February 18, 2014

Grants & Awards

TREC is tweeting. Follow us @TRECResearch


New TREC article
Facility versus unit level reporting of quality indicators in nursing homes when performance monitoring is the goal
Norton PG, Murray M, Doupe MB, Cummings GG, Poss JW, Squires JE, et al.
BMJ Open 2014;4(2)

To demonstrate the benefit of defining operational management units in nursing homes and computing quality indicators on these units as well as on the whole facility. Design Calculation of adjusted Resident Assessment Instrument – Minimum Data Set 2.0 (RAI–MDS 2.0) quality indicators for: PRU05 (prevalence of residents with a stage 2–4 pressure ulcer), PAI0X (prevalence of residents with pain) and DRG01 (prevalence of residents receiving an antipsychotic with no diagnosis of psychosis), for quarterly assessments between 2007 and 2011 at unit and facility levels. Comparisons of these risk-adjusted quality indicators using statistical process control (control charts). Setting A representative sample of 30 urban nursing homes in the three Canadian Prairie Provinces. Measurements Explicit decision rules were developed and tested to determine whether the control charts demonstrated improving, worsening, unchanging or unclassifiable trends over the time period. Unit and facility performance were compared. Results In 48.9% of the units studied, unit control chart performance indicated different changes in quality over the reporting period than did the facility chart. Examples are provided to illustrate that these differences lead to quite different quality interventions. Conclusions Our results demonstrate the necessity of considering facility-level and unit-level measurement when calculating quality indicators derived from the RAI–MDS 2.0 data, and quite probably from any RAI measures.

New article by Matthias Hoben, Janet Squires, and Carole Estabrooks
Linguistic validation of the Alberta Context Tool and two measures of research use, for German residential long term care
Hoben M, Bar M, Mahler C, Berger S, Squires J, Estabrooks C, et al.
BMC Research Notes 2014;7(1):67

To study the association between organizational context and research utilization in German residential long term care (LTC), we translated three Canadian assessment instruments: the Alberta Context Tool (ACT), Estabrooks’ Kinds of Research Utilization (RU) items and the Conceptual Research Utilization Scale. Target groups for the tools were health care aides (HCAs), registered nurses (RNs), allied health professionals (AHPs), clinical specialists and care managers. Through a cognitive debriefing process, we assessed response processes validity–an initial stage of validity, necessary before more advanced validity assessment. Methods We included 39 participants (16 HCAs, 5 RNs, 7 AHPs, 5 specialists and 6 managers) from five residential LTC facilities. We created lists of questionnaire items containing problematic items plus items randomly selected from the pool of remaining items. After participants completed the questionnaires, we conducted individual semi-structured cognitive interviews using verbal probing. We asked participants to reflect on their answers for list items in detail. Participants’ answers were compared to concept maps defining the instrument concepts in detail. If at least two participants gave answers not matching concept map definitions, items were revised and re-tested with new target group participants. Results Cognitive debriefings started with HCAs. Based on the first round, we modified 4 of 58 ACT items, 1 ACT item stem and all 8 items of the RU tools. All items were understood by participants after another two rounds. We included revised HCA ACT items in the questionnaires for the other provider groups. In the RU tools for the other provider groups, we used different wording than the HCA version, as was done in the original English instruments. Only one cognitive debriefing round was needed with each of the other provider groups. Conclusion Cognitive debriefing is essential to detect and respond to problematic instrument items, particularly when translating instruments for heterogeneous, less well educated provider groups such as HCAs. Cognitive debriefing is an important step in research tool development and a vital component of establishing response process validity evidence. Publishing cognitive debriefing results helps researchers to determine potentially critical elements of the translated tools and assists with interpreting scores.

New Article by Dr. Whitney Berta
Seeking Accountability: Multi-Service Accountability Agreements (MSAAs) in Ontario’s Community Support Sector Canada-flat-icon
Steele Gray CA, Berta W, Deber R, Lum J
Health Reform Observer 2(1);2014

Multi-Service Accountability Agreements (MSAAs) have been put in place to hold Community Sector Service (CSS) agencies to account for services receiving public funding in Ontario. The MSAA seeks to support financial and performance accountability, requiring CSS agencies to report on their performance quarterly. The MSAA is an expenditure policy tool that has undergone several iterations, each informed by negotiations between the Ontario Ministry of Health and Long-term Care (MOHLTC), the province’s regional authorities – known as Local Health Integration Networks (LHINs) – and organizations/associations representing CSS agency interests. This approach to accountability is consistent with a broader focus on the government role as “steering” service delivery rather than “rowing.” The MSAA offers a standardized, politically acceptable approach to accountability. However, the MSAA relies heavily on performance indicators that may not adequately reflect quality care. The MSAA exemplifies the tension between the need for strong standardized accountability requirements for publicly-funded health service providers and the need for services that meet the needs of their communities.

New article by Dr. Susan Slaughter
Making the most of mealtimes (m3): grounding mealtime interventions with a conceptual model.
Non UofA Access
Keller H, Carrier N, Duizer L, Lengyel C, Slaughter S, Steele C.
Journal of the American Medical Directors Association 2014 Mar;15(3):158-161.

Mealtime is a complex process with multiple levels of influence, including residents, staff, home, and government. Intervention research needs to be based on a conceptual framework grounded in current evidence that demonstrates that there are several influences on the varied activities (eg, arriving, eating, waiting, socializing) that occur during a mealtime 3 and that there are several intermediate (eg, BPSD, food intake, strength) and ultimate outcomes (eg, nutritional status, comorbidity, quality of life, functional ability, mortality) to consider

TREC’s A Profile of Residents in Prairie Nursing Homes was one of the most downloaded articles in Canadian Journal on Aging in 2013. And it’s free to access until March 31st.

CALL FOR ABSTRACTS: KT Canada Annual Scientific Meeting 2014
12-13 June Québec City, PQ
DEADLINE 17 March 21:59 MT

We invite you to join the discussion on de-adoption of ineffective or untested clinical practices through attendance at the KT Canada Annual Scientific Meeting. Advancing our collective knowledge of this issue is critical because abandoning ineffective or harmful practices are essential for improving patient health and strengthening our health care system. We invite interested people to submit an abstract on advancing KT science. Special consideration will be given to those that focus on de-adoption and or economic analysis of de-adoption strategies.

CALL FOR CONTENT: Call for content for the Canadian Knowledge Mobilization Forum 2014
Saskatoon SK 9-10 June

The 2014 Canadian Knowledge Mobilization Forum will focus on “Putting Research to Work”. We will examine the results of Knowledge Mobilization activities that lead to social and economic innovation – for individuals, families, communities, businesses, non-profit organizations and international collaborative agencies.

CALL FOR ABSTRACTS: KT Canada Annual Scientific Meeting 2014
12-13 June Québec City, PQ
DEADLINE 17 March 21:59 MT

We invite you to join the discussion on de-adoption of ineffective or untested clinical practices through attendance at the KT Canada Annual Scientific Meeting. Advancing our collective knowledge of this issue is critical because abandoning ineffective or harmful practices are essential for improving patient health and strengthening our health care system. We invite interested people to submit an abstract on advancing KT science. Special consideration will be given to those that focus on de-adoption and or economic analysis of de-adoption strategies.

CALL FOR PAPERS: Exploring Mixed Methods in Organizational Sciences
DEADLINE to submit a 5 – 7 page proposal 30 June 2014

Organizational Research Methods invites papers for a Feature Topic on Mixed Methods in the Organizational Sciences. Guest editors for this feature topic are Jose F. Molina-Azorin, Donald Bergh, Kevin Corley, and David Ketchen.
Topics include, but are not limited to:
– Philosophy of science issues related to mixed methods research
– Explanations of how mixed methods can help to carry out context specific research.
– Evaluations of how mixed methods can enhance organizational research by carrying out multilevel studies and bridging macro and micro inquiry
– Guidance on how mixed methods can simultaneously examine outcomes and process issues.
– Analysis of the implications and opportunities of mixed methods to bridge the science practice gap, emphasizing the relevance of mixed methods studies to practice.
– Development and validation of new measures using a mixed methods approach.
– Quality issues in mixed methods in organizational sciences.

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Grants & Awards

AIHS Announces the 2014 Partnership for Research and Innovation in the Health System (PRIHS) Competition
DEADLINE for LOI 4 April 16:00 MT

The Partnership for Research and Innovation in the Health System (PRIHS) is a partnership between Alberta Innovates – Health Solutions (AIHS) and Alberta Health Services (AHS) aimed at improving health outcomes for patients across Alberta. This partnered funding opportunity targets high impact research activities within the AHS Strategic Clinical Networks (SCNs) [see box] that align with the priorities identified in the Alberta’s Health Research and Innovation Strategy (AHRIS) and the AHS Health Plan. PRIHS supports networks of health researchers and clinical practitioners across the continuum of care, with an emphasis on population health and community and primary care, that can reassess potentially inefficient activities within the health system and identify sustainable solutions to improve overall quality of care and value for money in the health system.

NCCMT: KT graduate student award

Each year, the National Collaborating Centres for Public Health (NCCPH) recognizes the work of graduate students regarding knowledge translation (KT) in public health in Canada. The award is open to students who are currently enrolled in a graduate program (full or part-time) OR students who completed a graduate degree in the last 12 months. Applicants must be students at a Canadian academic institution, and in a discipline relevant to public health.

