October 13th, 2015



New article by Dr. Whitney Berta, Dr. Lisa Cranley, Dr. James Dearing, Dr. Elizabeth Dogherty, Dr. Janet Squires, and Dr. Carole Estabrooks
Why (we think) facilitation works: insights from organizational learning theory.
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W. Berta, L. Cranley, J. W. Dearing, E. J. Dogherty, J. E. Squires and C. A. Estabrooks.
Implement Sci 2015 Oct 6;10(1):141-015-0323-0

BACKGROUND: Facilitation is a guided interactional process that has been popularized in health care. Its popularity arises from its potential to support uptake and application of scientific knowledge that stands to improve clinical and managerial decision-making, practice, and ultimately patient outcomes and organizational performance. While this popular concept has garnered attention in health services research, we know that both the content of facilitation and its impact on knowledge implementation vary. The basis of this variation is poorly understood, and understanding is hampered by a lack of conceptual clarity. DISCUSSION: In this paper, we argue that our understanding of facilitation and its effects is limited in part by a lack of clear theoretical grounding. We propose a theoretical home for facilitation in organizational learning theory. Referring to extant literature on facilitation and drawing on theoretical literature, we discuss the features of facilitation that suggest its role in contributing to learning capacity. We describe how facilitation may contribute to generating knowledge about the application of new scientific knowledge in health-care organizations. Facilitation’s promise, we suggest, lies in its potential to stimulate higher-order learning in organizations through experimenting with, generating learning about, and sustaining small-scale adaptations to organizational processes and work routines. The varied effectiveness of facilitation observed in the literature is associated with the presence or absence of factors known to influence organizational learning, since facilitation itself appears to act as a learning mechanism. We offer propositions regarding the relationships between facilitation processes and key organizational learning concepts that have the potential to guide future work to further our understanding of the role that facilitation plays in learning and knowledge generation.

New article by Dr. Janet Squires and Dr. Ali Hutchinson
Identifying the domains of context important to implementation science: a study protocol.
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J. E. Squires, I. D. Graham, A. M. Hutchinson, et al.
Implement Sci 2015 Sep 28;10(1):135-015-0325-y

BACKGROUND: There is growing recognition that “context” can and does modify the effects of implementation interventions aimed at increasing healthcare professionals’ use of research evidence in clinical practice. However, conceptual clarity about what exactly comprises “context” is lacking. The purpose of this research program is to develop, refine, and validate a framework that identifies the key domains of context (and their features) that can facilitate or hinder (1) healthcare professionals’ use of evidence in clinical practice and (2) the effectiveness of implementation interventions. METHODS/DESIGN: A multi-phased investigation of context using mixed methods will be conducted. The first phase is a concept analysis of context using the Walker and Avant method to distinguish between the defining and irrelevant attributes of context. This phase will result in a preliminary framework for context that identifies its important domains and their features according to the published literature. The second phase is a secondary analysis of qualitative data from 13 studies of interviews with 312 healthcare professionals on the perceived barriers and enablers to their application of research evidence in clinical practice. These data will be analyzed inductively using constant comparative analysis. For the third phase, we will conduct semi-structured interviews with key health system stakeholders and change agents to elicit their knowledge and beliefs about the contextual features that influence the effectiveness of implementation interventions and healthcare professionals’ use of evidence in clinical practice. Results from all three phases will be synthesized using a triangulation protocol to refine the context framework drawn from the concept analysis. The framework will then be assessed for content validity using an iterative Delphi approach with international experts (researchers and health system stakeholders/change agents). DISCUSSION: This research program will result in a framework that identifies the domains of context and their features that can facilitate or hinder: (1) healthcare professionals’ use of evidence in clinical practice and (2) the effectiveness of implementation interventions. The framework will increase the conceptual clarity of the term “context” for advancing implementation science, improving healthcare professionals’ use of evidence in clinical practice, and providing greater understanding of what interventions are likely to be effective in which contexts.

New article by Dr. Jo Rycroft-Malone
Application of simplified Complexity Theory concepts for healthcare social systems to explain the implementation of evidence into practice.
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J. Chandler, J. Rycroft-Malone, C. Hawkes and J. Noyes.
J Adv Nurs 2015 Sep 21

AIM: To examine the application of core concepts from Complexity Theory to explain the findings from a process evaluation undertaken in a trial evaluating implementation strategies for recommendations about reducing surgical fasting times. BACKGROUND: The proliferation of evidence-based guidance requires a greater focus on its implementation. Theory is required to explain the complex processes across the multiple healthcare organizational levels. This social healthcare context involves the interaction between professionals, patients and the organizational systems in care delivery. Complexity Theory may provide an explanatory framework to explain the complexities inherent in implementation in social healthcare contexts. DESIGN: A secondary thematic analysis of qualitative process evaluation data informed by Complexity Theory. METHOD: Seminal texts applying Complexity Theory to the social context were annotated, key concepts extracted and core Complexity Theory concepts identified. These core concepts were applied as a theoretical lens to provide an explanation of themes from a process evaluation of a trial evaluating the implementation of strategies to reduce surgical fasting times. Sampled substantive texts provided a representative spread of theoretical development and application of Complexity Theory from late 1990’s-2013 in social science, healthcare, management and philosophy. FINDINGS: Five Complexity Theory core concepts extracted were ‘self-organization’, ‘interaction’, ’emergence’, ‘system history’ and ‘temporality’. Application of these concepts suggests routine surgical fasting practice is habituated in the social healthcare system and therefore it cannot easily be reversed. A reduction to fasting times requires an incentivised new approach to emerge in the surgical system’s priority of completing the operating list. CONCLUSION: The application of Complexity Theory provides a useful explanation for resistance to change fasting practice. Its utility in implementation research warrants further attention and evaluation.

Dr. Jennifer Baumbusch discusses why the health needs of aging adults are in urgent need of attention.

We have to shift our thinking away from short-term solutions. We need to be planning to support people as they age over time. Policy makers and leaders need to design services and supports that meet the complex needs of this population.

An Evidence-Informed National Seniors Strategy for Canada
Dr. Samir K. Sinha, Dr. Geoffrey Anderson, Bailey Griffin, and Ivy Wong

Historically, our federal government has been able to play a key role as a standard-setter, catalyst and funder of important social change in areas like the delivery of health care. We believe that in a similar way our federal government can enable the meaningful change that will be needed to meet the needs of ageing Canadians. The way we approach our coming of age will also require coordination and mobilization across government departments as well as between the private and public sectors. Indeed, we will need an integrated approach where the federal government helps keep us all moving in the right direction. The aspiration to deliver on this agenda will be shared by Canadians of all ages across the country. This document proposes what a National Seniors Strategy should entail.

Don’t miss TREC’s October Newsletter

Learn more about the latest TREC news including research, new members, regional leads, and more.


Book Series on Nursing History: Narratives for the Twenty-First Century

This series features nurses as critical actors in driving social, cultural, professional, and clinical changes while delivering health care. Offering fresh and well-researched approaches to nursing history, books in the series will seek to engage a readership both within and beyond academe. The focus primarily will be on books intended for understanding and teaching the importance of the history of nursing for all students and scholars in health care in and beyond the classroom.

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


Improving the Implementation of Evidence-Based Clinical Practices in Adolescent Reproductive Health Care Services.
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L. M. Romero, D. Middleton, T. Mueller, L. Avellino and R. Hallum-Montes.
J Adolesc Health 2015 Sep 14

PURPOSE: The purposes of the study were to describe baseline data in the implementation of evidence-based clinical practices among health center partners as part of a community-wide teen pregnancy prevention initiative and to identify opportunities for health center improvement. METHODS: Health center partner baseline data were collected in the first year (2011) and before program implementation of a 5-year community-wide teen pregnancy prevention initiative. A needs assessment on health center capacity and implementation of evidence-based clinical practices was administered with 51 health centers partners in 10 communities in the United States with high rates of teen pregnancy. RESULTS: Health centers reported inconsistent implementation of evidence-based clinical practices in providing reproductive health services to adolescents. Approximately 94.1% offered same-day appointments, 91.1% had infrastructure to reduce cost barriers, 90.2% offered after-school appointments, and 80.4% prescribed hormonal contraception without prerequisite examinations or testing. Approximately three quarters provided visual and audio privacy in examination rooms (76.5%) and counseling areas (74.5%). Fewer offered a wide range of contraceptive methods (67.8%) and took a sexual health history at every visit (54.9%). Only 45.1% reported Quick Start initiation of hormonal contraception, emergency contraception (43.1%), or intrauterine devices (12.5%) were “always” available to adolescents. CONCLUSIONS: The assessment highlighted opportunities for health center improvement. Strategies to build capacity of health center partners to implement evidence-based clinical practices may lead to accessibility and quality of reproductive health services for adolescents in the funded communities.

Implementation Science and Comparative Effectiveness Research
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Bonham A, Solomon M, Mittman B, Ommaya A, Berlin A.
In: Levy A, Sobolev B, editors. Comparative Effectiveness Research in Health Services Springer US; 2015. p. 1-23.

The resurgence of interest in comparative effectiveness research (CER) in the last decade has trained a bright spotlight on ensuring that clinical findings obtained from CER are implemented and disseminated to routine practice so that all patients and populations benefit. The focus on implementation science as part of CER reflects the collective realization that findings from clinical studies have not uniformly resulted in changes in the practices of health care providers or patients, nor have they always yielded improvements in health outcomes. Implementation science, as defined by the journal that bears its name is, “the scientific study of methods to promote the systematic uptake of proven clinical treatments, practices, organizational and management interventions into routine practice, and hence to improve health” “Implementation Science About Implementation Science.” The field has evolved as a multidisciplinary science, drawing principles from the behavioral and social sciences, process engineering, economics, and traditional health services research. Parallel to this evolution, new methodologies and evaluation approaches have emerged to track the processes, organizational contexts, and other elements which contribute to the successful implementation of CER findings. Embedding implementation research into CER starts with strong multidisciplinary teams – from institutional leadership to frontline care providers – to bridge the gap between research and operations; and then depends on organizational receptivity, appropriate infrastructure, and project-specific researcher-clinician partnerships. Governmental agencies around the world are already using forms of implementation science to inform health care; in the United States, the 2010 passage of health care reform legislation offers an unprecedented opportunity to make implementation science part and parcel of clinical practice. This chapter brings together a brief history of implementation science and CER with a discussion of the current political and economic context, an overview of the major funders in this space, and the myriad evaluation frameworks and other conceptual models for the successful uptake of evidence into practice. Readers will also find a treatment of the ethics associated with research in this field, and a consideration of the state of the research workforce, followed by recommendations for the future.

In an Age of Open Access to Research Policies: Physician and Public Health NGO Staff Research Use and Policy Awareness.
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L. L. Moorhead, C. Holzmeyer, L. A. Maggio, R. M. Steinberg and J. Willinsky.
PLoS One 2015 Jul 22;10(7):e0129708

INTRODUCTION: Through funding agency and publisher policies, an increasing proportion of the health sciences literature is being made open access. Such an increase in access raises questions about the awareness and potential utilization of this literature by those working in health fields. METHODS: A sample of physicians (N=336) and public health non-governmental organization (NGO) staff (N=92) were provided with relatively complete access to the research literature indexed in PubMed, as well as access to the point-of-care service UpToDate, for up to one year, with their usage monitored through the tracking of web-log data. The physicians also participated in a one-month trial of relatively complete or limited access. RESULTS: The study found that participants’ research interests were not satisfied by article abstracts alone nor, in the case of the physicians, by a clinical summary service such as UpToDate. On average, a third of the physicians viewed research a little more frequently than once a week, while two-thirds of the public health NGO staff viewed more than three articles a week. Those articles were published since the 2008 adoption of the NIH Public Access Policy, as well as prior to 2008 and during the maximum 12-month embargo period. A portion of the articles in each period was already open access, but complete access encouraged a viewing of more research articles. CONCLUSION: Those working in health fields will utilize more research in the course of their work as a result of (a) increasing open access to research, (b) improving awareness of and preparation for this access, and (c) adjusting public and open access policies to maximize the extent of potential access, through reduction in embargo periods and access to pre-policy literature.

Organizational and Individual Determinants of Evidence Use by Managers in Public Human Service Organizations
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Bowen McBeath, Monica Pérez Jolles, Sarah Carnochan and Michael J. Austin.
Human Service Organizations: Management, Leadership & Governance 2015 08/08; 2015/10;39(4):267-289

Promoting the use of evidence by managers is a strategy for enhancing effectiveness in human service organizations, and for responding to the demands of performance management. This study addresses two multipart questions. First, what levels of managerial evidence use exist in public human service organizations and for what purposes is this evidence used? Second, what organizational factors and individual attitudinal characteristics are associated with different levels of evidence use? Based on survey data from a sample of administrators, middle managers, and supervisors in 11 county public human service organizations located in the San Francisco Bay Area, we find that managers are engaged in evidence use at moderate levels. They are most engaged in reviewing agency reports, searching for research literature and other evidence, and using online resources to identify promising practices. Evidence use is found to be positively associated with having access to performance measurement systems, being an administrator, and being innovation minded and responsive to organizational change. Our findings suggest that evidence use by human service managers may be contingent on organizational resources, organizational role, and individual attitudes. These results underscore the importance of training human service managers in evidence-informed practice in order to promote agencywide knowledge utilization and organizational effectiveness.

