Congratulations to Dr. Greta Cummings.
Greta is to be inducted into 2015 Nurse Researcher Hall of Fame. She is one of 19 (and the only Canadian) nurse researchers joining The Honor Society of Nursing, Sigma Theta Tau International (STTI) International Nurse Researcher Hall of Fame. Congratulations Greta!!!!!!
CALL FOR PAPERS:
American Journal for Nursing Call for Papers for 2015
Specific clinical topics we currently seek:
-Community acquired pneumonia
-Treatment options for acute and chronic pain
-Acute and chronic pediatric topics: pain, scoliosis;
-Acute and chronic neurological topics – revisiting stroke; migraine management
-Current best practice in managing ovarian cancer; managing side effects from therapies
-Best practice in anticoagulant therapy
-Skin and wound care
-Acute/critical care topics: heart failure, sepsis update, respiratory failure
-Autoimmune disorders (lupus)
-General MCH topics
Pay-for-performance policy and data-driven decision making within nursing homes: a qualitative study.
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Abrahamson K, Miech E, Davila HW, Mueller C, Cooke V, Arling G.
BMJ quality & safety 2015 Mar 6
Health systems globally and within the USA have introduced nursing home pay-for-performance (P4P) programmes in response to the need for improved nursing home quality. Central to the challenge of administering effective P4P is the availability of accurate, timely and clinically appropriate data for decision making. We aimed to explore ways in which data were collected, thought about and used as a result of participation in a P4P programme. METHODS: Semistructured interviews were conducted with 232 nursing home employees from within 70 nursing homes that participated in P4P-sponsored quality improvement (QI) projects. Interview data were analysed to identify themes surrounding collecting, thinking about and using data for QI decision making. RESULTS: The term ‘data’ appeared 247 times in the interviews, and over 92% of these instances (228/247) were spontaneous references by nursing home staff. Overall, 34% of respondents (79/232) referred directly to ‘data’ in their interviews. Nursing home leadership more frequently discussed data use than direct care staff. Emergent themes included using data to identify a QI problem, gathering data in new ways at the local level, and measuring outcomes in response to P4P participation. Alterations in data use as a result of policy change were theoretically consistent with the revised version of the Promoting Action on Research Implementation in Health Services framework, which posits that successful implementation is a function of evidence, context and facilitation. CONCLUSIONS: Providing a reimbursement context that facilitates the collection and use of reliable local evidence may be an important consideration to others contemplating the adaptation of P4P policies.
Socio-contextual Determinants of Research Evidence Use in Public-Youth Systems of Care.
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Garcia AR, Kim M, Palinkas LA, Snowden L, Landsverk J.
Administration and Policy in Mental Health 2015 Feb 22
Recent efforts have been devoted to understanding the conditions by which research evidence use (REU) is facilitated from the perspective of system leaders in the context of implementing evidence-based child mental health interventions. However, we have limited understanding of the extent to which outer contextual factors influence REU. Outer contextual factors for 37 counties in California were gathered from public records in 2008; and child welfare, juvenile justice, and mental health system leaders’ perceptions of their REU were measured via a web-based survey from 2010 to 2012. Results showed that leaders with higher educational attainment and in counties with lower expenditures on inpatient mental health services were significantly associated with higher REU. Positive relationships between gathering research evidence and racial minority concentration and poverty at the county level were also detected. Results underscore the need to identify the organizational and socio-political factors by which mental health services and resources meet client demands that influence REU, and to recruit and retain providers with a graduate degree to negotiate work demands and interpret research evidence.
The gas cylinder, the motorcycle and the village health team member: a proof-of-concept study for the use of the Microsystems Quality Improvement Approach to strengthen the routine immunization system in Uganda.
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Bazos DA, LaFave LR, Suresh G, Shannon KC, Nuwaha F, Splaine ME.
Implementation science 2015 Dec;10(1):215-015-0215-3. Epub 2015 Mar 8
Although global efforts to support routine immunization (RI) system strengthening have resulted in higher immunization rates, the World Health Organization (WHO) estimates that the proportion of children receiving recommended DPT3 vaccines has stagnated at 80% for the past 3 years (WHO Fact sheet-Immunization coverage 2014, WHO, 2014). Meeting the WHO goal of 90% national DPT3 coverage may require locally based strategies to support conventional approaches. The Africa Routine Immunization Systems Essentials-System Innovation (ARISE-SI) initiative is a proof-of-concept study to assess the application of the Microsystems Quality Improvement Approach for generating local solutions to strengthen RI systems and reach those unreached by current efforts in Masaka District, Uganda. METHODS: The ARISE-SI intervention had three components: health unit (HU) advance preparations, an action learning collaborative, and coaching of improvement teams. The intervention was informed and assessed using qualitative and quantitative methods. Data collection focused on changes and outcomes of improvement efforts among five HUs and one district-level team during the intervention (June 2011-February 2012) and five follow-up months. RESULTS: Workshops and team meetings had a 95% attendance rate. All teams gained RI system knowledge and implemented changes to address locally identified problems. Specific changes included: RI register implementation and expanded use, Child Health Card provision and monitoring, staff cross-training, staffing pattern changes, predictable outreach schedules, and health system leader-community leader meetings. Several RI system barriers prevalent across Masaka District (e.g., lack of backup HU gas cylinders, inadequate outreach transportation, and village health team underutilization) were successfully addressed. Three of five HUs significantly increased the vaccines administered. All improvements were sustained 5 months post-intervention. External evaluation validated the findings of high levels of participant engagement, empowerment to make change, and willingness to sustain improvements. CONCLUSIONS: The Microsystems Quality Improvement Approach is a comprehensive approach, grounded in systems thinking, and coupled with intensive coaching. It provides a robust framework for engaging teams in the development of unique local solutions that strengthen RI systems in resource poor settings. The sustained improvements in local RI systems from this study provide evidence that this approach may be an effective framework for enhancing the WHO’s Reaching Every District (RED) immunization strategy.
Innovation attributes and adoption decisions: perspectives from leaders of a national sample of addiction treatment organizations.
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Knudsen HK, Roman PM.
Journal of substance abuse treatment 2015 Feb;49:1-7
Drawing on diffusion theory to further knowledge about evidence-based practices (EBPs) in the treatment of substance use disorders (SUDs), this study describes the perceived importance of innovation attributes in adoption decisions within a national sample of SUD treatment organizations. Face-to-face interviews were conducted with leaders of 307 organizations. A typology differentiated organizations reporting: (1) adoption of a treatment innovation in the past year (“recent adoption”), (2) plans to adopt an innovation in the upcoming year (“planned adoption”), or (3) no actual or planned adoption (“non-adoption”). About 30.7% of organizations reported recent adoption, 20.5% indicated planned adoption, and 48.8% were non-adopters. Leaders of organizations reporting recent adoption (n=93) or planned adoption (n=62) rated the importance of innovation attributes, including relative advantage, compatibility, complexity, and observability, on these adoption decisions using a Likert scale that ranged from 0 to 5. Innovation attributes most strongly endorsed were consistency with the program’s treatment philosophy (mean=4.47, SD=1.03), improvement in the program’s reputation with referral sources (mean=4.00, SD=1.33), reputational improvement with clients and their families (mean=3.98, SD=1.31), and reductions in treatment dropout (mean=3.75, SD=1.54). Innovation characteristics reflecting organizational growth and implementation costs were less strongly endorsed. Adopters and planners were generally similar in their importance ratings. There were modest differences in importance ratings when pharmacological innovations were compared to psychosocial interventions. These findings are consistent with diffusion theory and suggest that efforts to link EBPs with client satisfaction and potential reputational benefits may enhance the diffusion of EBPs. Attention to these attributes when developing and evaluating SUD treatment interventions may enhance efforts to increase subsequent adoption. Copyright © 2015 Elsevier Inc.
Knowledge transfer and exchange frameworks in health and their applicability to palliative care: scoping review protocol.
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Prihodova L, Guerin S, Kernohan WG.
Journal of advanced nursing 2015 Mar 5
To review knowledge transfer and exchange frameworks used in health, to analyse the core concepts of these frameworks and appraise their potential applicability to palliative care. BACKGROUND: Although there are over 60 different models of knowledge transfer and exchange designed for various areas of the fields of health care, many remain largely unrefined and untested. There is a lack of studies that create guidelines for scaling-up successful implementation of research findings and of proven models ensuring that patients have access to optimal health care, guided by current research. DESIGN: The protocol for this scoping review was devised according to the guidelines proposed by Arksey and O’Malley () and Levac et al. (). METHODS: The protocol includes decisions about the review objectives, inclusion criteria, search strategy, study selection, data extraction, quality assessment, data synthesis and plans for dissemination. DISCUSSION: The review will allow us to identify the currently used models of knowledge transfer and exchange in healthcare setting and analyse their applicability to the complex demands of palliative care. Results from this review will identify effective way of translating different types of knowledge to different PC providers and could be used in hospital, community and home based PC and future research. © 2015 John Wiley & Sons Ltd.
Barriers in implementing research among registered nurses working in the care of the elderly: A multicenter study in Spain
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Sarabia-Cobo C, Sarabia-Cobo A, Perez V, Hermosilla C, Nunez MJ, de Lorena P.
Applied Nursing Research
This study identified barriers to the utilization of research results perceived by nurses who work in nursing homes in Spain. Methods An observational, cross-sectional, descriptive, and multicentre study was conducted in 126 nursing homes in different Spanish cities. The BARRIERS to Research Utilization Scale (BARRIERS scale) was used to identify barriers. Results A total of 756 nurses responded (92.48%). BARRIERS Scale variables with the highest scores included Characteristics of the organization (mean = 24.89, SD = 4.37), followed by Professional features (mean = 21.87, SD = 4.85). The specific barriers that were rated the highest included “not enough time on the job to implement new ideas” (mean = 3.89, SD = 0.98), followed by “unknown nursing research” (mean = 2.75; SD = 1.22) and “Doctors do not cooperate in the implementation” (mean = 3.01, SD = 1.85). Conclusions Geriatric nurses perceive time as the main barrier to implementing the results of research in practice. The number and nature of the barriers are consistent with studies from other countries. Knowledge of the barriers is crucial for institutions and educators to instigate measures that improve the implementation of nursing research, especially in an area like elderly care. To our knowledge, this is the first study conducted among geriatric nurses in Spain.
The disconnect between evidence and practice: a systematic review of person-centred interventions and training manuals for care home staff working with people with dementia.
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Fossey J, Masson S, Stafford J, Lawrence V, Corbett A, Ballard C.
International journal of geriatric psychiatry 2014 Aug;29(8):797-807
The overall objective is to determine the availability of person-centred intervention and training manuals for dementia care staff with clinical trial evidence of efficacy. DESIGN: Interventions were identified using a search of electronic databases, augmented by mainstream search engines, reference lists, hand searching for resources and consultation with an expert panel. The specific search for published manuals was complemented by a search for randomised control trials focussing on training and activity-based interventions for people with dementia in care homes. Manuals were screened for eligibility and rated to assess their quality, relevance and feasibility. RESULTS: A meta-analysis of randomised control trials indicated that person-centred training interventions conferred significant benefit in improving agitation and reducing the use of antipsychotics. Each of the efficacious packages included a sustained period of joint working and supervision with a trained mental health professional in addition to an educational element. However, of the 170 manuals that were identified, 30 met the quality criteria and only four had been evaluated in clinical trials. CONCLUSIONS: Despite the availability of a small number of evidence-based training manuals, there is a widespread use of person-centred intervention and training manuals that are not evidence-based. Clearer guidance is needed to ensure that commissioned training and interventions are based on robust evidence. Copyright © 2014 John Wiley & Sons, Ltd.
Developing a fidelity assessment instrument for nurse home visitors.
