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New article by Dr. Whitney Berta
Staffing in Ontario’s Long-Term Care Homes: Differences by Profit Status and Chain Ownership
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Ontario has the highest proportion of for-profit nursing homes in Canada. These facilities, which are known in Ontario as long-term care (LTC) homes, offer 24-hour custodial as well as nursing care to individuals who cannot live independently. Increasingly, they are also operating as members of multi-facility chains. Using longitudinal data (1996-2011) from the Residential Care Facilities Survey (n = 627), our analysis revealed discernible differences in staffing levels by profit status and chain affiliation. We found for-profit LTC homes – especially those owned by a chain organization – provided significantly fewer hours of care, after adjusting for variation in the residents’ care needs. Findings from this study offer new information on the impact of organizational structure on staffing levels in Ontario’s LTC homes and have implications for other jurisdictions where a growing presence of private, chain-affiliated operators has been observed.
New article by Dr. Jo Rycroft-Malone
Challenges, solutions and future directions in the evaluation of service innovations in health care and public health
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Policies and interventions in the health-care system may have a wide range of effects on multiple patient outcomes and operate through many clinical processes. This presents a challenge for their evaluation, especially when the effect on any one patient is small. In this essay, we explore the nature of the health-care system and discuss how the empirical evidence produced within it relates to the underlying processes governing patient outcomes. We argue for an evidence synthesis framework that first models the underlying phenomena common across different health-care settings and then makes inferences regarding these phenomena from data. Bayesian methods are recommended. We provide the examples of electronic prescribing and increased consultant provision at the weekend.
New report by Dr. Malcolm Doupe
Supportive Housing for Seniors: Reform Implications for Manitoba’s Older Adult Continuum of Care
The older adult care continuum is generally comprised of home care services, community-based supportive housing, and personal care homes (PCHs). This research examines supportive housing and PCH use in the Winnipeg Health Region, first by identifying the proportion of newly admitted PCH residents who are clinically similar to most supportive housing tenants. We also compare some additional features of these groups, such as differences in user fees paid, differences in people’s informal support networks, and differences in their healthcare use patterns. Collectively, this research helps to define the potential for expanding supportive housing as an alternate to PCH use in Winnipeg, and identifies some of the more salient reform strategies required to help make this work.
New articles by Dr. Greta Cummings
Implementation of Symptom Protocols for Nurses Providing Telephone‐Based Cancer Symptom Management: A Comparative Case Study
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BACKGROUND: The pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) team developed 13 evidence-informed protocols for symptom management. AIM: To build an effective and sustainable approach for implementing the COSTaRS protocols for nurses providing telephone-based symptom support to cancer patients. METHODS: A comparative case study was guided by the Knowledge to Action Framework. Three cases were created for three Canadian oncology programs that have nurses providing telephone support. Teams of researchers and knowledge users: (a) assessed barriers and facilitators influencing protocol use, (b) adapted protocols for local use, (c) intervened to address barriers, (d) monitored use, and (e) assessed barriers and facilitators influencing sustained use. Analysis was within and across cases. RESULTS: At baseline, >85% nurses rated protocols positively but barriers were identified (64-80% needed training). Patients and families identified similar barriers and thought protocols would enhance consistency among nurses teaching self-management. Twenty-two COSTaRS workshops reached 85% to 97% of targeted nurses (N = 119). Nurses felt more confident with symptom management and using the COSTaRS protocols (p < .01). Protocol adaptations addressed barriers (e.g., health records approval, creating pocket versions, distributing with telephone messages). Chart audits revealed that protocols used were documented for 11% to 47% of patient calls. Sustained use requires organizational alignment and ongoing leadership support. LINKING EVIDENCE TO ACTION: Protocol uptake was similar to trials that have evaluated tailored interventions to improve professional practice by overcoming identified barriers. Collaborating with knowledge users facilitated interpretation of findings, aided protocol adaptation, and supported implementation. Protocol implementation in nursing requires a tailored approach. A multifaceted intervention approach increased nurses’ use of evidence-informed protocols during telephone calls with patients about symptoms. Training and other interventions improved nurses’ confidence with using COSTaRS protocols and their uptake was evident in some documented telephone calls. Protocols could be adapted for use by patients and nurses globally.