A Frailty Index Based on Common Laboratory Tests in Comparison With a Clinical Frailty Index for Older Adults in Long-Term Care Facilities. Canada-flat-icon
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K. Rockwood, M. McMillan, A. Mitnitski and S. E. Howlett.
J Am Med Dir Assoc 2015 Oct 1;16(10):842-847

INTRODUCTION: Easily employed measures of frailty are needed in the evaluation of elderly people. Recently, a frailty index (FI) based on deficits in commonly used laboratory tests (the FI-LAB) has been proposed. To address the usefulness of the FI-LAB in long-term care (LTC) settings, we studied institutionalized participants in the Canadian Study of Health and Aging first clinical examination database. Our objectives were to compare the FI-LAB with a clinical FI LTC (FI-Clinical-LTC) focused on common health deficits seen in LTC and to assay its relationship with mortality. METHODS: In this secondary analysis, Canadian Study of Health and Aging first clinical examination participants who, at baseline, were LTC residents, and who consented to having blood drawn for 21 commonly employed laboratory tests (eg, complete blood count, electrolytes, renal, thyroid, and liver function) were studied. A 23-item FI-LAB was constructed based on the 21 laboratory tests, plus measures of systolic and diastolic blood pressure. The FI-Clinical-LTC was constructed from data obtained during the clinical evaluation and the FI-LAB was constructed from laboratory data plus systolic and diastolic blood pressure measurements. A combined FI (FI-Combined) included all items from each index. Predictive validity was tested using Cox proportional hazards analysis and overall utility was evaluated using the Akaike Information Criterion and the Wald statistic. RESULTS: The mean FI-Clinical-LTC was 0.32 +/- 0.14, the FI-LAB was 0.26 +/- 0.11 and the FI-Combined was 0.30 +/- 0.11. There was a strong linear relationship (Pearson correlation coefficient = 0.95) between the FI-LAB and the FI-Clinical-LTC, with a significant slope of 0.18 (P value of <.0001). Strong relationships with mortality were demonstrated through Kaplan-Meier curves and Cox regressions, with the FI-Clinical-LTC having a hazard ratio of 1.03, FI-LAB ratio of 1.02, and FI-combined ratio of 1.04 for each 0.01 increment in the corresponding FI in age and sex adjusted models. CONCLUSIONS: An FI based on routinely collected laboratory data can identify LTC residents at increased risk of death. This approach may be a useful screening tool in this setting.

An institutional approach to support the conduct and use of health policy and systems research: The Nodal Institute in the Eastern Mediterranean Region.
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F. El-Jardali, S. Saleh, R. Khodor, et al.
Health Res Policy Syst 2015 Oct 1;13:40-015-0032-9

BACKGROUND: The use of health policy and systems research (HPSR) to support decision making in health systems is limited in the Eastern Mediterranean Region (EMR). This is partly due to the lack of effective initiatives to strengthen regional HPSR capacities and promote its use in decision making. This paper offers a structured reflection on the establishment and core functioning of a HPSR Nodal Institute for the EMR with specific focus on the approach used to support the conduct and use of HPSR. It seeks to gain better understanding of the activities conducted by the Nodal Institute, the methods by which the Nodal Institute implemented these activities, and the outcomes of these activities. METHODS: A multi-faceted approach was implemented by the Nodal Institute in collaboration with regional academic/research institutions, Sub-Nodes. The overall approach was a phased one that included the selection of Sub-Nodes, mapping of academic/research institutions in the EMR, stakeholders’ meetings, and HPSR capacity building workshops, and culminated with a regional meeting. RESULTS: The mapping of academic/research institutions in the EMR resulted in the identification of 50 institutions, of which only 32 were engaged in HPSR. These institutions have the highest HPSR involvement in information/evidence (84%) and the lowest in human resources for health (34%). Their main HPSR focus areas included quality of healthcare services, patient safety, management of non-communicable diseases, and human resources for health. Regional HPSR challenges among these institutions were identified. The validation and ranking questionnaires resulted in the identification of country-specific HPSR priorities according to stakeholders in three countries. From these results, cross-cutting HPSR priorities among the countries related to primary healthcare, non-communicable diseases, human resources for health, as well as cross-cutting HPSR priorities among stakeholders and according to stakeholders of the countries, were extracted. CONCLUSION: The Nodal Institute in the EMR is a promising initiative to support the conduct and use of HPSR in health policies. The approach and findings reported in this paper allow for the development of opportunities towards the building of capacity for HPSR in the region and other countries and provide a roadmap for academic/research institutions interested in HPSR in the region.

The transcatheter aortic valve implementation (TAVI)-a qualitative approach to the implementation and diffusion of a minimally invasive surgical procedure.
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S. Merkel, M. Eikermann, E. A. Neugebauer and S. von Bandemer.
Implement Sci 2015 Oct 6;10(1):140-015-0330-1

BACKGROUND: The transcatheter aortic valve implantation (TAVI), a minimally invasive surgical procedure to treat patients with severe symptomatic aortic stenosis, showed a rapid diffusion in Germany compared to the international level. The aim of this study is to identify and analyze factors affecting the implementation and diffusion of the procedure in hospitals using a qualitative application of the diffusion of innovations theory. METHODS: We conducted problem-centered interviews with cardiologists and cardiac surgeons working in German hospitals. The multi-level model “diffusion of innovations in health services organizations” developed by Greenhalgh et al. was used to guide the research. Data was analyzed using content and a thematic analysis. RESULTS: Among the ten participants who were interviewed, we found both barriers and facilitators related to the innovation itself, system readiness and antecedents, communication and influence, and the outer context. Key issues were the collaboration between cardiologists and cardiac surgeons, reimbursement policies, requirements needed to conduct the procedure, and medical advantages of the method. CONCLUSIONS: The findings show that there are multiple factors influencing the diffusion of TAVI that go beyond the reimbursement and cost issues. The diffusion of innovations model proved to be helpful in understanding the different aspects of the uptake of the procedure. A central theme that affected the implementation of TAVI was the collaboration and competition between involved medical departments: cardiology and cardiac surgery. Against this background, it seems especially important to moderate and coordinate the cooperation of the different medical disciplines.

Reframing implementation as an organisational behaviour problem: Inside a teamwork improvement intervention
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Robyn Clay-Williams and Jeffrey Braithwaite.
J of Health Org and Mgt 2015 09/21; 2015/10;29(6):670-683

Purpose – The purpose of this paper is to report on a process evaluation of a randomised controlled trial (RCT) intervention study that tested the effectiveness of classroom- and simulation-based crew resource management courses, alone and in combination, and identifies organisational barriers and facilitators to implementation of team training programmes in healthcare. Design/methodology/approach – The RCT design consisted of a before and after study with a team training intervention. Quantitative data were gathered on utility and affective reactions to training, and on teamwork knowledge, attitudes, and behaviours of the learners. A sample of participants was interviewed at the conclusion of the study. Interview responses were analysed, alongside qualitative elements of the classroom course critique, to search for evidence, context, and facilitation clues to the implementation process. Findings – The RCT method provided scientifically robust data that supported the benefits of classroom training. Qualitative data identified a number of facilitators to implementation of team training, and shed light on some of the ways that learning was diffused throughout the organisation. Barriers to successful implementation were also identified, including hospital time and resource constraints and poor organisational communication. Originality/value – Quantitative randomised methods have intermittently been used to evaluate team training interventions in healthcare. Despite two decades of team training trials, however, the authors do not know as well as the authors would like what goes on inside the “black box” of such RCTs. While results are usually centred on outcomes, this study also provides insight into the context and mechanisms associated with those outcomes and identifies barriers and facilitators to successful intervention implementation.

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Health Care Administration and Organization

Perceptions and employment intentions among aged care nurses and nursing assistants from diverse cultural backgrounds: A qualitative interview study
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Fengsong Gao, Cheryl Tilse, Jill Wilson, Anthony Tuckett and Peter Newcombe.
Journal of Aging Studies 2015 12;35:111-122

The residential aged care industry faces shortages and high turnover rates of direct care workers. This situation is further complicated by the increasing cultural diversity of residents and staff. To retain direct care workers, it is crucial to explore their perceptions of the rewards and difficulties of care work, and their employment intentions in multicultural environments. A qualitative descriptive study was used to understand perceptions of the rewards and difficulties of residential aged care work for core direct care workers (i.e. nurses and nursing assistants), how these were related to their intentions to stay or leave, and how these varied between nurses and nursing assistants, and between locally and overseas born workers. Individual interviews were conducted between June and September 2013 with 16 direct care workers in an Australian residential aged care facility with a specific focus on people from culturally and linguistically diverse backgrounds. It was found that direct care workers’ employment intentions were related to their perceptions and management of the rewards and difficulties of care work. Their experiences of care work, the employment characteristics, and the organizational resources that fitted their personality, ability, expectations, and essential needs were viewed as rewards. Evaluating their jobs as meaningful was a shared perception for direct care workers who intended to stay. Individual workers’ perceptions of the rewarding aspects of care work served to counterbalance the challenges of care work, and promoted their intentions to stay. Perceptions and employment intentions varied by occupational groups and by cultural backgrounds. Overseas born direct care workers are valuable resources in residential aged care facility rather than a limitation, but they do require organizational support, such as cultural awareness of the management, English language support, a sense of family, and appropriate job responsibility. The findings indicated that aged care policy makers and service providers should understand the range of individual direct care workers’ positive and negative perceptions, and their employment intentions within the context of their roles and their cultural backgrounds.

Securing and Managing Nursing Home Resources: Director of Nursing Tactics.
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E. O. Siegel, H. M. Young, L. Zysberg and V. Santillan.
Gerontologist 2015 Oct;55(5):748-759

PURPOSE OF THE STUDY: Shrinking resources and increasing demands pose managerial challenges to nursing homes. Little is known about how directors of nursing (DON) navigate resource conditions and potential budget-related challenges. This paper describes the demands-resources tensions that DONs face on a day-to-day basis and the tactics they use to secure and manage resources for the nursing department. DESIGN AND METHODS: We conducted a secondary analysis of data from a parent study that used a qualitative approach to understand the DON position. A convenience sample of 29 current and previous DONs and administrators from more than 15 states participated in semistructured interviews for the parent study. Data analysis included open coding and thematic analysis. RESULTS: DONs address nursing service demands-resources tensions in various ways, including tactics to generate new sources of revenue, increase budget allocations, and enhance cost efficiencies. IMPLICATIONS: The findings provide a rare glimpse into the operational tensions that can arise between resource allocations and demands for nursing services and the tactics some DONs employ to address these tensions. This study highlights the DON’s critical role, at the daily, tactical level of adjusting and problem-solving within existing resource conditions. How DONs develop these skills and the extent to which these skills may improve nursing home quality and value are important questions for further practice-, education-, and policy-level investigation.

Effects of a Psychoeducational Intervention for Direct Care Workers Caring for People With Dementia: Results From a 6-Month Follow-Up Study.
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A. Barbosa, M. Nolan, L. Sousa, A. Marques and D. Figueiredo.
Am J Alzheimers Dis Other Demen 2015 Sep 22

This study aimed to assess the effects of a psychoeducational intervention, designed to improve direct care workers’ stress, burnout and job satisfaction, and person-centered communicative behavior in people with dementia. A pretest-posttest control group design was conducted in 4 aged-care facilities. Two experimental facilities received a psychoeducational intervention, and 2 control facilities received an education only. Data were gathered from 53 care workers at baseline, immediately, and 6 months after the intervention, through self-administrated instruments and video-recorded morning care sessions. The experimental group showed a significant decrease in care workers’ burnout and a significant improvement in several communicative behaviors (eg, involvement). Stress levels deteriorated at 6 months, and no intervention effects were found for job satisfaction. The findings highlight the importance of providing care workers with both technical competences and tools for stress management, as this might be associated with a reduction in their levels of exhaustion and improved communicative behaviors.

Evaluation of a hybrid paper?electronic medication management system at a residential aged care facility.
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R. A. Elliott, C. Y. Lee and S. Y. Hussainy.
Aust Health Rev 2015 Sep 21

Objectives The aims of the study were to investigate discrepancies between general practitioners’ paper medication orders and pharmacy-prepared electronic medication administration charts, back-up paper charts and dose-administration aids, as well as delays between prescribing, charting and administration, at a 90-bed residential aged care facility that used a hybrid paper-electronic medication management system.Methods A cross-sectional audit of medication orders, medication charts and dose-administration aids was performed to identify discrepancies. In addition, a retrospective audit was performed of delays between prescribing and availability of an updated electronic medication administration chart. Medication administration records were reviewed retrospectively to determine whether discrepancies and delays led to medication administration errors.Results Medication records for 88 residents (mean age 86 years) were audited. Residents were prescribed a median of eight regular medicines (interquartile range 5-12). One hundred and twenty-five discrepancies were identified. Forty-seven discrepancies, affecting 21 (24%) residents, led to a medication administration error. The most common discrepancies were medicine omission (44.0%) and extra medicine (19.2%). Delays from when medicines were prescribed to when they appeared on the electronic medication administration chart ranged from 18 min to 98 h. On nine occasions (for 10% of residents) the delay contributed to missed doses, usually antibiotics.Conclusion Medication discrepancies and delays were common. Improved systems for managing medication orders and charts are needed.What is known about the topic? Hybrid paper-electronic medication management systems, in which prescribers’ orders are transcribed into an electronic system by pharmacy technicians and pharmacists to create medication administration charts, are increasingly replacing paper-based medication management systems in Australian residential aged care facilities. The accuracy and safety of these systems has not been studied.What does this paper add? The present study identified discrepancies between general practitioners’ orders and pharmacy-prepared electronic medication administration charts, back-up paper medication charts and dose-administration aids, as well as delays between ordering, charting and administering medicines. Discrepancies and delays sometimes led to medication administration errors.What are the implications for practitioners? Facilities that use hybrid systems need to implement robust systems for communicating medication changes to their pharmacy and reconciling prescribers’ orders against pharmacy-generated medication charts and dose-administration aids. Fully integrated, paperless medication management systems, in which prescribers’ electronic medication orders directly populate an electronic medication administration chart and are automatically communicated to the facility’s pharmacy, could improve patient safety.

