Canada
Health Council of Canada: Where you live matters
2014
According to a new report released today, Canadians’ views about the health care system have grown more positive in the last decade, and more than half (61 per cent) rate their health status as very good or excellent, putting Canada among the top three of the 11 countries surveyed. However, there remain large and concerning variations in patients’ experiences among provinces in terms of wait times and coordination of care, quality of care, patient safety, preventive care, and financial barriers.
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Aging
Obesity and Physical Frailty in Older Adults: A Scoping Review of Lifestyle Intervention Trials
Non UofA Access
Starr KNP, McDonald SR, Bales CW.
Journal of the American Medical Directors Association 2014
Many frail older adults are thin, weak, and undernourished; this component of frailty remains a critical concern in the geriatric field. However, there is also strong evidence that excessive adiposity contributes to frailty by reducing the ability of older adults to perform physical activities and increasing metabolic instability. Our scoping review explores the impact of being obese on physical frailty in older adults by summarizing the state of the science for both clinical markers of physical function and biomarkers for potential underlying causes of obesity-related decline. We used the 5-stage methodological framework of Arksey and O’Malley to conduct a scoping review of randomized trials of weight loss and/or exercise interventions for obesity (body mass index ≥ 30 kg/m2) in older adults (aged >60 years). The literature consistently confirmed benefits of lifestyle interventions to physical function assessed at the clinical level. Generally speaking, weight loss alone produced a greater effect than exercise alone, and the best outcomes were achieved with a combination of weight loss and exercise, especially exercise programs that combined aerobic, resistance, and flexibility training. Weight loss interventions tended to reduce markers of inflammation and/or oxidative damage when more robust weight reduction was achieved and maintained over time, whereas exercise did not change markers of inflammation. However, participation in a chronic exercise program did reduce the oxidative stress induced by an acute bout of exercise. Weight loss interventions consistently reduced lipid accumulation in the muscle; however, in response to exercise, 3 studies showed an increase and 2 a decrease in muscle lipid infiltration.
Care and Respect for Elders in Emergencies Program: A Preliminary Report of a Volunteer Approach to Enhance Care in the Emergency Department
Non UofA Access
Sanon M, Baumlin KM, Kaplan SS, Grudzen CR.
Journal of the American Geriatrics Society 2014 Jan 15
Older adults who present to an emergency department (ED) generally have more-complex medical conditions with complicated care needs and are at high risk for preventable adverse outcomes during their ED visit. The Care and Respect for Elders with Emergencies (CARE) volunteer initiative is a geriatric-focused volunteer program developed to help prevent avoidable complications such as falls, delirium and use of restraints, and functional decline in vulnerable elders in the ED. The CARE program consists of bedside volunteer interventions ranging from conversation to various short activities designed to engage and reorient high-risk, older, unaccompanied individuals in the ED. This article describes the development and characteristics of the CARE program, the services provided, the experiences of the elderly patients and their volunteers, and the growth of the program over time. CARE volunteers provide elders with the additional attention needed in an often chaotic, unfamiliar environment by enhancing their care, improving satisfaction, and preventing potential decline.© 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.
Implementation of advanced practice nurse clinic for management of behavioral symptoms in dementia: A dyadic intervention (innovative practice)
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Barton C.
Dementia 2014
Behavioral symptoms are common in all types of dementia and often result in significant caregiver stress and illness, institutionalization of the patient, and reduced quality of life for the patient and caregiver. Health care practitioners often lack the expertise or time to adequately assess behavioral symptoms or counsel caregivers about interventions. Our goal was to implement a specialty clinic managed by advanced practice nurses to assess and manage behavioral symptoms associated with dementia. The clinic evaluations consisted of an assessment of the patient by the Nurse Practitioner during the time that the family caregiver(s) was interviewed by the Clinical Nurse Specialist and focused on an assessment of the cognitive and functional abilities of the patient, identification of triggers for the problematic behaviors, and assessment of caregiver coping. We evaluated 66 dyads since implementation in February 2010. The patients were primarily female, Caucasian, 74.3 years of age with Alzheimer’s disease. The majority of caregivers were spouses (n = 44) followed by adult children (n = 20) and then siblings (n = 2). Targeted interventions were developed and caregiver counseling, support, and education were an integral part of the consultation and included written information, video instruction, and internet resources. Evaluations indicated caregivers and referring providers found the appointment helpful in managing behavioral symptoms and caregiver stress.