Work engagement in professional nursing practice: A systematic review
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Background Work engagement in professional nursing practice is critically important to consider when addressing key challenges of health systems, including the global nursing shortage, pressures to reduce health care spending, and increasing demands for quality care and positive outcomes for patients. However, research on work engagement in professional nursing practice has not yet been synthesized and therefore, does not provide a sufficient foundation of knowledge to guide practice and further research. Objectives The overall aim of this systematic review is to determine what is currently known about the antecedents and outcomes of work engagement in professional nursing practice Design Systematic review Data sources The search strategy included eight electronic databases: CINAHL, MEDLINE, PsycINFO, PROQUEST, SCOPUS, Web of Science, EMBASE, and Business Source Complete. The search was conducted in October 2013. Quantitative and qualitative research that examined relationships between work engagement and antecedent or outcome factors was included. Review methods Quality assessment, data extractions, and analysis were completed on all included studies. Data extracted from included studies were synthesized through descriptive and narrative synthesis. Content analysis was used to categorize factors into themes and categories. Results 3621 titles and abstracts were screened and yielded 113 manuscripts for full text review. Full text review resulted in 18 included studies. All factors examined were grouped into either influences or outcomes of work engagement. A total of 77 influencing factors were categorized into 6 themes: organizational climate, job resources, professional resources, personal resources, job demands, and demographic variables. A total of 17 outcomes of work engagement were categorized into 3 themes: performance and care outcomes, professional outcomes, and personal outcomes. Based on the results, we adapted the Job Demands-Resources (JD-R) model and developed the Nursing Job Demands-Resources (NJD-R) model for work engagement in professional nursing practice, which reflects key adaptations related to organizational climate and professional resources. Conclusions Our findings indicate that a wide range of antecedents, at multiple levels, is related to registered nurses’ work engagement. Positive outcomes of work engagement are valuable to both performance and the individual nurse. The NJD-R model offers nursing science a valuable beginning framework to understand the current evidence, further direct nursing research, and begin to guide practice and policy. The results offer opportunities for nurse leaders to promote work engagement in professional nurses through action on organizational level resources.
Testing the social cognitive career theory in Thai nurses’ interest to become nurse educators: A structural equation modeling analysis
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A shortage of nurse educators generates a systemic problem in nursing education. A model to develop interventions directed at enhancing graduate nursing student interest in assuming a future faculty role is needed. This study used a social cognitive career theory perspective to examine the effects of past performance in teaching and supervision, social influence, observing others teaching, perceived task demands for nurse educators, self-efficacy, and outcome expectations on Thai graduate nursing students’ (n=236) interest to become a nurse educator. Results of structural equation modeling analyses revealed that social influence and past performance in teaching and supervision had significant effects on interest to become a nurse educator when mediated by self-efficacy and outcome expectations. Observing others teaching and perceived task demands for nurse educators did not significantly predict interest in faculty roles. These findings provide new knowledge about factors and their influence on the development of interest to assume faculty roles. Implications for nursing education include the design of feasible graduate curricula that enhance students’ abilities in faculty role and increases valuation of teaching careers.; A shortage of nurse educators generates a systemic problem in nursing education. A model to develop interventions directed at enhancing graduate nursing student interest in assuming a future faculty role is needed. This study used a social cognitive career theory perspective to examine the effects of past performance in teaching and supervision, social influence, observing others teaching, perceived task demands for nurse educators, self-efficacy, and outcome expectations on Thai graduate nursing students’ (n=236) interest to become a nurse educator. Results of structural equation modeling analyses revealed that social influence and past performance in teaching and supervision had significant effects on interest to become a nurse educator when mediated by self-efficacy and outcome expectations. Observing others teaching and perceived task demands for nurse educators did not significantly predict interest in faculty roles. These findings provide new knowledge about factors and their influence on the development of interest to assume faculty roles. Implications for nursing education include the design of feasible graduate curricula that enhance students’ abilities in faculty role and increases valuation of teaching careers.
Report from the Health Policy Partnership
Person-centred care: Full Report
The state of play in person-centred care: A pragmatic review of how person-centred care is defined, applied and measured, featuring selected key contributors and case studies across the field.
Calls for Abstracts
21-22 November, Harrogate International Conference Centre, Yorkshire
Grants & Awards
NIH Funding Opportunities
The purpose of this Funding Opportunity Announcement (FOA) is to support innovative approaches to identifying, developing, testing, evaluating and/or refining strategies to disseminate and implement evidence-based practices (e.g. behavioral interventions; prevention, early detection, diagnostic, treatment and disease management interventions; quality improvement programs) into public health, clinical practice, and community settings. Conversely, there is a benefit in understanding circumstances that create a need to “de-implement” or reduce the use of strategies and interventions that are not evidence-based, have been prematurely widely adopted, yield sub-optimal benefits for patients, or are harmful or wasteful. In addition, studies to advance dissemination and implementation research methods and measures are encouraged.