Contributing influences of work environment on sleep quantity and quality of nursing assistants in long-term care facilities: A cross-sectional study.
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Y. Zhang, L. Punnett, G. P. McEnany and R. Gore.
Geriatr Nurs 2015 Sep 15

The effect of shift work on nurses’ sleep is well-studied, but there are other challenging aspects of health care work that might also affect the sleep of direct caregivers. This study examined the influence of the long-term care work environment on sleep quantity and quality of nursing assistants. A cross-sectional survey collected data from 650 nursing assistants in 15 long-term care facilities; 46% reported short sleep duration and 23% reported poor sleep quality. A simple additive index of the number of beneficial work features (up to 7) was constructed for analysis with Poisson regression. With each unit increase of beneficial work features, nursing assistants were 7% less likely to report short sleep duration and 17% less likely to report poor sleep quality. These results suggest that effective workplace interventions should address a variety of work stressors, not only work schedule arrangements, in order to improve nursing assistants’ sleep health.

Health care professionals’ perspectives of advance care planning for people with dementia living in long-term care settings: A narrative review of the literature.
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E. R. Beck, S. McIlfatrick, F. Hasson and G. Leavey.
Dementia (London) 2015 Sep 16

This paper provides an overview of the evidence on the perspective of health care professionals (HCPs) in relation to advance care planning (ACP) for people with dementia, residing in long-term care settings. A narrative approach was adopted to provide a comprehensive synthesis of previously published literature in the area. A systematic literature search identified 14 papers for inclusion. Following review of the studies four themes were identified for discussion; Early integration and planning for palliative care in dementia; HCPs ethical and moral concerns regarding ACP; Communication challenges when interacting with the person with dementia and their families and HCPs need for education and training. Despite evidence, that HCPs recognise the potential benefits of ACP, they struggle with its implementation in this setting. Greater understanding of dementia and the concept of ACP is required to improve consistency in practice. Synthesising the existing evidence will allow for further understanding of the key issues, potentially resulting in improved implementation in practice.

Comparative analysis of the expected demands for nursing care services among older people from urban, rural, and institutional environments.
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E. Borowiak, J. Kostka and T. Kostka.
Clin Interv Aging 2015 Feb 2;10:405-412

BACKGROUND: Demand for nursing and social services may vary depending on the socio-demographic variables, health status, receipt of formal and informal care provided, and place of residence. OBJECTIVES: To conduct a comparative analysis of the expectations of older people from urban, rural, and institutional environments concerning nursing care with respect to the care provided and elements of a comprehensive geriatric assessment. MATERIAL AND METHODS: The study comprised 2,627 individuals above the age of 65 years living in urban (n=935) and rural (n=812) areas as well as nursing homes (n=880). RESULTS: Family care was most often expected both in urban (56.6%) and rural (54.7%) environments, followed by care provided simultaneously by a family and nurse (urban – 18.8%; rural – 26.1%) and realized only by a nurse (urban – 24.6%; rural – 19.2%). Not surprisingly, nursing home residents most commonly expected nursing care (57.5%) but 33.1% preferred care provided by family or friends and neighbors. In the whole cohort of people living in the home environment (n=1,718), those living with family demonstrated willingness to use primarily care implemented by the family (62.0%), while respondents living alone more often expected nursing services (30.3%). In the logistic regression model, among the respondents living in the city, only the form of care already received determined the expectations for nursing care. Among the respondents living in the county, the presence of musculoskeletal disorders, better nutritional status, and current care provided by family decreased expectations for nursing care. Higher cognitive functioning, symptoms of depression, and living alone increased the willingness to obtain nursing care. CONCLUSION: Older inhabitants of urban areas, rural areas, and those residing in institutions have different expectations for individual nursing care. Nearly 45% of seniors living in the community expect to obtain nursing care, while only 1.6% do not expect any social or nursing help. While the expectations for the provision of nursing care are significantly increased by living alone, they are decreased by having access to care provided by family. Support for families to take care of elderly relatives would appear to be essential for an effective nursing and social care system.

The main cost drivers in dementia: a systematic review.
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S. Schaller, J. Mauskopf, C. Kriza, P. Wahlster and P. L. Kolominsky-Rabas.
Int J Geriatr Psychiatry 2015 Feb;30(2):111-129

OBJECTIVES: Because of the increasing prevalence of dementia worldwide, combined with limited healthcare expenditures, a better understanding of the main cost drivers of dementia in different care settings is needed. METHODS: A systematic review of cost-of-illness (COI) studies in dementia was conducted from 2003 to 2012, searching the following databases: PubMed (Medline), Cochrane Library, ScienceDirect (Embase) and National Health Service Economic Evaluations Database. Costs (per patient) by care setting were analyzed for total, direct, indirect and informal costs and related to the following: (1) cost perspective and (2) disease severity. RESULTS: In total, 27 studies from 14 different healthcare systems were evaluated. In the included studies, total annual costs for dementia of up to $70,911 per patient (mixed setting) were estimated (average estimate of total costs = $30,554). The shares of cost categories in the total costs for dementia indicate significant differences for different care settings. Overall main cost drivers of dementia are informal costs due to home based long term care and nursing home expenditures rather than direct medical costs (inpatient and outpatient services, medication). CONCLUSIONS: The results of this review highlight the significant economic burden of dementia for patients, families and healthcare systems and thus are important for future health policy planning. The significant variation of cost estimates for different care settings underlines the need to understand and address the financial burden of dementia from both perspectives. For health policy planning in dementia, future COI studies should follow a quality standard protocol with clearly defined cost components and separate estimates by care setting and disease severity.

Staff’s person-centredness in dementia care in relation to job characteristics and job-related well-being: a cross-sectional survey in nursing homes.
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B. M. Willemse, J. De Jonge, D. Smit, Q. Visser, M. F. Depla and A. M. Pot.
J Adv Nurs 2015 Feb;71(2):404-416

AIM: To explore the role of nursing staff’s person-centredness caring for people with dementia in relation to their work environment and job-related well-being. BACKGROUND: Given the development towards person-centred care and labour force issues, research has recently focused on the effect of person-centredness on nursing staff’s well-being. Findings from occupational stress research suggest that employees’ personal characteristics, such as person-centredness, can moderate the impact particular job characteristics have on their job-related well-being. DESIGN: Cross-sectional survey. METHODS: A national survey was conducted among healthcare staff (n = 1147) in 136 living arrangements for people with dementia in the Netherlands (2008-2009). Hierarchical regression analyses were used. RESULTS: Person-centredness moderates the relationship between coworker support and three outcomes of job-related well-being and between supervisor support and two of these outcomes. For highly person-centred nursing staff, coworker support was found to have a weaker impact and supervisor support to have a stronger impact on their job-related well-being. In addition, direct effects showed that person-centredness was weakly associated with more job satisfaction, more emotional exhaustion and more strongly with more personal accomplishment. CONCLUSION: Nursing staff’s person-centredness does play a modest role in relation to job characteristics and job-related well-being. Findings indicate that person-centredness is not only beneficial to residents with dementia as found earlier, but also for nursing staff themselves; specifically, in case nursing staff members feel supported by their supervisor. Since a more person-centred workforce feels more competent, further implementation of person-centred care might have a positive impact on the attractiveness of the profession.

Essential competencies for the education of nursing assistants and care helpers in elderly care.
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B. Oeseburg, R. Hilberts and P. F. Roodbol.
Nurse Educ Today 2015 Oct;35(10):e32-5

BACKGROUND: The Dutch health care system faces huge challenges with regard to the demand on elderly care and the competencies of professionals required to meet this demand. However, a recent study showed that the curricula in vocational education for nursing assistants and care helpers remains inadequate to prepare them for the social and healthcare needs of the elderly. OBJECTIVE: To determine the essential competencies for the initial education of nursing assistants and care helpers in elderly care. METHODS: First, a draft version of essential competencies for the education of nursing assistants and care helpers in elderly care (N=120) was developed and approved by experts, also members of the project steering committee. Second, a Delphi survey was conducted to determine the essential competencies. The Delphi panel consisted of eleven field experts (teachers/educational developers) working for different vocational education training colleges in the Netherlands. RESULTS: Ten panel members participated in a two-round consensus building process via email. A definitive set of 116 essential competencies for the initial education of nursing assistants and 42 essential competencies for the initial education of care helpers were determined. CONCLUSIONS: The competencies in the definitive set are more in line with social and healthcare needs of the elderly like: autonomy, daily functioning prevention of health problems, healthy ageing and wellbeing, involvement of informal care, collaboration between professionals and informal care. The main challenge now is to translate these competencies into educational programmes for vocational education training colleges for care helpers and nursing assistants. Recommendations are made for the implementation of these competencies in the Dutch vocational education training colleges for care helpers and nursing assistants.

Gender bias in public long-term care? A survey experiment among care managers
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Niklas Jakobsson, Andreas Kotsadam, Astri Syse and Henning Øien.
Journal of Economic Behavior & Organization

Daughters of elderly women are more likely to provide informal care than sons. If care managers take this into account and view informal care as a substitute for formal care, they will statistically discriminate against the mothers of daughters. Using a survey experiment among professional needs assessors for long-term care services in Norway, we find that if a woman with a daughter had a son instead, she would receive 34 percent more formal care. On the other hand, daughters do not provide more care for fathers. Correspondingly, we find no effect of child gender for fathers in the experiment.

Choosing Privacy over Interaction: Restructuring Expectations and Interpretations of Community Integration in Canadian Small-House Long-Term Care Settings Canada-flat-icon
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Emily Roberts
Journal of Housing For the Elderly 2015 07/03; 2015/10;29(3):209-232

In Nova Scotia, Canada, the small-house model of care has been introduced as an alternative to institutional care settings, and the province has funded and built 11 new long-term care (LTC) communities in the small-house model. Each of the new facilities was built with multiple cottages housing 12 to 15 residents; each cottage features private bedrooms and a residentially scaled kitchen and dining area. Through smaller numbers of residents living in home areas, the goal of the Provincial Department of Health was to encourage relationship building, as well as to provide opportunities for autonomy and choice in resident daily living. A qualitative case study was conducted in one of these small-house communities, focusing on the model’s impact on resident interaction and community integration. Thematic analysis revealed that while resident social patterns were directly impacted by the physical environment and culture of care in the new model, interpretations of these patterns by staff and family members were influenced by preexisting expectations of community integration rooted in institutional care models of the past.

A structured review of long-term care demand modelling.
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P. Worrall and T. J. Chaussalet.
Health Care Manag Sci 2015 Jun;18(2):173-194

Long-term care (LTC) represents a significant and substantial proportion of healthcare spends across the globe. Its main aim is to assist individuals suffering with more or more chronic illnesses, disabilities or cognitive impairments, to carry out activities associated with daily living. Shifts in several economic, demographic and social factors have raised concerns surrounding the sustainability of current systems of LTC. Substantial effort has been put into modelling the LTC demand process itself so as to increase understanding of the factors driving demand for LTC and its related services. Furthermore, such modeling efforts have also been used to plan the operation and future composition of the LTC system itself. The main aim of this paper is to provide a structured review of the literature surrounding LTC demand modeling and any such industrial application, whilst highlighting any potential direction for future researchers.

Examining Time Use of Dutch Nursing Staff in Long-Term Institutional Care: A Time-Motion Study
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Astrid Tuinman, Mathieu H. G. de Greef, Wim P. Krijnen, Roos M. B. Nieweg and Petrie F. Roodbol.
Journal of the American Medical Directors Association 2015/10

Objectives Increasing residents’ acuity levels and available resources in long-term institutional care requires insight into the care provided by nursing staff so as to guide task allocation and optimal use of resources, and enhance quality of care. The purpose of this study was to examine the relationship between time use and type of nursing staff, residents’ acuity levels, and unit type by using a standardized nursing intervention classification.; ObjectivesIncreasing residents’ acuity levels and available resources in long-term institutional care requires insight into the care provided by nursing staff so as to guide task allocation and optimal use of resources, and enhance quality of care. The purpose of this study was to examine the relationship between time use and type of nursing staff, residents’ acuity levels, and unit type by using a standardized nursing intervention classification.

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Health Care Innovation and Quality Assurance

A quality improvement project to decrease emergency department and medical intensive care unit transfer times.
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R. I. Cohen, H. Kennedy, B. Amitrano, M. Dillon, S. Guigui and A. Kanner.
J Crit Care 2015 Jul 26

OBJECTIVE: To reduce transfer time of critically ill patients from the emergency department (ED) to the medical intensive care unit (MICU). DESIGN: A prospective, observational study assessing preimplementation and postimplementation of quality improvement interventions in a tertiary academic medical center. INTERVENTIONS: A team of frontline health care professional including ED, MICU, and supporting services using the clinical microsystems approach mapped out existing practice patterns, determined causes for delays, and used the Plan-Do-Study-Act to test changes. Measurements and Main Results The team identified multiple issues that contributed to delays. These included poor coordination between transport services, respiratory therapy, and nursing in transferring patients from the ED as well delays in identification and transfer of stable MICU patients. These interventions reduced transfer time from 4.2 (3.4-5.7) hours to 2.2 (1.4-3.1) hours (median [interquartile range]; P < .001). Hospital length of stay decreased from 9.9 +/- 9 to 8.3 +/- 7 days (P < .03). CONCLUSION: A team made up of frontline health care professionals using a structured quality improvement process and implementing multifaceted, multistage interventions, reduced transfer delays, and length of stay. Added benefits included engagement among members of the 2 microsystems and a more cohesive approach to patient care.

Examining the use of telehealth in community nursing: identifying the factors affecting frontline staff acceptance and telehealth adoption.
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J. Taylor, E. Coates, L. Brewster, G. Mountain, B. Wessels and M. S. Hawley.
J Adv Nurs 2015 Feb;71(2):326-337

AIMS: To examine frontline staff acceptance of telehealth and identify barriers to and enablers of successful adoption of remote monitoring for patients with Chronic Obstructive Pulmonary Disease and Chronic Heart Failure. BACKGROUND: The use of telehealth in the UK has not developed at the pace and scale anticipated by policy. Many existing studies report frontline staff acceptance as a key barrier, however data are limited and there is little evidence of the adoption of telehealth in routine practice. DESIGN: Case studies of four community health services in England that use telehealth to monitor patients with Chronic Obstructive Pulmonary Disease and Chronic Heart Failure. METHODS: Thematic analysis of qualitative interviews with 84 nursing and other frontline staff; and 21 managers and key stakeholders; data collected May 2012-June 2013. FINDINGS: Staff attitudes ranged from resistance to enthusiasm, with varied opinions about the motives for investing in telehealth and the potential impact on nursing roles. Having reliable and flexible technology and dedicated resources for telehealth work were identified as essential in helping to overcome early barriers to acceptance, along with appropriate staff training and a partnership approach to implementation. Early successes were also important, encouraging staff to use telehealth and facilitating clinical learning and increased adoption. CONCLUSIONS: The mainstreaming of telehealth hinges on clinical ‘buy-in’. Where barriers to successful implementation exist, clinicians can lose faith in using technology to perform tasks traditionally delivered in person. Addressing barriers is therefore crucial if clinicians are to adopt telehealth into routine practice.