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Black KJ, Wenger MB, O’Fallon M.
Research in nursing & health 2015 Mar 16
Fidelity monitoring is a core component for successful translation of evidence-based interventions, yet little guidance is available on developing tools to assess intervention fidelity that are valid and feasible for use in community settings. We partnered with nurses in the field to develop a fidelity monitoring instrument that would capture the essential elements of the nursing intervention that is the core of Nurse-Family Partnership, a prenatal and early childhood home visitation program. Using a grounded approach, we employed concept mapping to identify the salient behavioral characteristics associated with the program, and then, adapting Dreyfus’ model of skill development, created a tool to assess nurse home visitors (NHVs) according to their stage of growth. In a pilot, the Nursing Practice Assessment (NPA) form was used to assess 188 NHVs. The average time to complete the tool was 1 hour, and skill development stage was concordant with years of NHV experience. According to surveys of supervisors and NHVs, the tool captured the essential elements of the program model. Articulating the essential elements of each skill development stage can provide a foundation for professional development for NHVs. In response to feedback, online training modules were developed prior to large-scale implementation in the field. The grounded methods used to develop the NPA enhanced its internal consistency and implementation feasibility and could be utilized by other public health nursing programs. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.
Implementation of a health policy advisory committee as a knowledge translation platform: the Nigeria experience.
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Uneke CJ, Ndukwe CD, Ezeoha AA, Uro-Chukwu HC, Ezeonu CT.
International journal of health policy and management 2015 Feb 4;4(3):161-168
In recent times, there has been a growing demand internationally for health policies to be based on reliable research evidence. Consequently, there is a need to strengthen institutions and mechanisms that can promote interactions among researchers, policy-makers and other stakeholders who can influence the uptake of research findings. The Health Policy Advisory Committee (HPAC) is one of such mechanisms that can serve as an excellent forum for the interaction of policy-makers and researchers. Therefore, the need to have a long term mechanism that allows for periodic interactions between researchers and policy-makers within the existing government system necessitated our implementation of a newly established HPAC in Ebonyi State Nigeria, as a Knowledge Translation (KT) platform. The key study objective was to enhance the capacity of the HPAC and equip its members with the skills/competence required for the committee to effectively promote evidence informed policy-making and function as a KT platform. METHODS: A series of capacity building programmes and KT activities were undertaken including: i) Capacity building of the HPAC using Evidence-to-Policy Network (EVIPNet) SUPPORT tools; ii) Capacity enhancement mentorship programme of the HPAC through a three-month executive training programme on health policy/health systems and KT in Ebonyi State University Abakaliki; iii) Production of a policy brief on strategies to improve the performance of the Government’s Free Maternal and Child Health Care Programme in Ebonyi State Nigeria; and iv) Hosting of a multi-stakeholders policy dialogue based on the produced policy brief on the Government’s Free Maternal and Child Health Care Programme. RESULTS: The study findings indicated a noteworthy improvement in knowledge of evidence-to-policy link among the HPAC members; the elimination of mutual mistrust between policy-makers and researchers; and an increase in the awareness of importance of HPAC in the Ministry of Health (MoH). CONCLUSION: Findings from this study suggest that a HPAC can function as a KT platform and can introduce a new dimension towards facilitating evidence-to-policy link into the operation of the MoH, and can serve as an excellent platform to bridge the gap between research and policy.
Nurses experience of using scientific knowledge in clinical practice: a grounded theory study.
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Renolen A, Hjalmhult E.
Scandinavian journal of caring sciences 2015 Mar 9
Guidelines recommend the use of evidence-based practice in nursing. Nurses are expected to give patients care and treatment based on the best knowledge available. They may have knowledge and positive attitudes, but this does not mean that they are basing their work on evidence-based practice. Knowledge is still lacking about what is needed to successfully implement evidence-based practice. AIM: The aim of this study was to gain more knowledge about what nurses perceive as the most important challenge in implementing evidence-based practice and to explain how they act to face and overcome this challenge. METHOD: We used classical grounded theory methodology and collected data through four focus groups and one individual interview in different geographical locations in one large hospital trust in Norway. Fourteen registered clinical practice nurses participated. We analysed the data in accordance with grounded theory, using the constant comparative method. RESULTS: Contextual balancing of knowledge emerged as the core category and explains how the nurses dealt with their main concern, how to determine what types of knowledge they could trust. The nurses’ main strategies were an inquiring approach, examining knowledge and maintaining control while taking care of patients. They combined their own experienced-based knowledge and the guidelines of evidence-based practice with a sense of control in the actual situation. CONCLUSION: The grounded theory contextual balancing of knowledge may help us to understand how nurses detect what types of knowledge they can trust in clinical practice. The nurses needed to rely on what they did, and they seemed to rely on their own experience rather than on research. © 2015 Nordic College of Caring Science.
Translating evidence into healthcare policy and practice: Single versus multi-faceted implementation strategies – is there a simple answer to a complex question?
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Harvey G, Kitson A.
International journal of health policy and management 2015 Mar 5;4(3):123-126
How best to achieve the translation of research evidence into routine policy and practice remains an enduring challenge in health systems across the world. The complexities associated with changing behaviour at an individual, team, organizational and system level have led many academics to conclude that tailored, multi-faceted strategies provide the most effective approach to knowledge translation. However, a recent overview of systematic reviews questions this position and sheds doubt as to whether multi-faceted strategies are any better than single ones. In this paper, we argue that this either-or distinction is too simplistic and fails to recognize the complexity that is inherent in knowledge translation. Drawing on organizational theory relating to boundaries and boundary management, we illustrate the need for translational strategies that take account of the type of knowledge to be implemented, the context of implementation and the people and processes involved.
What Do Science Communicators Talk About When They Talk About Science Communications? Engaging With the Engagers
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Cormick C, Nielssen O, Ashworth P, La Salle J, Saab C.
Science Communication 2015 04/01;37(2):274-282
A series of workshops on impediments and solutions to best practice in science communication in Australia not only provided insights into the diversity of the community of practice but also reflected discords between best practice and popular ideas among practitioners.
Improving allied health professionals’ research implementation behaviours for children with cerebral palsy:protocol for a before-after study.
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Imms C, Novak I, Kerr C, Shields N, Randall M, Harvey A, et al.
Implementation science : IS 2015 Dec;10(1):202-014-0202-0. Epub 2015 Feb 6
Cerebral palsy is a permanent disorder of posture and movement caused by disturbances in the developing brain. It affects approximately 1 in every 500 children in developed countries and is the most common form of childhood physical disability. People with cerebral palsymay also have problems with speech, vision and hearing, intellectual difficulties and epilepsy. Health and therapy services are frequently required throughout life, and this care should be effective and evidence informed; however, accessing and adopting new research findings into day-to-day clinical practice is often delayed. METHODS/DESIGN: This 3-year study employs a before and after design to evaluate if a multi-strategy intervention can improve researchimplementation among allied health professionals (AHPs) who work with children and young people with cerebral palsy and to establish if children’shealth outcomes can be improved by routine clinical assessment. The intervention comprises (1) knowledge brokering with AHPs, (2) access to an online research evidence library, (3) provision of negotiated evidence-based training and education, and (4) routine use of evidence-based measures with children and young people aged 3-18 years with cerebral palsy. The study is being implemented in four organisations, with a fifth organisation acting as a comparison site, across four Australian states. Effectiveness will be assessed using questionnaires completed by AHPs at baseline, 6, 12 and 24 months, and by monitoring the extent of use of evidence-based measures. Children’s health outcomes will be evaluated by longitudinal analyses. DISCUSSION: Government, policy makers and service providers all seek evidence-based information to support decision-making about how to distribute scarce resources, and families are seeking information to support intervention choices. This study will provide knowledge about what constitutes an efficient, evidence-informed service and which allied health interventions are implemented for children with cerebral palsy.
Translational research may be most successful when it fails.
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The Hastings Center report 2015 Mar;45(2):39-40
In this issue of the Hastings Center Report, Jonathan Kimmelman and Alex London argue that in assessing the success of clinical translation, it is narrow-minded to focus only on how many new drugs get licensed and how quickly they achieve licensure. Kimmelman and London show that clinical translation should be judged on its ability to generate as comprehensive an intervention ensemble as possible for the tested interventions. I would like to extend Kimmelman and London’s position in two ways. First, I would argue that in the current environment, failures should be seen not just as acceptable, but probably as the most useful outcomes that translational research efforts can offer. Second, an intervention ensemble probably cannot be generated with information only about the drug or drugs produced by a single company. For most conditions and diseases, there are already a large number of other interventions whose use is supported or contradicted by various levels of evidence. © 2015 The Hastings Center.
Care dependency and nursing care problems in nursing home residents with and without dementia: a cross-sectional study.
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Schussler S, Dassen T, Lohrmann C.
Aging clinical and experimental research 2014 Dec 20
Chronic diseases, like dementia, can lead to care dependency and nursing care problems. This study aims to compare the degree of care dependency and the prevalence of nursing care problems (pressure ulcer, incontinence, malnutrition, falls, restraints) between residents with and without dementia and between the stages of dementia. METHODS: A cross-sectional design was chosen and a total of 277 residents with and 249 residents without dementia from nine Austrian nursing homes were assessed by staff using standardized instruments. RESULTS: Significantly more residents with than without dementia are completely or to a great extent care dependent (54.5 vs. 16.9 %). The comparison of care dependency between the stages of dementia indicates a large difference between moderate and severe dementia (completely care dependent: 9.3 vs. 44.3 %). The comparison of the assessed nursing care problems between residents with and without dementia reveals a significant difference only with regard to incontinence (urinary: 84.2 vs. 53.2 %, fecal: 50.9 vs. 17.7 %, double: 49.1 vs. 14.9 %). Urinary incontinence is high even in early dementia at 64 %, reaching 94 % in severe dementia. Fecal- and double incontinence are comparatively much lower in early dementia (both types 12 %) and rise to more than 80 % (both types) in severe dementia. CONCLUSION: These results highlight areas in which dementia care needs further improvements. The authors suggest maximizing residents’ independence to stabilize care dependency and improve incontinence care. Furthermore, longitudinal studies are recommended to deepen insight into the development of care dependency and nursing care problems in dementia residents.
A Longitudinal Examination of Social Participation, Loneliness, and Use of Physician and Hospital Services
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Newall N, McArthur J, Menec VH.
Journal of aging and health 2015 Apr;27(3):500-518
This study examined whether social participation and loneliness predicted health care service use (physician visits, hospitalizations, length of stay in hospital). METHOD: Participants’ (N = 954; 54% female; aged 45+ years) health data were tracked over 2.5 years following in-person interviews. RESULTS: Being lonely was associated with greater number of physician visits, though this relationship was mediated by health. Neither loneliness nor social participation was associated with admission to hospital. However, for those who were hospitalized at least once over 2.5 years, being lonely was associated with a higher odds of being re-hospitalized; furthermore, greater social participation was associated with a lower odds of being in the hospital for an extended duration. These relationships held even when controlling for initial health. DISCUSSION: Results provide evidence, using objective health care data, of the potential importance of social factors in predicting adults’ physician visits, re-hospitalization, and length of stay in hospital. © The Author(s) 2014.
The EPCOR Model: A Model for Promoting the Successful Implementation of Evidence-Based Nursing in Hospital-Based Settings.
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Wang MY, Kao CC, Lin CF.