Program Announcement Number: PAR 10-038, PAR 10-039, PAR-10-040
CIHR: SPOR Innovative Clinical Trials, Catalyst Grant
Sponsored by the Strategy for Patient Oriented Research (SPOR), the current catalyst grant funding opportunity aims to support the development of iCT research proposals in preparation for application to the multi-year iCT funding opportunities under the same initiative. The specific objective of this funding opportunity is to: Mobilize research communities to explore methodologies to advance research in innovative clinical trials research. Examples of activities that might be conducted under this Funding Opportunity (but are not restricted to) are: Planning and execution of pilot projects or feasibility studies to demonstrate proof of concept and/or generate preliminary data; Development and/or validation of new tools, methodologies and/or protocols.
CIHR: SPOR Innovative Clinical Trial Multi-Year Grant
Sponsored by the Strategy for Patient Oriented Research (SPOR), the multi-year iCT grant will support innovative clinical trials design development. The specific objectives of this funding opportunity are to: Enable new and established investigators to undertake innovative clinical trials in using new or existing methods; Support the development and testing of innovative methods; Build capacity for iCT research through training and mentoring.
Operating Grant: SPOR PIHCI Network – Knowledge Synthesis Grants
The purpose of this funding opportunity is to support knowledge syntheses and scoping reviews, which are the cornerstone of knowledge translation. They transform vast libraries of scientific literature into knowledge that is reliable, relevant and readable for knowledge users (individuals who are likely to be able to use research results to make informed decisions about health policies, programs and/or practices). Research questions should be driven by the needs of policy makers to have evidence-informed decision making.
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KT
Health Care Administration and Organization
Health Care Innovation and Quality Assurance
Organizational Change
Research Practice and Methodology
Aging
KT
Translational research and symptom management in oncology nursing 
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In recent years, translational research (TR) has become a new approach for bridging basic research and clinical practice. This article examines studies in which the authors used TR to learn more about the underlying causes of selected symptoms, and to discuss these results in the context of cancer nursing and symptom management. A literature review was undertaken, plus critical analysis of the authors. TR conducted by cancer nursing scholars has been relatively limited in the past, but is becoming more common as nurses complete additional academic work in the basic sciences and develop research teams with colleagues of those areas of knowledge. The goal in these studies is to show how a set of variables explains differential interventional effects. The availability of TR provides new evidence for the management of symptoms experienced by individuals with cancer, which could lead to improvements in the care of cancer patients across the world.
A systematic review of the use of the Consolidated Framework for Implementation Research
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BACKGROUND: In 2009, Damschroder et al. developed the Consolidated Framework for Implementation Research (CFIR), which provides a comprehensive listing of constructs thought to influence implementation. This systematic review assesses the extent to which the CFIR’s use in implementation research fulfills goals set forth by Damschroder et al. in terms of breadth of use, depth of application, and contribution to implementation research. METHODS: We searched Scopus and Web of Science for publications that cited the original CFIR publication by Damschroder et al. (Implement Sci 4:50, 2009) and downloaded each unique result for review. After applying exclusion criteria, the final articles were empirical studies published in peer-review journals that used the CFIR in a meaningful way (i.e., used the CFIR to guide data collection, measurement, coding, analysis, and/or reporting). A framework analysis approach was used to guide abstraction and synthesis of the included articles. RESULTS: Twenty-six of 429 unique articles (6 %) met inclusion criteria. We found great breadth in CFIR application; the CFIR was applied across a wide variety of study objectives, settings, and units of analysis. There was also variation in the method of included studies (mixed methods (n = 13); qualitative (n = 10); quantitative (n = 3)). Depth of CFIR application revealed some areas for improvement. Few studies (n = 3) reported justification for selection of CFIR constructs used; the majority of studies (n = 14) used the CFIR to guide data analysis only; and few studies investigated any outcomes (n = 11). Finally, reflections on the contribution of the CFIR to implementation research were scarce. CONCLUSIONS: Our results indicate that the CFIR has been used across a wide range of studies, though more in-depth use of the CFIR may help advance implementation science. To harness its potential, researchers should consider how to most meaningfully use the CFIR. Specific recommendations for applying the CFIR include explicitly justifying selection of CFIR constructs; integrating the CFIR throughout the research process (in study design, data collection, and analysis); and appropriately using the CFIR given the phase of implementation of the research (e.g., if the research is post-implementation, using the CFIR to link determinants of implementation to outcomes).
