New Article by Dr. Anne-Marie Boström
A model for implementing guidelines for person-centered care in a nursing home setting.
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Vikstrom S, Sandman PO, Stenwall E, Bostrom AM, Saarnio L, Kindblom K, et al.
International psychogeriatrics 2014 Aug 19:1-11
Systematic evaluations of knowledge translation interventions in nursing homes to improve practice are scarce. There is also a lack of studies focusing on creating sustainable evidence-based practice in the setting of residential dementia care. Methods: The aim of this paper is to describe a model for implementing national evidence-based guidelines for care of persons with dementia in nursing homes. The secondary aim is to outline the nursing home staff experiences during the first year of the implementation process. The intervention had a participatory action research approach. This included educational activities such as: (i) thematic seminars introducing national guidelines for dementia care, (ii) regular unit-based seminars; and (iii) later dissemination of information in reflective seminars and several days of poster-exhibitions. Areas of practice development were selected on each of the 24 units, based on unit-specific needs, and a quality improvement strategy was applied and evaluated. Each unit met ten times during a period of eight months. Data for this study were extracted from the reflective seminars and poster presentations, analyzed using a qualitative content analysis. Results: Findings showed that implementation of guidelines were perceived by staff as beneficial for both staff and the residents. However, barriers to identification of relevant sources of evidence and barriers to sustainable implementation were experienced. Conclusions: One of our assumptions was that dementia nursing homes can benefit from becoming knowledge driven, with care practices founded in evidence-based sources. Our findings show that to be partly true, even though most staff units found their efforts to pursue and utilize knowledge adversely impacted by time-logistics and practical workload challenges.
New edition of Knowledge Translation in Health Care: Moving from Evidence to Practice. With 2 chapters by Drs. Carole Estabrooks and Ali Hutchinson
Knowledge Translation in Health Care: Moving from Evidence to Practice
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Knowledge translation in health care: moving from evidence to practice. 2nd ed. Chichester, West Sussex: Wiley BMJIBooks; 2013.
Knowledge Translation in Health Care is a practical introduction to knowledge translation for everyone working and learning within health policy and funding agencies, and as researchers, clinicians and trainees. Using everyday examples, it explains how to use research findings to improve health care in real life. This new second edition defines the principles and practice of knowledge translation and outlines strategies for successful knowledge translation in practice and policy making. It includes relevant real world examples and cases of knowledge translation in action that are accessible and relevant for all stakeholders including clinicians, health policy makers, administrators, managers, researchers, clinicians and trainees. From an international expert editor and contributor team, and fully revised to reflect current practice and latest developments within the field, Knowledge Translation in Health Care is the practical guide for all health policy makers and researchers, clinicians, trainee clinicians, medical students and other healthcare professionals seeking to improve healthcare practice.
New articles by Dr. Lars Wallin
Relationship between work context and adherence to a clinical practice guideline for peripheral venous catheters among registered nurses in pediatric care.
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Forberg U, Wallin L, Johansson E, Ygge BM, Backheden M, Ehrenberg A.
Worldviews on evidence-based nursing 2014 Aug;11(4):227-239
It is known that registered nurses’ (RNs’) work context is related to their use of research and that it can affect nurse and patient satisfaction, as well as the outcomes of care. However, little is known about the relationship between work context and nurses’ adherence to clinical practice guidelines. The aim of this study was to describe RNs’ adherence to a clinical practice guideline (CPG) on the management of peripheral venous catheters (PVCs), their perceptions of work context, and how nurses’ work context and characteristics relate to guideline adherence. METHODS: This cross-sectional survey was conducted at a large pediatric university hospital in Sweden. Data were collected through a questionnaire on RNs’ adherence to components of a CPG and by using the Alberta Context Tool to assess the nurses’ perceptions of work context, including leadership, culture, feedback processes, and other organizational characteristics. RESULTS: Work context-in the form of structural and electronic resources, information sharing activities, and feedback processes-was in different ways associated with the adherence to the CPG components. The RNs’ adherence on unit level varied: half the units demonstrated complete adherence on disinfection of hands, whereas a majority of the units reported less than 70% adherence on the use of disposable gloves and the daily inspection of a PVC site. LINKING EVIDENCE TO ACTION: Our findings indicate that components in one CPG might require diverse implementation strategies because they are linked to different contextual factors. © 2014 Sigma Theta Tau International.
Facilitators and barriers to applying a national quality registry for quality improvement in stroke care.
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Eldh AC, Fredriksson M, Halford C, Wallin L, Dahlstrom T, Vengberg S, et al.
BMC health services research 2014 Aug 27;14:354-6963-14-354
National quality registries (NQRs) purportedly facilitate quality improvement, while neither the extent nor the mechanisms of such a relationship are fully known. The aim of this case study is to describe the experiences of local stakeholders to determine those elements that facilitate and hinder clinical quality improvement in relation to participation in a well-known and established NQR on stroke in Sweden. METHODS: A strategic sample was drawn of 8 hospitals in 4 county councils, representing a variety of settings and outcomes according to the NQR’s criteria. Semi-structured telephone interviews were conducted with 25 managers, physicians in charge of the Riks-Stroke, and registered nurses registering local data at the hospitals. Interviews, including aspects of barriers and facilitators within the NQR and the local context, were analysed with content analysis. RESULTS: An NQR can provide vital aspects for facilitating evidence-based practice, for example, local data drawn from national guidelines which can be used for comparisons over time within the organisation or with other hospitals. Major effort is required to ensure that data entries are accurate and valid, and thus the trustworthiness of local data output competes with resources needed for everyday clinical stroke care and quality improvement initiatives. Local stakeholders with knowledge of and interest in both the medical area (in this case stroke) and quality improvement can apply the NQR data to effectively initiate, carry out, and evaluate quality improvement, if supported by managers and co-workers, a common stroke care process and an operational management system that embraces and engages with the NQR data. CONCLUSION: While quality registries are assumed to support adherence to evidence-based guidelines around the world, this study proposes that a NQR can facilitate improvement of care but neither the registry itself nor the reporting of data initiates quality improvement. Rather, the local and general evidence provided by the NQR must be considered relevant and must be applied in the local context. Further, the quality improvement process needs to be facilitated by stakeholders collaborating within and outside the context, who know how to initiate, perform, and evaluate quality improvement, and who have the resources to do so.
Publication recommended by Dr. Carole Estabrooks
Alzheimer’s Association: Alzheimer’s Facts and Figures 2014
2014 Alzheimer’s Disease Facts and Figures is a statistical resource for U.S. data related to Alzheimer’s disease, the most common type of dementia, as well as other dementias. Background and context for interpretation of the data are contained in the Overview. This information includes definitions of the various types of dementia and a summary of current knowledge about Alzheimer’s disease. Additional sections address prevalence, mortality and morbidity, caregiving and use and costs of care and services. The Special Report discusses women and Alzheimer’s disease.
CALL FOR PAPERS:
Advances in Nursing Science
Models of Care for the Future: As nations worldwide seek to establish models of care that provide quality and efficiency, nurse leaders are emerging to play a significant role in the development of these models. For this issue of ANS we are seeking manuscripts that provide theoretical underpinnings of creative models of care, as well as evidence that supports their implementation. Manuscripts should be clearly grounded in a nursing perspective; the content can include philosophic, theoretic, empirical or ethical aspects related to the model.
DEADLINE: 15 October
Translational Scholarship: For this issue of ANS we are seeking manuscripts that provide methodologic innovations that bring nursing theory, research and practice together, including translational research, emancipatory and participative approaches. Nursing research reports of studies using these methodologies are welcome, as are manuscripts that provide philosophic, theoretical or methodologic explanations of these approaches to scholarship. Manuscripts should include a strong emphasis on the development of nursing as a discipline.
DEADLINE 15 January
Veteran’s Health: Given recent history of international conflict and violence, the health and well-being of those who have served the military of any country world-wide has become a major challenge that influences the well-being of families, communities and nations. For this issue of ANS we seek manuscripts that address nursing perspectives on health care for veterans, their families and communities. We welcome research reports that provide evidence for nursing practice, theoretical and philosophic perspectives, or methodologic issues related to investigating health issues and nursing concerns for this population.