European hospital managers’ perceptions of patient-centred care.
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A. Taylor and O. Groene.
J Health Organ Manag 2015 Sep 21;29(6):711-728

Purpose – The spotlight has recently been placed on managers’ responsibility for patient-centred care as a result of Mid Staffordshire NHS Foundation Trust failings. In previous research, clinicians reported that managers do not have an adequate structured plan for implementing patient-centred care. The purpose of this paper is to assess the perceptions of European hospital management with respect to factors affecting the implementation of a patient-centred approach. Design/methodology/approach – In total, 15 semi-structured interviews were conducted with hospital managers (n=10), expert country informants (n=2), patient organisations (n=2) and a user representative (n=1) from around Europe. Participants were purposively and snowball sampled. Interviews were analysed using framework analysis. Findings – Most participants felt that current levels of patient-centred care are inadequate, but accounted that there were a number of macro, meso and micro challenges they faced in implementing this approach. These included budget constraints, political and historical factors, the resistance of clinicians and other frontline staff. Organisational culture emerged as a central theme, shaped by these multi-level factors and influencing the way in which patient-centred care was borne out in the hospital. Participants proposed that the needs of patients might be better met through increasing advocacy by patient organisations and greater staff contact with patients. Originality/value – This study is the first of its kind to obtain management views from around Europe. It offers an insight into different models of how patient-centred care is realised by management. It indicates that managers see the value of a patient-centred approach but that they feel restricted by a number of factors at multiple level

Evidence Summary and Recommendations for Improved Communication during Care Transitions.
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P. D. Jackson, M. S. Biggins, L. Cowan, B. French, S. L. Hopkins and C. R. Uphold.
Rehabil Nurs 2015 Sep 22

BACKGROUND: Communication between levels of care can be complex for any patient. For the Servicemember or Veteran with complex medical issues, who needs transitioning between multiple levels of care, this communication involves detailed, individualized information pivotal to quality clinical outcomes and patient/family satisfaction. These complex cases also typically include communication between multiple family members. PURPOSE: The purpose was to summarize the evidence and present recommendations for facilitating effective transitions of patient care within the complex Veterans Affairs (VA) Polytrauma System of Care. DESIGN: Evidence Based Review. METHODS: Selected members of the VA Office of Nursing Service Polytrauma Field Advisory Committee conducted an evidence-based review, and queried a clinical panel of polytrauma nursing experts and direct care rehabilitation nurses. FINDINGS: Search results, key practice recommendations, a plan of care template, and future plans for dissemination and implementation are presented. CONCLUSIONS: Communication is a key to success when managing many details and requires both focus and knowledge of larger systems. CLINICAL RELEVANCE: Direct communication, using a standardized approach, is recommended for successful patient transitions.

Scaling up quality care for mothers and newborns around the time of birth: an overview of methods and analyses of intervention-specific bottlenecks and solutions.
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K. E. Dickson, M. V. Kinney, S. G. Moxon, et al.
BMC Pregnancy Childbirth 2015;15 Suppl 2:S1-2393-15-S2-S1. Epub 2015 Sep 11

BACKGROUND: The Every Newborn Action Plan (ENAP) and Ending Preventable Maternal Mortality targets cannot be achieved without high quality, equitable coverage of interventions at and around the time of birth. This paper provides an overview of the methodology and findings of a nine paper series of in-depth analyses which focus on the specific challenges to scaling up high-impact interventions and improving quality of care for mothers and newborns around the time of birth, including babies born small and sick. METHODS: The bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the ENAP process. Country workshops engaged technical experts to complete a tool designed to synthesise “bottlenecks” hindering the scale up of maternal-newborn intervention packages across seven health system building blocks. We used quantitative and qualitative methods and literature review to analyse the data and present priority actions relevant to different health system building blocks for skilled birth attendance, emergency obstetric care, antenatal corticosteroids (ACS), basic newborn care, kangaroo mother care (KMC), treatment of neonatal infections and inpatient care of small and sick newborns. RESULTS: The 12 countries included in our analysis account for the majority of global maternal (48%) and newborn (58%) deaths and stillbirths (57%). Our findings confirm previously published results that the interventions with the most perceived bottlenecks are facility-based where rapid emergency care is needed, notably inpatient care of small and sick newborns, ACS, treatment of neonatal infections and KMC. Health systems building blocks with the highest rated bottlenecks varied for different interventions. Attention needs to be paid to the context specific bottlenecks for each intervention to scale up quality care. Crosscutting findings on health information gaps inform two final papers on a roadmap for improvement of coverage data for newborns and indicate the need for leadership for effective audit systems. CONCLUSIONS: Achieving the Sustainable Development Goal targets for ending preventable mortality and provision of universal health coverage will require large-scale approaches to improving quality of care. These analyses inform the development of systematic, targeted approaches to strengthening of health systems, with a focus on overcoming specific bottlenecks for the highest impact interventions.

The Falls In Care Home study: A feasibility randomized controlled trial of the use of a risk assessment and decision support tool to prevent falls in care homes.
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G. M. Walker, S. Armstrong, A. L. Gordon, et al.
Clin Rehabil 2015 Sep 18

OBJECTIVE: To explore the feasibility of implementing and evaluating the Guide to Action Care Home fall prevention intervention. DESIGN: Two-centre, cluster feasibility randomized controlled trial and process evaluation. SETTING: Purposive sample of six diverse old age/learning disability, long stay care homes in Nottinghamshire, UK. SUBJECTS: Residents aged over 50 years, who had fallen at least once in the past year, not bed-bound, hoist-dependent or terminally ill. INTERVENTIONS: Intervention homes (n = 3) received Guide to Action Care Home fall prevention intervention training and support. Control homes (n = 3) received usual care. OUTCOMES: Recruitment, attrition, baseline and six-month outcome completion, contamination and intervention fidelity, compliance, tolerability, acceptance and impact. RESULTS: A total of 81 of 145 (56%) care homes expressed participatory interest. Six of 22 letter respondent homes (27%) participated. The expected resident recruitment target was achieved by 76% (52/68). Ten (19%) residents did not complete follow-up (seven died, three moved). In intervention homes 36/114 (32%) staff attended training. Two of three (75%) care homes received protocol compliant training. Staff valued the training, but advised greater management involvement to improve intervention implementation. Fall risks were assessed, actioned and recorded in care records. Of 115 recorded falls, 533/570 (93%) of details were complete. Six-month resident fall rates were 1.9 and 4.0 per year for intervention and control homes, respectively. CONCLUSIONS: The Guide to Action Care Home is implementable under trial conditions. Recruitment and follow-up rates indicate that a definitive trial can be completed. Falls (primary outcome) can be ascertained reliably from care records.

Ethical oversight in quality improvement and quality improvement research: new approaches to promote a learning health care system.
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K. Fiscella, J. N. Tobin, J. K. Carroll, H. He and G. Ogedegbe.
BMC Med Ethics 2015 Sep 17;16(1):63-015-0056-2

BACKGROUND: Institutional review boards (IRBs) distinguish health care quality improvement (QI) and health care quality improvement research (QIR) based primarily on the rigor of the methods used and the purported generalizability of the knowledge gained. Neither of these criteria holds up upon scrutiny. Rather, this apparently false dichotomy may foster under-protection of participants in QI projects and over-protection of participants within QIR. DISCUSSION: Minimal risk projects should entail minimal oversight including waivers for informed consent for both QI and QIR projects. Minimizing the burdens of conducting QIR, while ensuring minimal safeguards for QI projects, is needed to restore this imbalance in oversight. Potentially, such ethical oversight could be provided by the integration of Institutional Review Boards and Clinical Ethical Committees, using a more integrated and streamlined approach such as a two-step process involving a screening review, followed by a review by committee trained in QIR. Standards for such ethical review and training in these standards, coupled with rapid review cycles, could facilitate an appropriate level of oversight within the context of creating and sustaining learning health care systems. We argue that QI and QIR are not reliably distinguishable. We advocate for approaches that improve protections for QI participants while minimizing over-protection for participants in QIR through reasonable ethical oversight that aligns risk to participants in both QI and QIR with the needs of a learning health care system.

“Striving for Excellence”: Minimum Data Set Coordinators’ Perceptions of Their Role in the Nursing Home.
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R. I. Bjarnadottir, P. K. Semeraro, C. T. Herzig, et al.
J Gerontol Nurs 2015 Sep 1;41(9):32-41

The purpose of the current study was to explore how Minimum Data Set (MDS) coordinators perceive their role and the assessment process. Eleven MDS coordinators from 10 geographically dispersed nursing homes (NHs) were interviewed between May and September 2013. Four broad themes emerged from content analysis: (a) information gathering, (b) interdisciplinary coordination, (c) role challenges, and (d) resources. The first two themes referred to key components and competencies in the MDS coordinators’ role, the third theme dealt with certain challenges inherent in the role, and the fourth theme highlighted resources that helped address these challenges. The current study provides insight into how MDS coordinators perceive their role, as well as some of the challenges they face to successfully enact that role. The current findings can help inform NH management staff, such as directors of nursing and NH administrators, and policy makers, on how best to support MDS coordinators’ work to enable efficient and accurate resident assessment processes.

Pioneering a Nursing Home Quality Improvement Learning Collaborative: A Case Study of Method and Lessons Learned.
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S. M. Gillespie, T. Olsan, D. Liebel, et al.
J Am Med Dir Assoc 2015 Sep 24

OBJECTIVES: To describe the development of a nursing home (NH) quality improvement learning collaborative (QILC) that provides Lean Six Sigma (LSS) training and infrastructure support for quality assurance performance improvement change efforts. DESIGN: Case report. SETTING/PARTICIPANTS: Twenty-seven NHs located in the Greater Rochester, NY area. INTERVENTION: The learning collaborative approach in which interprofessional teams from different NHs work together to improve common clinical and organizational processes by sharing experiences and evidence-based practices to achieve measurable changes in resident outcomes and system efficiencies. MEASUREMENTS: NH participation, curriculum design, LSS projects. RESULTS: Over 6 years, 27 NHs from urban and rural settings joined the QILC as organizational members and sponsored 47 interprofessional teams to learn LSS techniques and tools, and to implement quality improvement projects. CONCLUSIONS: NHs, in both urban and rural settings, can benefit from participation in QILCs and are able to learn and apply LSS tools in their team-based quality improvement efforts.

Nursing Leader Collaboration to Drive Quality Improvement and Implementation Science.
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R. W. Ryan, K. K. Harris, L. Mattox, O. Singh, M. Camp and M. R. Shirey.
Nurs Adm Q 2015 Jul-Sep;39(3):229-238

Nursing leadership opportunities to improve quality and align resources in health care exist. An estimated 18% of United States gross domestic product is spent on health care delivery systems that produce poor outcomes. The purpose of this article was to describe how quality improvement and implementation science initiatives enhance outcomes using nursing leadership strategies that play an integral role in aligning key colleagues to drive the collaborative process. A critical appraisal of the literature was conducted, which supports the importance of evidenced-based practice improvement, collaborative change process, and professional role of nursing leadership. Limited evidence exists related to practice strategies for nursing leaders to implement sustainable change at the unit level for successful alignment of resources. Strategies based on Rogers’ Diffusion of Innovation Theory are recommended to address the gap in the literature. The strategies aim to increase meaningful knowledge or the “why,” create a tipping point, and implement sustainable change starting with the end in mind. Nurse leaders are a central component for driving alignment and implementing change at the unit level. Uses of the described evidenced-based strategies have implications for nursing practice, education, and scholarship.

A model for implementing guidelines for person-centered care in a nursing home setting.
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S. Vikstrom, P. O. Sandman, E. Stenwall, et al.
Int Psychogeriatr 2015 Jan;27(1):49-59

BACKGROUND: Systematic evaluations of knowledge translation interventions in nursing homes to improve practice are scarce. There is also a lack of studies focusing on creating sustainable evidence-based practice in the setting of residential dementia care. METHODS: The aim of this paper is to describe a model for implementing national evidence-based guidelines for care of persons with dementia in nursing homes. The secondary aim is to outline the nursing home staff experiences during the first year of the implementation process. The intervention had a participatory action research approach. This included educational activities such as: (i) thematic seminars introducing national guidelines for dementia care, (ii) regular unit-based seminars; and (iii) later dissemination of information in reflective seminars and several days of poster-exhibitions. Areas of practice development were selected on each of the 24 units, based on unit-specific needs, and a quality improvement strategy was applied and evaluated. Each unit met ten times during a period of eight months. Data for this study were extracted from the reflective seminars and poster presentations, analyzed using a qualitative content analysis. RESULTS: Findings showed that implementation of guidelines were perceived by staff as beneficial for both staff and the residents. However, barriers to identification of relevant sources of evidence and barriers to sustainable implementation were experienced. CONCLUSIONS: One of our assumptions was that dementia nursing homes can benefit from becoming knowledge driven, with care practices founded in evidence-based sources. Our findings show that to be partly true, even though most staff units found their efforts to pursue and utilize knowledge adversely impacted by time-logistics and practical workload challenges.