The journal of nursing research : JNR 2015 Mar;23(1):15-24
An effective organizational infrastructure is essential to successfully implement and sustain an evidence-based nursing (EBN) practice. Although EBN has been promoted in Taiwan for more than 10 years, variations in the organizational policies and strategies necessary to support EBN among healthcare organizations have prevented effective implementation. Barriers to the implementation of EBN located at the organizational level have also been reported. The need for a model that focuses on the organizational infrastructure to promote EBN in Taiwan has therefore become increasingly apparent. PURPOSE: This study aims to develop a model that contains the key contextual elements of organizational infrastructure necessary to effectively promote EBN, especially in hospital settings. METHODS: A steering committee drafted the components and related strategies of the proposed model. Delphi technique was used to obtain consensus on the proposed model among a group of experts with expertise in EBN. Thirty experts participated in all three rounds of the Delphi survey. To confirm the appropriateness of the proposed model for clinical settings, the model was further reviewed by a focus group composed of experts with experience in implementing EBN or evidence-based medicine in hospitals. The strategies were then further modified based on the suggestions of this focus group, and only those strategies that best fit hospital settings were retained. RESULTS: Five key contextual elements and related strategic processes were identified, including equipment, policy, training courses, outcome indicators, and reward plans. The resultant model was named EPCOR, an acronym composed of the names of each identified element. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: EPCOR is a comprehensive model of organizational infrastructure and strategic procedures for implementing EBN in hospital-based settings in Taiwan. Organizations may use the EPCOR model to initiate and implement EBN practices and then to evaluate their effectiveness.
Music Therapists’ Research Activity and Utilization Barriers: A Survey of the Membership
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Journal of music therapy 2015 03/11
Music therapists have access to a rapidly expanding body of research supporting the use of music-based interventions. What is not known is the extent to which music therapists access these resources and what factors may prevent them from incorporating research findings into clinical work. Objective: After constructing the Music Therapists’ Research Activity and Utilization Barrier (MTRAUB) database, the purposes of this study involved: assessing the extent to which American Music Therapy Association (AMTA) members engage in certain research-related activities; and identifying respondents’ perceived barriers to integrating research into clinical practice. Methods: This study employed a quantitative, non-experimental approach using an online survey. Respondents included professional, associate, student/graduate student, retired, inactive, and honorary life members of AMTA. Instrumentation involved a researcher-designed Background Questionnaire as well as the Barriers to Research Utilization Scale (BARRIERS; Funk, Champagne, Wiese, & Tornquist, 1991), a tool designed to assess perceived barriers to incorporating research into practice. Results: Of the 3,194 survey invitations distributed, 974 AMTA members replied (a response rate of 30%). Regarding research-related activities, descriptive findings indicate that journal reading is the most frequently reported research-related activity while conducting research is the least frequently reported activity. Results from the BARRIERS Scale indicated that Organizational and Communication factors are perceived as interfering most prominently with the ability to utilize research in clinical practice. Conclusions: Findings suggest that research-related activity and perceived barriers vary as a function of educational attainment, work setting, and occupational role. The author discusses these differential findings in detail, suggests supportive mechanisms to encourage increased research activity and utilization, and offers recommendations for further analysis of the MTRAUB data.
“Entrenched practices and other biases”: unpacking the historical, economic, professional, and social resistance to de-implementation.
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Montini T, Graham ID.
Implementation science : IS 2015 Dec;10(1):211-015-0211-7. Epub 2015 Feb 13
In their article on “Evidence-based de-implementation for contradicted, unproven, and aspiring healthcare practices,” Prasad and Ioannidis (IS 9:1, 2014) referred to extra-scientific “entrenched practices and other biases” that hinder evidence-based de-implementation. DISCUSSION: Using the case example of the de-implementation of radical mastectomy, we disaggregated “entrenched practices and other biases” and analyzed the historical, economic, professional, and social forces that presented resistance to de-implementation. We found that these extra-scientific factors operated to sustain a commitment to radical mastectomy, even after the evidence slated the procedure for de-implementation, because the factors holding radical mastectomy in place were beyond the control of individual clinicians. We propose to expand de-implementation theory through the inclusion of extra-scientific factors. If the outcome to which we aim is appropriate and timely de-implementation, social scientific analysis will illuminate the context within which the healthcare practitioner practices and, in doing so, facilitate de-implementation by pointing to avenues that lead to systems change. The implications of our analysis lead us to contend that intervening in the broader context in which clinicians work-the social, political, and economic realms-rather than focusing on healthcare professionals’ behavior, may indeed be a fruitful approach to effect change.
Supporting Evidence-Informed Health Policy Making: The Development and Contents of an Online Repository of Policy-Relevant Documents Addressing Healthcare Renewal in Canada
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Kowalewski K, Lavis J, Wilson M, Carter N
Healthcare Policy, 10(2)]
Objectives: (1) To develop an online repository of policy-relevant documents, other than and complementary to those from the peer-reviewed scientific literature, addressing healthcare renewal in Canada; and (2) to describe the distribution of document contents. Methods: An iterative scoping review approach was undertaken. Documents were identified through website hand-searches and referrals from 19 Canadian health organizations. Descriptive frequencies were calculated, such as for document type. Findings: In July 2014, 1,034 documents were in the Evidence-Informed Healthcare Renewal Portal. The top three types of documents were situation analyses (n = 390, 38%), health and health system data (n = 191, 18%) and jurisdictional reviews (n = 115, 11%). The top three national priority areas addressed were health human resources (n = 778, 75%), quality as a performance indicator (n = 502, 49%) and information technology (n = 385, 37%). Conclusion: The process of developing a systematic method for identifying these documents has yielded a new resource to support evidence-informed health policy making and has identified a large volume of policy-relevant documents addressing healthcare renewal priority areas in Canada.
Effect of Published Scientific Evidence on Glycemic Control in Adult Intensive Care Units.
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Niven DJ, Rubenfeld GD, Kramer AA, Stelfox HT.
JAMA internal medicine 2015 Mar 16
Little is known about the deadoption of ineffective or harmful clinical practices. A large clinical trial (the Normoglycemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation [NICE-SUGAR] trial) demonstrated that strict blood glucose control (tight glycemic control) in patients admitted to adult intensive care units (ICUs) should be deadopted; however, it is unknown whether deadoption occurred and how it compared with the initial adoption. OBJECTIVE: To evaluate glycemic control in critically ill patients before and after the publication of clinical trials that initially suggested that tight glycemic control reduced mortality (Leuven I) but subsequently demonstrated that it increased mortality (NICE-SUGAR). DESIGN, SETTING, AND PARTICIPANTS: Interrupted time-series analysis of 353 464 patients admitted to 113 adult ICUs from January 1, 2001, through December 31, 2012, in the United States using data from the Acute Physiology and Chronic Health Evaluation database. MAIN OUTCOMES AND MEASURES: The physiologically most extreme blood glucose level on day 1 of ICU admission defined glycemic control as tight control (glucose level, 80-110 mg/dL; to convert to millimoles per liter, multiply by 0.0555), hypoglycemia (glucose level, <70 mg/dL), and hyperglycemia (glucose level, ≥180 mg/dL). Temporal changes in each marker were examined using mixed-effects segmented linear regression. RESULTS: Before the publication of Leuven I, 17.2% (95% CI, 16.2%-18.2%) of ICU admissions had tight glycemic control, 3.0% (95% CI, 2.6%-3.5%) had hypoglycemia, and 40.2% (95% CI, 38.8%-41.5%) had hyperglycemia. After the publication of Leuven I, there were significant increases in the relative proportion of admissions with tight glycemic control (1.7% per quarter; 95% CI, 1.2%-2.3%; P < .001) and hypoglycemia (2.5% per quarter; 95% CI, 1.9%-3.2%; P < .001) and decreases in those with hyperglycemia (0.6% per quarter; 95% CI, 0.4%-0.9%; P < .001). Following the publication of NICE-SUGAR, there was no change in the proportion of patients with tight glycemic control or hyperglycemia. There was an immediate decrease in the relative proportion of patients with hypoglycemia (22.4%; 95% CI, 13.2%-30.1%; P < .001) but no subsequent change over time. CONCLUSIONS AND RELEVANCE: Among patients admitted to adult ICUs in the United States, there was a slow steady adoption of tight glycemic control following publication of a clinical trial that suggested benefit, with little to no deadoption following a subsequent trial that demonstrated harm. There is an urgent need to understand and promote the deadoption of ineffective clinical practices.
Health Care Administration and Organization
Regulation of Nursing Assistants: A Critical International Issue?
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Netherwood M, Skittrall R, Alexis O.
Contemporary nurse 2014 Sep 21:4778-478
Health care or nursing assistants are valuable members of health care teams who undertake a wide range of tasks, contribute to meeting the increasingly complex healthcare needs of patients and have various levels of training. However, they are not subject to regulation in countries such as the United Kingdom (UK), Australia or New Zealand. If training and regulation are pre-requisites for ensuring the standards of care delivered by registered nurses, then this must also apply to nursing assistants. Regulation ensures the need for on-going education and development which is critical to maintaining and refreshing the values underpinning compassionate care for both nursing assistants and registered nurses.
Structural characteristics of hospitals and nurse-reported care quality, work environment, burnout and leaving intentions.
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Lindqvist R, Smeds Alenius L, Griffiths P, Runesdotter S, Tishelman C.
Journal of nursing management 2015 Mar;23(2):263-274
To investigate whether hospital characteristics not readily susceptible to change (i.e. hospital size, university status, and geographic location) are associated with specific self-reported nurse outcomes. BACKGROUND: Research often focuses on factors within hospitals (e.g. work environment), which are susceptible to change, rather than on structural factors in their own right. However, numerous assumptions exist about the role of structural factors that may lead to a sense of pessimism and undermine efforts at constructive change. METHOD: Data was derived from survey questions on assessments of work environment and satisfaction, intention to leave, quality of care and burnout (measured by the Maslach Burnout Inventory), from a population-based sample of 11 000 registered nurses in Sweden. Mixed model regressions were used for analysis. RESULT: Registered nurses in small hospitals were slightly more likely to rank their working environment and quality of nursing care better than others. For example 23% of staff in small hospitals were very satisfied with the work environment compared with 20% in medium-sized hospitals and 21% in large hospitals. Registered nurses in urban areas, who intended to leave their job, were more likely to seek work in another hospital (38% vs. 32%).
This article reports a pilot evaluation of Comfort Care Rounds (CCRs)–a strategy for addressing long-term care home staff’s palliative and end-of-life care educational and support needs. Using a qualitative descriptive design, semistructured individual and focus group interviews were conducted to understand staff members’ perspectives and feedback on the implementation and application of CCRs. Study participants identified that effective advertising, interest, and assigning staff to attend CCRs facilitated their participation. The key barriers to their attendance included difficulty in balancing heavy workloads and scheduling logistics. Interprofessional team member representation was sought but was not consistent. Study participants recognized the benefits of attending; however, they provided feedback on how the scheduling, content, and focus could be improved. Overall, study participants found CCRs to be beneficial to their palliative and end-of-life care knowledge, practice, and confidence. However, they identified barriers and recommendations, which warrant ongoing evaluation. Copyright 2015, SLACK Incorporated.
Changes in turnover and vacancy rates of care workers in England from 2008 to 2010: panel analysis of national workforce data.
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Hussein S, Ismail M, Manthorpe J.
Health & social care in the community 2015 Mar 4
The combination of growing demand for long-term care and higher expectations of care staff needs to be set in the context of long-standing concerns about the sustainability of recruitment and retention of front-line staff in the United Kingdom. Organisational and work environment factors are associated with vacancy levels and turnover rates. The aim of the current analysis was to investigate changes in turnover and vacancy rates over time experienced by a sample of social care employers in England. Taking a follow-up approach offers potentially more accurate estimates of changes in turnover and vacancy rates, and enables the identification of any different organisational characteristics which may be linked to reductions in these elements over time. The study constructed a panel of 2964 care providers (employers) using 18 separate data sets from the National Minimum Data Set for Social Care during 2008-2010. The findings indicate slight reductions in vacancy rates but the presence of enduring, high turnover rates among direct care workers over the study period. However, the experience of individual employers varied, with home-care providers experiencing significantly higher turnover rates than other parts of the sector. These findings raise questions around the quality and motivations of new recruits and methods of reducing specific vacancy levels. At a time of increased emphasis on care at home, it is worthwhile examining why care homes appear to have greater stability of staff and fewer vacancies than home-care agencies. © 2015 The Authors.