DEADLINE: 15 April
Technologies, Nursing & Health: Nursing, of necessity, has adapted over the past half century to the burgeoning presence of technology that has been developed for the diagnosis and treatment of sickness and disease. For this issue of ANS we seek scholarly works that extend the critical analysis of technologies from a nursing perspective, and works that provide evidence upon which to build nursing practice in ways that balance the use of appropriate technologies with the person-to-person relationship and caring that is central to nursing practice. We welcome articles that present empirical research, philosophic analyses, and development of theoretical models that inform the appropriate use of technology.
DEADLINE: 15 July
Women & Girls: In 2011, the United Nations declared October 11th an annual “International Day of the Girl Child.” We are dedicating the mid-year 2016 issue of ANS in anticipation of the October 2016 international observance focusing on girls. We seek manuscripts that address nursing perspectives on health care for girls and women, their families and communities. We welcome research reports that provide evidence for nursing practice, theoretical and philosophic perspectives, or methodologic issues related to investigating health issues and nursing concerns for women and girls. We particularly welcome manuscripts with an international focus.
DEADLINE 15 October
CALL FOR ABSTRACTS:
2015 Quality Forum
18-20 February Vancouver
DEADLINE 10 September
By bringing together clinicians, administrators, executives, patients, researchers and quality improvement leaders, the Quality Forum creates an opportunity to exchange knowledge, discuss ideas and identify new potential for collaboration.
Grants & Awards
TVN Catalyst Grant Program 2014
LOI DEADLINE 17 October
Technology Evaluation in the Elderly Network (TVN) is offering funding to catalyze creativity, novelty, and innovation in research to benefit Canada’s seriously ill, frail elderly. The Catalyst Grant Program will fund projects of up to one (1) year in length and normally up to $100,000 each. For projects of exceptional merit and with adequate justification, there may be an opportunity to increase the budget to $150,000. Catalyst Grants will support scalable research studies including pilot studies, feasibility studies, translation studies and novel and innovative approaches aligned with TVN strategic priorities and patient-centred research themes, and that demonstrate knowledge translational capacity aimed at improving care for the seriously ill elderly. For this competition, projects will be prioritized that are:
-demonstration projects aiming to investigate system changes for the benefit of the seriously ill, frail elderly, or
-knowledge mobilization projects that seek to improve the update or application of existing evidence to improve the care of the seriously ill, frail elderly.
An ethnographic study of nurses’ experience with nursing research and its integration in practice.
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Dupin CM, Borglin G, Debout C, Rothan-Tondeur M.
Journal of advanced nursing 2014 Sep;70(9):2128-2139
To report from a study aimed at illuminating how French Registered Nurses experience and engage in nursing research in clinical practice. BACKGROUND: Nursing research in France is mainly conducted by nurses working at clinical research units rather than by dedicated nurse researchers. Education, i.e. advanced degrees, in the field of nursing research is still in its infancy and not yet consistent with the international context. Outside France, the general perception is that nursing research is a unified part of professional nursing. Consequently, in-depth knowledge about how nurses in a French clinical context might experience and engage in nursing research is still lacking. DESIGN: The design of this study was influenced by an ethnographic approach as described by the French anthropologists Beaud and Weber. METHOD: Data, participatory observations, field notes and interviews (n = 6) were collected in a teaching hospital between April-August 2012. The field consisted of a wound-care unit and clinical research units. Collected data were analysed based on Beaud and Weber’s description of analysis. RESULTS: Three beliefs were identified: being a unified part of a research team, being an integral part of ‘crosswise – across’ activities and being part of research activities. CONCLUSION/IMPLICATION FOR RESEARCH: Commitment to nursing research was strengthened by patient-related issues. Based on this context, nursing research would likely benefit from the support of a naturalized reciprocity between clinical practice and research. © 2014 John Wiley & Sons Ltd.
The effectiveness of four translation strategies on nurses’ adoption of an evidence-based bladder protocol.
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The Journal of neuroscience nursing 2014 Aug;46(4):218-226
The primary purpose of this study was to examine the effects of an intervention consisting of the four translation strategies of educational materials, educational meetings, reminders, and audit and feedback on nurses’ adoption of an evidence-based bladder program for patients with stroke in an acute care setting. The secondary purpose was to evaluate the difference in incontinence episodes of patients with stroke before and after nurses received the intervention. Finally, the purpose was to evaluate the influence of nurses’ attitudes and the demographic characteristics on the adoption and use of the evidence-based bladder program after receiving the intervention. This study was the first to provide empirical support for the influence of the combination of these four translation strategies and nurses’ attitudes toward research on the adoption of evidence-based practice in a time-series design study. Thus, the combined use of the four translation strategies did have an impact on nurses’ adoption of evidence-based practice.
Hawaii’s Statewide Evidence-based Practice Program.
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Mark DD, Latimer RW, White JP, Bransford D, Johnson KG, Song VL.
The Nursing clinics of North America 2014 Sep;49(3):275-290
Hawaii’s innovative statewide evidence-based practice program facilitates practice change across multiple health care systems. The innovation eliminated duplicative efforts and provided resources, was compatible with the values of health care organizations, and had experience with a pilot program. Interpersonal and mass media communication promoted and embedded the practice change. Users included nurse champions with multidisciplinary team members. The rate of adoption varied across projects and, although resources seemed to be a major determinant of successful institutionalization, there does not seem to be a predictable pattern of successful project implementation. Copyright © 2014 Elsevier Inc. All rights reserved.
Knowledge Translation and the Governance of Health Research in Canada: A Critical Discourse Analysis (Dissertation)
University of Western Ontario 2014
Knowledge translation (KT) is a dominant discourse in the governance of health research in Canada. I critically examine the KT discourse of the Canadian Institutes of Health Research (CIHR), Canada’s major health research funder. Informed by a governmentality perspective, I explore how the KT discourse operates to shape the directions of health research and the activities of health researchers using critical discourse analysis with a sample of publicly available CIHR documents. This KT discourse is constructed through three rationales: a “gap” between knowledge creation and its application; financial and health care accountabilities for public investment in health research; and, the expectation of economic prosperity and an international competitive edge for Canada. Through these rationales, the use of health research becomes problematized and KT is constructed as an unquestioned solution. KT is constructed to function in ways consistent with the three rationales in shaping health research and researchers in particular directions. Ideal health research is “innovative”, “world-class”, and demonstrates an economic return on taxpayers’ investment. Health researchers are constructed as the workforce in a transformed “research enterprise”, expected to meet knowledge “users’” needs. CIHR is constructed as the Government of Canada’s “health research investment agency”, a national manager of health research and researchers and international authority in KT. KT operates as a technology of governance, with potential effects in prioritizing particular health research agendas and privileging particular kinds of researcher orientations within the context of neoliberal rationalities of government. The rationales are considered in relation to evidence-based medicine and new public management to critically reflect on the contemporary governance of health research and researchers in Canada.
Creating an Interest in Research and Development as a Means of Reducing the Gap between Theory and Practice in Primary Care: An Interventional Study Based on Strategic Communication.
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International journal of environmental research and public health 2014 Aug 26;11(9):8689-8708
Today, healthcare professionals are faced with the challenge of implementing research results in an optimal way. It is therefore important to create a climate that is conducive to research and development (R&D). For this reason, new strategies are required to enhance healthcare professionals’ interest in innovative thinking and R&D. Strategic communication with roots in sociology, psychology and political science was employed as a means of achieving long-term behavioural change. The aim of this study was to describe, follow up and evaluate a primary care intervention based on strategic communication intended to increase healthcare professionals’ interest in R&D over time. An interventional cohort study comprising all staff members (N = 1276) in a Swedish primary care area was initiated in 1997 and continued for 12 years. The intention to engage in R&D was measured on two occasions; at 7 and 12 years. Both descriptive statistics and bivariate analyses were employed. The results demonstrated that the positive attitude to R&D increased over time, representing a first step towards new thinking and willingness to change work practices for the benefit of the patient. Strategic communication has not been previously employed as a scientific tool to create a long-term interest in R&D within primary care.