Does mandating nursing home participation in quality reporting make a difference? Evidence from Massachusetts.
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D. B. Mukamel, Z. Ye, L. G. Glance and Y. Li.
Med Care 2015 Aug;53(8):713-719

BACKGROUND: Quality report cards have been shown to be effective in influencing patients’ referrals and promoting quality improvement in some instances and not others. In this study, we investigate one of the mechanisms that may detract from their effectiveness: voluntary versus mandatory participation of nursing homes in public quality reporting. OBJECTIVES: To answer 2 questions: (1) Were the nursing homes choosing not to participate low-quality performers relative to those who chose to participate? (2) Once participation became mandatory, did those that did not voluntarily participate initially, improve more than those that participated voluntarily? RESEARCH DESIGN: Massachusetts published the Massachusetts Satisfaction Survey report card for nursing homes for the years 2005, 2007, and 2009. Nursing homes’ participation was voluntary in 2005 and mandatory in 2007 and 2009. We performed a retrospective statistical analysis of the relationship between nursing homes’ decision to participate in quality reporting and 12 quality outcomes: deficiency citations, staffing, and 8 survey domains. SUBJECTS: A total of 424 Massachusetts nursing homes. RESULTS: Sixty-seven percent of nursing homes participated in reporting voluntarily. Volunteer nursing homes had better quality for all measures (significant at the 0.05 level or trending toward significance at the 0.10 level for all but 2). Once reporting became mandatory, nonvolunteers improved more than volunteers in all but 2 staffing measures (trending toward significance at the 0.10 level in 5). CONCLUSIONS: Report cards are more effective if nursing homes’ participation is mandated. Nonmandatory reporting systems, as those implemented by some states and professional associations, lead to missed opportunities for quality improvements.

Tele-health-care in the elderly living in nursing home: the first Sicilian multimodal approach.
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R. De Luca, A. Bramanti, M. C. De Cola, et al.
Aging Clin Exp Res 2015 Sep 29

BACKGROUND: The continued aging of the population is affecting the health of the industrialized countries, with an increasing burden for the healthcare system. Thus, during the last decade, we assisted to relevant progress in the medical treatment and rehabilitation techniques and devices, including the development of telemedicine for geriatric care. AIM: To demonstrate the effectiveness of a novel tele-health-care model allowing a better management of elderly living in nursing homes. METHODS: Fifty-nine elderly patients (19 males and 40 females; mean age 79.1 (+/-9.2), were randomly divided into two groups: the experimental group that performed a proper telemonitoring with a multimodal approach (including monitoring of the vital signs and neurological/psychological counseling), and the control group, which underwent standard in-home nursing care. Neurobehavioral symptoms and quality of life were assessed in both the groups at baseline, and after the telecare protocol’s end. RESULTS: The experimental group had a statistically significant reduction in Geriatric Depression Scale (p < 0.01) and Brief Psychiatric Rating Scale (p < 0.05) scores, and an improvement in their quality of life. Moreover, mean blood pressure and heart rate were lower in the experimental than in the control group (p < 0.05), and admission to health care services was higher in the control than in the experimental group (p < 0.05). CONCLUSIONS: Telemedicine can be considered as an important tool in improving health and quality of life in the elderly living in nursing homes, and potentially reducing healthcare service access, hospitalization, and costs.

Building a Foundation of Continuous Improvement in a Rapidly Changing Environment: The Dartmouth-Hitchcock Value Institute Experience.
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S. P. McGrath and G. T. Blike.
Jt Comm J Qual Patient Saf 2015;41(10):435-433

BACKGROUND: A performance improvement competency development program, known as the Value Institute (VI), was established at Dartmouth-Hitchcock (D-H; Lebanon, New Hampshire) in 2011 to develop a performance improvement-focused workforce and systems capable of meeting the challenges of creating a sustainable health system. METHODS: A tiered competency development program that provides patient safety, health care quality, and improvement science education, and an execution support infrastructure that enables access to performance improvement tools for all employees, comprise the core of the VI. RESULTS: At 20 months after the launch of the first VI classes, more than 10% of all employees were trained to the Yellow Belt level, and approximately 1.5% of all employees became advanced practitioners (Green Belts or Black Belts). Improvement projects have focused on both clinical and business process optimization, as well as regulatory and accreditation compliance and patient safety. Project savings during the two years of operation have exceeded the investment of resources to establish this long-term performance improvement capability by 2.5 times. CONCLUSIONS: The D-H VI model promotes multidisciplinary team-based learning, incremental skill development, and access to a common continuous improvement vocabulary and method for all employees-all key to building the teams and momentum needed for successful execution of improvement work and to maintain outcomes. Initial outcomes, represented by organizational spread, project execution status, participants’ feedback scores, and return on investment estimates, suggest that robust team-based learning combined with coaching provides sufficient depth and breadth of learning and effective opportunities to gain practical experience in continuous improvement.

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Organizational Change

Pragmatism in Organization Studies: Meeting the Challenges of a Dynamic and Complex World
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Moshe Farjoun, Christopher Ansell and Arjen Boin.
Organization Science 2015 10/07; 2015/10

Organizational scholars have shown a growing interest in drawing on the philosophy of Pragmatism to address contemporary problems and theoretical questions. We elucidate Pragmatism’s core ideas and show their uniqueness and relevance to the field. We present Pragmatism as a problem-solving philosophy that builds on a rich and behaviorally plausible model of human nature, views reality in terms of processes and relations, and highlights the interplay of meaning and action. We demonstrate how Pragmatist ideas can help transcend the perennial problem of agency and structure and illustrate how these ideas might contribute to one specific domain of research on categories and categorization. More generally, Pragmatism is well suited to understanding the contemporary challenges of change and complexity especially as they play out across multiple levels of analysis. We argue that Pragmatism provides a “third way” between rational and structural approaches and represents a living school of organization theory in its own right.

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Research Practice and Methodology

Conceptualizing Longitudinal Mixed Methods Designs A Methodological Review of Health Sciences Research
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Vicki L. Plano Clark, Nancy Anderson, Jessica A. Wertz, Yuchun Zhou, Karen Schumacher and Christine Miaskowski.
Journal of Mixed Methods Research 2015 10/01;9(4):297-319

Longitudinal research is well suited for investigating phenomena that change over time. With the growing acceptance of mixed methods, researchers are combining qualitative and quantitative approaches within longitudinal research. However, little attention has been paid to how researchers integrate longitudinal mixed methods databases. The purpose of this methodological review was to describe how researchers combine mixed methods and longitudinal approaches in practice and delineate dimensions and issues inherent within these complex designs. We examined published empirical studies from the health sciences that self-identified as longitudinal and mixed methods. Our results identify major dimensions, variations, and issues for designing longitudinal mixed methods research and suggest recommendations for researchers interested in using this complex approach.

Recruitment of Older Adults: Success May Be in the Details.
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J. C. McHenry, K. C. Insel, G. O. Einstein, A. N. Vidrine, K. M. Koerner and D. G. Morrow.
Gerontologist 2015 Oct;55(5):845-853

PURPOSE: Describe recruitment strategies used in a randomized clinical trial of a behavioral prospective memory intervention to improve medication adherence for older adults taking antihypertensive medication. RESULTS: Recruitment strategies represent 4 themes: accessing an appropriate population, communication and trust-building, providing comfort and security, and expressing gratitude. Recruitment activities resulted in 276 participants with a mean age of 76.32 years, and study enrollment included 207 women, 69 men, and 54 persons representing ethnic minorities. Recruitment success was linked to cultivating relationships with community-based organizations, face-to-face contact with potential study participants, and providing service (e.g., blood pressure checks) as an access point to eligible participants. Seventy-two percent of potential participants who completed a follow-up call and met eligibility criteria were enrolled in the study. The attrition rate was 14.34%. IMPLICATIONS: The projected increase in the number of older adults intensifies the need to study interventions that improve health outcomes. The challenge is to recruit sufficient numbers of participants who are also representative of older adults to test these interventions. Failing to recruit a sufficient and representative sample can compromise statistical power and the generalizability of study findings.

Retrospective analysis of the quality of reports by author-suggested and non-author-suggested reviewers in journals operating on open or single-blind peer review models
Maria K. Kowalczuk, Frank Dudbridge, Shreeya Nanda, Stephanie L. Harriman, Jigisha Patel and Elizabeth C. Moylan.
BMJ Open 2015 09/01;5(9)

To assess whether reports from reviewers recommended by authors show a bias in quality and recommendation for editorial decision, compared with reviewers suggested by other parties, and whether reviewer reports for journals operating on open or single-blind peer review models differ with regard to report quality and reviewer recommendations. Design Retrospective analysis of the quality of reviewer reports using an established Review Quality Instrument, and analysis of reviewer recommendations and author satisfaction surveys. Setting BioMed Central biology and medical journals. BMC Infectious Diseases and BMC Microbiology are similar in size, rejection rates, impact factors and editorial processes, but the former uses open peer review while the latter uses single-blind peer review. The Journal of Inflammation has operated under both peer review models. Sample Two hundred reviewer reports submitted to BMC Infectious Diseases, 200 reviewer reports submitted to BMC Microbiology and 400 reviewer reports submitted to the Journal of Inflammation. Results For each journal, author-suggested reviewers provided reports of comparable quality to non-author-suggested reviewers, but were significantly more likely to recommend acceptance, irrespective of the peer review model (p<0.0001 for BMC Infectious Diseases, BMC Microbiology and the Journal of Inflammation). For BMC Infectious Diseases, the overall quality of reviewer reports measured by the Review Quality Instrument was 5% higher than for BMC Microbiology (p=0.042). For the Journal of Inflammation, the quality of reports was the same irrespective of the peer review model used. Conclusions Reviewers suggested by authors provide reports of comparable quality to non-author-suggested reviewers, but are significantly more likely to recommend acceptance. Open peer review reports for BMC Infectious Diseases were of higher quality than single-blind reports for BMC Microbiology. There was no difference in quality of peer review in the Journal of Inflammation under open peer review compared with single blind.

Methodology and reporting quality of reporting guidelines: systematic review.
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X. Wang, Y. Chen, N. Yang, et al.
BMC Med Res Methodol 2015 Sep 22;15(1):74-015-0069-z

BACKGROUND: With increasing attention put on the methodology of reporting guidelines, Moher et al. conducted a review of reporting guidelines up to December 2009. Information gaps appeared on many aspects. Therefore, in 2010, the Guidance for Developers of Health Research Reporting Guidelines was developed. With more than four years passed and a considerable investment was put into reporting guideline development, a large number of new, updated, and expanded reporting guidelines have become available since January 2010. We aimed to systematically review the reporting guidelines published since January 2010, and investigate the application of the Guidance. METHODS: We systematically searched databases including the Cochrane Methodology Register, MEDLINE, and EMBASE, and retrieved EQUATOR and the website (if available) to find reporting guidelines as well as their accompanying documents. We screened the titles and abstracts resulting from searches and extracted data. We focused on the methodology and reporting of the included guidelines, and described information with a series of tables and narrative summaries. Data were summarized descriptively using frequencies, proportions, and medians as appropriate. RESULTS: Twenty-eight and 32 reporting guidelines were retrieved from databases and EQUATOR network, respectively. Reporting guidelines were designed for a broad spectrum of types of research. A considerable number of reporting guidelines were published and updated in recent years. Methods of initial items were given in 45 (75 %) guidelines. Thirty-eight (63 %) guidelines reported they have reached consensus, and 35 (58 %) described their consensus methods. Only 9 (15 %) guidelines followed the Guidance. CONCLUSIONS: Only few guidelines were developed complying with the Guidance. More attention should be paid to the quality of reporting guidelines.

Using realist review to inform intervention development: methodological illustration and conceptual platform for collaborative care in offender mental health.
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M. Pearson, S. L. Brand, C. Quinn, et al.
Implement Sci 2015 Sep 28;10(1):134-015-0321-2

BACKGROUND: This paper reports how we used a realist review, as part of a wider project to improve collaborative mental health care for prisoners with common mental health problems, to develop a conceptual platform. The importance of offenders gaining support for their mental health, and the need for practitioners across the health service, the criminal justice system, and the third sector to work together to achieve this is recognised internationally. However, the literature does not provide coherent analyses of how these ambitions can be achieved. This paper demonstrates how a realist review can be applied to inform complex intervention development that spans different locations, organisations, professions, and care sectors. METHODS: We applied and developed a realist review for the purposes of intervention development, using a three-stage process. (1) An iterative database search strategy (extending beyond criminal justice and offender health) and groups of academics, practitioners, and people with lived experience were used to identify explanatory accounts (n = 347). (2) From these accounts, we developed consolidated explanatory accounts (n = 75). (3) The identified interactions between practitioners and offenders (within their organisational, social, and cultural contexts) were specified in a conceptual platform. We also specify, step by step, how these explanatory accounts were documented, consolidated, and built into a conceptual platform. This addresses an important methodological gap for social scientists and intervention developers about how to develop and articulate programme and implementation theory underpinning complex interventions. RESULTS: An integrated person-centred system is proposed to improve collaborative mental health care for offenders with common mental health problems (near to and after release) by achieving consistency between the goals of different sectors and practitioners, enabling practitioners to apply scientific and experiential knowledge in working judiciously and reflectively, and building systems and aligning resources that are centred on offenders’ health and social care needs. CONCLUSIONS: As part of a broader programme of work, a realist review can make an important contribution to the specification of theoretically informed interventions that have the potential to improve health outcomes. Our conceptual platform has potential application in related systems of health and social care where integrated, and person-centred care is a goal.