Convergence of Implementation Science, Precision Medicine, and the Learning Health Care System: A New Model for Biomedical Research
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With the rapidly changing environment of health care delivery and the numerous precision medicine studies across the biomedical enterprise, an opportunity exists to study how data from both observational studies and clinical trials can be used to improve health outcomes in real-world practice settings. Implementation science may be able to help provide the missing ingredient at the intersection of precision medicine and learning health care systems.
Training in dissemination and implementation research: a field-wide perspective
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We report outcomes of an NIH-convened meeting on training for dissemination and implementation (D&I) research, focused on accelerating translation of research to healthcare practice. Participants included leaders of current trainings, center directors, and those trained in existing programs. Given the large proportion of D&I research focused on cancer control, mental health, and substance abuse, participants overwhelmingly reflected the experiences and challenges of gaining capacity in behavioral health-related D&I research. The 2-day meeting required participants to draw upon their experiences to help build a field-wide perspective for D&I research training, identify resources needed to support this perspective, and brainstorm gaps in training that needed to be filled. Questions were sent to participants in advance, and responses were synthesized and presented to discuss during the meeting. A preliminary “field-wide” perspective emerged, spanning multiple disciplines, training models, and career levels. Current programs face high demand, need for continued evolution to reflect field advances, and sustainability challenges. Current gaps include implementation practice and predoctoral training. Federal funding is key to D&I research training, be it through grants or agency-led training programs, in order to span and address specialized disease and disorder foci and career tracks.
Which health research gets used and why? An empirical analysis of 30 cases
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BACKGROUND: While health research is considered essential for improving health worldwide, it remains unclear how it is best organized to contribute to health. This study examined research that was part of a Ghanaian-Dutch research program that aimed to increase the likelihood that results would be used by funding research that focused on national research priorities and was led by local researchers. The aim of this study was to map the contribution of this research to action and examine which features of research and translation processes were associated with the use of the results. METHODS: Using Contribution Mapping, we systematically examined how 30 studies evolved and how results were used to contribute to action. We combined interviews with 113 purposively selected key informants, document analysis and triangulation to map how research and translation processes evolved and contributions to action were realized. After each case was analysed separately, a cross-case analysis was conducted to identify patterns in the association between features of research processes and the use of research. RESULTS: The results of 20 of the 30 studies were used to contribute to action within 12 months. The priority setting and proposal selection process led to the funding of studies which were from the outset closely aligned with health sector priorities. Research was most likely to be used when it was initiated and conducted by people who were in a position to use their results in their own work. The results of 17 out of 18 of these user-initiated studies were translated into action. Other features of research that appeared to contribute to its use were involving potential key users in formulating proposals and developing recommendations. CONCLUSIONS: Our study underlines the importance of supporting research that meets locally-expressed needs and that is led by people embedded in the contexts in which results can be used. Supporting the involvement of health sector professionals in the design, conduct and interpretation of research appears to be an especially worthwhile investment.
A systematic review of the outcomes of educational interventions to nurses with simultaneous strategies for guideline implementation
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AIMS: To systematically review the literature on the outcomes of educational interventions relevant to nurses with regard to guideline implementation. BACKGROUND: Previous reviews on interventions to implement guidelines have focused on particular clinical problems, but only one included nursing studies. DESIGN: A systematic review based on the procedure of the Centre for Reviews and Dissemination. METHODS: We searched for papers published from 1 January 2008 to 26 February 2015 using the Cochrane, CINAHL and PubMed MEDLINE databases and paper references were searched manually. Quality appraisal was conducted with tools developed by Thomas et al. and National Heart, Lung, and Blood Institute. Data were analysed with qualitative content analysis and narrative synthesis. RESULTS: The data included 13 studies based on a quasi-experimental study design of 13 different educational interventions, described according to their development and realisation, learning content and teaching and learning methods. Seven interventions were supported by simultaneous strategies, 12 studies reported statistically significant outcomes for the interventions on at least one measurement area and six studies reported improvements in the quality of patient care. Interventions with multi-dimensional content, teaching and learning methods produced several good outcomes. CONCLUSION: Guidelines were implemented in a heterogeneous way and the interventions were delivered once and mainly on a local basis. In the future, we need to test these interventions in different nursing contexts, measure the outcomes on patient care and carry out randomised controlled trials on their effectiveness. It is important to standardise interventions, as this will allow them to be replicated and compared.