Positive attitudes and person-centred care predict of sense of competence in dementia care staff
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Mullan MA, Sullivan KA.
Aging & mental health 2015 Mar 11:1-8
The number of people who will require institutional care for dementia is rapidly rising. This increase raises questions about how the workforce can meet the challenge of providing quality care. A promising psychological concept that could improve staff and care recipient outcomes is staff sense of competence in their capacity to provide dementia care. The purpose of this study was to elucidate the relative importance of staff factors associated with sense of competence. METHOD: Sixty-one Australian dementia care staff (mostly nurses, 69%; and allied health, 21%) were recruited. Measures included the Sense of Competence in Dementia Care Staff (criterion) and standardised measures of empirically derived predictors: training, knowledge, attitudes and person-centred care strategies. RESULTS: Standard multiple regression revealed that 33.9% of the variance in sense of competence was explained by the combination of the four predictors. Attitudes and person-centred strategies each uniquely explained a moderate amount of variance, while training and knowledge were not significant predictors of sense of competence. CONCLUSION: A positive attitude towards people with dementia, and stronger intentions to implement person-centred care strategies, predicted a greater sense of competence to provide care, whereas knowledge and training, commonly believed to be important contributors to sense of competence in dementia care, did not predict this outcome. Investing in strategies that address staff attitude and encourage person-centred care could influence sense of competence, and by extension, dementia care.
Care assistant experiences of dementia care in long-term nursing and residential care environments
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Talbot R, Brewer G.
Dementia 2015 03/19
Care assistants have a unique insight into the lives of service users and those factors which may impede or enhance the delivery of high quality dementia oriented care. To address the paucity of research in this area, the present study examined care assistant experiences of dementia care in British long-term residential and nursing environments. Semi-structured interviews were conducted with eight care assistants and transcripts were analysed using interpretive phenomenological analysis. Super-ordinate themes emerging from the data were psychological wellbeing of the care assistant, barriers to effective dementia care, the dementia reality and organisational issues within the care environment. The study revealed important deficiencies in understanding and varying levels of dementia training. Whilst person centred strategies were being implemented, task orientated care remained dominant. Furthermore, care assistants reported taking the perspectives of those with dementia into account, and actively using these to develop relationship centred care.
Orchestrating energy for shifting busyness to strategic work.
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Shirey MR, Hites L.
The Journal of nursing administration 2015 Mar;45(3):124-127
This department highlights change management strategies that may be successful in strategically planning and executing organizational change initiatives. In this article, the authors discuss the elements of busy work and offers strategies for shifting to focused, strategic work. A useful energy preservation framework is introduced to promote vitality that drives engagement, productivity, and innovation.
Varieties of Qualifications, Training, and Skills in Long-Term Care: A German, Japanese, and UK Comparison
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Human resource management 2015
This article considers the systems of qualifications and training in the long-term elderly care sector in Germany, Japan, and the United Kingdom. Each country faces similar challenges of coping with increasing demand and securing staff for quality and cost-effective care. However, the three countries organize qualifications and training in very different ways. In the case of formal care workers, there is a hierarchy of training and skills, with Germany at the top, Japan in the middle, and the United Kingdom at the bottom. However, comparing the whole workforce, Germany has developed a dualistic structure with both highly and lowly trained workers; Japan has developed a relatively large proportion of moderately trained and qualified staff; and the UK workforce consists of a relatively large proportion of lowly trained and unqualified workers. Explanations are considered and implications offered for human resource management. © 2015 Wiley Periodicals, Inc.
The Shape of Caring Review report, commissioned by Health Education England (HEE) in partnership with the Nursing and Midwifery Council (NMC) has now been published. In the report Lord Willis, Chair of the review, makes 34 recommendations for the future education and training of nurses and care assistants. Lord Willis, the independent Chair of the review, said: “There are 1.3 million care assistants and half a million registered nurses in England: it is vital to invest in this essential workforce. “In the future, patients and the public will have more complex clinical needs and higher expectations than ever before. The education and training of nurses and care assistants need to reflect the changing care environment, and equip them to deliver high quality care. “Today’s report makes recommendations for changes in education and training which will help to meet our future needs. I hope that it will be seen as a framework to shape the debate on how we can develop a world class caring workforce.
Health Care Innovation and Quality Assurance
Application of a trigger tool in near real time to inform quality improvement activities: a prospective study in a general medicine ward.
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Wong BM, Dyal S, Etchells EE, Knowles S, Gerard L, Diamantouros A, et al.
BMJ quality & safety 2015 Mar 6
Retrospective record review using trigger tools remains the most widely used method for measuring adverse events (AEs) to identify targets for improvement and measure temporal trends. However, medical records often contain limited information about factors contributing to AEs. We implemented an augmented trigger tool that supplemented record review with debriefing front-line staff to obtain details not included in the medical record. We hypothesised that this would foster the identification of factors contributing to AEs that could inform improvement initiatives. METHOD: A trained observer prospectively identified events in consecutive patients admitted to a general medical ward in a tertiary care academic medical centre (November 2010 to February 2011 inclusive), gathering information from record review and debriefing front-line staff in near real time. An interprofessional team reviewed events to identify preventable and potential AEs and characterised contributing factors using a previously published taxonomy. RESULTS: Among 141 patients, 14 (10%; 95% CI 5% to 15%) experienced at least one preventable AE; 32 patients (23%; 95% CI 16% to 30%) experienced at least one potential AE. The most common contributing factors included policy and procedural problems (eg, routine protocol violations, conflicting policies; 37%), communication and teamwork problems (34%), and medication process problems (23%). However, these broad categories each included distinct subcategories that seemed to require different interventions. For instance, the 32 identified communication and teamwork problems comprised 7 distinct subcategories (eg, ineffective intraprofessional handovers, poor interprofessional communication, lacking a shared patient care, paging problems). Thus, even the major categories of contributing factors consisted of subcategories that individually related to a much smaller subset of AEs. CONCLUSIONS: Prospective application of an augmented trigger tool identified a wide range of factors contributing to AEs. However, the majority of contributing factors accounted for a small number of AEs, and more general categories were too heterogeneous to inform specific interventions. Successfully using trigger tools to stimulate quality improvement activities may require development of a framework that better classifies events that share contributing factors amenable to the same intervention.
Quality mobility care in nursing homes: a model of moderating and mediating factors to guide intervention development.
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Taylor J, Sims J, Haines TP.
Research in gerontological nursing 2014 Nov-Dec;7(6):284-291
The current qualitative study aimed to understand factors in mobility care to inform practice improvements. Data were collected at three nursing homes in Melbourne, Australia, via interviews with 10 senior staff and 15 residents, focus groups with 18 direct care staff, and observations of 46 mobility events. Thematic and content analysis of data occurred. Findings included factors (a) intrinsic to residents, (b) intrinsic to staff, and (c) extrinsic to residents and staff, such as equipment and organizational factors. A model describing associations between factors and their roles as moderators and mediators of resident mobility was generated. Staff assistance, residents’ mobility effort, and equipment used during mobility were posited as complete or partial mediators of resident mobility outcomes. Barriers that may compromise the quality of mobility care in nursing homes emerged. The model provides direction for improvements in mobility care that integrate safety, mobility optimization, and person- and relationship-centered care. Copyright 2014, SLACK Incorporated.
The development of the MIBBO: A measure of resident preferences for physical activity in long term care settings.
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Kleynen M, Braun SM, van Vijven K, van Rossum E, Beurskens AJ.
Geriatric nursing (New York, N.Y.) 2015 Mar 14
Offering physical activities matching with the preferences of residents in long-term care facilities could increase compliance and contribute to client-centered care. A measure to investigate meaningful activities by using a photo-interview has been developed (“MIBBO”). In two pilot studies including 133 residents living on different wards in long-term care facilities, feasibility, most chosen activities, and consistency of preferences were investigated. It was possible to conduct the MIBBO on average in 30 min with the majority (86.4%) of residents. The most frequently chosen activities were: gymnastics and orchestra (each 28%), preparing a meal (31%), walking (outside, 33%), watering plants (38%), and feeding pets (40%). In a retest one week after the initial interview 69.4% agreement of chosen activities was seen. The MIBBO seems a promising measure to help health care professionals in identifying residents’ preferred activities. Future research should focus on the implementation of the tailored activity plan, incorporating it into the daily routine. Copyright © 2015 Elsevier Inc.
Implementation of a Diabetes Management Flow Sheet in a Long-Term Care Setting.
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Williams E, Curtis A.
Canadian journal of diabetes 2015 Mar 11
Physicians lack clear guidance about adaptation of clinical practice guidelines for elderly institutionalized patients with diabetes. In a large long-term care facility, a diabetes management flow sheet was trialed to determine which clinical parameters were found useful by clinicians in the management of diabetes in that setting. METHODS: Clinical practice guidelines for diabetes management were reviewed with attending physicians. Diabetes management flow sheets were distributed for all patients coded as having diabetes on their most recent minimum data sets. After a period of 14 months, flow sheet completion rates were ascertained and physicians were surveyed regarding the utility of the flow sheet. RESULTS: Initial flow sheet data were completed in full or in part for only 57% of the 121 study subjects; 39% of the subjects died within 14 months. Quarterly follow-up data were completed for 58% of the flow sheets. CONCLUSIONS: The diabetes management flow sheet was not found to be useful by attending physicians as a chronic-disease management tool. Copyright © 2015 Canadian Diabetes Association.
Influence of hospital and nursing home quality on hospital readmissions.
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Thomas KS, Rahman M, Mor V, Intrator O.
The American Journal of Managed Care 2014 Nov 1;20(11):e523-31
To determine whether the quality of the hospital and of the nursing home (NH) to which a patient was discharged were related to the likelihood of rehospitalization. Study Design Retrospective cohort study of 1,382,477 individual hospitalizations discharged to 15,356 NHs from 3683 hospitals between 2006 and 2008. Methods Data come from Medicare claims and enrollment records, Minimum Data Set, Online Survey Certification and Reporting Dataset, Hospital Compare, and the American Hospital Association Database. Cross-classified random effects models were used to test the association of hospital and NH quality measures and the likelihood of 30-day rehospitalization. Results Patients discharged from higher-quality hospitals (as indicated by higher scores on their accountability process measures and high nurse staffing levels) and patients who received care in higher-quality NHs (as indicated by high nurse staffing levels and lower deficiency scores) were less likely to be rehospitalized within 30 days. Conclusions The passage of the Affordable Care Act changed the accountability of hospitals for patients’ outcomes after discharge. This study highlights the joint accountability of hospitals and NHs for rehospitalization of patients.
The future of home health project: developing the framework for health care at home.
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Lee T, Schiller J.
Home healthcare now 2015 Feb;33(2):84-87
In addition to providing high-quality care to vulnerable patient populations, home healthcare offers the least costly option for patients and the healthcare system, particularly in postacute care. As the baby boom generation ages, policymakers are expressing concerns about rising costs, variation in home healthcare service use, and program integrity. The Alliance for Home Health Quality and Innovation seeks to develop a research-based strategic framework for the future of home healthcare for older Americans and those with disabilities. This article describes the initiative and invites readers to provide comments and suggestions.
Validity of the RAI-MDS for ascertaining diabetes and comorbid conditions in long-term care facility residents.
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Lix LM, Yan L, Blackburn D, Hu N, Schneider-Lindner V, Teare GF.