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Health Care Administration and Organization
Health Care Innovation and Quality Assurance
Organizational Change
Research Practice & Methodology


Knowledge transfer activities in social sciences and humanities: Explaining the interactions of research groups with non-academic agents
Non UofA Access
Olmos-Peñuela J, Castro-Martínez E, D’Este P.
Research Policy 2014

The aim of this research is to achieve a better understanding of the processes underlying knowledge transfer (KT) in social sciences and humanities (SSH). The paper addresses: first, the extent of SSH research groups’ engagement in KT and the formal KT activities used to interact with non-academic communities; and second, how the characteristics of research groups may influence engagement in various types of KT. The empirical analysis is at research group level using data derived from a questionnaire of SSH research groups belonging to the Spanish Council for Scientific Research (CSIC). We find that KT activities are based on relational rather than commercial activities. The most frequent relational activities in which SSH research groups engage are consultancy and contract research. We find also that the characteristics of research groups (e.g. size and multidisciplinarity) and individuals (e.g. academic status and star scientist) are associated with involvement in KT activities and that a deliberate focus on the societal impacts and relevance of the research conducted is strongly related to active engagement of research groups in all the modes of KT considered in this study. From a managerial perspective, our findings suggest that measures promoting a focus on the societal impact of research could enhance research groups’ engagement in KT activities. © 2013 Elsevier B.V. All rights reserved.

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Health Care Administration and Organization

Impact of a fixed price system on the supply of institutional long-term care: a comparative study of Japanese and German metropolitan areas.
Non UofA Access
Yoshida K, Kawahara K.
BMC health services research 2014 Feb 1;14(1):48

The need for institutional long-term care is increasing as the population ages and the pool of informal care givers declines. Care services are often limited when funding is controlled publicly. Fees for Japanese institutional care are publicly fixed and supply is short, particularly in expensive metropolitan areas. Those insured by universal long-term care insurance (LTCI) are faced with geographically inequitable access. The aim of this study was to examine the impact of a fixed price system on the supply of institutional care in terms of equity. METHODS: The data were derived from official statistics sources in both Japan and Germany, and a self-administered questionnaire was used in Japan in 2011. Cross-sectional multiple regression analyses were used to examine factors affecting bed supply of institutional/residential care in fixed price and free prices systems in Tokyo (Japan), and an individually-bargained price system in North Rhine-Westphalia (Germany). Variables relating to costs and needs were used to test hypotheses of cost-dependency and need-orientation of bed supply in each price system. Analyses were conducted using data both before and after the introduction of LTCI, and the results of each system were qualitatively compared. RESULTS: Total supply of institutional care in Tokyo under fixed pricing was found to be cost-dependent regarding capital costs and scale economies, and negatively related to need. These relationships have however weakened in recent years, possibly caused by political interventions under LTCI. Supply of residential care in Tokyo under free pricing was need-oriented and cost-dependent only regarding scale economies. Supply in North Rhine-Westphalia under individually bargained pricing was cost-independent and not negatively related to need. CONCLUSIONS: Findings suggest that publicly funded fixed prices have a negative impact on geographically equitable supply of institutional care. The contrasting results of the non-fixed-price systems for Japanese residential care and German institutional care provide further theoretical supports for this and indicate possible solutions against inequitable supply.

The relationship between small-scale nursing home care for people with dementia and staff’s perceived job characteristics.
Non UofA Access
Willemse BM, Depla MF, Smit D, Pot AM.
International psychogeriatrics 2014 Feb 10:1-12

Over the past few decades, new care models that are more resident-oriented and directed toward small-scale and homelike environments have been developed worldwide. The impact of these care models on the quality of life of residents has been studied. However, little research has been conducted to gain insight into how these new care models influence healthcare staff’s work environment. This study focuses on the consequences of small-scale care on staff’s perceived job characteristics. Methods: Data were derived from a sample of 136 Dutch living arrangements providing nursing home care for people with dementia (2008/2009), in which 1,327 residents and 1,147 staff participated. The relationship between two indicators of small-scale care (small-scale care characteristics and total number of residents with dementia in facility) and staff’s job characteristics (job demands, decision authority, coworker and supervisor support) were studied with multilevel regression analyses. All analyses were adjusted for staff, resident, and living arrangement characteristics when needed. Results: Both indicators of small-scale care were associated with job demands; staff perceived less time and work pressure as more characteristics of small-scale care were integrated and the facility had less residents with dementia in total. Only one indicator was associated with decision authority. As more characteristics of small-scale care were integrated, staff’s perceived decision authority was higher. No relationship was found with coworker and supervisor social support. Conclusions: Knowing that job demands and decision authority are important predictors of job appraisal and well-being, our findings show that small-scale care could have a beneficial impact on healthcare staff’s work environment.

Effects of Person-Centered Care Approaches to Dementia Care on Staff: A Systematic Review.
Non UofA Access
Barbosa A, Sousa L, Nolan M, Figueiredo D.
American Journal of Alzheimer’s Disease and Other Dementias 2014 Jan 20

Person-centered care (PCC) has been the subject of several intervention studies reporting positive effects on people with dementia. However, its impact on staff remains unclear. The purpose of this systematic review was to assess the impact of PCC approaches on stress, burnout, and job satisfaction of staff caring for people with dementia in residential aged care facilities. Research articles published up to 2013 were searched on PubMed, Web of Knowledge, Scopus, and EBSCO and reference lists from relevant publications. The review was limited to experimental and quasi-experimental studies, published in English and involving direct care workers (DCWs). In all, 7 studies were included, addressing different PCC approaches: dementia care mapping (n = 1), stimulation-oriented approaches (n = 2), emotion-oriented approaches (n = 2), and behavioral-oriented approaches (n = 2). Methodological weaknesses and heterogeneity among studies make it difficult to draw firm conclusions. However, 5 studies reported benefits on DCWs, suggesting a tendency toward the effectiveness of PCC on staff.

Associations between state regulations, training length, perceived quality and job satisfaction among certified nursing assistants: Cross-sectional secondary data analysis.
Non UofA Access
Han K, Trinkoff AM, Storr CL, Lerner N, Johantgen M, Gartrell K.
International journal of nursing studies 2014 Jan 8

In the U.S., there are federal requirements on how much training and annual continuing education a certified nursing assistant must complete in order to be certified. The requirements are designed to enable them to provide competent and quality care to nursing home residents. Many states also require additional training and continuing education hours as improved nursing home quality indicators have been found to be related to increased training. OBJECTIVES: This study investigated the associations among state level regulations, initial training quality and focus, and job satisfaction in certified nursing assistants. DESIGN: Cross-sectional secondary data analysis. SETTINGS: This study used the National Nursing Home Survey and National Nursing Assistant Survey as well as data on state regulations of certified nursing assistant training. PARTICIPANTS: 2897 certified nursing assistants in 580 nursing homes who were currently working at a nursing home facility, who represented 680,846 certified nursing assistants in US. METHODS: State regulations were related to initial training and job satisfaction among certified nursing assistants using chi square tests and binomial logistic regression models. Analyses were conducted using SAS-callable SUDAAN to correct for complex sampling design effects in the National Nursing Home Survey and National Nursing Assistant Survey. Models were adjusted for personal and facility characteristics. RESULTS: Certified nursing assistants reporting high quality training were more likely to work in states requiring additional initial training hours (p=0.02) and were more satisfied with their jobs (OR=1.51, 95% CI=1.09-2.09) than those with low quality training. In addition, those with more training focused on work life skills were 91% more satisfied (OR=1.91, 95% CI=1.41-2.58) whereas no relationship was found between training focused on basic care skills and job satisfaction (OR=1.36, 95% CI=0.99-1.84). CONCLUSIONS: Certified nursing assistants with additional initial training were more likely to report that their training was of high quality, and this was related to job satisfaction. Job satisfaction was also associated with receiving more training that focused on work life skills. Federal training regulations should reconsider additional hours for certified nursing assistant initial training, and include work life skills as a focus. As job satisfaction has been linked to nursing home turnover, attention to training may improve satisfaction, ultimately reducing staff turnover. Copyright © 2014 Elsevier Ltd. All rights reserved.

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Health Care Innovation and Quality Assurance

Nurse Staffing Impact on Quality of Care in Nursing Homes: A Systematic Review of Longitudinal Studies
Non UofA Access
Backhaus R, Verbeek H, Rossum Ev, Capezuti E, Hamers JPH.
Journal of the American Medical Directors Association 2014

The relationship between nurse staffing and quality of care (QoC) in nursing homes continues to receive major attention. The evidence supporting this relationship, however, is weak because most studies employ a cross-sectional design. This review summarizes the findings from recent longitudinal studies. Methods In April 2013, the databases PubMed, CINAHL, EMBASE, and PsycINFO were systematically searched. Studies were eligible if they (1) examined the relationship between nurse staffing and QoC outcomes, (2) included only nursing home data, (3) were original research articles describing quantitative, longitudinal studies, and (4) were written in English, Dutch, or German. The methodological quality of 20 studies was assessed using the Newcastle-Ottawa scale, excluding 2 low-quality articles for the analysis. Results No consistent relationship was found between nurse staffing and QoC. Higher staffing levels were associated with better as well as lower QoC indicators. For example, for restraint use both positive (ie, less restraint use) and negative outcomes (ie, more restraint use) were found. With regard to pressure ulcers, we found that more staff led to fewer pressure ulcers and, therefore, better results, no matter who (registered nurse, licensed practical nurse/ licensed vocational nurse, or nurse assistant) delivered care. Conclusions No consistent evidence was found for a positive relationship between staffing and QoC. Although some positive indications were suggested, major methodological and theoretical weaknesses (eg, timing of data collection, assumed linear relationship between staffing and QoC) limit interpretation of results. Our findings demonstrate the necessity for well-designed longitudinal studies to gain a better insight into the relationship between nurse staffing and QoC in nursing homes.

Use of telemedicine can reduce hospitalizations of nursing home residents and generate savings for medicare.
Non UofA Access
Grabowski DC, O’Malley AJ.
Health affairs (Project Hope) 2014 Feb;33(2):244-250

Hospitalizations of nursing home residents are frequent and result in complications, morbidity, and Medicare expenditures of more than a billion dollars annually. The lack of a physician presence at many nursing homes during off hours might contribute to inappropriate hospitalizations. Findings from our controlled study of eleven nursing homes provide the first indications that switching from on-call to telemedicine physician coverage during off hours could reduce hospitalizations and therefore generate cost savings to Medicare in excess of the facility’s investment in the service. But those savings were evident only at the study nursing homes that used the telemedicine service to a greater extent, compared to the other study facilities. Telemedicine service providers and nursing home leaders might need to take additional steps to encourage buy-in to the use of telemedicine at facilities with such services. At the same time, closer alignment of the stakeholders that bear the costs of telemedicine and those that might realize savings because of its use could offer further incentives for the adoption of telemedicine.