Psychological treatments for depression and anxiety in dementia and mild cognitive impairment.
Non UofA Access
Orgeta V, Qazi A, Spector AE, Orrell M.
The Cochrane database of systematic reviews 2014 Jan 22;1:CD009125
The main objective of this review was to assess the effectiveness of psychological interventions in reducing anxiety and depression in people with dementia or mild cognitive impairment (MCI). SEARCH METHODS: We searched the Cochrane Dementia and Cognitive Improvement Group Specialized Register and additional sources for both published and unpublished data. SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing a psychological intervention with usual care or a placebo intervention (social contact control) in people with dementia or MCI. DATA COLLECTION AND ANALYSIS: Two review authors worked independently to select trials, extract data and assess studies for risk of bias, using a data extraction form. We contacted authors when further information was not available from the published articles. MAIN RESULTS: Six RCTs involving 439 participants with dementia were included in the review, but no studies of participants with MCI were identified. The studies included people with dementia living in the community or in nursing home care and were carried out in several countries. Only one of the studies was classified as low risk of bias. Five studies were at unclear or high risk of bias due to uncertainties around randomisation, blinding and selective reporting of results. The studies used the different psychological approaches of cognitive behavioural therapy (CBT), interpersonal therapy and counselling. Two studies were of multimodal interventions including a specific psychological therapy. The comparison groups received either usual care, attention-control educational programs, diagnostic feedback or services slightly above usual care.Meta-analysis showed a positive effect of psychological treatments on depression (6 trials, 439 participants, standardised mean difference (SMD) -0.22; 95% confidence interval (CI) -0.41 to -0.03, moderate quality evidence) and on clinician-rated anxiety (2 trials, 65 participants, mean difference (MD) -4.57; 95% CI -7.81 to -1.32, low quality evidence), but not on self-rated anxiety (2 trials, SMD 0.05; 95% CI -0.44 to 0.54) or carer-rated anxiety (1 trial, MD -2.40; 95% CI -4.96 to 0.16). Results were compatible with both benefit and harm on the secondary outcomes of patient quality of life, activities of daily living (ADLs), neuropsychiatric symptoms and cognition, or on carers’ self-rated depressive symptoms, but most of the studies did not measure these outcomes. There were no reports of adverse events.
The Nursing Home as a Learning Environment: Dealing With Less Is Learning More.
Non UofA Access
Molema F, Koopmans R, Helmich E.
Academic medicine 2014 Jan 20
Despite the imperative to develop adequate competence in caring for the growing demographic of elderly patients with complex health care problems, nursing homes are underused as learning environments for the education of future doctors; thus, the authors aimed to gain more insight into the characteristics of the nursing home as a learning environment. METHOD: Approaching the nursing home as a learning environment from a predominantly sociocultural perspective, the authors carried out five focus group interviews (December 2011 through February 2012) with 36 family medicine and elderly care medicine residents during their nursing home placements. Data analysis was an iterative process following a grounded theory approach. The software ATLAS.ti supported data analysis. RESULTS: The authors identified 23 themes in five categories regarding the nursing home as a learning environment: organization, medical opportunities, communication, teamwork, and supervision. Working and learning in a nursing home was characterized by “dealing with less” (i.e., fewer resources), yet the residents reported that dealing with less resulted in “learning more.” Family medicine and elderly care residents from different backgrounds differed in their perceptions and specific learning needs. CONCLUSIONS: To the authors’ knowledge, this study is one of the first to identify characteristics of the nursing home as a learning environment. The main challenge in the nursing home is dealing with less, which, according to the residents in the present study, often leads to learning more. To ensure that learning really happens, the authors call for high-quality supervision to support learners in the nursing home environment.