BMC health services research 2014 Jan 15;14:17-6963-14-17
This study assessed the validity of the Resident Assessment Instrument Minimum Data Set (RAI-MDS) Version 2.0 for diagnoses of diabetes and comorbid conditions in residents of long-term care facilities (LTCFs). METHODS: Hospital inpatient, outpatient physician billing, RAI-MDS, and population registry data for 1997 to 2011 from Saskatchewan, Canada were used to ascertain cases of diabetes and 12 comorbid conditions. Prevalence estimates were calculated for both RAI-MDS and administrative health data. Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated using population-based administrative health data as the validation data source. Cohen’s κ was used to estimate agreement between the two data sources. RESULTS: 23,217 LTCF residents were in the diabetes case ascertainment cohort. Diabetes prevalence was 25.3% in administrative health data and 21.9% in RAI-MDS data. Overall sensitivity of a RAI-MDS diabetes diagnoses was 0.79 (95% CI: 0.79, 0.80) and the PPV was 0.92 (95% CI: 0.91, 0.92), when compared to administrative health data. Sensitivity of the RAI-MDS for ascertaining comorbid conditions ranged from 0.21 for osteoporosis to 0.92 for multiple sclerosis; specificity was high for most conditions. CONCLUSIONS: RAI-MDS clinical assessment data are sensitive to ascertain diabetes cases in LTCF populations when compared to administrative health data. For many comorbid conditions, RAI-MDS data have low validity when compared to administrative data. Risk-adjustment measures based on these comorbidities might not produce consistent results for RAI-MDS and administrative health data, which could affect the conclusions of studies about health outcomes and quality of care across facilities.
A refined compilation of implementation strategies: Results from the Expert Recommendations for Implementing Change (ERIC) project
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Powell BJ, Waltz TJ, Chinman MJ, Damschroder LJ, Smith JL, Matthieu MM, et al.
Implementation science 2015 Dec;10(1):209-015-0209-1. Epub 2015 Feb 12
Identifying, developing, and testing implementation strategies are important goals of implementation science. However, these efforts have been complicated by the use of inconsistent language and inadequate descriptions of implementation strategies in the literature. The Expert Recommendations for Implementing Change (ERIC) study aimed to refine a published compilation of implementation strategy terms and definitions by systematically gathering input from a wide range of stakeholders with expertise in implementation science and clinical practice. METHODS: Purposive sampling was used to recruit a panel of experts in implementation and clinical practice who engaged in three rounds of a modified Delphi process to generate consensus on implementation strategies and definitions. The first and second rounds involved Web-based surveys soliciting comments on implementation strategy terms and definitions. After each round, iterative refinements were made based upon participant feedback. The third round involved a live polling and consensus process via a Web-based platform and conference call. RESULTS: Participants identified substantial concerns with 31% of the terms and/or definitions and suggested five additional strategies. Seventy-five percent of definitions from the originally published compilation of strategies were retained after voting. Ultimately, the expert panel reached consensus on a final compilation of 73 implementation strategies. CONCLUSIONS: This research advances the field by improving the conceptual clarity, relevance, and comprehensiveness of implementation strategies that can be used in isolation or combination in implementation research and practice. Future phases of ERIC will focus on developing conceptually distinct categories of strategies as well as ratings for each strategy’s importance and feasibility. Next, the expert panel will recommend multifaceted strategies for hypothetical yet real-world scenarios that vary by sites’ endorsement of evidence-based programs and practices and the strength of contextual supports that surround the effort.
Advancing Management Innovation: Synthesizing Processes, Levels of Analysis, and Change Agents
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Volberda HW, Van DB, Mihalache OR.
Organization Studies 2014 09/01;35(9):1245-1264
Despite the mounting evidence that innovation in management can fuel competitive advantage, we still know relatively little about how firms introduce new ways of managing. The goal of this introductory essay—and the Themed Section it introduces—is to advance this knowledge. To this end, we first synthesize the main developments in the field of management innovation and show that the field has branched into four main theoretical perspectives (rational, institutional, international business, and theory development perspectives). We then address the fragmentation issue that emerges from our review by proposing a co-evolutionary framework of management innovation that takes into account the dynamic and multilevel nature of the concept; we thus integrate the generation, diffusion, adoption, and adaptation phases of the management innovation process at the organizational, inter-organizational and macro level. Our integrative framework also addresses the role of human agency (managerial intentionality of internal and external change agents) and makes a distinction between three types of management innovations (new to the world, new to the organization and adapted to its context, and new to the organization without adaptation). Furthermore, we discuss the contributions of the studies included in the Themed Section and identify several avenues for future research that we consider priorities for driving the further development of the field.
Feasibility of a web-based dementia feeding skills training program for nursing home staff.
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Batchelor-Murphy M, Amella EJ, Zapka J, Mueller M, Beck C.
Geriatric nursing (New York, N.Y.) 2015 Mar 10
Nursing home (NH) staff do not receive adequate training for providing feeding assistance to residents with dementia who exhibit aversive feeding behaviors (e.g., clamping mouth shut). The result is often low meal intake for these residents. This feasibility study tested a web-based dementia feeding skills program for staff in two United States NHs. Randomly assigned, the intervention staff received web-based dementia feeding skills training with coaching. Both groups participated in web-based pre-/post-tests assessing staff knowledge and self-efficacy; and meal observations measured NH staff and resident feeding behaviors, time for meal assistance, and meal intake. Aversive feeding behaviors increased in both groups of residents; however, the intervention NH staff increased the amount of time spent providing assistance and meal intake doubled. In the control group, less time was spent providing assistance and meal intake decreased. This study suggests that training staff to use current clinical practice guidelines improves meal intake. Copyright © 2015 Elsevier Inc.
Organizational culture change in U.S. hospitals: a mixed methods longitudinal intervention study
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Curry LA, Linnander EL, Brewster AL, Ting H, Krumholz HM, Bradley EH.
Implementation science 2015 Dec;10(1):218-015-0218-0. Epub 2015 Mar 7
Improving outcomes for patients with acute myocardial infarction (AMI) is a priority for hospital leadership, clinicians, and policymakers. Evidence suggests links between hospital organizational culture and hospital performance; however, few studies have attempted to shift organizational culture in order to improve performance, fewer have focused on patient outcomes, and none have addressed mortality for patients with AMI. We sought to address this gap through a novel longitudinal intervention study, Leadership Saves Lives (LSL). METHODS: This manuscript describes the methodology of LSL, a 2-year intervention study using a concurrent mixed methods design, guided by open systems theory and the Assess, Innovate, Develop, Engage, Devolve (AIDED) model of diffusion, implemented in 10 U.S. hospitals and their peer hospital networks. The intervention has three primary components: 1) annual convenings of the ten intervention hospitals; 2) semiannual workshops with guiding coalitions at each hospital; and 3) continuous remote support across all intervention hospitals through a web-based platform. Primary outcomes include 1) shifts in key dimensions of hospital organizational culture associated with lower mortality rates for patients with AMI; 2) use of targeted evidence-based practices associated with lower mortality rates for patients with AMI; and 3) in-hospital AMI mortality. Quantitative data include annual surveys of guiding coalition members in the intervention hospitals and peer network hospitals. Qualitative data include in-person, in-depth interviews with all guiding coalition members and selective observations of key interactions in care for patients with AMI, collected at three time points. Data integration will identify patterns and major themes in change processes across all intervention hospitals over time. CONCLUSIONS: LSL is novel in its use of a longitudinal mixed methods approach in a diverse sample of hospitals, its focus on objective outcome measures of mortality, and its examination of changes not only in the intervention hospitals but also in their peer hospital networks over time. This paper adds to the methodological literature for the study of complex interventions to promote hospital organizational culture change.
Organizational Factors Associated With Inappropriate Neuroleptic Drug Prescribing in Nursing Homes: A Multilevel Approach.
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Laffon de Mazieres C, Lapeyre-Mestre M, Vellas B, de Souto Barreto P, Rolland Y.
Journal of the American Medical Directors Association 2015 Mar 10
To determine whether the number of attending general practitioners (GPs) in nursing homes and other facility characteristics are associated with inappropriate neuroleptic prescribing. DESIGN: Cross-sectional study. SETTING: One hundred seventy-five nursing homes in France participating in the IQUARE (Impact d’une démarche QUAlité sur l’évolution des pratiques et le déclin fonctionnel des Résidents en EHPAD) study. PARTICIPANTS: A total of 6275 residents included between May and July 2011. MEASUREMENTS: The outcome measure was potentially inappropriate prescribing of neuroleptic drugs according to the approved indications and French guidelines. Resident characteristics and nursing home characteristics were electronically recorded by the nursing home’s coordinating physician. Because of the hierarchical structure of data (resident level and nursing home level), multivariate analysis using a multilevel binary logistic model was carried out to investigate factors associated with inappropriate neuroleptic prescribing. RESULTS: Of 6275 residents enrolled, 1532 (24.4%) had at least 1 prescription for a neuroleptic drug. This corresponded to 513 residents (33.5%) with appropriate prescribing (with regard to indication, substance and dose) and 1019 (66.5%) with potentially inappropriate prescribing. The multilevel binary logistic model showed that residents who lived in a nursing home with 30 GPs or more/100 beds had a higher likelihood of potentially inappropriate prescription than those who lived in nursing homes with fewer than 10 GPs/100 beds [adjusted odds ratio (aOR) 1.80; 95% confidence interval (CI) 1.04-3.12]. Residents who were ≥85 years old and those with dementia were more likely to have inappropriate prescription (aOR 1.75; 95% CI 1.32-2.32 and aOR, 2.06; 95% CI 1.56-2.74, respectively) such as the statement “no psychotropic drug prescription,” whereas the resident did in fact have a prescription (aOR 1.96; 95% CI 1.03-3.74). CONCLUSIONS: Organizational difficulties because of a large number of physicians probably explain the association with inappropriate prescribing of neuroleptics. Copyright © 2015 AMDA
Evaluating improvement and implementation for health
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Maidenhead, Berkshire, England: McGraw-Hill Education/Open University Press, 2014
he book examines different approaches to evaluating treatment, health service delivery, public health programmes and policy implementation. Clinicians and leaders want to make things better for patients and do more to prevent the problems they see everyday. All too often they find that research is not relevant or actionable and that researchers can be a burden to their work. More research can be more directly useful and we can use digital technology and partnership research to do this and reduce the costs of research. The book aims to enable practitioners to make more use of relevant research and to encourage more user-driven research.
Research Practice and Methodology
Learning Evaluation: blending quality improvement and implementation research methods to study healthcare innovations
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Balasubramanian BA, Cohen DJ, Davis MM, Gunn R, Dickinson LM, Miller WL, et al.
Implementation science 2015 Dec;10(1):219-015-0219-z. Epub 2015 Mar 10
In healthcare change interventions, on-the-ground learning about the implementation process is often lost because of a primary focus on outcome improvements. This paper describes the Learning Evaluation, a methodological approach that blends quality improvement and implementation research methods to study healthcare innovations. METHODS: Learning Evaluation is an approach to multi-organization assessment. Qualitative and quantitative data are collected to conduct real-time assessment of implementation processes while also assessing changes in context, facilitating quality improvement using run charts and audit and feedback, and generating transportable lessons. Five principles are the foundation of this approach: (1) gather data to describe changes made by healthcare organizations and how changes are implemented; (2) collect process and outcome data relevant to healthcare organizations and to the research team; (3) assess multi-level contextual factors that affect implementation, process, outcome, and transportability; (4) assist healthcare organizations in using data for continuous quality improvement; and (5) operationalize common measurement strategies to generate transportable results. RESULTS: Learning Evaluation principles are applied across organizations by the following: (1) establishing a detailed understanding of the baseline implementation plan; (2) identifying target populations and tracking relevant process measures; (3) collecting and analyzing real-time quantitative and qualitative data on important contextual factors; (4) synthesizing data and emerging findings and sharing with stakeholders on an ongoing basis; and (5) harmonizing and fostering learning from process and outcome data. Application to a multi-site program focused on primary care and behavioral health integration shows the feasibility and utility of Learning Evaluation for generating real-time insights into evolving implementation processes. CONCLUSIONS: Learning Evaluation generates systematic and rigorous cross-organizational findings about implementing healthcare innovations while also enhancing organizational capacity and accelerating translation of findings by facilitating continuous learning within individual sites. Researchers evaluating change initiatives and healthcare organizations implementing improvement initiatives may benefit from a Learning Evaluation approach.