Lean thinking in hospitals: is there a cure for the absence of evidence? A systematic review of reviews
Andersen H, Røvik KA, Ingebrigtsen T.
BMJ Open 2014;4(1)

Lean interventions aim to improve quality of healthcare by reducing waste and facilitate flow in work processes. There is conflicting evidence on the outcomes of lean thinking, with quantitative and qualitative studies often contradicting each other. We suggest that reviewing the literature within the approach of a new contextual framework can deepen our understanding of lean as a quality-improvement method. This article theorises the concept of context by establishing a two-dimensional conceptual framework acknowledging lean as complex social interventions, deployed in different organisational dimensions and domains. The specific aim of the study was to identify factors facilitating intended outcomes from lean interventions, and to understand when and how different facilitators contribute. Design A two-dimensional conceptual framework was developed by combining Shortell’s Dimensions of capability with Walshes’ Domains of an intervention. We then conducted a systematic review of lean review articles concerning hospitals, published in the period 2000–2012. The identified lean facilitators were categorised according to the intervention domains and dimensions of capability provided by the framework. Results We provide a framework emphasising context by relating facilitators to domains and dimensions of capability. 23 factors enabling a successful lean intervention in hospitals were identified in the systematic review, where management and a supportive culture, training, accurate data, physicians and team involvement were most frequent. Conclusions In the absence of evidence, the two-dimensional framework, incorporating the context, may prove useful for future research on variation in outcomes from lean interventions. Findings from the review suggest that characteristics and local application of lean, in addition to strategic and cultural capability, should be given further attention in healthcare quality improvement.

The impact of competition on quality and prices in the English care homes market.
Non UofA Access
Forder J, Allan S.
Journal of health economics 2013 Dec 30;34C:73-83

This study assesses the impact of competition on quality and price in the English care/nursing homes market. Considering the key institutional features, we use a theoretical model to assess the conditions under which further competition could increase or reduce quality. A dataset comprising the population of 10,000 care homes was used. We constructed distance/travel-time weighted competition measures. Instrumental variable estimations, used to account for the endogeneity of competition, showed quality and price were reduced by greater competition. Further analyses suggested that the negative quality effect worked through the effect on price – higher competition reduces revenue which pushes down quality. Copyright © 2013 Elsevier B.V. All rights reserved.

The public gets what the public wants: Experiences of public reporting in long-term care in Europe.
Non UofA Access
Rodrigues R, Trigg L, Schmidt AE, Leichsenring K.
Health policy (Amsterdam, Netherlands) 2014 Jan 8

Public reporting of quality in long-term care is advocated on the basis of allowing providers to improve their performance by benchmarking and supporting users to choose the best providers. Both mechanisms are intended to drive improvements in quality. However, there is relatively scarce comparative research on the experiences and impact of public reporting on quality in long-term care in Europe. METHODS: Using information gathered from key informants by means of a structured questionnaire and country profiles, this paper discusses experiences with public reporting mechanisms in seven European countries and available information on their impact on quality in long-term care. RESULTS: Countries surveyed included a variety of public reporting schemes, ranging from pilot programmes to statutory mechanisms. Public reporting mechanisms more often focus on institutional care. Inspections carried out as part of a legal quality assurance framework are the main source of information gathering, supplemented by provider self-assessments in the context of internal quality management and user satisfaction surveys. Information on quality goes well beyond structural indicators to also include indicators on quality of life of users. Information is displayed using numerical scores (percentages), but also measures such as ratings (similar to school grades) and ticks and crosses. Only one country corrects for case-mix. The internet is the preferred medium of displaying information. DISCUSSION: There was little evidence to show whether public reporting has a significant impact on driving users’ choices of provider. Studies reported low awareness of quality indicators among potential end users and information was not always displayed in a convenient format, e.g. through complicated numerical scores. There is scarce evidence of public reporting directly causing improved quality, although the relative youth and the pilot characteristics of some of the schemes covered here could also have contributed to downplay their impact. The establishment of public reporting mechanisms did however contribute to shaping the discussion on quality measurement in several of the countries surveyed. CONCLUSIONS: The findings presented in this paper highlight the need to consider some factors in the discussion of the impact of public reporting in long-term care, namely, the organisation of care markets, frequently characterised by limited competition; the circumstances under which user choice takes place, often made under conditions of duress; and the leadership conditions needed to bring about improvements in quality in different care settings. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Prevalence and quality of clinical pathways in Swedish intensive care units: a national survey.
Non UofA Access
Bjurling-Sjoberg P, Jansson I, Wadensten B, Engstrom G, Poder U.
Journal of evaluation in clinical practice 2014 Feb;20(1):48-57

To identify the prevalence of clinical pathways (CPs) in Swedish intensive care units (ICUs) and to explore the quality, content and evidence base of the documents. METHODS: A descriptive and explorative survey of all Swedish ICUs (N84) and a review of submitted examples of CPs (n12) were conducted. RESULTS: CPs were in use at 20% of the Swedish ICUs. There was a significant geographic variation but no relationship between the use of CPs and category of hospital, type of ICU, size of ICU or type of health record applied. In total, 56 CPs were reported within a range of scopes and extensions. The content of the ICUs’ CPs, as well as the degree to which they were interprofessional, evidence based, and renewed varied. CONCLUSIONS: Progress has been made in relation to CPs in recent years, but there is potential for further improvements. None of the ICUs had CPs that contained all key characteristics of a high-quality, interprofessional and evidence-based CP identified in the literature. Greater knowledge sharing and cooperation within the field would be beneficial, and further research is needed. © 2013 John Wiley & Sons, Ltd.

Enhanced fidelity to treatment for bipolar disorder: results from a randomized controlled implementation trial.
Non UofA Access
Waxmonsky J, Kilbourne AM, Goodrich DE, Nord KM, Lai Z, Laird C, et al.
Psychiatric services (Washington, D.C.) 2014 Jan 1;65(1):81-90

The authors compared fidelity to bipolar disorder treatment at community practices that received a standard or enhanced version of a novel implementation intervention called Replicating Effective Programs (REP). METHODS Five community practices in Michigan and Colorado were assigned at random to receive enhanced (N=3) or standard (N=2) REP to help implement Life Goals Collaborative Care (LGCC), a psychosocial intervention consisting of four self-management support group sessions, ongoing care management contacts by phone, and dissemination of guidelines to providers. Standard REP includes an intervention package consisting of an outline, a treatment manual and implementation guide, a standard training program, and as-needed technical assistance. Enhanced REP added customization of the treatment manual and ongoing, proactive technical assistance from internal and external facilitators. Multiple and logistic regression analyses determined the impact of enhanced versus standard REP on patient-level fidelity. RESULTS The participants (N=384) had a mean age of 42 years; 67% were women, and 30% were nonwhite. Participants attended an average of three group sessions and had an average of four care management contacts. After adjustment for patient factors, enhanced REP was associated with 2.6 (p<.001) times more total sessions and contacts than standard REP, which was driven by 2.5 (p<.01) times more care management contacts. Women and participants with a history of homelessness had fewer total sessions and contacts. CONCLUSIONS Enhanced REP was associated with improved LGCC fidelity, primarily for care management contacts. Additional customization of interventions such as LGCC may be needed to ensure adequate treatment fidelity for vulnerable populations.

Development and Testing of a Decision Aid on Goals of Care for Advanced Dementia
Non UofA Access
Einterz SF, Gilliam R, Chang Lin F, McBride JM, Hanson LC.
Journal of the American Medical Directors Association

Decision aids are effective to improve decision-making, yet they are rarely tested in nursing homes (NHs). Study objectives were to (1) examine the feasibility of a goals of care (GOC) decision aid for surrogate decision-makers (SDMs) of persons with dementia; and (2) to test its effect on quality of communication and decision-making. Design Pre-post intervention to test a GOC decision aid intervention for SDMs for persons with dementia in NHs. Investigators collected data from reviews of resident health records and interviews with SDMs at baseline and 3-month follow-up. Setting Two NHs in North Carolina. Participants Eighteen residents who were over 65 years of age, had moderate to severe dementia on the global deterioration scale (5, 6, or 7), and an English-speaking surrogate decision-maker. Intervention (1) GOC decision aid video viewed by the SDM and (2) a structured care plan meeting between the SDM and interdisciplinary NH team. Measurements Surrogate knowledge, quality of communication with health care providers, surrogate-provider concordance on goals of care, and palliative care domains addressed in the care plan. Results Eighty-nine percent of the SDMs thought the decision aid was relevant to their needs. After viewing the video decision aid, SDMs increased the number of correct responses on knowledge-based questions (12.5 vs 14.2; P < .001). At 3 months, they reported improved quality of communication scores (6.1 vs 6.8; P = .01) and improved concordance on primary goal of care with NH team (50% vs 78%; P = .003). The number of palliative care domains addressed in the care plan increased (1.8 vs 4.3; P < .001). Conclusions The decision-support intervention piloted in this study was feasible and relevant for surrogate decision-makers of persons with advanced dementia in NHs, and it improved quality of communication between SDM and NH providers. A larger randomized clinical trial is underway to provide further evidence of the effects of this decision aid intervention.