The Effect of Programs to Improve Oral Hygiene Outcomes for Older Residents in Long-Term Care: A Systematic Review.
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Coker E, Ploeg J, Kaasalainen S.
Research in gerontological nursing 2014 Jan 21:1-14
Nurses have a critical role in promoting oral health in dependent older adults residing in long-term care or having extended hospital stays. Strategies aimed at improving the quality of oral hygiene care nurses provide may contribute to better oral hygiene outcomes. The purpose of this systematic review was to examine the effect of intervention programs designed to enhance the ability of nurses or those to whom they delegate care to improve oral hygiene outcomes in frail older adults. Studies reported an educational program, either alone or augmented in some way. The study interventions consisted of: (a) single in-service education sessions; (b) single in-service education sessions supplemented by a “train-the-trainer” approach; and (c) education sessions supplemented with ongoing active involvement of a dental hygienist. None of the approaches emerged as being desirable over the others, as methodologically strong studies with good intervention integrity were lacking, and a variety of oral health outcomes were used to measure effectiveness of the interventions, making comparisons across studies difficult. Copyright 2014, SLACK Incorporated.
Prevalence of neurological conditions across the continuum of care based on interRAI assessments
Danila O, Hirdes J, Maxwell C, Marrie RA, Patten S, Pringsheim T, et al.
BMC Health Services Research 2014;14(1):29
Cohorts of individuals receiving care in nursing homes (N=103,820), home care (N=91,021), complex continuing care (N=10,581), and psychiatric hospitals (N=23,119) in Canada were drawn based on their most recent interRAI assessment within each sector for a six-month period in 2010. These data were linked to the Discharge Abstract Database and National Ambulatory Care Reporting System data sets to develop five different case definition scenarios for estimating prevalence. Results The conditions with the highest estimated prevalences in these care settings in Canada were Alzheimer’s disease and related dementias, Parkinson’s disease, epilepsy, and traumatic brain injury. However, there were notable cross-sector differences in the prevalence of each condition, and regional variations. Prevalence estimates based on acute hospital administrative data alone were substantially lower for all conditions evaluated. Conclusions The proportion of persons with neurological conditions in non-acute health care settings in Canada is substantially higher than is generally reported for the general population. It is essential for these care settings to have the expertise and resources to respond effectively to the strengths, preferences, and needs of the growing population of persons with neurological conditions. The use of hospital or emergency department records alone is likely to substantially underestimate the true prevalence of neurological conditions across the continuum of care. However, interRAI assessment records provide a helpful source of information for obtaining these estimates in nursing home, home care, and mental health settings.
Unmet Assistance Need Among Older American Indians: The Native Elder Care Study.
Non UofA Access
Schure MB, Conte KP, Goins RT.
The Gerontologist 2014 Jan 22
We examined the prevalence and correlates of unmet assistance need with respect to activities of daily living (ADLs) and instrumental activities of daily living (IADLs) among older American Indians. DESIGN AND METHODS: Data for our analyses were collected in 2006-2008 as part of the Native Elder Care Study, a cross-sectional study of community-dwelling American Indians aged ≥55 years. In-person interviewer-administered surveys were used to collect data on demographic characteristics, physical functioning, mental and physical health, personal assistance needs, and psychosocial resources. RESULTS: Among those with an assistance need, 47.8% reported an unmet need with one or more ADLs or IADLs. Significant adjusted correlates of unmet assistance need included greater number of ADL and IADL difficulties and lower levels of social support. IMPLICATIONS: Initiatives and programs aimed at increasing social support and augmenting informal care networks can support efforts to meet American Indian adults’ personal assistance needs.