Preference-adaptive randomization in comparative effectiveness studies
French B, Small D, Novak J, Saulsgiver K, Harhay M, Asch D, et al.
Determination of comparative effectiveness in a randomized controlled trial requires consideration of an intervention’s comparative uptake (or acceptance) among randomized participants and the intervention’s comparative efficacy among participants who use their assigned intervention. If acceptance differs across interventions, then simple randomization of participants can result in post-randomization losses that introduce bias and limit statistical power. Methods We develop a novel preference-adaptive randomization procedure in which the allocation probabilities are updated based on the inverse of the relative acceptance rates among randomized participants in each arm. In simulation studies, we determine the optimal frequency with which to update the allocation probabilities based on the number of participants randomized. We illustrate the development and application of preference-adaptive randomization using a randomized controlled trial comparing the effectiveness of different financial incentive structures on prolonged smoking cessation. Results Simulation studies indicated that preference-adaptive randomization performed best with frequent updating, accommodated differences in acceptance across arms, and performed well even if the initial values for the allocation probabilities were not equal to their true values. Updating the allocation probabilities after randomizing each participant minimized imbalances in the number of accepting participants across arms over time. In the smoking cessation trial, unexpectedly large differences in acceptance among arms required us to limit the allocation of participants to less acceptable interventions. Nonetheless, the procedure achieved equal numbers of accepting participants in the more acceptable arms, and balanced the characteristics of participants across assigned interventions. Conclusions Preference-adaptive randomization, coupled with analysis methods based on instrumental variables, can enhance the validity and generalizability of comparative effectiveness studies. In particular, preference-adaptive randomization augments statistical power by maintaining balanced sample sizes in efficacy analyses, while retaining the ability of randomization to balance covariates across arms in effectiveness analyses.
Seniors’ perspectives on care: a case study of the Alex Seniors health clinic, Calgary
Shaw M, Rypien C, Drummond N, Harasym P, Nixon L
BMC Research Notes
Primary care initiatives face an imperative to not only reduce barriers to care for their patients but also to uniquely accommodate the complex needs of at-risk patient populations. Patient-centered multidisciplinary care team models for primary care, like the Alex Seniors Clinic, are one approach for providing comprehensive care for marginalized seniors. The purpose of this qualitative study was to explore patient perspectives on the responsiveness of the Alex Seniors Clinic to their stated health needs. Results Themes reflected participants’ perspectives on factors impacting their health needs as vulnerable seniors as well as on the measures that the Alex Seniors Clinic has taken to meet those needs. Factors impacting health included: the nature of their relationships to the physical environment in which they lived, the nature of the relationships they had to others in that environment, and independence and autonomy. Participants identified accessibility, respect and support, and advocacy as the ways in which the clinic was working to address those health needs. Conclusions While respect and support, as well as advocacy, effectively addressed some patient needs, participants felt that accessibility problems continue to be health-related barriers for clinic patients. This may be due to the fact that issues of accessibility reflect larger community and social problems. Nevertheless, it is only through engaging the patient community for input on clinic approaches that an understanding can be gained of how closely a clinic’s care goals are currently aligning with patient perspectives of the care and services they receive.
Resident-to-resident abuse involves aggression and violence that occurs between long-term care (LTC) home residents and can have serious consequences for both aggressors and victims. To date, there has been no attempt to systematically assess the breadth of the problem in Canada. To address this gap, we undertook a scoping review to enhance understanding of resident-to-resident abuse in LTC homes. A redacted Canadian data set on resident-to-resident abuse is also reported on. Nine electronic literature databases were searched; a total of 784 abstracts were identified, but only 32 satisfied the inclusion criteria. The majority of records (75%) were retrospective case studies, qualitative studies, and reviews/commentaries. Of these, only 14 focused exclusively on resident-to-resident abuse. The redacted Canadian data set suggests resident-to-resident abuse makes up approximately one-third of reported abuse cases. Recommendations for future research, clinical practice, and policy are provided to raise awareness of this phenomenon to help decrease its incidence.
Residents’ Self-Reported Quality of Life in Long-Term Care Facilities in Canada
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Kehyayan V, Hirdes JP, Tyas SL, Stolee P.
Canadian journal on aging 2015 Mar 10:1-16
Quality of life (QoL) of long-term care (LTC) facility residents is an important outcome of care. This cross-sectional, descriptive study examined the self-reported QoL of LTC facility residents in Canada using the interRAI Self-Report Nursing Home Quality of Life Survey instrument. A secondary purpose was to test the instrument’s psychometric properties. Psychometric testing of the instrument supported its reliability and its convergent and content validity for assessing the residents’ QoL. Findings showed that residents rated positively several aspects of their life, such as having privacy during visits (76.9%) and staff’s being honest with them (73.6%). Residents gave lower ratings to other aspects such as autonomy, staff-resident bonding, and personal relationships. The findings point to gaps between facility philosophies of care and their translation into a care environment where care is truly resident-directed. Moreover, the findings have potential implications for resident care planning, facility programming, social policy development, and future research.
Early Hospital Readmission of Nursing Home Residents and Community-Dwelling Elderly Adults Discharged from the Geriatrics Service of an Urban Teaching Hospital: Patterns and Risk Factors
Non UofA Access
Bogaisky M, Dezieck L.
Journal of the American Geriatrics Society 2015
To compare rates and risk factors for early hospital readmission for nursing home residents and community-dwelling older adults. Design Retrospective cohort study. Setting Geriatric inpatient service at a large urban hospital. Participants Nursing home residents (n = 625) and community-dwelling individuals (n = 413) aged 65 and older admitted over a 1-year period. Measurements Thirty-day readmissions. Results There were 1,706 hospital admissions within the 1-year study period involving 1,038 individuals. The 30-day readmission rate was higher for subjects discharged to a nursing home than those discharged to the community (34.4% vs 22.6%, P < .001). Chronic kidney disease and pressure ulcers were associated with greater risk of readmission in both groups. Chronic obstructive pulmonary disease was a risk factor for readmission only in community-dwelling individuals. Congestive heart failure and dementia were associated with greater risk of readmission only in nursing home residents. Readmission rates varied between individual nursing homes by more than a factor of 2. Risk of readmission was 30% lower in nursing home residents cared for by hospitalist than nonhospitalist geriatricians. Conclusion Higher rates of hospital readmission for individuals discharged to nursing homes than to the community and differing patterns of risk factors for readmission indicate the importance of customized interventions to reduce readmission rates for two distinct elderly populations.
The Elderhaus Program of All-inclusive Care for the Elderly in North Carolina: Improving Functional Outcomes and Reducing Cost of Care: Preliminary Data.
Non UofA Access
Fretwell MD, Old JS, Zwan K, Simhadri K.
Journal of the American Geriatrics Society 2015 Mar 6
The Program of All-inclusive Care for the Elderly (PACE) is at a crossroads in its evolution as a community-based alternative to institutionally based nursing home care. Because of their perceived value and cost savings to Medicaid and Medicare, PACE programs are under increasing pressure to expand the numbers of individuals they serve while simultaneously reducing the overall cost of care. During the first 5 years of operations, the Elderhaus PACE Program in Wilmington, North Carolina, has reduced use of acute hospital care and skilled nursing home care while demonstrating that 46% of their participants improved and 20% of participants maintained their level of functional independence. It is felt that use of a plan of care organized according to standard domains of function and the quantifiable method of documenting improvement in functional health outcomes represent a critical factor in improved outcomes despite lower use of costly hospital and institutional care. The next step will be to disseminate the plan of care process to other PACE programs and measure its effect on participant functional outcomes and cost of care. The fact that the majority of PACE programs in North Carolina are using an electronic medical record that has the standard domains and quantitative functional measures embedded in the software will facilitate this step. Benchmarks for service use data are already being collected and will be compared with service use after the implementation of the plan of care process. © 2015
The burden of disease in older people and implications for health policy and practice.
Non UofA Access
Prince MJ, Wu F, Guo Y, Gutierrez Robledo LM, O’Donnell M, Sullivan R, et al.
Lancet 2015 Feb 7;385(9967):549-562
23% of the total global burden of disease is attributable to disorders in people aged 60 years and older. Although the proportion of the burden arising from older people (≥60 years) is highest in high-income regions, disability-adjusted life years (DALYs) per head are 40% higher in low-income and middle-income regions, accounted for by the increased burden per head of population arising from cardiovascular diseases, and sensory, respiratory, and infectious disorders. The leading contributors to disease burden in older people are cardiovascular diseases (30·3% of the total burden in people aged 60 years and older), malignant neoplasms (15·1%), chronic respiratory diseases (9·5%), musculoskeletal diseases (7·5%), and neurological and mental disorders (6·6%). A substantial and increased proportion of morbidity and mortality due to chronic disease occurs in older people. Primary prevention in adults aged younger than 60 years will improve health in successive cohorts of older people, but much of the potential to reduce disease burden will come from more effective primary, secondary, and tertiary prevention targeting older people. Obstacles include misplaced global health priorities, ageism, the poor preparedness of health systems to deliver age-appropriate care for chronic diseases, and the complexity of integrating care for complex multimorbidities. Although population ageing is driving the worldwide epidemic of chronic diseases, substantial untapped potential exists to modify the relation between chronological age and health. This objective is especially important for the most age-dependent disorders (ie, dementia, stroke, chronic obstructive pulmonary disease, and vision impairment), for which the burden of disease arises more from disability than from mortality, and for which long-term care costs outweigh health expenditure. The societal cost of these disorders is enormous. Copyright © 2015 Elsevier Ltd.
Japan’s long-term care policy for older people: The emergence of innovative “mobilisation” initiatives following the 2005 reforms
Journal of Aging Studies 2015 /4;33(0):11-21
Japan leads the global race for solutions to the increasing long-term care demand from an ageing population. Initial responses in 2000 saw the launch of the public Long-Term Care Insurance (LTCI) system which witnessed an unexpectedly substantial uptake — with doubts raised about financial viability and sustainability. The post-2005 LTCI reform led to the adoption of innovations — including the “mobilisation” of active, older volunteers to support their frailer peers. This strategy, within the wider government’s “2025 Vision” to provide total care for the entire older population, sought to secure financial viability and sustainability. Drawing on qualitative in-depth interviews with 21 provider organisations this study will examine three “mobilisation” schemes and identify those factors contributing to overall strengths while acknowledging complexities, diversities and challenges the schemes encountered. Initial literature written by mobilisation proponents may have been overly optimistic: this study seeks to balance such views through providing an understanding and analysis of these mobilisation schemes’ realities. The findings will provide insights and suggest more caution to policy-makers intending to promote such schemes — in both Japan and in countries considering doing so. Furthermore, more evaluation is required to obtain evidence to support financial feasibility and sustainability.
Monetary costs of agitation in older adults with Alzheimer’s disease in the UK: prospective cohort study.
Non UofA Access
Morris S, Patel N, Baio G, Kelly L, Lewis-Holmes E, Omar RZ, et al.