The role of researchers in disseminating evidence to public health practice settings: a cross-sectional study
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BACKGROUND: Evidence-based public health interventions, which research has demonstrated offer the most promise for improving the population’s health, are not always utilized in practice settings. The extent to which dissemination from researchers to public health practice settings occurs is not widely understood. This study examines the extent to which public health researchers in the United States are disseminating their research findings to local and state public health departments. METHODS: In a 2012, nationwide study, an online questionnaire was administered to 266 researchers from the National Institutes of Health, the Centers for Disease Control and Prevention, and universities to determine dissemination practices. Logistic regression analyses were used to examine the association between dissemination to state and/or local health departments and respondent characteristics, facilitators, and barriers to dissemination. RESULTS: Slightly over half of the respondents (58%) disseminated their findings to local and/or state health departments. After adjusting for other respondent characteristics, respondents were more likely to disseminate their findings to health departments if they worked for a university Prevention Research Center or the Centers for Disease Control and Prevention, or received their degree more than 20 years ago. Those who had ever worked in a practice or policy setting, those who thought dissemination was important to their own research and/or to the work of their unit/department, and those who had expectations set by their employers and/or funding agencies were more likely to disseminate after adjusting for work place, graduate degree and/or fellowship in public health, and the year the highest academic degree was received. CONCLUSIONS: There is still room for improvement in strengthening dissemination ties between researchers and public health practice settings, and decreasing the barriers researchers face during the dissemination process. Researchers could better utilize national programs or workshops, knowledge brokers, or opportunities provided through academic institutions to become more proficient in dissemination practices.
Improving competencies in evidence-based dementia care: Results from a pilot study on a novel inter-professional training course (the KOMPIDEM project)
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OBJECTIVE: In order to address well-known challenges in dementia care, an inter-professional course was developed to improve medical students’ and nursing students’ competencies in the provision of evidence-based care for people with dementia. The course comprises lectures, problem-based learning (PbL) tutorials and visitations to care facilities. A pilot study was conducted to evaluate the acceptance and feasibility of the inter-professional course. METHODOLOGY: Alongside preliminary implementation of the newly developed course, a pre-post survey was carried out involving all participating students. The questionnaire contained standardized and open-ended questions on participants’ views regarding the quality and relevance of several course components and characteristics. The data were analyzed by means of descriptive statistics. RESULTS: When the course was offered the first time, multiple barriers became evident, leading to premature course termination and subsequent revision of the curriculum. When the revised course was offered, 10 medical students and 8 nursing students participated. The course proved feasible, and the median overall quality was rated as “2” (IQR 2-3) at a rating scale ranging from 1 (very good) to 6 (inadequate). Following aspects were most frequently judged positively: the course’s inter-professional scope, the visitations to care facilities and the PbL tutorials. Potential for improvement was particularly noted with regard to a more distinct focus on well-defined, mainly practical learning outcomes. There were no indications of systematic between-group differences in the medical and nursing students’ perceptions of the course program. CONCLUSIONS: The results confirmed the feasibility of the inter-professional course on dementia care and the relevance of its inter-professional scope. However, to ensure sustainable course implementation in the long term, further program adaptations based on current findings and further evaluation studies focusing on objective parameters of the process and outcome quality are required.
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Health Care Administration and Organization
Who Is Providing the Predominant Care for Older Adults With Dementia?
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OBJECTIVES: To identify which clinical specialties are most central for care of people with dementia in the community and long-term care (LTC) settings. DESIGN: Cross-sectional analysis. PARTICIPANTS: Fee-for-service Medicare beneficiaries aged >/=65 years with dementia. MEASUREMENTS: Specialty, categorized into primary care (internal or family medicine, geriatrics, or nurse practitioners [NPs]) versus other specialties, of the predominant provider of care (PPC) for each patient, defined by providing the most ambulatory visits. RESULTS: Among 2,598,719 beneficiaries with dementia, 74% lived in the community and 80% had a PPC in primary care. In LTC, 91% had primary care as their PPC compared with 77% in the community (P < .001). Cardiology and neurology were the most frequent specialties. NPs were PPCs for 19% of dementia patients in LTC versus 7% in the community (P < .001). CONCLUSION: It is unknown whether specialists are aware of their central role for many dementia patients’ care needs. In LTC, NPs play the lead role as PPCs.