Key messages
-Integrated care is a process that must be led, managed and nurtured over time.
-Initiatives often have to navigate and overcome existing organisational and funding silos.
-There is no single organisational model or approach that best supports integrated care.
-The starting point should be a clinical/service model designed to improve care for people, not an organisational model with a pre-determined design.
-Fully integrated organisations are not the end (goal).
-Greater use of ICT is potentially an important enabler of integrated care, but is not a necessary condition.
-Professionals need to work together in multidisciplinary teams (with clearly defined roles) or provider networks – generalists and specialists, in health and social care. However, patients with complex needs that span health and social care may require an intensity of support that goes beyond what primary care physicians can deliver.
-Important service-level design elements of care for older people with chronic and multiple conditions include holistic care assessments, care planning, a single point of entry, and care co-ordination.
-Success is more likely where there is a specific focus on working with individuals and informal carers to support self-management.
-Personal contact with a named care co-ordinator and/or case manager is more effective than remote monitoring or telephone-based support.
Joseph Rowntree Foundation: Dementia-Friendly Yorkshire First Steps on the Journey (UK)
January 2014
This collection of case studies brings together 20 siple examples of grassroots dementia-friendly work that is transforming communities across Yorkshire. Some of case studies are: making train travel simpler, protection from doorstep crime, dementia friendly grocery shopping and libraries, and memory cafés.
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Events
Non UofA
Conference Board of Canada: Western Health Summit 2014
21-22 May Edmonton
This event will feature the Conference Board’s latest research on health care economics, transformation, innovation, and workplace wellness. Our team of researchers offers diverse perspectives and new ideas and insights to help you with your health care challenges.
Online
Canadian Cochrane Centre: Using Cochrane Reviews in real life
Thursday 6 February 10:00-11:00 MT
How does a consumer use Cochrane Reviews when communicating with health care professionals and making health care decisions? An active consumer who is involved and contributes to Cochrane Reviews, will share her experience including tips and strategies for using the information found in Cochrane reviews and decision aids.
Canadian Cochrane Centre: Consumer-led knowledge translation: leveraging patient experience and networks to disseminate Cochrane Reviews
Wednesday 12 February 10:00-11:00 MT
Improving patient access to quality treatment information is a key goal of The Cochrane Collaboration. This webinar will explore a Canadian consumer led strategy to share Cochrane Review results in understandable and useable ways with target audiences, including consumers, to enhance shared decision making and self-management. Examples of consumer involvement throughout the Cochrane Review process will also be discussed. The session will be interactive with participant feedback encouraged.
2014 Cochrane 101 Series
Thursday 20 March, 27 March, 3 April 10:00-11:00 MT each day
Cochrane 101: An Introduction to The Cochrane Collaboration, The Steps of a Cochrane Review: An Overview, Let’s Start at the Very Beginning: Getting the Question Right for Your Cochrane Review.
Courses
KT Canada Summer Institute
9-11 June Québec City Costs: Free(trainees only), $1000 (junior faculty)
DEADLINE for application 14 March
The purpose of this Summer Institute is to provide participants with the opportunity to increase their understanding of knowledge translation research as well as opportunities and challenges in this field. The Summer Institute will provide participants with the chance to network with colleagues including national and international KT experts. The theme of the 2014 Institute is “Knowledge Translation for 4 Ps (patients, providers, public and policymakers”. The Summer Institute (SI) is aimed at graduate students, post-doctoral and clinical fellows, and junior faculty who study issues relevant to KT and those who want to learn more about how to advance their research skills in this area. We encourage applications from trainees working in a wide range of disciplines that span all of CIHR’s research themes (biomedical, clinical, health services, and population health). Attendees will have the opportunity to share their research projects (proposals and/or projects with preliminary results) through poster sessions that will facilitate further networking opportunities. Participation in the poster session also allows attendees to be eligible to apply for funding from their home institutions (where this funding is available) to attend the summer institute.