BMJ open 2015 Mar 13;5(3):e007382-2014-007382
While nearly half of all people with Alzheimer’s disease (AD) have agitation symptoms every month, little is known about the costs of agitation in AD. We calculated the monetary costs associated with agitation in older adults with AD in the UK from a National Health Service and personal social services perspective. DESIGN: Prospective cohort study. SETTING: London and the South East Region of the UK (LASER-AD study). PARTICIPANTS: 224 people with AD recruited between July 2002 and January 2003 and followed up for 54 months. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was health and social care costs, including accommodation costs and costs of contacts with health and social care services. Agitation was assessed using the Neuropsychiatric Inventory (NPI) agitation score. RESULTS: After adjustment, health and social care costs varied significantly by agitation, from £29 000 over a 1 year period with no agitation symptoms (NPI agitation score=0) to £57 000 at the most severe levels of agitation (NPI agitation score=12; p=0.01). The mean excess cost associated with agitation per person with AD was £4091 a year, accounting for 12% of the health and social care costs of AD in our data, and equating to £2 billion a year across all people with AD in the UK. CONCLUSIONS: Agitation in people with AD represents a substantial monetary burden over and above the costs associated with cognitive impairment.
Conceptual model of the impact of an experiential arts program on persons with dementia and their care partners
Non UofA Access
Burnside LD, Knecht MJ, Hopley EK, Logsdon RG.
Dementia 2015 03/19
Community-based arts programs for persons with dementia and their care partners hold tremendous potential for increasing cognitive, social, and creative engagement and improving quality of life for these dyads. This is a qualitative, grounded theory analysis of here:now , a joint arts engagement program for persons with dementia and their care partners that involves gallery tours and art classes. Twenty-one care partners and 13 persons with dementia completed in-depth, semi-structured telephone interviews approximately two weeks following participation in the program. The program was well received by both persons with dementia and care partners as evidenced by high levels of engagement, mindfulness, social connection, and positive interactions. Factors identified as important to the experience included the museum space itself, the facilitation process, and socialization with other participants. Results form the basis for a conceptual model for assessing outcomes of arts programming and highlight the unique position of museums to support persons with dementia and their care partners in the community.
A Pilot Evaluation of Psychosocial Support for Family Caregivers of Relatives with Dementia in Long-Term Care: The Residential Care Transition Module.
Non UofA Access
Gaugler JE, Reese M, Sauld J.
Research in gerontological nursing 2015 Mar 13:1-12
This multiple method pilot evaluation aimed to generate preliminary data on the effectiveness of the Residential Care Transition Module (RCTM). The RCTM is a six-session, 4-month psychosocial intervention designed to help families manage their emotional and psychological distress following residential care placement of a cognitively impaired relative. Seventeen family caregivers of relatives in a nursing home or assisted living memory care unit were randomly assigned to the RCTM treatment condition and 19 family caregivers were assigned to a usual care control group. Caregivers in the treatment condition reported significantly (p < 0.05) less emotional distress at 4 and 8 months on self-reported surveys than those in the control group. Post-RCTM focus groups emphasized the importance of readily available psychosocial support for families following the placement transition. The findings suggest that the provision of skilled psychosocial support can help families manage emotional distress and crises in the months following a cognitively impaired relative’s admission to residential long-term care. Copyright 2015, SLACK Incorporated.
Using the Newcastle Model to understand people whose behaviour challenges in dementia care.
Non UofA Access
Jackman L, Beatty A.
Nursing older people 2015 Mar 2;27(2):32-39
National guidance for working with people whose behaviour challenges in dementia care suggests that a psychosocial approach should be the first-line intervention. However, there is little guidance for nurses about how to assess and manage behaviour that challenges in people with dementia. Nurses across specialties who work with older people might be asked to contribute to an assessment or provide advice to care home staff or families. This article presents one psychosocial model – the Newcastle Model – that provides a framework and process in which to understand behaviour that challenges in terms of needs which are unmet, and suggests a structure in which to develop effective interventions that keep people with dementia central to their care.
Frailty Index and Mortality in Nursing Home Residents in France: Results From the INCUR Study.
Non UofA Access
Tabue-Teguo M, Kelaiditi E, Demougeot L, Dartigues JF, Bruno V, Matteo C.
Journal of the American Medical Directors Association 2015 Mar 10
The objective of this study was to examine whether the capacity of an age-related deficit accumulation index (the so-called Frailty Index [FI] proposed by Rockwood) to predict mortality in a nursing home population. DESIGN, SETTING, AND PARTICIPANTS: Data are from a longitudinal cohort study (ie, the Incidence of pNeumonia and related ConseqUences in nursing home Residents [INCUR]) of 773 older persons (74.4% women) living in 13 French nursing homes. MEASUREMENTS: The FI was computed as the ratio between actual and 30 potential deficits the participant might have presented at the baseline visit (range between 0 [no deficit] and 1 [30 deficits]). Death events were monitored and detected over a 12-month follow-up. The risk of death was estimated using Cox proportional hazards models. RESULTS: Mean age of participants was 86.2 (SD 7.5) years, with a mean FI of 0.35 (SD 0.11). At the end of the follow-up, 135 (17.4%) death events were recorded. A positive association between the FI and mortality (per 0.01 FI increment: age- and gender-adjusted hazard ratio 1.018, 95% confidence interval 1.002-1.035, P = .03) was reported. The use of the traditional 0.25 cut-point for detecting the frailty status is inadequate in this population. CONCLUSION: The FI is able to predict mortality even in very old and complex elders, such as nursing home residents. Copyright © 2015 AMDA
Nonpharmacologic Interventions to Heal Pressure Ulcers in Older Patients: An Overview of Systematic Reviews (The SENATOR-ONTOP Series).
Non UofA Access
Velez-Diaz-Pallares M, Lozano-Montoya I, Abraha I, Cherubini A, Soiza RL, O’Mahony D, et al.
Journal of the American Medical Directors Association 2015 Feb 27
Pressure ulcers (PUs) are more frequent in older patients, and the healing process is usually challenging. Nonpharmacologic interventions may play a role in the treatment of older people with PUs, but most systematic reviews (SRs) have not addressed this specific population using convincing outcome measures. OBJECTIVE: To summarize and critically appraise the evidence from SRs of the primary studies on nonpharmacologic interventions to treat PUs in older patients. DESIGN: SR and meta-analysis of comparative studies. METHODS: PubMed, Cochrane Database of Systematic Reviews, EMBASE, and CINHAL (from inception to October 2013) were searched. A new search for updates in the Cochrane Database was launched in July 2014. SRs that included at least 1 comparative study evaluating any nonpharmacologic intervention to treat PUs in older patients, in any health care setting, were included. Any primary study with experimental design was then identified and included. From each primary study, quality assessment was undertaken as specified by the Cochrane Collaboration and the Grading of Recommendations Assessment, Development and Evaluation working group. Interventions were identified and compared among different studies to explore the possibility of performing a meta-analysis, using complete ulcer healing as the outcome measure. RESULTS: One hundred ten SRs with 45 primary studies satisfied the inclusion criteria. The most frequent interventions explored in these trials were support surfaces (13 studies), nutrition (8), and electrotherapy (6). High or moderate quality of evidence was found in none of the interventions, mainly because of the very serious risk of bias of most studies and imprecision in the treatment effect. Evidence grade is very low or insufficient to support the use of any support surface, nutrition intervention, multicomponent interventions, repositioning or other adjunctive therapy (ultrasound, negative pressure, laser, electromagnetic, light, shock wave, hydrotherapy, radiofrequency, or vibration therapy) to increase the rates of PU healing in older patients. Electrotherapy showed some beneficial effect in the treatment of PUs, although the quality of evidence is low. CONCLUSIONS: In older patients with PUs, evidence to use any nonpharmacologic therapy to increase the rates of wound healing is inconclusive, except for low quality evidence that supports the use of electrotherapy. This situation is especially alarming for interventions that are usually standard clinical practice (repositioning, support surfaces). Although there is some evidence in younger populations and other types of ulcers, studies in older populations with PUs using sound methodology are needed. Copyright © 2015 AMDA
This study analyzes the effect of informal caregiving on older adults’ labor supply and economic resources. Although we find no evidence that caregiving affects the wages or hours of workers, we do find that it reduces the likelihood of working. Men who provide personal care to parents or intensive care to spouses are less likely to work, as are women who provide intensive care to parents. As a result, over time, caregivers have a significantly higher probability of falling into poverty and also experience a smaller percentage growth in assets—particularly those who care for their spouses.
A report has been published about progress made on Global Action Against Dementia. Following the commitments made at the G8 Dementia Summit in December 2013, the Global Action Against Dementia programme has helped to co-ordinate work between and within different countries, to improve quality of life for people living with dementia and their carers. The report on Global Action Against Dementia:
-celebrates all that is being achieved and highlights how the summit has provided a springboard for new action at both an individual government/organisational level as well as in new collaborative relationships
-seeks to provide a flavour of the breadth of work that is underway
-demonstrates the commitment that has been built among the G7 countries to work together, to share what they know and what they find out about dementia, and to join with a wide range of stakeholders to advance the work
-shows what can be achieved when countries and sectors work together when presented with a health and care challenge on such a scale.
Ethical Theory and the Myth of the Average Patient: A Sorry Tale of Inattentional Blindness
Friday 24 April 12:00-13:00
Dvorkin Centre (2G2.07 WMC), University of Alberta Hospital
Dr. Derek Sellman will be giving this talk.
Researching Complex Interventions in Health: The State of the Art
14-15 October Exeter, UK £150
This conference will bring together leading international contributors from the field of complex interventions for two days of presentations, workshops and discussion on the latest thinking in applied clinical health services research. The conference is jointly convened by David Richards, University of Exeter Medical School, UK and Ingalill Rahm-Hallberg, Lund University, Sweden. The conference is supported by the European Science Foundation.
Save the date: From definitions to action: meeting the needs of health care’s highest users
25 May Montréal PQ
CIHI is pleased to announce From definitions to action: meeting the needs of health care’s highest users, a pre-CAHSPR 1-day forum. Connect with our distinguished roster of high-user leaders and speakers. Be part of an informative dialogue with others from across Canada as we
-Identify the practical implications of using different approaches to define high users;
-Profile new tools and research resources available from CIHI, Statistics Canada and CIHR;
-Showcase leading-edge approaches to understanding and predicting high use from across Canada; and
-Highlight concrete examples of using data to inform intervention strategies.
Webinar: Engaging decision-makers for a more sustainable Age-friendly City and Community
Wednesday 1 April 13:00 MT
Are you involved in an Age-friendly City and Community (AFCC) initiative and want to better understand the politics of a community and how to manoeuvre through various systems towards successful decision-maker engagement? The International Federation on Ageing (IFA) in collaboration with Grantmakers in Aging (GIA) is pleased to announce a webinar series geared towards addressing and resolving barriers towards sustainable age-friendly cities and communities. Learn how you can tailor and target age-friendly strategies to better engage with decision-makers in government and industry sectors. Trust, enthusiasm, a commitment of success and a defensible social and economic argument are characteristics toward common goals and sustainability.
CFHI webinar: Population- Based Responsibility: A Unique Canadian Experience in Population Health
Thursday 26 March 10:00-11:00 MT
The reorganization of Quebec’s health and social services system in 2004 was based on the concepts of population-based responsibility and tiered services. To meet the challenge of exercising population-based responsibility, a consortium of several partners (IPCDC) was formed, in 2005. The members and the team of this Consortium guide the CSSSs, the regional agencies and their partners in organizational projects in order to strengthen action skills, knowledge sharing and the competencies required to accomplish change. The origins, development, guidance methods and results of IPCDC, will be presented in relation to the objectives of the Triple Aim for Populations developed by the Institute for Healthcare Improvement (IHI).