Discriminant content validity of a theoretical domains framework questionnaire for use in implementation research.
Non UofA Access
Huijg JM, Gebhardt WA, Crone MR, Dusseldorp E, Presseau J.
Implementation science 2014 Jan 15;9(1):11-5908-9-11

To improve the implementation of innovations in healthcare settings, it is important to understand factors influencing healthcare professionals’ behaviors. We aimed to develop a generic questionnaire in English and in Dutch assessing the 14 domains of behavioral determinants from the revised TDF (Cane et al., 2012) that can be tailored to suit different targets, actions, contexts, and times of interest, and to investigate questionnaire items’ discriminant content validity. METHODS: We identified existing questionnaires including items assessing constructs within TDF domains and developed new items where needed. Nineteen judges allocated 79 items to one or more TDF domains. One-sample t-tests were used to examine the discriminant content validity of each item, i.e., whether items measured intended domains or whether items measured a combination of domains. RESULTS: We identified items judged to discriminately measure 11 out of 14 domains. Items measuring the domains Reinforcement, Goals, and Behavioral regulation were judged to measure a combination of domains. CONCLUSIONS: We have developed a questionnaire in English and in Dutch able to discriminately assess the majority of TDF domains. The results partly support Cane et al.’s (2012) 14-domain validation of the TDF and suggest that Michie et al.’s (2005) 12-domain original version might be more applicable in developing a TDF-based questionnaire. The identified items provide a robust basis for developing a questionnaire to measure TDF-based determinants of healthcare professionals’ implementation behaviors to suit different targets, actions, contexts, and times. Future research should investigate the concurrent and predictive validity and reliability of such a questionnaire in practice.

The Interventions to Reduce Acute Care Transfers (INTERACT) Quality Improvement Program: An Overview for Medical Directors and Primary Care Clinicians in Long Term Care.
Non UofA Access
Ouslander JG, Bonner A, Herndon L, Shutes J.
Journal of the American Medical Directors Association 2014 Mar;15(3):162-170

Interventions to Reduce Acute Care Transfers (INTERACT) is a publicly available quality improvement program that focuses on improving the identification, evaluation, and management of acute changes in condition of nursing home residents. Effective implementation has been associated with substantial reductions in hospitalization of nursing home residents. Familiarity with and support of program implementation by medical directors and primary care clinicians in the nursing home setting are essential to effectiveness and sustainability of the program over time. In addition to helping nursing homes prevent unnecessary hospitalizations and their related complications and costs, and thereby continuing to be or becoming attractive partners for hospitals, health care systems, managed care plans, and accountable care organizations, effective INTERACT implementation will assist nursing homes in meeting the new requirement for a robust quality assurance performance improvement program, which is being rolled out by the federal government over the next year. Copyright © 2014 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Rogers’ Innovation Adoption Attributes: A Systematic Review and Synthesis of Existing Research
Non UofA Access
Kapoor KK, Dwivedi YK, Williams MD.
Inf Syst Manage 2014;31(1):74-91.

A systematic approach is adopted to review the literature, followed by a meta-analysis of articles on Rogers’ innovation-attributes. All publications from 1996-2011 are extracted; 226 relevant innovation articles are studied to showcase the informative trends pertaining to Rogers’ five attributes-eight features of ideal innovation-attribute study (approach, dependent variable, study type, instrument, measure, attributes, innovations, adopting unit), and antecedents-descendants of Rogers’ innovation attributes. These findings, limitations, and future research suggestions are presented. © 2014 Copyright Taylor and Francis Group, LLC.

Creating peer groups for assessing and comparing nursing home performance.
Non UofA Access
Byrne MM, Daw C, Pietz K, Reis B, Petersen LA.
The American Journal of Managed Care 2013 Nov;19(11):933-939

Publicly reported performance data for hospitals and nursing homes are becoming ubiquitous. For such comparisons to be fair, facilities must be compared with their peers. Objectives: To adapt a previously published methodology for developing hospital peer groupings so that it is applicable to nursing homes and to explore the characteristics of “nearest-neighbor” peer groupings. Study Design: Analysis of Department of Veterans Affairs administrative databases and nursing home facility characteristics. Methods: The nearest-neighbor methodology for developing peer groupings involves calculating the Euclidean distance between facilities based on facility characteristics. We describe our steps in selection of facility characteristics, describe the characteristics of nearest-neighbor peer groups, and compare them with peer groups derived through classical cluster analysis. Results: The facility characteristics most pertinent to nursing home groupings were found to be different from those that were most relevant for hospitals. Unlike classical cluster groups, nearest neighbor groups are not mutually exclusive, and the nearest-neighbor methodology resulted in nursing home peer groupings that were substantially less diffuse than nursing home peer groups created using traditional cluster analysis. Conclusion: It is essential that healthcare policy makers and administrators have a means of fairly grouping facilities for the purposes of quality, cost, or efficiency comparisons. In this research, we show that a previously published methodology can be successfully applied to a nursing home setting. The same approach could be applied in other clinical settings such as primary care.

Impact of Provider Coordination on Nurse and Physician Perceptions of Patient Care Quality.
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McIntosh N, Burgess JF,Jr, Meterko M, Restuccia JD, Alt-White AC, Kaboli P, et al.
Journal of nursing care quality 2014 Feb 6

The objective of this study was to assess the role of provider coordination on nurse manager and physician perceptions of care quality, while controlling for organizational factors. Findings indicated that nurse-nurse coordination was positively associated with nurse manager perceptions of care quality; neither physician-physician nor physician-nurse coordination was associated with physician perceptions. Organizational factors associated with positive perceptions of care quality included facility support of education for nurses and physicians, and the use of multidisciplinary rounding.

Regulating Long-Term Care Quality: An International Comparison
Available for purchase March 2014. A copy is on order for UofA Libraries
Includes chapter by Dr. John Hirdes

The number of elderly people relying on formal long-term care services is dramatically increasing year after year, and the challenge of ensuring the quality and financial stability of care provision is one faced by governments in both the developed and developing world. This edited book is the first to provide a comprehensive international survey of long-term care provision and regulation, built around a series of case studies from Europe, North America and Asia. The analytical framework allows the different approaches that countries have adopted to be compared side by side and readers are encouraged to consider which quality assurance approaches might best meet their own country’s needs. Wider issues underpinning the need to regulate the quality of long-term care are also discussed. This timely book is a valuable resource for policymakers working in the health care sector, researchers and students taking graduate courses on health policy and management.

Using clinical communities to improve quality (UK)
Health Foundation Inspiring Improvement, Dec 2013

This report introduces an approach – the clinical community – used by the Health Foundation’s Closing the Gap through Clinical Communities programme to support and secure improvements in health systems across multiple sites. The programme supported 11 clinical communities to come together around shared goals, to learn from each other but with the latitude to develop and apply local solutions. The programme has led to a range of improvements in the quality of care which continue to be sustained today.

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Organizational Change

Culture as a predictor of resistance to change: A study of competing values in a psychiatric nursing context.
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Johansson C, Astrom S, Kauffeldt A, Helldin L, Carlstrom E.
Health policy (Amsterdam, Netherlands) 2014 Feb;114(2-3):156-162

It is well known that a conservative organizational culture can hinder the implementation of new organizational models. Prior to introducing something new it is important to identify the culture within the organization. This paper sets out to detect the feasibility of reform in a psychiatric clinic in a Swedish hospital prior to implementation of a new working method – a structured tool based on the International Classification of Functioning Disability and Health. A survey consisting of two instruments – an organizational values questionnaire (OVQ) and a resistance to change scale (RTC) – was distributed to registered and assistant nurses at the clinic. The association between the organizational subcultures and resistance to change was investigated with regression analysis. The results revealed that the dominating cultures in the outpatient centers and hospital wards were characterized by human relation properties such as flexibility, cohesion, belongingness, and trust. The mean resistance to change was low, but the subscale of cognitive rigidity was dominant, reflecting a tendency to avoid alternative ideas and perspectives. An instrument like the one employed in the study could be a useful tool for diagnosing the likelihood of extensive and costly interventions. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Connections count: How relational embeddedness and relational empowerment foster absorptive capacity
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Ebers M, Maurer I.
Research Policy 2014;43(2):318-332

While research has produced ample evidence showing that absorptive capacity affects innovation and organizational performance outcomes, we still know little about why some organizations possess greater absorptive capacity than others. This study extends previous research by showing how absorptive capacity emerges as an unintended consequence from organizational boundary spanners’ external and internal relational embeddedness and their relational empowerment. Drawing upon survey data from 218 inter-organizational projects in the German engineering industry, we propose and find empirically that potential and realized absorptive capacity have partially distinct antecedents. Moreover, we show that the two components of absorptive capacity unfold not only separate but also complementary effects on innovation, implying that the whole of absorptive capacity is greater than its parts. In examining how different components of absorptive capacity emerge and unfold their effects, this study addresses critical limitations of the literature on absorptive capacity. © 2013 Elsevier B.V. All rights reserved.

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Research Practice & Methodology

Strategies to improve retention in randomised trials: a Cochrane systematic review and meta-analysis
Brueton VC, Tierney JF, Stenning S, Meredith S, Harding S, Nazareth I, et al.
BMJ Open 2014;4(2)

Objective To quantify the effect of strategies to improve retention in randomised trials. Design Systematic review and meta-analysis.Results 38 retention trials were identified. Six broad types of strategies were evaluated. Strategies that increased postal questionnaire responses were: adding, that is, giving a monetary incentive (RR 1.18; 95% CI 1.09 to 1.28) and higher valued incentives (RR 1.12; 95% CI 1.04 to 1.22). Offering a monetary incentive, that is, an incentive given on receipt of a completed questionnaire, also increased electronic questionnaire response (RR 1.25; 95% CI 1.14 to 1.38). The evidence for shorter questionnaires (RR 1.04; 95% CI 1.00 to 1.08) and questionnaires relevant to the disease/condition (RR 1.07; 95% CI 1.01 to 1.14) is less clear. On the basis of the results of single trials, the following strategies appeared effective at increasing questionnaire response: recorded delivery of questionnaires (RR 2.08; 95% CI 1.11 to 3.87); a ‘package’ of postal communication strategies (RR 1.43; 95% CI 1.22 to 1.67) and an open trial design (RR 1.37; 95% CI 1.16 to 1.63). There is no good evidence that the following strategies impact on trial response/retention: adding a non-monetary incentive (RR=1.00; 95% CI 0.98 to 1.02); offering a non-monetary incentive (RR=0.99; 95% CI 0.95 to 1.03); ‘enhanced’ letters (RR=1.01; 95% CI 0.97 to 1.05); monetary incentives compared with offering prize draw entry (RR=1.04; 95% CI 0.91 to 1.19); priority postal delivery (RR=1.02; 95% CI 0.95 to 1.09); behavioural motivational strategies (RR=1.08; 95% CI 0.93 to 1.24); additional reminders to participants (RR=1.03; 95% CI 0.99 to 1.06) and questionnaire question order (RR=1.00, 0.97 to 1.02). Also based on single trials, these strategies do not appear effective: a telephone survey compared with a monetary incentive plus questionnaire (RR=1.08; 95% CI 0.94 to 1.24); offering a charity donation (RR=1.02, 95% CI 0.78 to 1.32); sending sites reminders (RR=0.96; 95% CI 0.83 to 1.11); sending questionnaires early (RR=1.10; 95% CI 0.96 to 1.26); longer and clearer questionnaires (RR=1.01, 0.95 to 1.07) and participant case management by trial assistants (RR=1.00; 95% CI 0.97 to 1.04). Conclusions Most of the trials evaluated questionnaire response rather than ways to improve participants return to site for follow-up. Monetary incentives and offers of monetary incentives increase postal and electronic questionnaire response. Some strategies need further evaluation. Application of these results would depend on trial context and follow-up procedures.