Online
NHS: The School for Health and Care Radicals
Open to anyone. Starts January 31st but modules are available for download.
A virtual learning programme for people who want to join others to change the world of health and care.
News
VA Program Reduces MRSA Germ Cases at Long-Term Care Centers
The number of infections with dangerous antibiotic-resistant bacteria at VA long-term care centers has dropped since a program to combat the problem was launched in 2009, a new report shows.
Dying to be heard: Plight of seniors in care begs better follow-up, families say
Across Canada, reports of seniors being fatally attacked in care facilities, and dementia sufferers wandering away from nursing homes, have spurred urgent calls to better track similar incidents, and to act on inquest recommendations that could prevent future tragedies among older, or mentally ill, people.
Prince Albert Parkland getting long-term care clients into beds faster
The healthcare team developed and tested a standard form that captures all information assessors need to fill vacant beds quickly and appropriately. The form is designed to be quick and easy for long-term care staff to fill out, so they can notify the assessors within two hours of a vacancy.
Diverse realities of aging immigrants
Laxmi Adhikari isn’t what you would call a senior citizen. But the 55-year-old wants to be ready for his senior years when they arrive. As a recent immigrant from Bhutan, Adhikari knows he faces extra challenges. When it comes to aging, things are just different here in Canada, he said.
New alzheimer resource centre brings relief to families
The opening of the Prairie North Resource Centre in Saskatoon has ushered in a wave of relief and hope among those who deal with the disease everyday.
Missing the target on health care performance?
Setting targets has long been a mechanism in industrial psychology to motivate managers and workers to achieve specific organizational objectives. In the last decade, targets have become important methods of driving performance improvement in health care. However, deciding where and when to set targets is a challenge facing health care decision makers.
NHS England Research and Development Strategy Consultation
The vision of the Research and Development Strategy is to:
-Support development of high quality commissioning underpinned by research and innovation,
-Support NHS England in becoming an excellent organisation by encouraging a culture that values and promotes research and innovation
-Create an evidence based decision making culture
-Ensure research undertaken or commissioned by NHS England is patient centred
-Offer every patient the opportunity to take part in research (where practical)
-Contribute to economic growth
Leicester City Council seeks foster carers for elderly people
A fostering scheme where families will be paid to take elderly people into their homes is to be tried in Leicester.
Alzheimer’s documentary comes close to ‘Genius’
All tales about victims of dementia are tragic, not just for the sufferer but for the loved ones involved. But the story of Dedham resident Pam White, subject of an affecting, lyrical documentary by her son Banker White and co-directed by Anna Fitch, involves an especially cruel irony. A year after Pam started writing “The Genius of Marian,” a book about her Alzheimer’s-afflicted mother, the painter Marian Williams Steele, Pam herself was diagnosed with the disease. She was 61. In intimate, diary form, White borrows the title of his mother’s unfinished book to chronicle her battle against the inevitable, and the equally courageous efforts of her husband and children in caring for her. Their daily struggle will resound not only with those who face the same situation, but with all who must someday confront the inevitabilities of illness, loss, and grief.
How one hospital is dealing with Canada’s aging population
The Globe and Mail and Sunnybrook Health Sciences Centre join forces for a rare, uncensored look at the challenges Canadian hospitals face on the ground, and what doctors, nurses and other key players think it will take to meet them.
Calgary nursing home to change wound care after resident deaths
Alberta Health Minister Fred Horne says a nursing home where two residents died from badly-infected sores over the last year is now under deadline to make changes in how it takes care of wounds and dressings.
Resources
The PATHway to Aging Well website was designed to help seniors and caregivers in west Northumberland plan for life after 65. It was designed and built by a local team of seniors, caregivers and healthcare providers with the support of 12 partners who came together around The Change Foundation’s PATH project. The website was launched at the end of 2013.