A model for increasing appreciation, accessibility and application of research in nursing
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Journal of Professional Nursing
The confidence and engagement of nurses (and midwives) in research is an area for continued development. The Research Appreciation, Accessibility, and Application Model (RAAAM) developed in 2011 provides a framework for enhancing research activities by nurses within the clinical setting. Unlike other models, the RAAAM does not assume a pre-existing capacity or knowledge of research; however the model incorporates the multiple research activities that comprise a research culture. While it is acknowledged that undertaking a research project is not for everyone, using evidenced based knowledge for practice development is essential and relates to all clinical staff. The RAAAM model presents four domains – Research Appreciation, Research Accessibility, Research Application and Research Sustainability. Research appreciation is a first step in realising the potential beneficial impact of research in practice. Relating these activities to identified key result areas that are drawn from keystakeholders completes the loop ensuring sustainability of research activities and processes. The model presented here offers a practical and user friendly approach for research enhancement in nursing using the platform of a clinical and academic partnership.
Psychometric analysis of two new scales: the evidence-based practice nursing leadership and work environment scales.
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Pryse Y, McDaniel A, Schafer J.
Worldviews on evidence-based nursing 2014 Aug;11(4):240-247
Those in nursing have been charged with practicing to the full extent of their education and training by the Institute of Medicine. Therefore, evidence-based practice (EBP) has never been more important to nursing than in the current healthcare environment. Frequently the burden of EBP is the responsibility of the bedside practitioner, but has been found to be a process that requires leadership and organizational support. A key underlying component of a strong EBP environment includes effective communications and collaboration among staff and nursing leadership. AIMS: Developing measurement tools that examine the milieu and nursing leadership in which the staff nurse practices is an important component of understanding the factors that support or hinder EBP. The aim of this study is to report on the development and analysis of two new scales designed to explore leadership and organizational support for EBP. The EBP Nursing Leadership Scale (10 items) examines the staff nurses perception of support provided by the nurse manager for EBP, and the EBP Work Environment Scale (8 items) examines organizational support for EBP. METHODS: Staff nurses who worked at least .5 FTE in direct patient care, from two inner city hospitals (n = 422) completed the scales. The scales were evaluated for internal consistency reliability with the Cronbach alpha technique, content validity using a panel of experts, and construct validity by RESULTS: The content validity index computed from expert rankings was .78 to 1.0 with an average of.96. Cronbach’s alpha was .96 (n = 422) for the EBP Nursing Leadership Scale and .86 (n = 422) for the EBP Work Environment Scale. Factor analysis confirmed that each scale measured a unidimensional construct (p < .000). LINKING EVIDENCE TO ACTION: The EBP Nursing Leadership Scale and the EBP Work Environment Scale are psychometrically sound instruments to examine organizational influences on EBP. © 2014 Sigma Theta Tau International.
This study examines the evolution of service provision to the elderly in the area of institutional and home care in Quebec, as well as related legislation and tax and financial incentives. In light of the increased privatization of risks associated with dependency, the study assesses whether the government’s approach meets the needs and expectations of the people concerned, especially in light of ongoing changes in the labour market and current thinking about family support systems.
Health Care Administration and Organization
Inter-professional perspectives of dementia services and care in England: Outcomes of a focus group study.
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Sutcliffe CL, Jasper R, Roe B, Jolley D, Crook A, Challis DJ.
Dementia (London, England) 2014 Aug 28
Many people living with dementia are supported at home using a variety of health and social care services. This paper reports the findings from a focus group study undertaken with staff in community mental health teams to explore areas for improvement in relation to national policies and recommendations for dementia care. Two focus groups were held with staff (n = 23) in 2011 to discuss topics including service delivery, information and communication, and provision of health and community care for people with dementia. Respondents identified problems with information sharing and incompatible electronic systems; inflexibility in home care services; and poor recognition of dementia in hospital settings. General practitioners had developed a greater awareness of the disease and some community services worked well. They felt that budgetary constraints and a focus on quality indicators impeded good dementia care. Key areas suggested by staff for improvements in dementia care included the implementation of more flexible services, dementia training for health and social care staff, and better quality care in acute hospital settings. © The Author(s)
Professional care providers in dementia care in eight European countries; their training and involvement in early dementia stage and in home care
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Hallberg IR, Cabrera E, Jolley D, Raamat K, Renom-Guiteras A, Verbeek H, et al.
Knowledge concerning professionals involved in dementia care throughout its trajectory is sparse; the focus has mainly been on nursing-home care and less on home care, diagnosis and treatment of the disease and its complications despite the fact that home care is the most prominent type of care. The aim of this study was to explore and describe professional care providers involved in dementia care and their educational level applying the International Standard Classification of Education (ISCED) and further to investigate practice in the RightTimePlaceCare-countries with regard to screening, diagnostic procedures and treatment of dementia and home care. The findings demonstrate more similarities than differences in terms of type of professionals involved among the countries although untrained staff were more common in some countries. Findings also show that many types of professionals are involved, who to turn to may not be clear, for instance in terms of medical specialities and it may be unclear who bears the ultimate responsibility. The professionals involved in diagnosis, treatment and care are educated to bachelor’s level or above whilst everyday care is provided by people trained at a lower ISCED level or with no formal training. Registered nurses as well as occupational therapists have bachelor’s degrees in most countries, but not in Germany or Estonia. Professionals specifically trained in dementia care are not so common. Further research is needed to reveal not only who provides the diagnostics and treatment, but also how home care is organised and quality assured. Many different types of professionals serve as providers along the trajectory of the disease which may be difficult for the patient and the informal caregiver to cope with.
A recent study investigated a small number of chief executive officers in NHS acute hospitals and mental health trusts to determine how they actually mobilise knowledge and evidence resources prior to making decisions. NHS CEOs seek information and use knowledge most of the day (even if in unplanned ways, particularly through conversations with trusted colleagues), simply to be able to make sense of the world.
The review found compelling evidence that NHS organisations with high levels of staff engagement – where staff are strongly committed to their work and involved in decision-making – deliver better quality care. These organisations report:
-lower mortality rates
-better patient experience
-lower rates of sickness absence and staff turnover.
Organisations with low levels of staff engagement are more likely to provide poor-quality care – the failures in care at Mid Staffordshire NHS Foundation Trust are a high-profile example of this. While staff engagement levels have increased across the NHS in recent years, the review found significant variations between organisations. It calls on all NHS organisations to make staff engagement a key priority in order to improve care at a time of unprecedented financial and service pressures. The review found emerging evidence that staff-led mutuals deliver higher levels of staff engagement and, as a result, recommends NHS organisations are given greater freedom to become mutuals, on a voluntary basis. It calls on the government to launch a programme of pathfinders to gather further evidence about the benefits of mutuals and whether they could be adopted on a larger scale across the NHS.
This paper examines assistants’ contribution to and fit with healthcare teams and the broader workforce reform agenda. It analyses the available evidence relating to the assistant workforce, including: • the characteristics of the Australian assistant workforce • current Australian assistant workforce roles, scopes of practice and models • tested models for the most efficient and effective use and skills mix in healthcare teams • the barriers and enablers to large-scale and consistent uptake of this workforce.
Health Care Innovation and Quality Assurance
The complexity in the implementation process of empowerment-based chronic kidney care: a case study.
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Nygardh A, Malm D, Wikby K, Ahlstrom G.
BMC nursing 2014 Jul 30;13:22-6955-13-22. eCollection 2014
This study is part of an interactive improvement intervention aimed to facilitate empowerment-based chronic kidney care using data from persons with CKD and their family members. There are many challenges to implementing empowerment-based care, and it is therefore necessary to study the implementation process. The aim of this study was to generate knowledge regarding the implementation process of an improvement intervention of empowerment for those who require chronic kidney care. METHODS: A prospective single qualitative case study was chosen to follow the process of the implementation over a two year period. Twelve health care professionals were selected based on their various role(s) in the implementation of the improvement intervention. Data collection comprised of digitally recorded project group meetings, field notes of the meetings, and individual interviews before and after the improvement project. These multiple data were analyzed using qualitative latent content analysis. RESULTS: TWO FACILITATOR THEMES EMERGED: Moving spirit and Encouragement. The healthcare professionals described a willingness to individualize care and to increase their professional development in the field of chronic kidney care. The implementation process was strongly reinforced by both the researchers working interactively with the staff, and the project group. One theme emerged as a barrier: the Limitations of the organization. Changes in the organization hindered the implementation of the intervention throughout the study period, and the lack of interplay in the organization most impeded the process. CONCLUSIONS: The findings indicated the complexity of maintaining a sustainable and lasting implementation over a period of two years. Implementing empowerment-based care was found to be facilitated by the cooperation between all involved healthcare professionals. Furthermore, long-term improvement interventions need strong encouragement from all levels of the organization to maintain engagement, even when it is initiated by the health care professionals themselves.