Assessing the Predictive Validity of Strength of Evidence Grades: A Meta-Epidemiological Study
AHRQ, 2015

We sought to determine the predictive validity of the U.S. Evidence-based Practice Center (EPC) approach to GRADE (Grading of Recommendations Assessment, Development and Evaluation) by examining how reliably it can predict the likelihood that treatment effects remain stable as new studies emerge. Study design and setting. Based on 37 Cochrane reports with outcomes graded as high strength of evidence (SOE), we prepared 160 documents using portions of these bodies of evidence in a chronological order. We randomly assigned these documents, which represented different levels of SOE, to professional systematic reviewers from seven academic centers in Austria, Canada, and the United States, who dually graded the SOE using guidance for the EPC program. For each of the 160 documents, we determined whether estimates remained stable as subsequent studies were added to the evidence base. For each grade of SOE, we compared the observed proportion of stable estimates with the expected proportion from an international survey. To determine the predictive validity, we used the Hosmer-Lemeshow test to assess calibration and the C (concordance) index to assess discrimination. Results. Overall, the predictive validity of the EPC approach to GRADE for the stability of effect estimates was limited. Except for moderate SOE, the expected and observed proportions of stable effect estimates differed considerably. Estimates graded as high SOE were less likely to remain stable than expected by producers and users of systematic reviews. By contrast, estimates graded as low or insufficient SOE were substantially more likely to remain stable than expected. In this sample, the EPC approach to GRADE could not reliably predict the likelihood that individual bodies of evidence remain stable as new evidence becomes available. Depending on the definition used, C-indices ranged between 0.56 (95% CI, 0.47 to 0.66) and 0.58 (95% CI, 0.50 to 0.67) indicating a low discriminatory ability. Conclusion. The limited predictive validity of the EPC approach to GRADE seems to reflect a mismatch between expected and observed changes in treatment effects as bodies of evidence advance from insufficient to high SOE. In addition, many low or insufficient grades appear to be too strict.

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Unintentional Discontinuation of Chronic Medications for Seniors in Nursing Homes: Evaluation of a National Medication Reconciliation Accreditation Requirement Using a Population-Based Cohort Study. Canada-flat-icon
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N. M. Stall, H. D. Fischer, C. F. Wu, et al.
Medicine (Baltimore) 2015 Jun;94(25):e899

Transitions of care leave patients vulnerable to the unintentional discontinuation of medications with proven efficacy for treating chronic diseases. Older adults residing in nursing homes may be especially susceptible to this preventable adverse event. The effect of large-scale policy changes on improving this practice is unknown.The objective of this study was to analyze the effect of a national medication reconciliation accreditation requirement for nursing homes on rates of unintentional medication discontinuation after hospital discharge.It was a population-based retrospective cohort study that used linked administrative records between 2003 and 2012 of all hospitalizations in Ontario, Canada. We identified nursing home residents aged >/=66 years who had continuous use of >/=1 of the 3 selected medications for chronic disease: levothyroxine, HMG-CoA reductase inhibitors (statins), and proton pump inhibitors (PPIs).In 2008 medication reconciliation became a required practice for accreditation of Canadian nursing homes.The main outcome measures included the proportion of patients who restarted the medication of interest after hospital discharge at 7 days. We also performed a time series analysis to examine the impact of the accreditation requirement on rates of unintentional medication discontinuation.The study included 113,088 adults aged >/=66 years who were nursing home residents, had an acute hospitalization, and were discharged alive to the same nursing home. Overall rates of discontinuation at 7-days after hospital discharge were highest in 2003-2004 for all nursing homes: 23.9% for thyroxine, 26.4% for statins, and 23.9% for PPIs. In most of the cases, these overall rates decreased annually and were lowest in 2011-2012: 4.0% for thyroxine, 10.6% for statins, and 8.3% for PPIs. The time series analysis found that nursing home accreditation did not significantly lower medication discontinuation rates for any of the 3 drug groups.From 2003 to 2012, there were marked improvements in rates of unintentional medication discontinuation among hospitalized older adults who were admitted from and discharged to nursing homes. This change was not directly associated with the new medication reconciliation accreditation requirement, but the overall improvements observed may have been reflective of multiple processes and not 1 individual intervention.

Normal Aging or Depression? A Qualitative Study on the Differences Between Subsyndromal Depression and Depression in Very Old People.
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M. Ludvigsson, A. Milberg, J. Marcusson and E. Wressle.
Gerontologist 2015 Oct;55(5):760-769

PURPOSE OF THE STUDY: The aim of this study was to make a qualitative comparison of experiences of being in very old people with subsyndromal depression (SSD), in relation to the experiences of very old people with syndromal depression or nondepression. Through investigation and deeper understanding of the interface between depressive disease and normal aging, clinicians might give more accurate prevention or treatment to those very old persons who need such help. DESIGN AND METHODS: Semistructured qualitative interviews were conducted for 27 individuals of 87-88 years of age, who were categorized in the 3 strata of nondepressive, SSD, and syndromal depression. Transcripts were analyzed using qualitative content analysis within each stratum and later with a comparison between the strata. RESULTS: The content analysis resulted in 4 themes in people with SSD, as defined by a self-report depression screening instrument, giving a comprehensive picture of SSD in very old people, and also showed qualitative differences between the SSD, syndromal depression, and nondepressive groups. A main finding was that SSD differs qualitatively from syndromal depression but not clearly from nondepression. IMPLICATIONS: The results might indicate that SSD in very old people is not related to pathology but to normal aging, even though the condition correlates with negative health parameters. Overlooking certain psychosocial aspects of living in the very old may pose a risk of both underdiagnosis and overdiagnosis in the spectrum of depressive disorders.

Development of Six Arts, a Culturally Appropriate Multimodal Nonpharmacological Intervention in Dementia.
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G. H. Wong, C. K. Ng, C. K. Lai, et al.
Gerontologist 2015 Oct;55(5):865-874

PURPOSE: There is accumulating evidence for the efficacy of nonpharmacological multimodal stimulation interventions in maintaining cognition and improving quality of life in people with mild-to-moderate dementia. However, the complex nature of these interventions limits their application in practice and research. We report here the design and development of a culturally appropriate framework, the Six Arts, to guide delivery of multimodal interventions in a Chinese community. DESIGN AND DEVELOPMENT: The Six Arts are a core set of Confucian philosophy comprising 6 disciplines of rites, music, archery, charioteering, literacy, and numeracy. They correspond to major mind-body functional domains of social functioning; music and rhythm; visuospatial and fine motor skills; kinesthetic and gross motor skills; language and verbal skills; and executive function. Using Six Arts as a framework, we mapped theoretical principles and evidence-based nonpharmacological interventions of cognitive stimulation, physical exercise, and social activities against the 6 functional domains. From 2011, we field-tested the use of Six Arts in structuring intervention programs in 263 people in a dementia day center in Hong Kong. RESULTS: The Six Arts was operationalized through the development of an intervention activity database, a scoring system for intensity level, and a service delivery model for application in dementia day centers. IMPLICATIONS: Six Arts can be used as framework for structuring nonpharmacological group intervention programs in dementia day center in a metropolitan Chinese city. Its cultural appropriateness may facilitate communication and shared decision making with families with dementia in communities influenced by Confucian philosophy.

Decision Factors Nurses Use to Assess Pain in Nursing Home Residents With Dementia.
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T. B. Monroe, A. Parish and L. C. Mion.
Arch Psychiatr Nurs 2015 Oct;29(5):316-320

Nurses caring for older people with various psychiatric illnesses face many obstacles when treating pain. One setting with a high percentage of psychiatric conditions is long-term care where more than half of residents have some form of dementia, and behavioral symptoms of dementia (BSDs) may mimic behavioral displays of pain. Furthermore, two-thirds of nursing home residents have pain. Thus, many nursing home residents with dementia have pain that may be confounded by BSDs. Since many people with dementia are at risk for poor pain management, determining current methods in which nurses assess and manage pain in nursing home residents will aid in recognizing potential barriers to using current pain management guidelines and help develop strategies to enhance nurses’ assessment and management of pain in this vulnerable population. The aim of this study was to explore nursing home nurses’ cues and practices to identify and alleviate pain in nursing home residents with dementia. Nurses use the constructs of ‘comfort’ and ‘quality of life’ as key components in their overall pain assessment strategy in people with dementia. Indeed, the extensive process they use involving frequent reassessment and application of interventions is geared towards “appearance of comfort.” Nurses reported difficulty in ascertaining whether a person with dementia was in pain, and they expressed further difficulty determining the intensity associated with resident pain. Nurses further reported that residents with dementia who are not well know by the staff were are greater risk of poor pain management. It was not unusual for nurses to discuss the importance of conflict resolution among family members as well as allowing for open expression of family’s concerns. Nurses had to focus not only on the resident’s comfort, but also the families’ level of comfort with pain management, especially at the end-of-life. Findings support further use and development of discomfort behavior scales to help manage pain.

Development of a nursing care problems coping scale for male caregivers for people with dementia living at home.
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M. Nishio and M. Ono.
J Rural Med 2015;10(1):34-42

OBJECTIVE: The number of male caregivers has increased, but male caregivers face several problems that reduce their quality of life and psychological condition. This study focused on the coping problems of men who care for people with dementia at home. It aimed to develop a coping scale for male caregivers so that they can continue caring for people with dementia at home and improve their own quality of life. The study also aimed to verify the reliability and validity of the scale. PATIENTS/MATERIAL AND METHODS: The subjects were 759 men who care for people with dementia at home. The Care Problems Coping Scale consists of 21 questions based on elements of questions extracted from a pilot study. Additionally, subjects completed three self-administered questionnaires: the Japanese version of the Zarit Caregiver Burden Scale, the Depressive Symptoms and the Self-esteem Emotional Scale, and Rosenberg Self-Esteem Scale. RESULTS: There were 274 valid responses (36.1% response rate). Regarding the answer distribution, each average value of the 21 items ranged from 1.56 to 2.68. The median answer distribution of the 21 items was 39 (SD = 6.6). Five items had a ceiling effect, and two items had a floor effect. The scale stability was about 50%, and Cronbach’s alpha was 0.49. There were significant correlations between the Care Problems Coping Scale and total scores of the Japanese version of the Zarit Caregiver Burden Scale, the Depressive Symptoms and Self-esteem Emotional Scale, and the Rosenberg Self-Esteem Scale. CONCLUSION: The answers provided on the Care Problems Coping Scale questionnaire indicated that male caregivers experience care problems. In terms of validity, there were significant correlations between the external questionnaires and 19 of the 21 items in this scale. This scale can therefore be used to measure problems with coping for male caregivers who care for people with dementia at home.

Bathing Disability and Bathing Persons with Dementia.
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Z. R. Wolf and K. E. Czekanski.
Medsurg Nurs 2015 Jan-Feb;24(1):9-14, 22

Bathing disability, evidence of functional decline, predicts admission to long-term care facilities following acute care hospitalizations. Nurses are challenged to assess bathing disability in hospitalized older persons and those with dementia to support their maximal functional performance and implement diverse bathing strategies.

Malnutrition and Dysphagia in long-term care: a systematic review. Canada-flat-icon
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A. M. Namasivayam and C. M. Steele.
J Nutr Gerontol Geriatr 2015;34(1):1-21

Determining the co-occurrence of malnutrition and dysphagia is important to understand the extent to which swallowing impairment contributes to poor food intake in long-term care (LTC). This review investigated the impact of dysphagia on malnutrition in LTC by synthesizing the results of published literature. Seven electronic databases were used to search for English-language publications reporting malnutrition and dysphagia in LTC facilities from 1946 to 2013. Fourteen studies were eligible for inclusion. Overall, the literature on the co-occurrence of malnutrition and dysphagia in LTC shows a paucity of high-quality evidence. Articles reviewed lacked consistent definitions for both conditions. Methods used to confirm each diagnosis also differed and were of questionable validity. Based on a review of the literature, evidence of the existence of concurrent concerns with respect to malnutrition and dysphagia emerges. The reported frequency of participants in LTC with dysphagia ranges from 7% to 40%, while the percentage of those who were malnourished ranges from 12% to 54%. Due to discrepancies used to describe and measure these conditions, it is difficult to determine the exact prevalence of either condition separately, or in combination. Consequently, the impact of dysphagia on malnutrition must be considered and studied using valid definitions and measures.

Dementia Care Management in an Underserved Community: The Comparative Effectiveness of Two Different Approaches.
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J. Chodosh, B. A. Colaiaco, K. I. Connor, et al.
J Aging Health 2015 Aug;27(5):864-893

OBJECTIVES: To compare the effectiveness and costs of telephone-only approach to in-person plus telephone for delivering an evidence-based, coordinated care management program for dementia. METHODS: We randomized 151 patient-caregiver dyads from an underserved predominantly Latino community to two arms that shared a care management protocol but implemented in different formats: in-person visits at home and/or in the community plus telephone and mail, versus telephone and mail only. We compared between-arm caregiver burden and care-recipient problem behaviors (primary outcomes) and patient-caregiver dyad retention, care quality, health care utilization, and costs (secondary outcomes) at 6- and 12-months follow-up. RESULTS: Care quality improved substantially over time in both arms. Caregiver burden, care-recipient problem behaviors, retention, and health care utilization did not differ across arms but the in-person program cost more to deliver. DISCUSSION: Dementia care quality improved regardless of how care management was delivered; large differences in effectiveness or cost offsets were not detected.

Using sense-making theory to aid understanding of the recognition, assessment and management of pain in patients with dementia in acute hospital settings.
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D. Dowding, V. Lichtner, N. Allcock, et al.
Int J Nurs Stud 2015 Aug 31

BACKGROUND: The recognition, assessment and management of pain in hospital settings is suboptimal, and is a particular challenge in patients with dementia. The existing process guiding pain assessment and management in clinical settings is based on the assumption that nurses follow a sequential linear approach to decision making. In this paper we re-evaluate this theoretical assumption drawing on findings from a study of pain recognition, assessment and management in patients with dementia. AIM: To provide a revised conceptual model of pain recognition, assessment and management based on sense-making theories of decision making. METHODS: The research we refer to is an exploratory ethnographic study using nested case sites. Patients with dementia (n=31) were the unit of data collection, nested in 11 wards (vascular, continuing care, stroke rehabilitation, orthopaedic, acute medicine, care of the elderly, elective and emergency surgery), located in four NHS hospital organizations in the UK. Data consisted of observations of patients at bedside (170h in total); observations of the context of care; audits of patient hospital records; documentary analysis of artefacts; semi-structured interviews (n=56) and informal open conversations with staff and carers (family members). FINDINGS: Existing conceptualizations of pain recognition, assessment and management do not fully explain how the decision process occurs in clinical practice. Our research indicates that pain recognition, assessment and management is not an individual cognitive activity; rather it is carried out by groups of individuals over time and within a specific organizational culture or climate, which influences both health care professional and patient behaviour. CONCLUSIONS: We propose a revised theoretical model of decision making related to pain assessment and management for patients with dementia based on theories of sense-making, which is reflective of the reality of clinical decision making in acute hospital wards. The revised model recognizes the salience of individual cognition as well as acknowledging that decisions are constructed through social interaction and organizational context. The model will be used in further research to develop decision support interventions to assist with the assessment and management of patients with dementia in acute hospital settings.