This measure is used to assess the percent of long-stay, high-risk residents with Stage II-IV pressure ulcers.
Canadian Coalition for Global Health Research: Knowledge Translation Curriculum
This comprehensive curriculum is a teaching and learning resource. It includes fully resourced lesson plans and provides a thorough overview of key concepts, conflicts, and methods in Knowledge Translation (KT). Grounded in philosophy, political science, and health research, the curriculum explores the complex ideas and theories that shape intersections among research, practice and policy processes.
New from CIHI Interactive Tool: Canada’s Health System International Comparisons
As health care systems evolve to meet new demands and growing needs, measuring and monitoring quality of care has become increasingly common both in Canada and worldwide. This tool uses the OECD’s quality of care indicators to provide an in-depth look at the quality of care within Canada’s health care system, compared with systems in other countries. These comparisons can help us identify best performers and determine benchmarks for quality improvement.
Quality Palliative Care in Long Term Care Toolkit
Costs $175
Long term care homes provide care for residents until the end of life. Each year approximately 20% of residents die and most wish to stay at home. Staff work very hard to provide palliative care to residents and their families. The Quality Palliative Care in Long Term Care (QPC-LTC) toolkit can support long term care homes these efforts.
CFI launches Navigator, an online search tool
A new web service is making it easier for university laboratories and research centres to showcase their expertise and facilities to businesses seeking research partners.
Over-90s ambulance trips ‘rising’
The number of over-90s brought to A&E by ambulance in England has risen over the past five years, NHS data shows. There were 300,039 trips in 2012-13 compared to 147,325 in 2007-08 – a rise of 104%, according to the Health and Social Care Information Centre
A Knowledge Broker’s Perspective on Research
Michael Johnny, Manager, Knowledge Mobilization at York University outlines three fundamental aspects of knowledge mobilization.
Infection prevention and control in residential and community aged care
The National Health and Medical Research Council of Australia have put together the Infection Prevention and Control in residential and community aged care guide for staff of long-term care to help stop the spread of infection.
This website gives a detailed overview of how long-term care homes and staff can handle complaints in their facilities.
Opportunities
Managing Editor Support
Cochrane Editorial Unit, Flexible location
DEADLINE 7 February
The Cochrane Editorial Unit (CEU) is part of The Cochrane Collaboration, and was established in 2009 under the direction of the Editor in Chief of The Cochrane Library, Dr David Tovey. The CEU team supports all 53 Cochrane Review Groups (CRGs) and other entities to ensure that The Cochrane Library continues to meet the needs of users, and appropriately reflects the commitment of CRG teams and authors.
Assistant/Associate Professor
UBC School of Population and Public Health Vancouver BC
DEADLINE 1 March
The position seeks a cancer prevention researcher with research expertise in modifiable risk factors such as tobacco control, diet and nutrition, obesity and energy balance, physical activity, occupational and environmental exposures, and emerging risk factors including infectious agents.
NHS Clinical Effectiveness Team Leader
DEADLINE 14 February UK
This is an exciting time to join our dedicated Clinical Effectiveness team. We are seeking an exceptional candidate to lead this team and provide the strategic direction and be responsible for the operational delivery of the clinical effectiveness function across Central Southern CSU. Working to the Associate Director Commissioning, Strategic Planning & Service Redesign, and with the support of two Clinical Effectiveness Managers, the Team Leader will ensure the provision of a high quality priority-setting and clinical effectiveness service to our customers, so that both commissioned and provider services take account of evidence-based practices, national guidance and standards, and are supported to deliver clinically effective care within the national legislative framework.
Journal of Psychiatric and Mental Health Nursing
DEADLINE March 25
The Journal of Psychiatric and Mental Health Nursing is an international, peer-reviewed publication providing a forum for the publication of original contributions that lead to the advancement of psychiatric and mental health nursing practice. It publishes papers which reflect developments in knowledge, attitudes and skills, and integration of these into practice.