Do Patient-Centered Medical Homes Reduce Emergency Department Visits?
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David G, Gunnarsson C, Saynisch PA, Chawla R, Nigam S.
Health services research 2014 Aug 12
To assess whether adoption of the patient-centered medical home (PCMH) reduces emergency department (ED) utilization among patients with and without chronic illness. DATA SOURCES: Data from approximately 460,000 Independence Blue Cross patients enrolled in 280 primary care practices, all converting to PCMH status between 2008 and 2012. RESEARCH DESIGN: We estimate the effect of a practice becoming PCMH-certified on ED visits and costs using a difference-in-differences approach which exploits variation in the timing of PCMH certification, employing either practice or patient fixed effects. We analyzed patients with and without chronic illness across six chronic illness categories. PRINCIPAL FINDINGS: Among chronically ill patients, transition to PCMH status was associated with 5-8 percent reductions in ED utilization. This finding was robust to a number of specifications, including analyzing avoidable and weekend ED visits alone. The largest reductions in ED visits are concentrated among chronic patients with diabetes and hypertension. CONCLUSIONS: Adoption of the PCMH model was associated with lower ED utilization for chronically ill patients, but not for those without chronic illness. The effectiveness of the PCMH model varies by chronic condition. Analysis of weekend and avoidable ED visits suggests that reductions in ED utilization stem from better management of chronic illness rather than expanding access to primary care clinics. © Health Research and Educational Trust.
Does the Introduction of Nursing Home Culture Change Practices Improve Quality?
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Miller SC, Lepore M, Lima JC, Shield R, Tyler DA.
Journal of the American Geriatrics Society 2014
Objectives To understand whether nursing home (NH) introduction of culture change practices is associated with improved quality. Design NH-level panel study using multivariate fixed-effects statistical modeling to estimate the effect of culture change introduction on quality outcomes. Setting Eight hundred twenty-four U.S. NHs with culture change practice involvement beginning between 2005 and 2010. Participants Directors of nursing and nursing home administrators. Measurements A culture change practice score (derived from a 2009/10 national NH survey) was used to stratify NHs according to practice implementation (high (scores in the top quartile; n = 217) vs other (n = 607)). NH-level outcomes included prevalence of seven care practices and three resident outcomes, health-related and quality-of-life weighted survey deficiencies, and average number of hospitalizations per resident year. Results For NHs with high practice implementation, introduction of culture change was associated with a significant decrease in prevalence of restraints, tube feeding, and pressure ulcers; an increase in the proportion of residents on bladder training programs; and a small decrease in the average number of hospitalizations per resident year (coefficient −0.04, standard error (SE) 0.02, P = .06). For NHs with lower practice implementation (practice scores in lower three quartiles), introduction was associated with fewer health-related (coefficient −5.26, SE 3.05; P = .09) and quality-of-life (coefficient −0.10, SE 0.05; P = .04) survey deficiencies, although these NHs also had small statistically significant increases in the prevalence of residents with urinary tract infections and in average hospitalizations per resident year (coefficient 0.03, SE 0.01, P = .02). Conclusion The introduction of NH culture change appears to result in significant improvements in some care processes and outcomes in NHs with high practice implementation. For other NHs, culture change introduction results in fewer survey deficiencies.
Implementation of the patient-centered medical home in the veterans health administration: associations with patient satisfaction, quality of care, staff burnout, and hospital and emergency department use.
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JAMA internal medicine 2014 Aug 1;174(8):1350-1358
In 2010, the Veterans Health Administration (VHA) began implementing the patient-centered medical home (PCMH) model. The Patient Aligned Care Team (PACT) initiative aims to improve health outcomes through team-based care, improved access, and care management. To track progress and evaluate outcomes at all VHA primary care clinics, we developed and validated a method to assess PCMH implementation. OBJECTIVES: To create an index that measures the extent of PCMH implementation, describe variation in implementation, and examine the association between the implementation index and key outcomes. DESIGN, SETTING, AND PARTICIPANTS: We conducted an observational study using data on more than 5.6 million veterans who received care at 913 VHA hospital-based and community-based primary care clinics and 5404 primary care staff from (1) VHA clinical and administrative databases, (2) a national patient survey administered to a weighted random sample of veterans who received outpatient care from June 1 to December 31, 2012, and (3) a survey of all VHA primary care staff in June 2012. Composite scores were constructed for 8 core domains of PACT: access, continuity, care coordination, comprehensiveness, self-management support, patient-centered care and communication, shared decision making, and team-based care. MAIN OUTCOMES AND MEASURES: Patient satisfaction, rates of hospitalization and emergency department use, quality of care, and staff burnout. RESULTS: Fifty-three items were included in the PACT Implementation Progress Index (Pi2). Compared with the 87 clinics in the lowest decile of the Pi2, the 77 sites in the top decile exhibited significantly higher patient satisfaction (9.33 vs 7.53; P < .001), higher performance on 41 of 48 measures of clinical quality, lower staff burnout (Maslach Burnout Inventory emotional exhaustion subscale, 2.29 vs 2.80; P = .02), lower hospitalization rates for ambulatory care-sensitive conditions (4.42 vs 3.68 quarterly admissions for veterans 65 years or older per 1000 patients; P < .001), and lower emergency department use (188 vs 245 visits per 1000 patients; P < .001). CONCLUSIONS AND RELEVANCE: The extent of PCMH implementation, as measured by the Pi2, was highly associated with important outcomes for both patients and providers. This measure will be used to track the effectiveness of implementing PACT over time and to elucidate the correlates of desired health outcomes.
Barriers and facilitators to the uptake of computerized clinical decision support systems in specialty hospitals: protocol for a qualitative cross-sectional study.
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Moja L, Liberati E, Galuppo L, Gorli M, Maraldi M, Nanni O, et al.
Implementation science 2014 Aug 28;9(1):105
Computerized clinical decision support systems (CDSSs) have been shown to improve the efficiency and quality of patient care by connecting healthcare professionals with high quality, evidence-based information at the point-of-care. The mere provision of CDSSs, however, does not guarantee their uptake. Rather, individual and institutional perceptions can foster or inhibit the integration of CDSSs into routine clinical workflow. Current studies exploring health professionals¿ perceptions of CDSSs focus primarily on technical and usability issues, overlooking the social or cultural variables as well as broader administrative or organizational roles that may influence CDSS adoption. Moreover, there is a lack of data on the evolution of perceived barriers or facilitators to CDSS uptake across different stages of implementation. Methods We will conduct a qualitative, cross-sectional study in three Italian specialty hospitals involving frontline physicians, nurses, information technology staff, and members of the hospital board of directors. We will use semi-structured interviews following the Grounded Theory framework, progressively recruiting participants until no new information is gained from the interviews. Discussion CDSSs are likely to become an integral and diffuse part of clinical practice. Various factors must be considered when planning their introduction in healthcare settings. The findings of this study will guide the development of strategies to facilitate the successful integration of CDSSs into the regular clinical workflow. The evaluation of diverse health professionals across multiple hospital settings in different stages of CDSS uptake will better capture the complexity of roles and contextual factors affecting CDSS uptake.
Health Research Policy and Systems Journal issues special collection on
Advancing the application of systems thinking in health
Systems thinking provides an understanding of the complexity of health systems, which is fundamental for strengthening the design, implementation and evaluation of health systems interventions, policies and strategies. The primary objective of this Series is to support the shift from abstract concepts to actual applications and experiences of systems thinking in health, particularly in LMIC. Articles include:
Advancing the application of systems thinking in health: a realist evaluation of a capacity building programme for district managers in Tumkur, India
Advancing the application of systems thinking in health: understanding the growing complexity governing immunization services in Kerala, India
Advancing the application of systems thinking in health: sustainability evaluation as learning and sense-making in a complex urban health system in Northern Bangladesh
Advancing the application of systems thinking in health: managing rural China health system development in complex and dynamic contexts
Advancing the application of systems thinking in health
Advancing the application of systems thinking in health: analysing the contextual and social network factors influencing the use of sustainability indicators in a health system – a comparative study in Nepal and Somaliland
Advancing the application of systems thinking in health: advice seeking behavior among primary health care physicians in Pakistan
The application of systems thinking in health: why use systems thinking?