Choosing sensitivity analyses for randomised trials: principles
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Morris TP, Kahan BC, White IR.
BMC medical research methodology 2014 Jan 24;14(1):11-2288-14-11

Sensitivity analyses are an important tool for understanding the extent to which the results of randomised trials depend upon the assumptions of the analysis. There is currently no guidance governing the choice of sensitivity analyses. DISCUSSION: We provide a principled approach to choosing sensitivity analyses through the consideration of the following questions: 1) Does the proposed sensitivity analysis address the same question as the primary analysis? 2) Is it possible for the proposed sensitivity analysis to return a different result to the primary analysis? 3) If the results do differ, is there any uncertainty as to which will be believed? Answering all of these questions in the affirmative will help researchers to identify relevant sensitivity analyses. Treating analyses as sensitivity analyses when one or more of the answers are negative can be misleading and confuse the interpretation of studies. The value of these questions is illustrated with several examples. SUMMARY: By removing unreasonable analyses that might have been performed, these questions will lead to relevant sensitivity analyses, which help to assess the robustness of trial results.

Using mixed methods to select optimal mode of administration for a patient-reported outcome instrument for people with pressure ulcers
Rutherford C, Nixon J, Brown J, Lamping D, Cano S.
BMC Medical Research Methodology 2014;14(1):22

When developing new measuring instruments or deciding upon one for research, consideration of the ‘best’ method of administration for the target population should be made. Current evidence is inconsistent in differentiating superiority of any one method in terms of quantity and quality of response. We trialed a novel mixed methods approach in early scale development to determine the best administration method for a new patient-reported outcome instrument for people with pressure ulcers (the PU-QOL). Methods Cognitive interviews were undertaken with 35 people with pressure ulcers to determine appropriateness of a self-completed version of the PU-QOL instrument. Quantitative analysis, including Rasch analysis, was carried out on PU-QOL data from 70 patients with pressure ulcers, randomised to self-completed or interview-administered groups, to examine data quality and differential item functioning (DIF). Results Cognitive interviews identified issues with PU-QOL self-completion. Quantitative analysis supported these findings with a large proportion of self-completed PU-QOLs returned with missing data. DIF analysis indicated administration methods did not impact the way patients from community care settings responded, supporting the equivalence of both administration versions. Conclusions Obtaining the best possible health outcomes data requires use of appropriate methods to ensure high quality data with minimal bias. Mixed methods, with the inclusion of Rasch, provided valuable evidence to support selection of the ‘best’ administration method for people with PUs during early PRO instrument development. We consider our approach to be generic and widely applicable to other elderly or chronically ill populations or suitable for use in limited samples where recruitment to large field tests is often difficult.

An overview of the statistical methods reported by studies using the Canadian community health survey. Canada-flat-icon
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Yergens DW, Dutton DJ, Patten SB.
BMC medical research methodology 2014 Jan 25;14(1):15

The Canadian Community Health Survey (CCHS) is a cross-sectional survey that has collected information on health determinants, health status and the utilization of the health system in Canada since 2001. Several hundred articles have been written utilizing the CCHS dataset. Previous analyses of statistical methods utilized in the literature have focused on a particular journal or set of journals to understand the statistical literacy required for understanding the published research. In this study, we describe the statistical methods referenced in the published literature utilizing the CCHS dataset(s). METHODS: A descriptive study was undertaken of references published in Medline, Embase, Web of Knowledge and Scopus associated with the CCHS. These references were imported into a java application utilizing the searchable Apache Lucene text database and screened based upon pre-defined inclusion and exclusion criteria. Full-text PDF articles that met the inclusion criteria were then used for the identification of descriptive, elementary and regression statistical methods referenced in these articles. The identification of statistical methods occurred through an automated search of key words on the full-text articles utilizing the java application. RESULTS: We identified 4811 references from the 4 bibliographical databases for possible inclusion. After exclusions, 663 references were used for the analysis. Descriptive statistics such as means or proportions were presented in a majority of the articles (97.7%). Elementary-level statistics such as t-tests were less frequently referenced (29.7%) than descriptive statistics. Regression methods were frequently referenced in the articles: 79.8% of articles contained reference to regression in general with logistic regression appearing most frequently in 67.1% of the articles. CONCLUSIONS: Our study shows a diverse set of analysis methods being referenced in the CCHS literature, however, the literature heavily relies on only a subset of all possible statistical tools. This information can be used in identifying gaps in statistical methods that could be applied to future analysis of public health surveys, insight into training and educational programs, and also identifies the level of statistical literacy needed to understand the published literature.

Factors influencing recruitment to research: qualitative study of the experiences and perceptions of research teams.
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Newington L, Metcalfe A.
BMC medical research methodology 2014 Jan 23;14(1):10-2288-14-10

Recruiting the required number of participants is vital to the success of clinical research and yet many studies fail to achieve their expected recruitment rate. Increasing research participation is a key agenda within the NHS and elsewhere, but the optimal methods of improving recruitment to clinical research remain elusive. The aim of this study was to identify the factors that researchers perceive as influential in the recruitment of participants to clinically focused research. METHODS: Semi-structured interviews were conducted with 11 individuals from three clinical research teams based in London. Sampling was a combination of convenience and purposive. The interviews were audio recorded, transcribed verbatim and analysed using the framework method to identify key themes. RESULTS: Four themes were identified as influential to recruitment: infrastructure, nature of the research, recruiter characteristics and participant characteristics. The main reason individuals participate in clinical research was believed to be altruism, while logistical issues were considered important for those who declined. Suggestions to improve recruitment included reducing participant burden, providing support for individuals who do not speak English, and forming collaborations with primary care to improve the identification of, and access to, potentially eligible participants. CONCLUSIONS: Recruiting the target number of research participants was perceived as difficult, especially for clinical trials. New and diverse strategies to ensure that all potentially eligible patients are invited to participate may be beneficial and require further exploration in different settings. Establishing integrated clinical and academic teams with shared responsibilities for recruitment may also facilitate this process. Language barriers and long journey times were considered negative influences to recruitment; although more prominent, these issues are not unique to London and are likely to be important influences in other locations.

Capacity development in health systems and policy research: a survey of the Canadian context Canada-flat-icon
Non UofA Access
Grudniewicz A, Hedden L, Kromm S, Lavergne R, Menear M, Sivananthan S.
Health research policy and systems / BioMed Central 2014 Feb 7;12(1):9

Over the past decade, substantial global investment has been made to support health systems and policy research (HSPR), with considerable resources allocated to training. In Canada, signs point to a larger and more highly skilled HSPR workforce, but little is known about whether growth in HSPR human resource capacity is aligned with investments in other research infrastructure, or what happens to HSPR graduates following training. METHODS: We collected data from the Canadian Institutes of Health Research, Canada’s national health research funding agency, and the Canadian Association for Health Services and Policy Research on recent graduates in the HSPR workforce. We also surveyed 45 Canadian HSPR training programs to determine what information they collect on the career experiences of graduates. RESULTS: No university programs are currently engaged in systematic follow-up. Collaborative training programs funded by the national health research funding agency report performing short-term mandated tracking activities, but whether and how data are used is unclear. No programs collected information about whether graduates were using skills obtained in training, though information collected by the national funding agency suggests a minority (<30%) of doctoral-level trainees moving on to academic careers. CONCLUSIONS: Significant investments have been made to increase HSPR capacity in Canada and around the world but no systematic attempts to evaluate the impact of these investments have been made. As a research community, we have the expertise and responsibility to evaluate our health research human resources and should strive to build a stronger knowledge base to inform future investment in HSPR research capacity.

Using an integrated knowledge translation approach to build a public health research agenda Canada-flat-icon
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Kothari A, Regan S, Gore D, Valaitis R, Garcia J, Manson H, et al.
Health research policy and systems 2014 Jan 29;12(1):6

Public Health Systems Research is an emerging field of research that is gaining importance in Canada. METHODS: On October 22 and 23, 2012, public health researchers, practitioners, and policy-makers came together at the Accelerating Public Health Systems Research in Ontario: Building an Agenda think tank to develop a research agenda for the province. RESULTS: This agenda included the identification of the six top priorities for research in Ontario: public health performance, evidence-based practice, public health organization and structure, workforce, public health infrastructure, and partnerships/linkages. CONCLUSIONS: This paper explores the priorities in detail and hopes to bring more attention to this area of research.