Using simple technology to prompt multistep tasks in the home for people with dementia: An exploratory study comparing prompting formats.
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H. C. Boyd, N. M. Evans, R. D. Orpwood and N. D. Harris.
Dementia (London) 2015 Sep 30

OBJECTIVES: To investigate the relative effectiveness of different prompts for people with dementia during multistep tasks in the home, to inform prompting technology design. METHODS: Nine pairs of participants (one with dementia and a partner or relative) participated at home. The participants with mild to moderate dementia (5M/4F, aged 73-86 years) functioned at the Planned or Exploratory levels of the Pool Activity Level instrument. A touchscreen computer displayed different prompts during two set tasks: “card-and-envelope” and “CD player.” The trials were scored to establish the relative effectiveness of the prompts. Individual tasks were also explored. RESULTS: Text and audio prompts were each more effective than video or picture prompts for a card-and-envelope task, but this was not seen in a CD player task. The differences may be related to the type of actions within the tasks; the card-and-envelope actions were easier to convey verbally; the CD player actions lent themselves to visual prompts. CONCLUSIONS: Designers of technology-based prompts for people with dementia should consider that the effectiveness of different prompts is likely to be task dependent. Familiar, unambiguous language can increase the success of tailored prompts. There are significant practical challenges associated with choosing and deconstructing everyday tasks at home.

Geriatric Screening Tools to Select Older Adults Susceptible for Direct Transfer From the Emergency Department to Subacute Intermediate-Care Hospitalization.
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M. Inzitari, N. Gual, T. Roig, et al.
J Am Med Dir Assoc 2015 Oct 1;16(10):837-841

OBJECTIVES: Early transfer to intermediate-care hospitals, low-tech but with geriatric expertise, represents an alternative to conventional acute hospitalization for selected older adults visiting emergency departments (EDs). We evaluated if simple screening tools predict discharge destination in patients included in this pathway. DESIGN, SETTING, AND PARTICIPANTS: Cohort study, including patients transferred from ED to the intermediate-care hospital Parc Sanitari Pere Virgili, Barcelona, during 14 months (2012-2013) for exacerbated chronic diseases. MEASUREMENTS: At admission, we collected demographics, comprehensive geriatric assessment, and 3 screening tools (Identification of Seniors at Risk [ISAR], SilverCode, and Walter indicator). OUTCOME: Discharge destination different from usual living situation (combined death and transfer to acute hospitals or long-term nursing care) versus return to previous situation (home or nursing home). RESULTS: Of 265 patients (mean age +/- SD = 85.3 +/- 7.5, 69% women, 58% with acute respiratory infections, 38% with dementia), 80.8% returned to previous living situation after 14.1 +/- 6.5 days (mean +/- SD). In multivariable Cox proportional hazard models, ISAR >3 points (hazard ratio [HR] 2.06, 95% confidence interval [95% CI] 1.16-3.66) and >1 pressure ulcers (HR 2.09, 95% CI 1.11-3.93), but also continuous ISAR, and, in subanalyses, Walter indicator, increased the risk of negative outcomes. Using ROC curves, ISAR showed the best prediction among other variables, although predictive value was poor (AUC = 0.62 (0.53-0.71) for ISAR >3 and AUC = 0.65 (0.57-0.74) for continuous ISAR). ISAR and SilverCode showed fair prediction of acute hospital readmissions. CONCLUSIONS: Among geriatric screening tools, ISAR was independently associated with discharge destination in older adults transferred from ED to intermediate care. Predictive validity was poor. Further research on selection of candidates for alternatives to conventional hospitalization is needed.

Is Aging in Place Delaying Nursing Home Admission?
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Y. Young, J. Kalamaras, L. Kelly, D. Hornick and R. Yucel.
J Am Med Dir Assoc 2015 Oct 1;16(10):900.e1-900.e6

OBJECTIVES: This study examines whether aging in place (community-based living before admission to a nursing home) delays nursing home admission among New York State home health care recipients. DESIGN: Retrospective cohort study (January 2007-December 2012). SETTING: New York State. PARTICIPANTS: Adults age 65+ who received home health services for at least 2 months before permanent nursing home admission. MEASUREMENT AND ANALYSIS: Permanent transition is defined as home care patients who are discharged to and stay at a nursing home for more than 3 months. Data were abstracted from the Minimum Data Set (MDS) and Outcome and Assessment Information Set (OASIS). Descriptive and bivariate Kruskal-Wallis and chi(2) tests were performed. RESULTS: The average age of nursing home residents at admission remained steady at 83 years between 2007 and 2012. The proportion of minority populations (Asian, black, Hispanic/Latino) increased, whereas the white population declined (P < .0001). The average length of stay at home increased 8 months, from 17 months in 2007 to 25 months in 2012 (P < .0001). Chronic conditions with significant increases in prevalence during the study period were hypertension (P < .0009), dementia (P < .0001), heart failure (P = .05), urinary incontinence (P < .0001), and bowel incontinence (P < .0001). Increases in functional disabilities requiring extensive human assistance included toileting, dressing, personal hygiene, and transferring (all P < .001). CONCLUSION: Home health services enabled recipients to remain at home 8 months longer, thus delaying nursing home entry. Given the increase in prevalence of comorbidities and disability, we anticipate a concomitant increase in support services at the nursing home. These results may inform policy and staffing decisions regarding adjustments in required caregivers’ credentials and nurse-patient ratios.

The cost-effectiveness of grip on challenging behaviour: an economic evaluation of a care programme for managing challenging behaviour.
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S. A. Zwijsen, J. E. Bosmans, D. L. Gerritsen, A. M. Pot, C. M. Hertogh and M. Smalbrugge.
Int J Geriatr Psychiatry 2015 Sep 30

OBJECTIVE: The objective of the study was to evaluate the cost-effectiveness of implementing the Grip on Challenging Behaviour care programme (GRIP) on dementia special care units in comparison with usual care. METHODS: A stepped wedge design was used. Challenging behaviour and quality of life were measured using the Cohen Mansfield Agitation Inventory (CMAI) and the QUALIDEM. Quality-adjusted life years (QALYs) were calculated using the EuroQol-5D. Psychoactive medication use (range 0-5 per measurement) and sick leave were registered. Costs included medication, time spent on challenging behaviour and education. Costs and effects were analysed using linear multilevel regression. Incremental cost-effectiveness ratios were calculated. Statistical uncertainty was estimated using bootstrapping. RESULTS: Seventeen dementia special care units participated. GRIP led to improvement on the QUALIDEM subscale social relations (1.6; 95% CI 0.18 to 3.4) and on the use of psychoactive medication (-0.73; 95% CI -1.1 to -0.46) and to a decrease in QALYs (-0.02; 95% CI -0.06 to -0.003). No significant effects on CMAI, sick leave and other QUALIDEM subscales were found. The intervention was not cost-effective in comparison with usual care with regard to CMAI score, QALYs and sick leave. The willingness to pay should be 320euro/point improvement on the QUALIDEM subscale social relations and 370euro/psychoactive medication less to reach a 0.95 probability of cost-effectiveness. CONCLUSION: It depends on how much society is willing to pay whether GRIP can be considered cost-effective. Because the appropriateness of the current methods for analysing cost-effectiveness in this specific population is uncertain, the positive effects on behaviour, medication and job satisfactions should also be taken in account in the decision making. Copyright (c) 2015 John Wiley & Sons, Ltd.

Effectiveness of individualised intervention on older residents with constipation in nursing home: a randomised controlled trial.
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T. T. Huang, S. D. Yang, Y. H. Tsai, Y. F. Chin, B. H. Wang and P. K. Tsay.
J Clin Nurs 2015 Sep 30

AIMS AND OBJECTIVES: To develop and examine the effectiveness of individualised intervention to reduce constipation among older adults in nursing homes. BACKGROUND: In long-term care facilities, approximately 60-80% of the residents have symptoms of constipation. Constipation may lead to haemorrhoids, faecal impaction, ulcers, intestinal bleeding and can also lead to a decrease in quality of life. Although a high prevalence of constipation in older adults can be seen, there is a lack of empirical evidence for delivering interventions based on individual risk factors of constipation. Many factors cause constipation but the risk factors are different for each individual. DESIGN: A prospective, randomised control trial conducted in northern Taiwan. METHODS: Nursing home residents (n = 43) were randomly assigned to either the control group or the experimental group. The control group received no extra care from the researcher while the experimental group received an individualised intervention and an eight-week follow-up. Participants were assessed using the Bristol Stool Form Scale, the Patient Assessment of Constipation Symptoms, types and dosages of laxative, and bowel sound observations. Data were taken at baseline, four weeks as well as eight weeks after the intervention. RESULTS: The participants in the experimental group had a significantly higher increase in the frequency of defecation (group effect, p = 0.029) and in bowel sounds (interaction effect, p = 0.010) compared to those in the control group. However, the two groups did not differ significantly in symptoms and the severity of the constipation symptoms, Bristol Stool Form and use of laxatives. CONCLUSIONS: The results of this trial suggest that the individualised intervention may be appropriate for decreasing constipation among nursing home residents and encourage further study and confirmation. RELEVANCE TO CLINICAL PRACTICE: Using individualised intervention to enhance the self-care ability related to constipation among older adults is recommended.

Factors Associated With Changes in Perceived Quality of Life Among Elderly Recipients of Long-Term Services and Supports.
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M. D. Naylor, K. B. Hirschman, A. L. Hanlon, et al.
J Am Med Dir Assoc 2015 Sep 26

OBJECTIVES: Advance knowledge about changes in multiple dimensions of health related quality of life (HRQoL) among older adults receiving long-term services and supports (LTSS) over time and across settings. DESIGN: A prospective, observational, longitudinal cohort design. SETTING: Nursing homes (NHs), assisted living facilities (ALFs), community. PARTICIPANTS: A total of 470 older adults who were first-time recipients of LTSS. MEASUREMENT: Single-item quality-of-life measure assessed every 3 months over 2 years. HRQoL domains of emotional status, functional status, and social support were measured using standardized instruments. RESULTS: Multivariable mixed effects model with time varying covariates revealed that quality-of-life ratings decreased over time (P < .001). Quality-of-life ratings were higher among enrollees with fewer depressive symptoms (P < .001), higher general physical function (P < .001), enhanced emotional well-being (P < .001), and greater social support (P = .004). Ratings also were higher among those with increased deficits in activities of daily living (P = .02). Ratings were highest among enrollees who received LTSS from ALFs, followed by NHs, then home and community-based services (H&CBS), but only findings between ALFs and H&CBS were statistically significant (P < .001). Finally, ratings tended to decrease over time among enrollees with greater cognitive impairment and increase over time among enrollees with less cognitive impairment (P < .001). CONCLUSIONS: Findings advance knowledge regarding what is arguably the most important outcome of elderly LTSS recipients: quality of life. Understanding associations between multiple HRQoL domains and quality of life over time and directly from LTSS recipients represents a critical step in enhancing care processes and outcomes of this vulnerable population.

Management of the behavioral and psychological symptoms of dementia (US)
National Resource Center for Academic Detailing, 2013

This report from the National Resource Center for Academic Detailing in the United States reviews the current data and best practices for health care providers on the topic of management of behavioral and psychological symptoms of dementia. It offers a summary of the current literature (until its date of publication in 2013) relevant to behavioral and psychological symptoms of dementia and describes practical strategies for managing and preventing these symptoms for the improvement of quality of life and care of the resident or patient.

Models of Dementia Assessment and Diagnosis: Indicative Cost Review (UK)
NHS 2015

This report identifies and reviews in detail three models of dementia assessment and diagnosis currently being used in dementia care in the NHS in England. Through semi-structured interviews with each unit it presents indicative costs for each model, benefits for patients and carers, key messages and considerations about developing the service, giving insight into how a local Clinical Commissioning Group (CCG) might approach a review of their local service with an aim to making improvements.

Conference Board of Canada: Federal Policy Action to Support the Health Care Needs of Canada’s Aging Population. Canada-flat-icon

This study examines the costs associated with implementing three large-scale policy changes at the federal level, all of which are intended to improve the quality of care provided by Canada’s health care system and lead to better health outcomes for Canadians. The first proposed policy change would transfer additional health care funding to the provinces and territories via a demographic top-up to the Canada Health Transfer. This would cover the costs expected to be incurred by the health care system due to Canada’s aging population. The second change would see the federal government cover the entire cost of prescribed medication for all Canadian households when those costs are greater than $1,500 per annum or 3 per cent of annual income. Finally, this report estimates the cost of changing the Canada Caregiver Tax Credit and Family Caregiver Tax Credit from non-refundable to refundable tax credits. Each of the three measures addresses the rising costs to the provinces, territories, and individuals of caring for Canada’s aging population. The first two are projected to cost more than $1 billion in each of the next five years, with costs rising in each successive year. The third is predicted to decrease federal government revenues by more than $90 million in the first year of implementation. Two insights can be gleaned from this study. First, it is evident that the aging of Canada’s population will have a significant negative impact on the country’s fiscal position in the coming years. (While only the first part of this analysis addresses aging per se, the aging factor figures significantly into the costs that would be realized for all three suggested policy modifications.) Second, the system of health care delivery in Canada differs in many ways from the systems in other developed nations. Both these findings are relevant for policy-makers considering and implementing policy changes such as those discussed in this report.