Advancing the application of systems thinking in health: exploring dual practice and its management in Kampala, Uganda
Advancing the application of systems thinking in health: understanding the dynamics of neonatal mortality in Uganda
Advancing the application of systems thinking in health: provider payment and service supply behaviour and incentives in the Ghana National Health Insurance Scheme – a systems approach
Advancing the application of systems thinking in health: South African examples of a leadership of sensemaking for primary health care
Advancing the application of systems thinking in health: realist evaluation of the Leadership Development Programme for district manager decision-making in Ghana
Advancing the application of systems thinking in health: realist evaluation of the Leadership Development Programme for district manager decision-making in Ghana
Advancing the application of systems thinking in health: why cure crowds out prevention
The Troubled State of America’s Nursing Homes
A Moran, Temple University
Even the most cursory search of news coverage involving nursing homes reveals that horror stories are not difficult to come by. Although the grisly details of each individual horror story vary, most of them share the same general story line — through some combination of gross negligence and profound systemic failure, elderly citizens can experience disturbing conditions in nursing homes that result in suffering and sometimes death. Although egregious stories make local news headlines every so often and prompt a brief firestorm of public criticism, the everyday reality of nursing homes is much less sensationalized, and arguably even more sobering. Statistics indicate that abuse and neglect frequently go unreported, and both research and anecdotes indicate that nursing homes often fail to live up to their billing as places of care, calm, and comfort. These indications raise troubling sociological, legal, and ethical questions about how we care for one of our most vulnerable populations — the elderly. This paper analyzes nursing home failures in light of the federal regulatory regime that oversees them. Section II provides a framework for the discussion of nursing homes by describing the choices seniors have for their living arrangements. In order to establish context for the current social and legal space inhabited by nursing homes, Section III traces the historical development of the modern nursing homes, with a particular focus on the landmark laws of the 1960s that paved the way for late-twentieth century proliferation of nursing homes. With this background in mind, Section IV explores the federal regulatory regime that governs nursing homes, and Section V details the bodies and mechanisms that enforce federal rules and regulations. Section VI provides evidence and statistics regarding the prevalence of abuse and neglect in nursing homes and argues that these data evidence a troubled regulatory system. Section VII examines the Patient Protection and Affordable Care Act, which has been heralded as the most significant legislation affecting the healthcare industry in decades, and concludes that the law does not contain provisions that will serve to reduce elder abuse and neglect in any significant way. Section VIII offers recommendations to improve nursing home care in light of the foundation provided by PPACA. Section IX discusses potential blowback that these and other solutions may present and urges reformers to proceed carefully and thoughtfully before enacting any proposed reform.
Insights from staff nurses and managers on unit-specific nursing performance dashboards: a qualitative study
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Jeffs L, Beswick S, Lo J, Lai Y, Chhun A, Campbell H.
BMJ Quality & Safety 2014 September 05
Performance data can be used to monitor and guide interventions aimed at improving the quality and safety of patient care. To use performance data effectively, nurses need to understand how to interpret and use data in meaningful ways to guide practice. Dashboards are interactive computerised tools that display performance data. In one large, urban teaching hospital in Toronto, Canada, unit-specific dashboards were implemented across the organisation. Methods A qualitative study was undertaken to explore the perceptions and experiences of front-line nurses and managers associated with the implementation of a unit-level dashboard. Six units were selected to participate in the study. Data were analysed using a directed content analysis approach. Results The sample included 56 study participants, including 51 front-line nurses and 5 unit managers. Three key themes emerged around nurses’ and unit managers’ perspectives on the implementation of unit-specific dashboards. Nurses and managers described that the Care Utilising Evidence dashboard was a visual tool that displayed data on the impact of the nursing care provided to patients. This tool also was used by the nurses and managers to keep track of processes of care and patient outcomes and experiences at a unit level. Further, nurses were able to use performance data to identify quality care improvements specific to their unit. Conclusions The results highlight how unit-specific dashboards are being used to monitor performance and drive quality improvement efforts from the perspectives of nurses and unit managers. In practice, nurse leaders may consider investing in dashboards as a quality improvement strategy to optimise the use of performance data at their organisations.
Over the course of this Assessment, we identified an emerging consensus that optimizing scopes of practice, paired with evolving models of shared care can provide a multidimensional approach to shift the health care system from one that is characteristically siloed to one that is collaborative and patient-focused. The report highlights the barriers and enablers related to optimal scopes of practice using the macro (structural), meso (institutional/organizational) and micro (practice) framework.
Research Practice & Methodology
How does under-reporting of negative and inconclusive results affect the false-positive rate in meta-analysis? A simulation study.
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BMJ open 2014 Aug 28;4(8):e004831-2014-004831
To investigate the impact of a higher publishing probability for statistically significant positive outcomes on the false-positive rate in meta-analysis. DESIGN: Meta-analyses of different sizes (N=10, N=20, N=50 and N=100), levels of heterogeneity and levels of publication bias were simulated. PRIMARY AND SECONDARY OUTCOME MEASURES: The type I error rate for the test of the mean effect size (ie, the rate at which the meta-analyses showed that the mean effect differed from 0 when it in fact equalled 0) was estimated. Additionally, the power and type I error rate of publication bias detection methods based on the funnel plot were estimated. RESULTS: In the presence of a publication bias characterised by a higher probability of including statistically significant positive results, the meta-analyses frequently concluded that the mean effect size differed from zero when it actually equalled zero. The magnitude of the effect of publication bias increased with an increasing number of studies and between-study variability. A higher probability of including statistically significant positive outcomes introduced little asymmetry to the funnel plot. A publication bias of a sufficient magnitude to frequently overturn the meta-analytic conclusions was difficult to detect by publication bias tests based on the funnel plot. When statistically significant positive results were four times more likely to be included than other outcomes and a large between-study variability was present, more than 90% of the meta-analyses of 50 and 100 studies wrongly showed that the mean effect size differed from zero. In the same scenario, publication bias tests based on the funnel plot detected the bias at rates not exceeding 15%. CONCLUSIONS: This study adds to the evidence that publication bias is a major threat to the validity of medical research and supports the usefulness of efforts to limit publication bias.
How pragmatic is it? Lessons learned using PRECIS and RE-AIM for determining pragmatic characteristics of research.
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Gaglio B, Phillips SM, Heurtin-Roberts S, Sanchez MA, Glasgow RE.
Implementation science : IS 2014 Aug 28;9(1):96
The need for high-quality evidence that is applicable in real-world, routine settings continues to increase. Pragmatic trials are designed to evaluate the effectiveness of interventions in real-world settings, whereas explanatory trials aim to test whether an intervention works under optimal situations. There is a continuum between explanatory and pragmatic trials. Most trials have aspects of both, making it challenging to label and categorize a trial and to evaluate its potential for translation into practice. Methods We summarize our experience applying the Pragmatic-Explanatory Continuum Indicator Summary (PRECIS) combined with external validity items based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to three studies to provide a more robust and comprehensive assessment of trial characteristics related to translation of research. We summarize lessons learned using domains from the combined frameworks for use in study planning, evaluating specific studies, and reviewing the literature and make recommendations for future use. Results A variety of coders can be trained to use the PRECIS and RE-AIM domains. These domains can also be used for diverse purposes, content areas, and study types, but are not without challenges. Both PRECIS and RE-AIM domains required modification in two of the three studies to evaluate and rate domains specific to study type. Lessons learned involved: dedicating enough time for training activities related to the domains; use of reviewers with a range of familiarity with specific study protocols; how to best adapt ratings that reflect complex study designs; and differences of opinion regarding the value of creating a composite score for these criteria.Conclusions Combining both frameworks can specifically help identify where and how a study is and is not pragmatic. Using both PRECIS and RE-AIM allows for standard reporting of key study characteristics related to pragmatism and translation. Such measures should be used more consistently to help plan more pragmatic studies, evaluate progress, increase transparency of reporting, and integrate literature to facilitate translation of research into practice and policy.
Scoping reviews: time for clarity in definition, methods, and reporting.