AHRQ: Design and Implementation of N-of-1 Trials: A User’s Guide (US)
February 2014

Design and Implementation of N-of-1 Trials: A User’s Guide provides information on the design and implementation of n-of-1 trials (a.k.a. single-patient trials), a form of prospective research in which different treatments are evaluated in an individual patient over time. The apparent simplicity of this study design has caused it to be enthusiastically touted in some research fields and yet overlooked, underutilized, misunderstood, or erroneously implemented in other fields. With the advent of comparative effectiveness research and patient-centered outcomes research, there is a renewed interest in n-of-1 trials as an important research method for generating unique scientific evidence on patient health outcomes. A core aspect of this interest is that the n-of-1 approach may overcome some important limitations of other methodologies that involve larger samples of subjects. As a result, findings from n-of-1 trials may be especially useful in informing key health care decisions by patients and providers, particularly when combined with other scientific evidence.

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Healthcare in Canada

Paradigm Freeze: Why It Is So Hard to Reform Health Care in Canada
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Editors: Harvey Lazar, John N. Lavis, Pierre-Gerlier Forest, and John Church

Why has health care reform proved a stumbling block for provincial governments across Canada? What efforts have been made to improve a struggling system, and how have they succeeded or failed? In Paradigm Freeze, experts in the field answer these fundamental questions by examining and comparing six essential policy issues – regionalization, needs-based funding, alternative payment plans, privatization, waiting lists, and prescription drug coverage – in five provinces.

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Awareness of impending death for residents of long-term care facilities. Canada-flat-icon
Non UofA Access
Cable-Williams B, Wilson D.
International journal of older people nursing 2014 Jan 17

To explore awareness of impending death for very old persons in long-term care facilities. BACKGROUND: The trajectories of decline that are associated with chronic progressive diseases in advanced old age have few prognostic markers. Consequently, it is difficult to determine when to start palliative or end-of-life care. DESIGN: Mixed methods. METHODS: Data were collected in three long-term care facilities in Canada. Statistical data were subjected to basic descriptive analysis. Qualitative data were collected using methods commonly associated with ethnography including interviews, focus groups, observations and artefact review. Constant-comparative analysis of qualitative data occurred as data were collected. RESULTS: A 2-stage layered awareness of impending death was identified: first generalised and then clinical awareness. Generalised awareness was characterised by an understanding of human mortality and an understanding of the person’s nearness to the end of an expected lifespan. Care routines and use of resources were not influenced by this early awareness. Clinical awareness of impending death was later acknowledged when health status changes suggested that death was likely within a few hours or days. The care then changed substantially to palliative in nature. CONCLUSIONS: Despite an awareness that death occurs naturally at the end of a long life and/or long illness, a serious decline towards death was not noticed or acknowledged until the last few hours or days of life, thus limiting palliative care to late-stage pain and symptom management. IMPLICATIONS FOR PRACTICE: Although this late-stage awareness of impending death is arguably the first necessary step for a change in nursing homes to a palliative-oriented approach to care for people who are nearing death in late life, timely acknowledgement of the potential for death is needed to facilitate improvements in care for residents of long-term facilities. © 2014 John Wiley & Sons Ltd.

Applying a palliative care approach in residential care: effects on nurse assistants’ experiences of care provision and caring climate.
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Beck I, Jakobsson U, Edberg AK.
Scandinavian journal of caring sciences 2014 Feb 5

A palliative care approach aims to integrate psychosocial and existential as well as relationship aspects in the care and is an approach that can be used in residential care. Nurse assistants are the ones who are closest to the residents but have limited prerequisites for working in accordance with the palliative care approach. We aimed to investigate the effects on nurse assistants’ experiences of care provision and the caring climate of an intervention applying a palliative care approach in residential care. METHODS: An intervention involving nurse assistants (n = 75) and their leaders (n = 9), in comparison with controls (n = 110), was evaluated using a questionnaire at three points in time. RESULTS: In the intervention group, positive effects were seen concerning the nurse assistants’ reports of the care provision in that they focused more on the residents’ stories about their lives and on communicating with the residents about what gave meaning to their lives. Also, negative effects were seen when the nurse assistants rated that the residents’ needs for medical and nursing care had not been met at the facility directly after the intervention. No effects were seen concerning the caring climate or the prerequisites of providing more person-centred care. CONCLUSION: The intervention seemed to have encouraged the nurse assistants to focus on relationship aspects with the residents. So as not to jeopardise the NAs’ well-being and to support NAs in keeping themselves involved in existential issues, their support most certainly needs to be continuous and ongoing. However, in spite of the leaders’ involvement, the intervention was not sufficient for changing the organisational prerequisites for more person-centred care. © 2014 Nordic College of Caring Science.

Interventions for preventing delirium in older people in institutional long-term care.
Non UofA Access
Clegg A, Siddiqi N, Heaven A, Young J, Holt R.
The Cochrane database of systematic reviews 2014 Jan 31;1:CD009537

OBJECTIVES: To assess the effectiveness of interventions for preventing delirium in older people in long term care. MAIN RESULTS: We included two trials that recruited 3636 participants. Both were complex single-component non-pharmacological delirium prevention interventions. Risk of bias for many items was unclear due to inadequate reporting. Notably, there was no evidence of blinding of trial participants or assessors in either trial. One small cluster-RCT (n = 98) of a hydration-based intervention reported no reduction in delirium incidence in the intervention group compared to control (RR 0.85, 95% confidence interval (CI) 0.18 to 4.00, analysis not adjusted for clustering, very low quality evidence). Results were imprecise and there were serious limitations evident in trial design. One large cluster-RCT (n = 3538) of a computerised system to identify medications that may contribute to delirium risk and trigger a pharmacist-led medication review reported a large reduction in delirium incidence (12-month HR 0.42, CI 0.34 to 0.51, moderate quality evidence) but no clear evidence of reduction in hospital admissions (HR 0.89, CI 0.72 to 1.10, moderate quality evidence), in mortality (HR 0.88, CI 0.66 to 1.17, moderate quality evidence) or in falls risk (HR 1.03, CI 0.92 to 1.15, moderate quality evidence). AUTHORS’ CONCLUSIONS: Our review identified very limited evidence on interventions for preventing delirium in older people in LTC. Introduction of a software-based intervention to identify medications that could contribute to delirium risk so that a pharmacist-led medication review and monitoring plan can be initiated may reduce incidence of delirium for older people in institutional LTC. This is based on one large RCT in the United States and may not be practical in other countries which do not have comparable information technology services available in care homes. Our review identified only one ongoing pilot trial of a multicomponent delirium prevention intervention and no trials of pharmacological agents. Future trials of computerised medication management systems and multicomponent non-pharmacological and pharmacological delirium prevention interventions for older people in LTC are needed to help inform the provision of evidence-based care for this vulnerable group.

Restraint use in home care: a qualitative study from a nursing perspective.
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Scheepmans K, Dierckx de Casterle B, Paquay L, Van Gansbeke H, Boonen S, Milisen K.
BMC geriatrics 2014 Feb 5;14(1):17

Despite the growing demand for home care and preliminary evidence suggesting that the use of restraint is common practice in home care, research about restraint use in this setting is scarce. METHODS: To gain insight into the use of restraints in home care from the perspective of nurses, we conducted a qualitative explorative study. We conducted semi-structured face-to-face interviews of 14 nurses from Wit-Gele Kruis, a home-care organization in Flanders, Belgium. Interview transcripts were analyzed using the Qualitative Analysis Guide of Leuven. RESULTS: Our findings revealed a lack of clarity among nurses about the concept of restraint in home care. Nurses reported that cognitively impaired older persons, who sometimes lived alone, were restrained or locked up without continuous follow-up. The interviews indicated that the patient’s family played a dominant role in the decision to use restraints. Reasons for using restraints included “providing relief to the family” and “keeping the patient at home as long as possible to avoid admission to a nursing home.” The nurses stated that general practitioners had no clear role in deciding whether to use restraints. CONCLUSIONS: These findings suggest that the issue of restraint use in home care is even more complex than in long-term residential care settings and acute hospital settings. They raise questions about the ethical and legal responsibilities of home-care providers, nurses, and general practitioners. There is an urgent need for further research to carefully document the use of restraints in home care and to better understand it so that appropriate guidance can be provided to healthcare workers.

Burden in Caregivers of Cognitively Impaired Elderly Adults at Time of Hospitalization: A Cross-Sectional Analysis.
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Shankar KN, Hirschman KB, Hanlon AL, Naylor MD.
Journal of the American Geriatrics Society 2014 Feb 6

To describe the factors associated with burden that caregivers of cognitively impaired older adults (dementia, delirium, or both) at the time of hospitalization experienced. DESIGN: Cross-sectional data analyses. SETTING: Three hospitals-one academic tertiary hospital and two associated community hospitals. PARTICIPANTS: Caregivers (N = 495) of cognitively impaired older adults at the time of hospital admission. MEASUREMENTS: Multivariable linear regression was performed to analyze the effect of the independent variables (caregiver: demographic characteristics, depressive symptoms, self-efficacy; older adult: neuropsychiatric symptoms, delirium, functional deficits) on caregiver burden. RESULTS: Higher burden was associated with younger caregiver age (P = .02), being a spouse (P = .03), depressive symptoms (P < .001), caregivers’ lower perceived self-efficacy in managing care recipient symptoms (P = .002), and limited finances at the end of the month (P = .01). Caregiver burden was also strongly associated with the care recipient factors distressing neuropsychiatric symptoms (P = .001), delirium (P = .001), and greater functional deficits in basic activities of daily living (P = .001). CONCLUSION: These findings suggest that caregivers of older adults who were cognitively impaired at hospital admission experience burden. Understanding the factors that contribute to burden at the time of hospitalization for caregivers of persons with cognitive impairment can inform the development of interventions targeted throughout the hospitalization that have the potential to decrease burden. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