Provision of dementia-related services in Canada: a comparative study
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BACKGROUND: Dementia is common, particularly among older adults, and is one of the major causes of dependency later in life. We sought to provide an overview and comparison of key services related to dementia care as the disease progresses in three large Canadian healthcare centres. METHODS: We identified family physicians, geriatric specialists, and dementia case managers from three major population centres in Canada with universal healthcare coverage. Using a standardized longitudinal dementia case vignette, participants were interviewed on services they would provide at each stage of the disease. We used principles of content analysis to generate codes and identify themes; appropriate time frames from the vignette fitting the necessary provision of services were derived from the Canadian consensus statement and determined in consultation with clinical experts. Proportions of participants that identified dementia-related care services were analyzed at each time point of the vignette using chi-square tests. RESULTS: Thirty-four healthcare providers from Calgary (Alberta), Edmonton (Alberta), and Ottawa (Ontario) participated. Review of our data identified seven overarching themes of dementia-related care services. Services provided in the community setting include future planning and related services, educational and social support services, and home care and respite services. Although all providers consistently identified educational and social support services (e.g. the Alzheimer Society) within the appropriate time frame, the provision of other services was variable. The proportion of providers reporting potential access of future planning services was significantly different across the three sites (Calgary, 91.7 %; Edmonton; 58.3 %; and Ottawa, 30.0 %), p = 0.012. Also, the proportion of providers that identified day program services were significantly different across the three sites (Calgary, 100.0 %; Edmonton, 91.7 %; and Ottawa, 60.0 %), p = 0.023 according to a chi-square test. CONCLUSIONS: We found important types of variability in service delivery among different regions in Canada for a typical patient with dementia and their family caregiver. Health systems can be calibrated by aligning services from different settings to appropriate time points in the vignette, which illustrates the dynamic course of service delivery and opportunities for improvement throughout the disease trajectory.
The Influence of Organizational Systems on Information Exchange in Long-Term Care Facilities: An Institutional Ethnography
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Person-centered care is heavily dependent on effective information exchange among health care team members. We explored the organizational systems that influence resident care attendants’ (RCAs) access to care information in long-term care (LTC) settings. We conducted an institutional ethnography in three LTC facilities. Investigative methods included naturalistic observations, in-depth interviews, and textual analysis. Practical access to texts containing individualized care-related information (e.g., care plans) was dependent on job classification. Regulated health care professionals accessed these texts daily. RCAs lacked practical access to these texts and primarily received and shared information orally. Microsystems of care, based on information exchange formats, emerged. Organizational systems mandated written exchange of information and did not formally support an oral exchange. Thus, oral information exchanges were largely dependent on the quality of workplace relationships. Formal systems are needed to support structured oral information exchange within and between the microsystems of care found in LTC.
Nursing Home Self-assessment of Implementation of Emergency Preparedness Standards
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Introduction Disasters often overwhelm a community’s capacity to respond and recover, creating a gap between the needs of the community and the resources available to provide services. In the wake of multiple disasters affecting nursing homes in the last decade, increased focus has shifted to this vital component of the health care system. However, the long-term care sector has often fallen through the cracks in both planning and response. Problem Two recent reports (2006 and 2012) published by the US Department of Health and Human Services (DHHS), Office of Inspector General (OIG), elucidate the need for improvements in nursing homes’ comprehensive emergency preparedness and response. The Center for Medicare and Medicaid Services (CMS) has developed an emergency preparedness checklist as a guidance tool and proposed emergency preparedness regulations. The purpose of this study was to evaluate the progress made in nursing home preparedness by determining the level of completion of the 70 tasks noted on the checklist. The study objectives were to: (1) determine the preparedness levels of nursing homes in North and South Carolina (USA), and (2) compare these findings with the 2012 OIG’s report on nursing home preparedness to identify current gaps. METHODS: A survey developed from the checklist of items was emailed to 418 North Carolina and 193 South Carolina nursing home administrators during 2014. One hundred seventeen were returned/”bounced back” as not received. Follow-up emails and phone calls were made to encourage participation. Sixty-three completed surveys and 32 partial surveys were received. Responses were compared to data obtained in a 2010 study to determine progress. RESULTS: Progress had been made in many of the overall planning and sheltering-in-place tasks, such as having contact information of local emergency managers as well as specifications for availability of potable water. Yet, gaps still persisted, especially in evacuation standards, interfacing with emergency management officials, establishing back-up evacuation sites and evacuation routes, identification of resident care items, and obtaining copies of state and local emergency planning regulations. CONCLUSION: Nursing homes have made progress in preparedness tasks, however, gaps persist. Compliance may prove challenging for some nursing homes, but closer integration with emergency management officials certainly is a step in the right direction. Further research that guides evacuation or shelter-in-place decision making is needed in light of persistent challenges in completing these tasks.