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Colquhoun HL, Levac D, O’Brien KK, Straus S, Tricco AC, Perrier L, et al.
Journal of clinical epidemiology 2014 Jul 14
The scoping review has become increasingly popular as a form of knowledge synthesis. However, a lack of consensus on scoping review terminology, definition, methodology, and reporting limits the potential of this form of synthesis. In this article, we propose recommendations to further advance the field of scoping review methodology. STUDY DESIGN AND SETTING: We summarize current understanding of scoping review publication rates, terms, definitions, and methods. We propose three recommendations for clarity in term, definition and methodology. RESULTS: We recommend adopting the terms “scoping review” or “scoping study” and the use of a proposed definition. Until such time as further guidance is developed, we recommend the use of the methodological steps outlined in the Arksey and O’Malley framework and further enhanced by Levac et al. The development of reporting guidance for the conduct and reporting of scoping reviews is underway. CONCLUSION: Consistency in the proposed domains and methodologies of scoping reviews, along with the development of reporting guidance, will facilitate methodological advancement, reduce confusion, facilitate collaboration and improve knowledge translation of scoping review findings. Copyright © 2014 Elsevier Inc. All rights reserved
Instrumentation issues in implementation science
Martinez R, Lewis C, Weiner B.
Implementation Science 2014;9(1):118
Like many new fields, implementation science has become vulnerable to instrumentation issues that potentially threaten the strength of the developing knowledge base. For instance, many implementation studies report findings based on instruments that do not have established psychometric properties. This article aims to review six pressing instrumentation issues, discuss the impact of these issues on the field, and provide practical recommendations.Discussion This debate centers on the impact of the following instrumentation issues: use of frameworks, theories, and models; role of psychometric properties; use of `home-grown? and adapted instruments; choosing the most appropriate evaluation method and approach; practicality; and need for decision-making tools. Practical recommendations include: use of consensus definitions for key implementation constructs; reporting standards (e.g., regarding psychometrics, instrument adaptation); when to use multiple forms of observation and mixed methods; and accessing instrument repositories and decision aid tools.Summary This debate provides an overview of six key instrumentation issues and offers several courses of action to limit the impact of these issues on the field. With careful attention to these issues, the field of implementation science can potentially move forward at the rapid pace that is respectfully demanded by community stakeholders.
Realist Impact Evaluation: An Introduction
Realist evaluation is a member of a family of theory-based evaluation approaches which begin by clarifying the ‘programme theory’: the mechanisms that are likely to operate, the contexts in which they might operate and the outcomes that will be observed if they operate as expected.
•Realist approaches assume that nothing works everywhere for everyone: context makes a big difference to programme outcomes. A realist evaluation asks not ‘what works?’ but ‘how or why does this work, for whom, in what circumstances?’
•Realist impact evaluation is most appropriate for evaluating new initiatives or programmes that seem to work but where ‘how and for whom’ is not yet understood; programmes that have previously demonstrated mixed patterns of outcomes; and those that will be scaled up, to understand how to adapt the intervention to new contexts.
Quality-of-life measures for use within care homes: a systematic review of their measurement properties.
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Aspden T, Bradshaw SA, Playford ED, Riazi A.
Age and Ageing 2014 Aug 3
OBJECTIVE: the aims of this review were (i) to identify quality-of-life (QoL) measures which have had their measurement properties validated in people residing in care homes or nursing homes, and to critically compare and summarise these instruments and (ii) to make recommendations for measurement instruments. METHODS: bibliographic databases PsycINFO, PubMed, Cochrane, CINAHL and Embase were searched for articles evaluating measurement properties of QoL instruments in people residing in care homes. Methodological quality of studies was assessed using the consensus-based standards for the selection of health measurement instruments checklist. Measurement properties of instruments were appraised using a systematic checklist. RESULTS: the search strategy resulted in 3252 unique citations, of which 15 articles were included in this review. These articles assessed 13 instruments, 8 of which were dementia or Alzheimer specific instruments. The QUALIDEM, a dementia-specific observational instrument, had the widest array of information available on its measurement properties, which were mostly satisfactory. Most measurement instruments lacked information on hypotheses testing and content validity. Information on responsiveness and measurement error was not available for any instrument. CONCLUSIONS: for people with dementia living in care homes, the QUALIDEM is recommended for measuring QoL. For residents without dementia, we recommend Kane et al.’s Psychosocial Quality of Life Domains questionnaire. Studies of higher methodological quality, assessing a wider range of measurement properties are needed to allow a more fully informed choice of QoL instrument. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved.
Does Dementia Caregiving Accelerate Frailty? Findings From the Health and Retirement Study.
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Dassel KB, Carr DC.
The Gerontologist 2014 Aug 26
PURPOSE OF THE STUDY: Numerous studies have discovered negative health consequences associated with spousal caregiving at the end of life; however, little is known about how care-recipient cognitive status impacts caregiver health outcomes, specifically in the area of frailty, and whether health consequences remain over time. This study examines differences in frailty between spousal caregivers of persons with and without a dementia diagnosis. DESIGN AND METHODS: Using 7 biannual waves of the Health and Retirement Study data (1998-2010), we examined odds of becoming frailer among surviving spouses of individuals who died between 2000 and 2010 (N = 1,246) with and without dementia. To assess increased frailty, we used a Frailty Index, which assesses chronic diseases, mobility, functional status, depressive symptoms, and subjective health. Logistic regression was used to examine the relationship between care-recipient cognitive status and whether, compared with the wave prior to death of the care-recipient, spousal caregivers were frailer: (1) in the wave the death was reported and (2) 2 years after the death was reported. RESULTS: Dementia caregivers had 40.5% higher odds of experiencing increased frailty by the time the death was reported and 90% higher odds in the following wave compared with non-dementia caregivers. IMPLICATIONS: Given our findings, we discuss public health implications regarding the health and well-being of caregivers of persons with dementia. Given projected increases in dementia diagnoses as the population ages, we propose a need for interventions that provide enhanced support for dementia caregivers. © The Author 2014
Emergency ambulance service involvement with residential care homes in the support of older people with dementia: an observational study
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Amador S, Goodman C, King D, Machen I, Elmore N, Mathie E, et al.
BMC geriatrics 2014 Aug 28;14(1):95
Older people resident in care homes have a limited life expectancy and approximately two-thirds have limited mental capacity. Despite initiatives to reduce unplanned hospital admissions for this population, little is known about the involvement of emergency services in supporting residents in these settings. METHODS: This paper reports on a longitudinal study that tracked the involvement of emergency ambulance personnel in the support of older people with dementia, resident in care homes with no on-site nursing providing personal care only. 133 residents with dementia across 6 care homes in the East of England were tracked for a year. The paper examines the frequency and reasons for emergency ambulance call-outs, outcomes and factors associated with emergency ambulance service use. RESULTS: 56% of residents used ambulance services. Less than half (43%) of all call-outs resulted in an unscheduled admission to hospital. In addition to trauma following a following a fall in the home, results suggest that at least a reasonable proportion of ambulance contacts are for ambulatory care sensitive conditions. An emergency ambulance is not likely to be called for older rather than younger residents or for women more than men. Length of residence does not influence use of emergency ambulance services among older people with dementia. Contact with primary care services and admission route into the care home were both significantly associated with emergency ambulance service use. The odds of using emergency ambulance services for residents admitted from a relative’s home were 90% lower than the odds of using emergency ambulance services for residents admitted from their own home. CONCLUSIONS: Emergency service involvement with this vulnerable population merits further examination. Future research on emergency ambulance service use by older people with dementia in care homes, should account for important contextual factors, namely, presence or absence of on-site nursing, GP involvement, and access to residents’ family, alongside resident health characteristics.
The Costs of Caring: Caregiver Strain & Work-Family Conflict Among Canadian Workers
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Glavin P, Peters A.
Journal of Family and Economic Issues 2014:1-16.
We analyzed survey data from a nationally representative study of Canadian labor force participants (n = 5,667) to examine the social distribution and mental health of those who provide unpaid health-related care to a family member or relative. As part of these analyses, we investigated gender differences in the association between caregiving frequency and mental health. Multivariate analyses revealed evidence that women caregivers experienced greater health penalties than men with care commitments. Mediation analyses further indicated that work-family conflict fully explained the caregiver strain experienced by men, while it only partially accounted for caregiver strain among women. These results extend previous research that has documented differences in the duties and experiences of men and women caregivers. We discuss direct empathetic crossover as a potential contributory factor for women’s caregiving strain.