Assessing the validity and intra-observer agreement of the MIDAM-LTC; an instrument measuring factors that influence personal dignity in long-term care facilities.
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Patients who are cared for in long-term care facilities are vulnerable to lose personal dignity. An instrument measuring factors that influence dignity can be used to better target dignity-conserving care to an individual patient, but no such instrument is yet available for the long-term care setting. The aim of this study was to create the Measurement Instrument for Dignity AMsterdam – for Long-Term Care facilities (MIDAM-LTC) and to assess its validity and intra-observer agreement. METHODS: Thirteen items specific for the LTC setting were added to the earlier developed, more general MIDAM. The MIDAM-LTC consisted of 39 symptoms or experiences for which presence as well as influence on dignity were asked, and a single item score for overall personal dignity. Questionnaires containing the MIDAM-LTC were administered face-to-face at two moments (with a 1-week interval) to 95 nursing home residents residing on general medical wards of six nursing homes in the Netherlands. Constructs related to dignity (WHO Well-Being Five Index, quality of life and physical health status) were also measured. Ten residents answered the questions while thinking aloud. Content validity, construct validity and intra-observer agreement were examined. RESULTS: Nine of the 39 items barely exerted influence on dignity. Eight of them could be omitted from the MIDAM-LTC, because the thinking aloud method revealed sensible explanations for their small influence on dignity. Residents reported that they missed no important items. Hypotheses to support construct validity, about the strength of correlations between on the one hand personal dignity and on the other hand well-being, quality of life or physical health status, were confirmed. On average, 83% of the scores given for each item’s influence on dignity were practically consistent over 1 week, and more than 80% of the residents gave consistent scores for the single item score for overall dignity. CONCLUSION: The MIDAM-LTC has good content validity, construct validity and intra-observer agreement. By omitting 8 items from the instrument, a good balance between comprehensiveness and feasibility is realised. The MIDAM-LTC allows researchers to examine the concept of dignity more closely in the LTC setting, and can assist caregivers in providing dignity-conserving care.

Delirium Risk Prediction, Healthcare Use and Mortality of Elderly Adults in the Emergency Department.
Non UofA Access
Kennedy M, Enander RA, Tadiri SP, Wolfe RE, Shapiro NI, Marcantonio ER.
Journal of the American Geriatrics Society 2014 Feb 10

To create a risk prediction rule for delirium in elderly adults in the emergency department (ED) and to compare mortality and resource use of elderly adults in the ED with and without delirium. DESIGN: Prospective observational study. SETTING: Urban tertiary care ED. PARTICIPANTS: Individuals aged 65 and older presenting for ED care (N = 700). MEASUREMENTS: A trained research assistant performed a structured mental status assessment and attention tests, after which delirium was determined using the Confusion Assessment Method. Data were collected on participant demographics, comorbidities, medications, ED course, hospital and intensive care unit (ICU) admission, length of stay, hospital charges, 30-day rehospitalization, and mortality. RESULTS: Nine percent of elderly study participants had delirium. Using logistic regression, a delirium prediction rule consisting of older age, prior stroke or transient ischemic attack, dementia, suspected infection, and acute intracranial hemorrhage was created had good predictive accuracy (area under the receiver operating characteristic curve = 0.77). Admitted participants with ED delirium had longer median lengths of stay (4 vs 2 days) and were more likely to require ICU admission (13% vs 6%) and to be discharged to a new long-term care facility (37% vs 9%) than those without. In all participants, ED delirium was associated with higher 30-day mortality (6% vs 1%) and 30-day readmission (27% vs 13%). CONCLUSION: This risk prediction rule may help identify a group of individuals in the ED at high risk of developing delirium who should undergo screening, but it requires external validation. Identification of delirium in the ED may enable physicians to implement strategies to decrease delirium duration and avoid inappropriate discharge of individuals with acute delirium, improving outcomes. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

A Chronic Grief Intervention for Dementia Family Caregivers in Long-Term Care.
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Paun O, Farran CJ, Fogg L, Loukissa D, Thomas PE, Hoyem R.
Western journal of nursing research 2014 Feb 6

Dementia caregivers do not relinquish their role after placing family members in long-term care and they experience increased chronic grief. The Chronic Grief Management Intervention (CGMI) is a12-week group-based program that uses guided discussion to deliver knowledge of Alzheimer’s or a related dementia and teach skills in communication, conflict resolution, and chronic grief management in dementia caregivers who placed their family members in long-term care. Using a quasi-experimental design, 83 caregivers from 15 long-term care facilities received either the CGMI (n = 34) or a comparison condition consisting of two check-in calls (n = 49). In this pilot study, we examined the feasibility of implementing the CGMI and evaluated the effects of the intervention on caregivers’ knowledge and skill and their chronic grief and depression. The intervention was feasible and resulted in significant improvement in caregivers’ heartfelt sadness and longing at 3 months and a significant drop in their guilt at the 6-month follow-up.

Development and Testing of a Decision Aid on Goals of Care for Advanced Dementia.
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Einterz SF, Gilliam R, Chang Lin F, McBride JM, Hanson LC.
Journal of the American Medical Directors Association 2014 Feb 6

Decision aids are effective to improve decision-making, yet they are rarely tested in nursing homes (NHs). Study objectives were to (1) examine the feasibility of a goals of care (GOC) decision aid for surrogate decision-makers (SDMs) of persons with dementia; and (2) to test its effect on quality of communication and decision-making. DESIGN: Pre-post intervention to test a GOC decision aid intervention for SDMs for persons with dementia in NHs. Investigators collected data from reviews of resident health records and interviews with SDMs at baseline and 3-month follow-up. SETTING: Two NHs in North Carolina. PARTICIPANTS: Eighteen residents who were over 65 years of age, had moderate to severe dementia on the global deterioration scale (5, 6, or 7), and an English-speaking surrogate decision-maker. INTERVENTION: (1) GOC decision aid video viewed by the SDM and (2) a structured care plan meeting between the SDM and interdisciplinary NH team. MEASUREMENTS: Surrogate knowledge, quality of communication with health care providers, surrogate-provider concordance on goals of care, and palliative care domains addressed in the care plan. RESULTS: Eighty-nine percent of the SDMs thought the decision aid was relevant to their needs. After viewing the video decision aid, SDMs increased the number of correct responses on knowledge-based questions (12.5 vs 14.2; P < .001). At 3 months, they reported improved quality of communication scores (6.1 vs 6.8; P = .01) and improved concordance on primary goal of care with NH team (50% vs 78%; P = .003). The number of palliative care domains addressed in the care plan increased (1.8 vs 4.3; P < .001). CONCLUSIONS: The decision-support intervention piloted in this study was feasible and relevant for surrogate decision-makers of persons with advanced dementia in NHs, and it improved quality of communication between SDM and NH providers. A larger randomized clinical trial is underway to provide further evidence of the effects of this decision aid intervention. Copyright © 2014 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Health insurance status and the care of nursing home residents with advanced dementia.
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Goldfeld KS, Grabowski DC, Caudry DJ, Mitchell SL.
JAMA internal medicine 2013 Dec 9-23;173(22):2047-2053

Nursing home residents with advanced dementia commonly experience burdensome and costly hospitalizations that may not extend survival or improve the quality of life. Fragmentation in health care has contributed to poor coordination of care for acutely ill nursing home residents. OBJECTIVE: To compare patterns of care and quality outcomes for nursing home residents with advanced dementia covered by managed care with those covered by traditional fee-for-service Medicare. DESIGN, SETTING, AND PARTICIPANTS: Choices, Attitudes, and Strategies for Care of Advanced Dementia at the End-of-Life (CASCADE) was a prospective cohort study including 22 nursing homes in the Boston, Massachusetts, area that monitored 323 nursing home residents for 18 months to better understand the course of advanced dementia at or near the end of life. Data from CASCADE and Medicare were linked to determine the health insurance status of study participants. EXPOSURES: The health insurance status of the resident, either managed care or traditional fee for service. MAIN OUTCOMES AND MEASURES: The outcomes included survival, symptoms related to comfort, treatment of pain and dyspnea, presence of pressure ulcers, presence of a do-not-hospitalize order, treatment of pneumonia, hospital transfer (admission or emergency department visit) for an acute illness, hospice referral, primary care visits, and family satisfaction with care. RESULTS: Residents enrolled in managed care (n = 133) were more likely to have do-not-hospitalize orders compared with those in traditional Medicare fee for service (n = 158) (63.7% vs 50.9%; adjusted odds ratio, 1.9; 95% CI, 1.1-3.4), were less likely to be transferred to the hospital for acute illness (3.8% vs 15.7%; adjusted odds ratio, 0.2; 95% CI, 0.1-0.5), had more primary care visits per 90 days (mean [SD], 4.8 [2.6] vs 4.2 [5.0]; adjusted rate ratio, 1.3; 95% CI, 1.1-1.6), and had more nurse practitioner visits (3.0 [2.1] vs 0.8 [2.6]; adjusted rate ratio, 3.0; 95% CI, 2.2-4.1). Survival, comfort, and other treatment outcomes did not differ significantly across groups. CONCLUSIONS AND RELEVANCE Medicare managed-care programs may offer a promising approach to ensure that nursing homes are able to provide appropriate, less burdensome, and affordable care, especially at the end of life.