2015 Training Institute for Dissemination and Implementation Research in Health
26-31 July Pasadena, CA
One of the most critical issues impeding improvements in public health today is the enormous gap between what we know can optimize health and healthcare and what actually gets implemented in every day practice. The science of dissemination and implementation (D&I) seeks to address this gap by understanding how to best ensure that evidence-based strategies to improve health and prevent disease are effectively delivered in clinical and public health practice.
Health Systems Workshop
15-19 June $2480
The Forum has led nearly 100 training workshops in more than 30 countries with health system policymakers, stakeholders and researchers from more than 60 countries. Drawing on this experience, the Forum provides online and in-person training about how to strengthen or reform health systems, and how to get cost-effective programs, services and drugs to those who need them, based on the best available research evidence. This training is for policymakers and stakeholders, as well as researchers, journalists and students.
Six months into an innovative project funded through Canadian Foundation for Healthcare Improvement (CFHI), Copper Ridge Place residents and staff are experiencing positive results. Minister of Health and Social Services Mike Nixon announced in Dawson today the work of the facility’s special care team to reduce the use of antipsychotic medication in residents with dementia is proving very successful.
Unpaid caregivers in Nova Scotia say the province should step up and give them more support, beyond the $400 a month given to low income households.
Nunavut may have the smallest proportion of seniors in the country but Alexander Sammurtok, the MLA for Rankin Inlet South, wants to be sure the territory is ready to accommodate the territory’s growing elderly population with a full-service 24-hour facility.
The Honourable Alice Wong, Minister of State (Seniors), has announced the appointments of Mr. William James Emmerton and Mr. Tim W. Kwan as members of the National Seniors Council (NSC).
Thousands of older people struggle with self-care, such as going to the toilet unaided, but don’t receive any paid or unpaid care.
Brunhilde Ortiz’s condition improved dramatically, her daughter said, after the 84-year-old started attending a “daycare at night” Alzheimer’s program at the Hebrew Home at Riverdale in the Bronx, N.Y.
Home care visits to elderly people should last for at least half an hour and be centred around personalised care rather than a “one-size fits all” service, says NICE.
The Government of Alberta has announced upgrades in 75 government-owned or supported seniors lodges during the next three years, improving 4,700 units. In addition, upgrades have been announced for 1,750 government owned or supported continuing care spaces in 30 facilities that currently do not have sprinklers.
The United Nurses of Alberta is taking the government to court, claiming the province is failing to enforce its own law requiring each nursing home to have a registered nurse on staff.
Alberta Health Services (AHS) will open 311 new “restorative care” spaces – 186 in Calgary and 125 in Edmonton – designed to help seniors maintain and improve function after a stay in hospital and help more seniors return home. Construction will be funded through the province’s Alberta Supportive Living Initiative (ASLI), as part of a major provincewide increase in continuing care beds.
In the hope of providing the country’s elderly with a louder voice, the University of Ottawa has announced it will host Canada’s first international longevity centre. The centre is a policy organization which advocates for seniors with the intention of helping them live longer, independent and healthier lives.
We are calling for the families and carers of people with dementia to have the same rights as the parents of sick children, and be allowed to remain with them in hospital for as many hours of the day and night as is humanly possible.
The National Assembly for Wales has announced its ambition to become a dementia-friendly organisation, supporting the 45,000 people living with dementia in Wales.
Alberta Health Services (AHS)-Edmonton Zone has participated in IHI’s last three Triple Aim cohorts, beginning in 2012-13. The teams focused on people in the Eastwood community who are homeless, unstably housed or have a chronically high acute care utilization. More than half of this population in Eastwood have histories of trauma, mental illness or substance abuse. AHS-Edmonton focused on designing, implementing and evaluating five improvement projects that would advance the Triple Aim for high-needs, high-costs patients in the Eastwood area.
For many people, email can take away time that could better be spent on a high-importance but non-urgent task.
Planning your career could be considered to be a contradiction in terms. How can you plan something which is largely out of your control? How can you predict whether and when a job will be advertised by an employer, or influence where it will be located? Furthermore, how can you plan for a career, if you’re not sure in which direction you want to go? Researchers are finding themselves in an increasingly competitive job market. Finding the right position can be difficult, especially if you are an early career researcher, so having a career plan could make all the difference.
Patrick Callaghan, Professor and Head of School of Health Sciences, The University of Nottingham, reflects on what the results of the 2014 Research Excellence Framework (REF), a major UK-wide assessment of university research, mean for nursing, midwifery and AHPs.
Incentive schemes tried in the US and UK have worked very well and appear to be affordable. So should Canadian funders and policymakers get over their reservations and start paying people to be healthier?
Sharing of information among EiCs regarding cases of suspected misconduct can play a significant role in preserving the integrity of the scientific record, allowing EICs of affected journals to conduct investigations with greater efficiency and effectiveness.
Dr. Estabrooks wants to make sure everyone knows about this journal. It may be a good spot for your next publication. Here are some details about it:
Impact Factor 1.119
While the goal of healthcare research has always been to improve the health of individuals and populations, many recognize that traditional research approaches have often produced more questions than answers. CER (also called patient-centered outcomes research) draws from the disciplines of health technology assessment, outcomes research, clinical epidemiology and implementation science, among others, to better answer the fundamental question ‘which treatment will work best, in which patient, and under what circumstances?’
Publishes the following:
-Studies of effectiveness or CER yielding new findings relating to diagnostics, therapeutics, surgical procedures, or other healthcare services or options;
-Systematic reviews of available evidence relating to the pros and cons of healthcare options for specific patient groups including comparative safety;
-Perspectives and debate relating to the performance of CER studies and best practice issues;
-Commentary on both patient-relevant outcomes and economic implications;
-Direct head-to-head comparisons of available diagnostic and therapeutic options – evaluating clinical alternatives with current standard of care;
-Clinical trial commentaries – evaluating and interpreting the findings of recently completed CER trials as well as presenting the design and rationale of newly commenced studies;
-Pharmacoeconomic studies, health economics and outcomes research.
In this post, Andrew Moore, Editor-in-Chief of BioEssays and Inside the Cell explores the decision to decline a review.
Through many focus groups with young carers and other partners in the community, the Young Carers Project (YCP) has developed a guide for young carers on how to manage and cope with their young carer responsibilities. It will also provide advice and guidance to adults and organizations on how they can support young carers in their community.
Program evaluation toolkit
Ontario Centre of Excellence for Child and Youth Mental Health
This toolkit contains resources for planning, doing and using program evaluation.
The Dementia Capability Toolkit identifies resources that States and communities can use to design initiatives to ensure that programs are dementia-capable. In dementia-capable systems, programs are tailored to the unique needs of people with Alzheimer’s disease or other dementias and their caregivers.
This document is designed as a guide to selected, recent resources on person-centred care in long-term care facilities.
Post-Doctoral Training In Addiction and Implementation Research
University of Arkansas for Medical Sciences
A postdoctoral position is available at the University of Arkansas for Medical Sciences for advanced training in addiction research and implementation science. The position is funded by a NIDA-supported T32 “Translational Training in Addiction.” The fellowship program offers training opportunities in basic, clinical, and implementation research, and offers opportunities for fellows to collaborate with faculty and other fellows across the translational continuum. The open position will be filled by a fellow interested in implementation science. Opportunities exist to work with senior implementation scientists on existing and/or new implementation-focused projects, e.g., developing and testing implementation strategies, observational studies of real-world implementation, hybrid clinical effectiveness-implementation trials, and preliminary research on barriers/facilitators to implementation. Fellowship-supported didactics will offer training in implementation science and addiction research. Successful candidates should have a PhD in relevant fields such as psychology, social work, nursing, public health, sociology, anthropology, or other related disciplines. Interested candidates should contact Geoff Curran, PhD (firstname.lastname@example.org), Professor and Director, Center for Implementation Research, University of Arkansas for Medical Sciences, Little Rock, AR.
Professor of Implementation Science
Department of Public Health Sciences, Karolinska Institute
We are looking for an experienced professor competent researcher with wide-ranging skills in implementation science and academic teaching. The successful candidate will lead development of this research area within the department. The new professor will be expected to attract external funding, drive forward research programmes as the head researcher and teach in global and public health on both second- and third-cycle programmes. Duties also include participating in implementation projects at the Stockholm County Council Centre for Epidemiology and Public Health.
University of Birmingham Research Fellowship
DEADLINE 28 March 2015
There is an opportunity to apply for a prestigious fellowship at the University of Birmingham in test evaluation research, that will lead to an established academic position. The University of Birmingham has a special scheme to award its own prestigious fellowships to outstanding individuals early in their career. Fellows are appointed to a permanent academic post, and will have 5 years with protected time for high-quality research. This will allow outstanding, high potential, early-career researchers of any age to establish themselves as rounded academics who will go on to make a full and excellent contribution to research, teaching and academic citizenship. A key focus of the University of Birmingham’s activity in the Applied Health Sciences is in developing, evaluating and applying methods to improve the evaluation of Medical Tests. Collaborations between clinicians, biostatisticians, health economists, evidence synthesists and trialists has created a research group of international renown, which aims to identify the best methods for evaluating the impact of tests on patients and the health services, whether tests are used for screening, diagnosis, prognosis or monitoring. Direct evaluation of patient benefit is challenging, as testing rarely changes health states, but rather acts in a multifactorial and complex manner, with benefit accruing from more appropriate and effective use of interventions, changing patient pathways and time frames, and minimising the harms of testing.
Journal of Advanced Nursing is seeking an Editor
DEADLINE 20 April
The successful candidate for the position of Editor will be recognized internationally for his or her academic and research achievements, will have worked at a strategic level within academia or healthcare, and will have an impressive track record of publications and presentations at conferences. The main functions within this role are: manuscript handling and quality control, strategic development, and journal promotion. The post involves working closely with the Publisher, the other Editors, and the Editor-in-Chief.
Senior Research Worker for the Centre for Implementation Science (CIS)
DEADLINE 30 March
Health Service and Population Research Department is looking to recruit a Senior Research Worker for the Centre for Implementation Science (CIS). The postholder will build up the academic and research profile of the newly established CIS and contribute to academic productivity and grant income. The post-holder, working under the direction of the CIS Associate Director, Professor Nick Sevdalis, will have a key role in the design and delivery of several implementation science-related projects.
2-year post-doctoral fellowship position School of Physical and Occupational Therapy
Faculty of Medicine, McGill University
DEADLINE 15 May
Under the supervision of Dr. André Bussières and Dr. Aliki Thomas, the post-doctoral fellow will conduct research in the area of knowledge translation (KT) and higher education (HE) in rehabilitation. Funding is available for the first year. The successful candidate will be expected to apply for competitive post-doctoral funding to support the second year of the fellowship. Applicants with a background in rehabilitation (e.g. chiropractic, occupational therapy, physical therapy) or other relevant health discipline are invited to apply. Applicants should have a strong interest in KT, evidence-based rehabilitation practices (EBRH), higher education and curriculum design to support EBRH and KT.
Health Service Researcher (Realist Review)
Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
DEADLINE 22 April
Applications are invited for a health services researcher to work on a realist review of interventions to improve antimicrobial prescribing of doctors in training. The project is the result of collaboration between the University of Oxford, University of Exeter and Plymouth University Peninsula Schools of Medicine and Dentistry
Infectious Disease KT specialist
NCCMT McMaster University, Hamilton ON
NCCMT is developing a knowledge-sharing platform (virtual centre) that will provide key audiences with information related to infection prevention, management and control for use during an infectious disease outbreak. The initial focus will be on Ebola. This is a six month project for which NCCMT is seeking a qualified and experienced public health professional(s) who have the appropriate expertise to search for, appraise, and summarize in lay language, infectious disease related information specifically regarding Ebola