The Oral Health Care Manager in a Patient-Centered Health Facility
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The dental hygienist team member has an opportunity to coordinate care within an interprofessional practice as an oral health care manager. BACKGROUND AND PURPOSE: Although dental hygienists are currently practicing within interprofessional teams in settings such as pediatric offices, hospitals, nursing homes, schools, and federally qualified health centers, they often still assume traditional responsibilities rather than practicing to the full extent of their training and licenses. This article explains the opportunity for the dental hygiene professional to embrace patient-centered care as an oral health care manager who can facilitate integration of oral and primary care in a variety of health care settings. METHODS: Based on an innovative model of collaboration between a college of dentistry and a college of nursing, an idea emerged among several faculty members for a new management method for realizing continuity and coordination of comprehensive patient care. Involved faculty members began working on the development of an approach to interprofessional practice with the dental hygienist serving as an oral health care manager who would address both oral health care and a patient’s related primary care issues through appropriate referrals and follow-up. This approach is explained in this article, along with the results of several pilot studies that begin to evaluate the feasibility of a dental hygienist as an oral health care manager. CONCLUSION: A health care provider with management skills and leadership qualities is required to coordinate the interprofessional provision of comprehensive health care. The dental hygienist has the opportunity to lead closer integration of oral and primary care as an oral health care manager, by coordinating the team of providers needed to implement comprehensive, patient-centered care.
A qualitative study exploring visible components of organizational culture: what influences the use of psychotropic medicines in nursing homes?
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BACKGROUND: The influence of organizational culture on how psychotropic medicines are used in nursing homes has not been extensively studied. Schein’s theory provides a framework for examining organizational culture which begins with the exploration of visible components of an organization such as behaviors, structures, and processes. This study aimed to identify key visible components related to the use of psychotropic medicines in nursing homes. METHODS: A qualitative study was conducted in eight nursing homes in Sydney, Australia. Purposive sampling was used to conduct semi-structured interviews with 40 participants representing a broad range of health disciplines. Thematic analysis was used to derive concepts. RESULTS: Three visible components were related to psychotropic medicine use. These were drugs and therapeutics committee meetings, pharmacist led medication management reviews and formal and informal meetings with residents and their families. We found that only a few nursing homes utilized drugs and therapeutics committee meetings to address the overuse of psychotropic medicines. Pharmacist led medication management reviews provided a lever to minimize inappropriate psychotropic prescribing for a number of nursing homes; however, in others it was used as a box-ticking exercise. We also found that some nursing homes used meetings with residents and their families to review the use of psychotropic medicines. CONCLUSION: This study was the first to illustrate that visible components of organizational culture do influence the use of psychotropic medicines and explains in detail what of the culture needs to be addressed to reduce inappropriate psychotropic prescribing.
Perceived Benefits, Barriers, and Drivers of Telemedicine From the Perspective of Skilled Nursing Facility Administrative Staff Stakeholders
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Potentially avoidable hospitalizations (PAHs) of skilled nursing facility (SNF) patients are common and costly. Telemedicine represents a unique approach to manage and potentially reduce PAHs in SNFs, having been used in a variety of settings to improve coordination of care and enhance access to providers. Nonetheless, broad implementation and use of telemedicine lags in SNFs relative to other health care settings. To understand why, we surveyed SNF administrative staff attending a 1-day telemedicine summit. Participants saw the highest value of telemedicine in improving the quality of care and reducing readmissions. They identified hospital and managed care telemedicine requirements as primary drivers of adoption. The most significant barrier to adoption was the initial investment required. A joint research-policy effort to improve the evidence base around telemedicine in SNFs and introduce incentives may improve adoption and continued use of telemedicine in this setting.