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Putting Evidence into Practice (PEP) Workshop
23-25 November University of Alberta

This three-day workshop involves a combination of plenaries, small group sessions led by experts in their topic area, and a fun, interactive session reinforcing key concepts learned during the workshop. Participants attending this workshop will engage in small group and plenary sessions to learn about knowledge synthesis and its application to healthcare practice.

Burnout in Healthcare Workers: An Ethical Imperative
Friday 16 October 12:00 – 13:00 Dvorkin Centre (2G2.07 WMC)

The John Dossetor Health Ethics Centre invites you to an upcoming Health Ethics Seminar. Peter Brindley, MD, FRCPC, FRCP (Edin)

Academic Center for Geriatric Dentistry – A multi professional task force to analyze, prevent and treat frailty in an aging population
Thursday 15 October 12:05 MT 5-099 ECHA

Dr. Sharon Compton invites you to attend this Discover Dental Sciences presentation. She is very pleased to be hosting two academic visitors from Karolinska Institute, Stockholm. The two visitors are:
-Dr. Gunilla Sandborgh-Englund
Professor & Director, Academic Center for Geriatric Dentistry (ACT),
Department of Dental Medicine; Karolinska Institutet
-Dr. Pia Skott, Dept. of Orofacial Medicine & Co-Director of ACT

Non UofA

Hellish Decisions in Healthcare: Value in Healthcare Forum (ViHF)
7-9 December 2015 Oxford UK

Hellish Decisions in Healthcare is designed as a community of practice for people who pay for or manage health services, to undertake action learning to improve their understanding of the three types of value – allocative, technical and personal – and then most importantly, increase all three dimensions of value in healthcare.


Social media – a key tool for knowledge mobilization
Wednesday 21 October 14:00-15:30 MT

Knowledge mobilization is all about making connections between research/researchers and organizations seeking to use research and expertise to inform their work. Social media are tools that help to make connections. Starting with an overview of social media tools this session will provide examples of how these tools are being used in practice to help connect research to impact.

Working with Dementia: Helping Employees with Cognitive Disabilities
Conference Board of Canada, On demand webinar

In this 60 minute session, David Harvey, Chief Public Policy and Program Initiatives Officer at the Alzheimer Society of Ontario, shares his insights on how employers can create a supportive work environment for employees living with dementia. In particular, he will discuss:
-Best practices for accommodating an employee with dementia
-Effective strategies for engaging, retaining and transitioning workers with dementia
-Supportive programs and practices for caregivers of individuals with dementia
-Community resources that can be useful

Webinar: Improving Care and Support for Unpaid Caregivers in Ontario: Findings from a Citizen Panel
Wednesday 4 November 11:00-12:00

This webinar will present findings from a citizen panel convened by the McMaster Health Forum in November 2014, which provided participants an opportunity to share their ideas and experiences related to improving care and support for unpaid caregivers. Panel participants were provided with a citizen brief that summarized in lay language what is known about the underlying problem, three options to address the problem and implementation considerations, and the panel consisted of facilitated deliberations about each of these areas.

Webinar: Depression in Dementia: Challenges in Diagnosis and Management
Wednesday 14 October 10:00-12:30

Depressive symptoms and major depressive disorder are common among individuals with Alzheimer’s disease and related forms of dementia. The relationship between depression and dementia is complex. Identifying depression in dementia (DpD) can be challenging as many symptoms of dementia can mimic depression, and depression can also contribute to development of cognitive impairment. Successful treatment planning for DpD relies on accurate detection of DpD when it is present or ruling out DpD when other conditions may be present. A number of brief screening tools may be useful in the diagnosis of DpD, although optimal screening tools to use for diagnosing DpD and factors that may affect the accuracy these tools are not known. In this presentation, attendees will be provided with an overview of factors related to DpD, challenges in diagnosing DpD with screening tools, and strategies that may be used to treat DpD. This presentation is part of a CIHR funded project examining the diagnostic test accuracy of depression rating scales for the diagnosis of DpD.

Webcast: Aging: Complexities, Opportunities, and Impacts on Society
Symposium on Aging at the National Academy of Medicine (NAM) Annual Meeting
Monday 19 October 06:00-15:20 MT

The daylong symposium includes:
9:10 am: Keynote address by Laura Carstensen, Founding Director of the Stanford Center on Longevity
10:15 am: Panel: The Biology of Aging: Advances and Implications
1:30 pm: Panel: Aging, Cognition, and Frailty
2:45 pm: Our Aging Society: Influences, Interventions, and Impacts
4:00 pm: Special Session: Innovation in Aging and Longevity

TVN Webinar: Systematic Review and Meta-Analysis of Communication Tools for End-of-Life Decision Making: Final Results of TVN-Funded Knowledge Synthesis
Wednesday 21 October 10:00 MT

With advances in medical care, end-of-life (EOL) decision-making has become an integral part of quality health care so that patients do not receive unwanted, invasive treatments. Many structured communication tools such as decision aids and educational interventions have been developed to help patients and clinicians. However, it is unclear whether such tools improve EOL communication and decision-making processes or increase the likelihood that patients will receive the kind of care they want at the end of life. Join Dr. John You, Dr. Simon Oczkowski and Dr. Han-Oh Chung of McMaster University as they explain the findings of their systematic review of existing communication tools for EOL decision-making.

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Fall 2015 Systematic Review Workshop
Institute of Work and Health
25-27 November Toronto

The workshop is designed to teach clinicians, researchers and decision-makers how to plan, conduct and communicate the findings of a systematic review.

MSc in Implementation and Improvement Science
King’s College London, UK

There are many theories of implementation and scores of improvement techniques. This MSc teaches what’s already known about various different approaches and how to critically examine techniques and theories.


CIHR Training Course: Sex and Gender in Biomedical Research
Online course available anytime

Supporting the aim of the Catalyst Grant: Sex as a Variable in Biomedical or Translational Research funding opportunity, the CIHR Institute of Gender and Health (CIHR-IGH) has developed a free online course, which examines how sex can be integrated into biomedical research at every stage of the research project. Take this training course to learn how to:
-Distinguish between and define sex and gender in biomedical research;
-Identify sex/gender differences in the mechanism, disease, or treatment under study;
-Assess a research protocol based on the integration or omission of sex and/or gender.

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New Home Care Services Guideline (UK)

The National Institute for Health and Care Excellence (NICE) has published a new guideline concerning high-quality home care services for older people (i.e. home care, sometimes known as domiciliary care). It puts the focus on supporting the aspirations, goals and priorities of each person. Home care visits to elderly people should last for at least 30 minutes. Continuity of care is another priority, to ensure home care worker(s) can become more familiar and build more stable relationships with care recipients.

Change Foundation launches first phase of long-term care project Canada-flat-icon

Phase One of The Change Foundation’s LTC project features a large online and paper survey of residents, family members, staff, and administrators involved in resident and family councils. These surveys will be the foundation of The Change Foundation’s work throughout the project. Results from this current survey are currently being reviewed and analyzed by The Change Foundation.

Recent changes at Tisdale’s Newmarket Place making residents feel more at home Canada-flat-icon

Residents in one cottage at Tisdale’s Newmarket Place are getting more personal attention from care staff thanks to recent changes in the set-up process for lunchtime meals.

An Aging Population, Without the Doctors to Match (US)

Currently there are fewer than 8,000 geriatricians in practice nationwide — and that number is shrinking. “We are an endangered species,” said Dr. Rosanne Leipzig, a geriatrician at Mt. Sinai Medical Center in New York. At the same time, the nation’s fastest-growing age group is over 65. Government projections hold that in 2050 there will be 90 million Americans 65 and older, and 19 million people over age 85.

A safer and more dignified transfer of care for older people (UK)

Facilitating early and well managed discharge from acute care is very important, as is supporting older people to live well at home, preventing early admissions to long-term care. NHS Providers has launched a Commission to capture good practice with regard to transfers of care in all settings across acute, community, mental health and ambulance services.

Starting the PhD – setting up your routine

At the start of the PhD you need to sort out how you will accomplish the necessary reading, and the writing that relates to the reading.

75 New Nurse Practitioners to be Hired in Ontario Long-Term Care Homes Canada-flat-icon

Ontario is providing funding for up to 75 new attending nurse practitioners in long-term care homes over three years, including 30 starting this fall. The new attending nurse practitioners will be the onsite primary care provider for patients. Working as part of a team of health professionals, these new nurses will help strengthen the care that residents receive in long-term care homes and the community.

When’s it OK to call care home residents ‘darling’? (UK)

CQC bans care home staff from calling residents “love”.

StatsCan: Canadian seniors outnumber children for the first time in recorded history Canada-flat-icon

Canada’s seniors have edged out the number of children under the age of 15, according to the latest population figures that experts say contain further evidence of a long-projected shift in the country’s demographic makeup.

I put my father in a nursing home at age 98. Then I brought him home.

My father never abandoned me. Why, then, I tormented myself, have I abandoned him? The answers were hardly comforting: Because caregiving is hard. Because at 67, I don’t have the energy to pull all-nighters and still function the next day. Because I’ve never had a lot of patience. Despite my doubts, though, it wasn’t a change of heart that forced me to bring Dad home. It was money, pure and simple.

Geriatricians call for controversial change to health care for seniors Canada-flat-icon

With the federal election campaign moving into fever pitch this week — we’re focusing on an issue Canadian voters consistently rank as a top priority … but one you may not be hearing a lot about on the campaign trail. Health Care.

Models of aging: How Japan, Denmark, Germany are riding out their senior wave Canada-flat-icon

As Canada’s seniors outnumber children, it can learn from countries with older populations.

Quality of Death Index 2015 Ranking palliative care across the world

The UK ranks first in the 2015 Quality of Death Index, a measure of the quality of palliative care in 80 countries around the world released today by The Economist Intelligence Unit (EIU). Canada ranks 11th.

Dementia advice now available through Health Link Canada-flat-icon

Alberta Health Services (AHS) is introducing specialized dementia advice available through Health Link to help support individuals and caregivers living with dementia, including people with Alzheimer’s disease.

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How to Get Writing Done

As a new academic year begins, how can you commit to writing regularly during your busy semester? Here are a few suggestions for increasing your productivity and working toward seeing your work in print.

How to Build the Social Ties You Need at Work

Relationships at work matter. Getting along with your coworkers not only makes your days more pleasant but also makes you better at your job. So what should you do if you realize you’re eating lunch alone every day or that you don’t even exchange pleasantries with your colleagues? How can you build more social connections at the office? How do you reach out to people, particularly if you’re an introvert or work remotely?

ResearchAlberta Canada-flat-icon

Recently launched by AIHS & partner, this site is intended to be a one-stop shop for clinical health research, e.g. clinical research roadmap, toolbox, glossary, SPOR services, etc.

NHS: Frailty Toolkit
Toolkit for general practice in supporting older people with frailty and achieving the requirements of the Unplanned Admissions Enhanced Service
Helen Lyndon & Dr Grant Stevens

Older people living with frailty make up between 9 per cent and 25 per cent of the UK population. This toolkit from NHS England aims to provide GPs and practice nurses with a suite of tools to support the case finding, assessment and case management of frail older patients. NHS England, in collaboration with Public Health England and Age UK, is also launching a new guide to healthy ageing today.

How to present years of scholarly work in 30 minutes

Delivering presentations is one of the foundations of scholarly work. But doing so outside of the classroom invariably poses different challenges. Becoming adept at crafting compelling presentations that engage a variety of audiences increases an academic’s opportunities to get others excited about their work.

Dementia: A Caregiver’s Guide
Baycrest Health Sciences, $27.99

Baycrest Health Sciences has published an expanded third edition of its quick reference guidebook for anyone looking after a person with Alzheimer’s or other dementia.

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Program Coordinator – Knowledge Synthesis Canada-flat-icon
Faculty of Medicine & Dentistry – Department of Pediatrics, University of Alberta Edmonton AB
Open until filled

Reporting to the Director, and under direction from the Assistant Director, Knowledge Translation (KT) Platform, Alberta SPOR SUPPORT unit, the Program Coordinator – Knowledge Synthesis coordinates high-level, complex research activities and analysis specific to Systematic Reviews and other forms of knowledge synthesis.

Program Coordinator – Knowledge Translation and Implementation Canada-flat-icon
Faculty of Medicine & Dentistry – Department of Pediatrics, University of Alberta Edmonton AB
Open until filled

Reporting to the Director, and under direction from the Assistant Director, Knowledge Translation (KT) Platform, Alberta SPOR SUPPORT unit, the Program Coordinator – Knowledge Translation and Implementation coordinates high level, complex research activities and analysis specific to knowledge translation and implementation. The position requires a high degree of knowledge about the science involved in this work as well as highly developed abilities in management and communication.

Program Coordinator – Training and Professional Development Canada-flat-icon
Faculty of Medicine & Dentistry – Department of Pediatrics, University of Alberta Edmonton AB
Open until filled

Reporting to the Director, and under direction from the Assistant Director, Knowledge Translation (KT) Platform, Alberta SPOR SUPPORT unit, Department of Pediatrics, the Program Coordinator – Training and Professional Development will lead the Training and Professional Development program within the SPOR KT Platform, addressing the areas of knowledge synthesis, knowledge translation and implementation science.

Assistant Director, Evaluation
Northwestern University Clinical and Translational Sciences Institute (NUCATS) at Feinberg School of Medicine, Norwestern University, Chicago IL

This individual will be responsible for daily management of the evaluation plan, design data collection tools, develop dashboards, produce reports for NCATS and the NUCATS Steering Committee, EAC, IAC and Executive Council and assist performance improvement projects in cooperation with NMHC. The Evaluation and Continuous Improvement (ECI) Program is charged with implementing a cohesive model of process and outcomes based evaluation. The primary duties will entail leading large cross functional teams to gather metrics and standardized definitions and delivering results in specific time frames. This position is expected to partner with the leadership team in developing strategic plans for the grant and the institute as a whole. This position will be part of a larger evaluation core within the library that will be available to researchers in FSM on large grant projects.

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