Effect of nursing home characteristics on residents’ quality of life: a systematic review.
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Xu D, Kane RL, Shamliyan TA.
Archives of Gerontology and Geriatrics 2013 Sep-Oct;57(2):127-142

The association between nursing home (NH) characteristics and residents’ quality of life (QOL) has not been systematically reviewed. This study synthesizes published evidence about the association between NH ownership, affiliation, location, chain membership, percentage of private rooms, facility size, and staffing with residents’ QOL. We searched Medline, Web of Science, CINAHL, and Scirus for primary studies published between 1960 and March 31, 2012. We critically appraised risk of bias according to study design, QOL measurements, and adjustment for residents’ characteristics. We analyzed the statistical and clinical significance, direction and magnitude of the association. From 1117 citations retrieved, we found one longitudinal quasi-experimental and 10 cross-sectional eligible studies. Variability in the NH characteristics reported and QOL measurements precluded meta-analysis. Studies with low and medium risk of bias (ROB) suggested that nonprofit NHs resulted in better QOL for residents. The low ROB study indicated that in certain QOL domains, rural facilities and facilities with a higher percentage of private rooms were associated with better self-reported resident QOL. All low and medium ROB studies found that RN, LVN/LPN and total nursing staff had no significant relationship with QOL. One longitudinal quasi-experimental study indicated that the Green House with individualized care had better QOL than conventional NHs. The available evidence does not permit strong conclusions about the association between NH characteristics and residents’ QOL. The evidence does, however, raise questions about whether NH structure alone can improve residents’ QOL and how residents’ QOL should be measured and improved. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Reactions and Interventions for Delusions in Nursing Home Residents with Dementia
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Cohen-Mansfield J, Golander H, Arnheim G, Cohen R.
American Journal of Alzheimer’s Disease and Other Dementias 2014

This is a qualitative and quantitative study examining institutional staff members’ reactions to delusions experienced by nursing home residents. Participants were 38 nursing home residents aged 65 and older, diagnosed with dementia. Data were collected from 8 nursing homes in Israel between June 2007 and January 2009. Assessments included Behavioral Pathology in Alzheimer’s Disease Rating Scale, Neuropsychiatric Inventory: Nursing Home version, Etiological Assessment of Psychotic Symptoms In Dementia, Activities of Daily Living, and Mini-Mental State Examination. A wide variety of interventions with dementia-related symptoms was found to be effective to varying degrees. This included general approaches for a variety of symptoms as well as symptom-specific interventions. Caregivers do not always seem to be aware that multiple approaches are available to them when dealing with dementia. The most effective approaches may be those tailored to the individual. Combining interventions may increase overall effectiveness. Caregiver’s experience and the institutional culture may affect the choice of intervention used, either positively or negatively.

Pressure-reducing interventions among persons with pressure ulcers: results from the first three national pressure ulcer prevalence surveys in Sweden.
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Baath C, Idvall E, Gunningberg L, Hommel A.
Journal of evaluation in clinical practice 2014 Feb;20(1):58-65

The overall aim of this study was to describe preventive interventions among persons with pressure ulcer (PU) in three nationwide PU prevalence surveys in Sweden. METHODS: A cross-sectional research design was used; more than 70 000 persons from different hospitals and nursing homes participated in the three prevalence surveys conducted in March 2011, October 2011 and March 2012. The methodology used was that recommended by the European Pressure Ulcers Advisory Panel. RESULTS: The overall prevalence of PU categories I-IV in hospitals was 16.6%, 14.4% and 16.1%, respectively. Corresponding figures for nursing homes were 14.5%, 14.2% and 11.8%, respectively. Heel protection/floating heels and sliding sheets were more frequently planned for persons with PU category I. CONCLUSIONS: Despite the three prevalence studies that have showed high prevalence of PU the use of preventing interventions is still not on an acceptable level. Heel protection/floating heels and sliding sheets were more frequently planned for persons with PUs, and individual-planned repositioning also increased. However, when persons already have a PU they should all have pressure-reducing preventive interventions to prevent the development of more PUs. Preventing PUs presents a challenge even when facilities have prevention programmes. A PU prevention programme requires an enthusiastic leader who will maintain the team’s focus and direction for all staff involved in patient care. © 2013 John Wiley & Sons, Ltd.

2012-2013 Alzheimer’s Disease Progress Report Intensifying the Research Effort (US)
National Institute on Aging 2014

Includes National Plan to Address Alzheimer’s Disease, Caring for People with Alzheimer’s Disease, and Health Disparities and Alzheimer’s Disease.

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The 6th International Conference on Patient- and Family-Centered Care
6-8 August Vancouver BC

Those who work tirelessly to improve the safety and quality of health care will come together in Vancouver August 6-8, 2014, sharing exemplary programs dedicated to fostering genuine partnerships and transformative change among patients, families, health care professionals, and policy specialists.

North American Data Documentation Initiative User Conference
Vancouver BC 31 March-2 April

NADDI 2014 is a two day conference. It will be of interest to both researchers and data professionals in the social sciences and other disciplines. A full day of training sessions will precede the conference (March 31). One focus of the second year’s conference will be on the use of DDI in “Documenting Reproducible Research” by individual research teams through the data lifecycle.


CFHI Webinar: How do we plan for meaningful, effective, and appropriate patient and family engagement?
Thursday February 20 10:00-11:30 MT

Hear how the Centre for Addiction and Mental Health in Toronto and the Fraser Health Authority in British Columbia developed and implemented a model to engage voices not traditionally heard in healthcare improvement. We will discuss their lessons learned, successes, as well as the challenges they met and overcame along the way.

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KT Canada: Pragmatic KT Trials Course
5-6 June Cost $600

The purpose of the 2 day workshop is to review the stages of trial design, from conceiving the question, to defining the intervention and comparators, to estimating the required sample size and developing a logistics plan. Interspersed with the short didactic and discussion review sessions are longer sessions during which you can draft your own protocol for a pilot trial, or even a large definitive trial, of you intervention and discuss it with colleagues doing exactly the same thing, led by experienced trialists, in a supportive environment. Participants must have a KT trial question in order to participate in the course. Please contact Gail Klein (kleing@smh.ca) to register and provide the following:
1. Name
2. Institution
3. Your KT trial question
For more information, please contact Gail Klein, kleing@smh.ca

KT Canada: Foundations of Knowledge Translation Course is currently accepting applications
DEADLINE for applications 21 February

The Foundations of Knowledge Translation (KT) course aims to: (1) build capacity in the practice of KT amongst researchers and knowledge users; (2) facilitate development and implementation of KT projects with various stakeholders; and (3) develop a sustainable, local community of practice. The Michael Smith Foundation for Health Research and the Vancouver Coastal Health Research Institute have partnered with the Knowledge Translation Program of St. Michael’s Hospital to implement and evaluate a course that combines three in-person workshops based in Vancouver, online course materials, mentorship, and a virtual community of practice. To apply, you or one member of your team must be either a research or clinician with the Vancouver Coastal Health Research Institute (VCHRI) organizations

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What is the Francis effect?

Health Secretary Jeremy Hunt has called it the “Francis effect”. He believes the publication of the public inquiry into the Stafford Hospital scandal – led by Robert Francis QC – has been a catalyst for improving care. But is this really true?

Councils in England ‘pay too little for home care’

Most councils in England are paying less than the industry recommended minimum for personal home care, a BBC investigation suggests.

CBC Cross Country Checkup: Are seniors in Canada getting the standard of care they need? Canada-flat-icon

Dr. Carole Estabroooks was one of the guests!!! Caring for seniors: The dreadful fire in a seniors residence in L’Isle-Verte, Quebec has put the focus on safety in seniors homes across the nation. But some say it’s only one of many aspects of care for the aged in need of attention. Are seniors in Canada getting the standard of care they need?

Federal budget strengthens university research with new funding Canada-flat-icon

University research was a big winner in a federal budget that kept its promise to offer modest spending increases overall at a time of restrained economic growth for Canada.

Alzheimer Society of Canada welcomes commitments to dementia research and caregiver support in Budget 2014 Canada-flat-icon

The Alzheimer Society of Canada applauds the Government of Canada for committing in Budget 2014 to advance research aimed at renewing investments in health research to tackle the growing onset of dementia and related illnesses, and to recognize and provide better support for family caregivers. Today’s budget will provide $15 million per year to the Canadian Institutes of Health Research for the expansion of the Strategy for Patient-Oriented Research, the creation of the Canadian Consortium on Neurodegeneration in Aging and other health research priorities.

Ontario needs to improve working conditions for home care worker Canada-flat-icon

Long the poor cousins in Ontario’s health care sector, home care’s personal support workers need improved pay and conditions.

Canada’s ERs missing mark on waiting times, new statistics reveal Canada-flat-icon

One in 10 Canadians who arrive at an emergency room sick enough to be admitted wait more than 27 hours for a bed, according to fresh data that reveal hospitals are missing by a wide margin a new target set by the country’s emergency physicians.

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Statistics Done Wrong: The woefully complete guide

Statistics Done Wrong is a guide to the most popular statistical errors and slip-ups committed by scientists every day, in the lab and in peer-reviewed journals. Many of the errors are prevalent in vast swathes of the published literature, casting doubt on the findings of thousands of papers. Statistics Done Wrong assumes no prior knowledge of statistics, so you can read it before your first statistics course or after thirty years of scientific practice.

CLWK: Connecting Learners with Knowledge Canada-flat-icon

CLWK started as a pilot project in 2010 and was created by nurses to explore innovative ways to meet nurses’ education needs. Membership grew considerably and it became a permanent, living resource. In February 2014 it merged with QExchange.ca which was home to communities for British Columbian health care providers. CLWK is now a growing group of communities that support healthcare providers to network and improve care.

Coevidence: Systematic Review Software
First review free then it’s US$19.95/mo

Covidence improves healthcare evidence synthesis by improving the efficiency and experience of creating and maintaining Systematic Reviews. If someone out there decides to use this, please consider reporting back to me on how this product works. I’m curious about it.

SPOR Support Presentation Slides Available

If you were unable to attend the SPOR SUPPORT Unit session held on 6 February, the Grant Assist Program (Health Sciences) has distributed slides.

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A funded PhD studentship on the topic of: The social and political intuitions supporting evidence advisory bodies in health

The studentship is organised through a collaboration of The London School of Hygiene and Tropical Medicine and The Institute of Education (members of the Bloomsbury Doctoral Training Centre for the Social Sciences), along with NICE-International (non-academic partner). The aims of this project are to investigate the social, political and economic factors supporting the establishment, successful functioning, and sustainability of government mandated evidence advisory bodies in health, while simultaneously training the PhD candidate in the applied work of global evidence-informed health policy development. Interested applicants should contact Dr. Justin Parkhurst in the first instance at: justin.parkhurst@lshtm.ac.uk

Journal of Clinical Nursing Seeks Editor
DEADLINE 31 March 2014

The successful candidate for the position of Editor will: be recognized internationally for the quality of her or his academic and research achievements; have worked at a strategic level within academia or healthcare; and have an impressive track record of publications and presentations at conferences.

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