Humanity is ageing rapidly and is doing so at a far greater rate than at any time in history. Until this century, wars and disease caused many early deaths but thankfully the world has largely left these tragedies in the past. Yet we are now faced with a challenge to create a society that embraces positively the economic and social impact of ageing. The Blueprint for an Ageing Australia sets out sets out the steps that must be taken now to ensure that ageing is an asset, not a liability. The Blueprint is the report of the Advisory Panel on Positive Ageing. The Advisory Panel was constituted in 2011 with a three-year mandate to produce a comprehensive policy review on the opportunities and challenges associated with an ageing Australia. In November 2013, the funding of the Panel was discontinued, and Per Capita entered into a partnership with four members of the Panel to re-establish the Panel and complete the Blueprint. This year, the Panel has held consultations around the country and engaged with stakeholders in ageing policy, health, superannuation, as well as culturally and linguistically diverse groups. This work has produced the Blueprint which provides a wide-ranging set of policy recommendations to place Australia at the forefront of forward-thinking policy on this demographic shift.
The report synthesizes findings from an international forum on home care convened in January by MSFHR and the B.C. Ministry of Health. Six international experts were invited to Vancouver to speak about home care practice in their respective countries, offering an important opportunity for BC policy-makers and researchers to learn how other jurisdictions are providing sustainable home care for seniors. Each expert speaker at the forum described the context for home care in his or her country as well as highlighting recent innovations and lessons learned from their own research. Following the presentations, participants discussed key lessons for B.C. before identifying a core set of objectives to guide the development of improved home care models.
In 2012, about 8.1 million individuals, or 28% of Canadians aged 15 years and older, provided care to a family member or friend with a long-term health condition, disability or aging needs. New data from the 2012 General Social Survey showed that women represented the slight majority of caregivers at 54%. The survey also found that caregiving responsibilities most often fell to those aged 45 to 64, with 44% of caregivers in this age category. Ailing parents were the most common recipients of care, with 39% of caregivers looking after the needs of their own parents and another 9% doing so for their parents-in-law. The least common were spouses, at 8%, and children, at 5%. For the first time, the survey looked at the types of health conditions requiring care. Age-related needs topped the list, with 28% of caregivers providing care for these needs. Cancer was next at 11%, followed by cardio-vascular disease at 9%, and mental illness at 7%.
Long Term Care: A Safe and Secure Environment
26-27 November 2014 Toronto
A comprehensive, content driven, two-day program has been developed in concert with leading experts to empower long-term care leaders to support their staff and provide quality care in a safe and respectful environment. You will take part in interactive presentations, case studies and panel discussions that demonstrate realistic solutions for creating a safe and patient-centered atmosphere to work and live. Hear practical strategies that will enable you to initiate change that will benefit your current residents using available resources.
Data Analytics for Healthcare
2-3 December Toronto ON
Organizations who embrace change and actively engage their staff in the process of healthcare transformation approach data analytics from a position of strength. Bringing together the stakeholders in clinical care, operations, IT, research and more, this summit will give you a comprehensive view of the new policies, initiatives and trends that will enrich your decision-making process. As Canada’s longest running and most respected data analytics knowledge exchange, this is your opportunity to source insights from healthcare and IT leaders.
Annual Forum on Patient Experience
23-24 September Toronto
During the 2nd annual Forum on Patient Experience, hosted by the Strategy Institute, you will hear patient stories, case studies, interactive Q&A, and peer-to-peer exchange. Join national and international thought leaders to source best practices, lessons learned and proven strategies. Be prepared to implement, sustain and continuously improve your patient experience vision. You will walk away with new ideas to continue to improve your patient experience journey.
Health Innovation Forum
2-3 October Montreal
This conference will equip patients, clinicians, administrators and policymakers with the inspiration, models and tools to pursue patient engagement initiatives that improve care and outcomes.
Canadian interRAI Conference
6-9 October Winnipeg
The 8th Canadian interRAI conference provides an important forum that brings together researchers, policy makers and practitioners using the interRAI system of instruments in community and home care, residential/long-term care, acute care, assisted living, mental health and palliative care. These evidence-based electronic instruments capture client/patient assessment information that is used to support care planning and delivery, quality improvement, health system management and policy development.
Second Global Dementia Legacy Event Co-hosted by Canada-France Harnessing the power of discoveries: Maximizing academia-industry synergies
11-12 September Ottawa This event will be hosted online
Ignited by discussions held at the recent G8 Summit on Dementia in London, Canada and France are co-hosting one of four legacy events. The event will explore how to take advantage of the synergies between industry and academia, and help release the power of discoveries.
KT Conference 2014: KT and Media Outreach Strategies
27, 29, 31 October 10:00-15:00 MT each day
SEDL’s Center on Knowledge Translation for Disability and Rehabilitation Research (KTDRR) is pleased to invite you to its second annual Online Knowledge Translation (KT) Conference sponsored by SEDL’s Center on Knowledge Translation for Disability and Rehabilitation Research (KTDRR) is designed to address effective KT and media outreach strategies. There is no fee to participate in the conference.
KT Canada Seminar: Use of KT models in the development of a Research Program
Thursday 11 September 10-11 MT
Speaker: Dr. Beverly Temple
This session will be hosted at the UofA in ECHA 5-099
-To understand how KT models can be used to guide research projects and a program of research
-To understand how to engage knowledge users in unique KT studies
-To understand how both integrated and end of grant KT was used to meet the needs of knowledge users in the Intellectual and Developmental Disability Sector
SEDL: An Introduction to the Campbell Collaboration
Tuesday 9 September 13:00-13:45 MT
This webcast focuses on the purpose and ambitions of the Campbell Collaboration (C2), an organization dedicated to building capacity to develop and learn from research evidence produced through rigorous systematic reviews. Presenters include: Dr. Eamonn Noonan, Dr. Julia Littell, and Dr. Sean Grant. Presenters address frequently asked questions about C2 and the role of evidence to better inform decision-making.
NICHE Webinar: Oral Health
Wednesday 17 September 11:00 MT FREE
In collaboration with NICHE (Nurses Improving Care for Healthsystem Elders), the Hartford Institute for Geriatric Nursing (HIGN) and the Oral Health Nursing Education and Practice (OHNEP) have developed a new Oral Health Webinar Series. This new series addresses and promotes interprofessional oral health, and provides tools and education that healthcare professionals can use to improve the quality of oral healthcare that older adults receive. Each webinar, one hour in length, provides nursing continuing education.
Translating Research into Practice: Using AHRQ and PCORI Evidence-Based Research for Nursing Practice
Wednesday 10 Sepetmber 12:00-13:00 MT Free but space is limited so register right away
AHRQ and PCORI recognize that nurses are always on the frontline of primary care, ensuring coordinated health care, patient education, and better health outcomes for all Americans. As the role of advanced practice registered nurses and other frontline nurses expands, it is important that they have access to evidence-based decision making tools.
AIHS Plain Language Workshop
4-5 November Calgary AB
Plain language is about writing in a way that is clear and understandable to your audience. In this intensive two-day workshop, instructors from Wordsmith Associates will teach you how to apply plain language skills to write effective emails, letter, and memos; KT proposals and plans; grant applications; lecture notes; and publications.
AIHS Scientist Knowledge Translation Training Workshop
4-5 December Calgary AB
This highly-regarded, two-day workshop helps participants build essential skills in knowledge translation. Join trainers Dr. Melanie Barwick and Dr. Donna Lockett to:
-develop knowledge translation plans
-communicate research findings to multiple audiences including the media
-link with policy and decision-makers
-understand the theory behind knowledge translation
-understand evidence-based knowledge translation strategies and evaluation methods
This workshop is of interest to researchers, KT professionals, practitioners, educators, and decision makers who wish to develop their knowledge translation (KT) skills. While the focus is on health, the course material is relevant to individuals working in all sectors.
It has long been known that more women than men get the deadly neurodegenerative disease, and an emerging body of research is challenging the common wisdom as to why. Although the question is by no means settled, recent findings suggest that biological, genetic and even cultural influences may play heavy roles.
Check out this list of the top ten developments in qualitative evaluation inquiry over the last decade. Is anything missing?
Depression, dental problems, difficulty buying groceries among most common reasons, study finds
The Alzheimer Knowledge Exchange (AKE) and the Canadian Dementia Resource and Knowledge Exchange (CDRAKE) will be combining activities to form an exciting new network called the brainXchange. The combination of AKE and CDRAKE will create new and enhanced knowledge exchange opportunities to help you achieve your goals. Leveraging both networks to access and share collective wisdom, knowledge and expertise, we will enable more effective provincial and national development and exchange together. No date been given for the launch of brainXchange.
The Agency for Healthcare Research and Quality (AHRQ) has established the new Center for Evidence and Practice Improvement (CEPI) to support one of its recently announced priority areas: improving health care quality by accelerating implementation of findings from patient-centered outcomes research (PCOR). The new Center realigns the functions of two AHRQ Centers— the Center for Outcomes and Evidence and the Center for Primary Care, Prevention, and Clinical Partnerships. The new Center will unify the Agency’s efforts and investments to accelerate practice improvement through the increased use of medical evidence and evidence-based information tools. CEPI will solicit input from external partners and work with the U.S. Department of Health and Human Services (HHS) to ensure that evidence is communicated, understood, and used by health care professionals, as well as patients and families, to improve the health care system for everyone.
CEPI consists of five divisions:
-Evidence-based Practice Center Program
-U.S. Preventive Services Task Force Program
-Division of Decision Science and Patient Engagement
-Division of Health Information Technology
-Division of Practice Improvement
The Center will also house the National Center for Excellence in Primary Care Research, which serves as the principal source of funding for primary care practice research in HHS.
Poor oral hygiene has been associated with many diseases, including cardiovascular diseases such as stroke, Alzheimer’s disease, respiratory ailments such as pneumonia, and periodontal disease. In long-term care (LTC) facilities, residents often need help with oral care, but rarely receive it. When help is provided, it generally comes from nursing assistants, who often do not have proper training on managing oral health issues in dependent adults and do not know the importance of proper oral hygiene in this population.
Providing oral healthcare to long-term care residents is often impeded by a multitude of obstacles, and there are few evidence-based resources on which direct care workers can rely. Annals of Long-Term Care® asked Rita Jablonski, PhD, about her experience providing oral care to residents, the barriers that she has encountered, and her research for overcoming care-resistant behavior in residents with dementia. She also offers insight on the short-term solutions to common oral health problems (eg, xerostomia, stomatitis), the long-term goals of integrating oral healthcare practices into widespread culture change, and the role of family caregivers in the care team.
With the Council of Federation meeting August 26-30 in Charlottetown, the Alzheimer Society of Canada is calling on Canada’s provincial and territorial premiers to make a national dementia plan a top priority.
The New Brunswick Medical Society is issuing its own prescription for fixing the province’s ailing health system and it calls for an infusion of cash to pay for new nursing homes, better access to primary care and more doctors.
On August 27, 104, the CNA President Dr. Karima Velji met one-on-one with the Council of the Federation’s chair, PEI’s Premier Robert Ghiz, to strongly support the call for a national inquiry into missing and murdered aboriginal women, discuss strategies for improving health care for aboriginal Canadians and reinforce the need for immediate action on a seniors health strategy.
Public health bodies across Canada, starved of census data, are paying for pricey surveys to collect their own local info but say they’re still flying blind on decisions that affect public health and taxpayer dollars. As predicted, the national household survey that replaced Statistics Canada’s long-form census has flawed data that becomes more flawed the more granular you get.
Quebec Premier Philippe Couillard is pushing his fellow premiers to adopt a new funding formula for health care transfer payments that would take into account a province’s aging population.
Canada’s Premiers have launched a dialogue with Canadians that engages key stakeholders on aging, and creates a Task Force to look at the impacts an aging population will have on Canada’s social and economic future. This work will raise awareness on the changing social and economic needs associated with an aging population and highlight work that provinces and territories are undertaking to address these issues.
The system is already failing to keep up. In Saskatoon, the local health region reports that more than 100 people are waiting for a long-term care bed, and the wait time is one month to three months. With the city’s seniors population projected to increase from about 13 per cent in 2012 to almost 18 per cent in 2032, we can expect the wait list to worsen if current service delivery and funding models continue.
The lobby of Rosewood Post-Acute Rehab, a nursing home in this Sacramento suburb, bears all the touches of a luxury hotel, including high ceilings, leather club chairs and paintings of bucolic landscapes. What really sets Rosewood apart, however, is its five-star rating from Medicare, which has been assigning hotel-style ratings to nearly every nursing home in the country for the last five years. Rosewood’s five-star status — the best possible — places it in rarefied company: Only one-fifth of more than 15,000 nursing homes nationwide hold such a distinction. But an examination of the rating system by The New York Times has found that Rosewood and many other top-ranked nursing homes have been given a seal of approval that is based on incomplete information and that can seriously mislead consumers, investors and others about conditions at the homes.
A leader in Congress has called for an evaluation of the nursing home five-star rating system in light of a recent New York Times article (see above). Rep. Elijah Cummings (D-MD) requested that Centers for Medicare & Medicaid Services officials brief his staff by Sept. 16. One area of concern is the heavy reliance on nursing homes’ self-reported data about staffing levels and quality of care, which may not be regularly audited for accuracy, Cummings stated in his Aug. 26 letter to CMS Administrator Marilyn Tavenner.
The Alzheimer Society is asking all levels of government to support a national dementia plan. It has recommended the creation of the Canadian Alzheimer’s Disease and Dementia Partnership. The Partnership would bring together researchers, health professionals, provincial governments, industry, people with dementia and their families, as well as Alzheimer Societies across Canada, in order to plan and implement a national dementia plan.
The public use microdata file for Cycle 26 (2012) of the General Social Survey (GSS) is now available. Cycle 26 focused on Canadians who provided care to family and friends for a long-term health condition, disability or age-related problems, as well as those who received care from family, friends or professionals. The survey covered individuals aged 15 years and over living in private households in the provinces. In addition to updating the care-related information collected in previous years, the 2012 GSS introduced new content, including the type and severity of the health condition necessitating the care; the impact of caregiving on the lives of caregivers; satisfaction with care received from various sources; and accessible housing. As in all GSS cycles, data were also collected on the respondent’s main activity, education, income and other sociodemographic characteristics.
This toolkit from the British Association of Occupational Therapists is a free online resource full of practical ideas of how to support care home residents to live their lives doing the day-to-day activities that are important to them. The toolkit promotes dignity and respect, mental and physical wellbeing and integration into the community. It includes free training materials and audit tools to review and evidence aspects of care such as personalisation and choice.
In this short documentary, the filmmaker Banker White explores how Alzheimer’s disease has revealed the strength of his parents’ marriage.
Learn about the critical role that partnerships with patients and families play in healthcare improvement as well as the evolving role of patients and families in reshaping the healthcare systems.
The use of antipsychotics in dementia is receiving global attention. This resource from AHS includes many exceptional resources for frontline staff:
-When to use – and avoid antipsychotics
-Common reasons for agitation and aggression
-Approaches to empower and protect staff
-Person-centred and non-pharmacologic ideas and strategies
-Tools for behaviour mapping, assessment, medication review
-Engaging videos and helpful tip-sheets for staff education
-Brochures and ideas for families and volunteers
For more information about the AUA project, see their latest newsletter.
The Shape of Caring Review will ensure that nurses and care assistants receive high quality education and training, which supports high quality patient care. It will bring together findings and expertise from recent major reviews such as Francis, Cavendish, Willis and Berwick and make recommendations for the reform of nursing and care assistant education and training in England. The Shape of Caring Review will produce a final report for the Sponsoring Board by January 2015.
Governing Council feels that in order for CIHR to maintain its unique role and leadership position, we must further adapt to an environment in which health research has become more collaborative and interdisciplinary, involving different players with different expectations. There is also a need for increased accountability to the public demonstrating how CIHR-supported research directly contributes to improved health and health care outcomes, and a necessity to adapt to ongoing fiscal constraints.
Michael Smith Foundation for Health Research (MSFHR), Vancouver BC
DEADLINE 28 September
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