‘We just do the dirty work’: dealing with incontinence, courtesy stigma and the low occupational status of carework in long-term aged care facilities
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AIMS AND OBJECTIVES: To systematically examine, describe and explain how continence care was determined, delivered and communicated in Australian long aged care facilities. BACKGROUND: Incontinence is a highly stigmatising condition that affects a disproportionally large number of people living in long-term aged care facilities. Its day-to-day management is mainly undertaken by careworkers. We conducted a Grounded theory study to explore how continence care was determined, delivered and communicated in long-term aged care facilities. This paper presents one finding, i.e. how careworkers in long-term aged care facilities deal with the stigma, devaluation and the aesthetically unpleasant aspects of their work. DESIGN: Grounded theory. METHODS: Eighty-eight hours of field observations in two long-term aged care facilities in Australia. In addition, in-depth interviews with 18 nurses and careworkers who had experience of providing, supervising or assessment of continence care in any long-term aged care facility in Australia. RESULTS: Occupational exposure to incontinence contributes to the low occupational status of carework in long-term aged care facilities, and continence care is a symbolic marker for inequalities within the facility, the nursing profession and society at large. Careworkers’ affective and behavioural responses are characterised by: (1) accommodating the context; (2) dissociating oneself; (3) distancing oneself and (4) attempting to elevate one’s role status. CONCLUSION: The theory extends current understandings about the links between incontinence, continence care, courtesy stigma, emotional labour and the low occupational status of carework in long-term aged care facilities. RELEVANCE TO CLINICAL PRACTICE: This study provides insights into the ways in which tacit beliefs and values about incontinence, cleanliness and contamination may affect the social organisation and delivery of care in long-term aged care facilities. Nurse leaders should challenge the stigma and devaluation of carework and careworkers, and reframe carework as ‘dignity work’.
Factors associated with high job satisfaction among care workers in Swiss nursing homes – a cross sectional survey study
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BACKGROUND: While the relationship between nurses’ job satisfaction and their work in hospital environments is well known, it remains unclear, which factors are most influential in the nursing home setting. The purpose of this study was to describe job satisfaction among care workers in Swiss nursing homes and to examine its associations with work environment factors, work stressors, and health issues. METHODS: This cross-sectional study used data from a representative national sample of 162 Swiss nursing homes including 4,145 care workers from all educational levels (registered nurses, licensed practical nurses, nursing assistants and aides). Care worker-reported job satisfaction was measured with a single item. Explanatory variables were assessed with established scales, as e.g. the Practice Environment Scale – Nursing Work Index. Generalized Estimating Equation (GEE) models were used to examine factors related to job satisfaction. RESULTS: Overall, 36.2 % of respondents reported high satisfaction with their workplace, while another 50.4 % were rather satisfied. Factors significantly associated with high job satisfaction were supportive leadership (OR = 3.76), better teamwork and resident safety climate (OR = 2.60), a resonant nursing home administrator (OR = 2.30), adequate staffing resources (OR = 1.40), fewer workplace conflicts (OR = .61), less sense of depletion after work (OR = .88), and fewer physical health problems (OR = .91). CONCLUSIONS: The quality of nursing home leadership-at both the unit supervisor and the executive administrator level-was strongly associated with care workers’ job satisfaction. Therefore, recruitment strategies addressing specific profiles for nursing home leaders are needed, followed by ongoing leadership training. Future studies should examine the effects of interventions designed to improve nursing home leadership and work environments on outcomes both for care staff and for residents.
Exploring staff perceptions on the role of physical environment in dementia care setting
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This study explored staff perceptions of the role of physical environment in dementia care facilities in affecting resident’s behaviors and staff care practice. We conducted focus groups with staff (n = 15) in two purposely selected care facilities in Vancouver, Canada. Focus group participants included nurses, care aides, recreation staff, administrative staff, and family. Data analysis revealed two themes: (a) a supportive physical environment contributes positively to both quality of staff care interaction and residents’ quality of life and (b) an unsupportive physical environment contributes negatively to residents’ quality of life and thereby makes the work of staff more challenging. The staff participants collectively viewed that comfort, familiarity, and an organized space were important therapeutic resources for supporting the well-being of residents. Certain behaviors of residents were influenced by poor environmental factors, including stimulation overload, safety risks, wayfinding challenge, and rushed care. This study demonstrates the complex interrelationships among the dementia care setting’s physical environment, staff experiences, and residents’ quality of life.
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Health Care Innovation and Quality Assurance
Tackling wicked problems in infection prevention and control: a guideline for co-creation with stakeholders
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BACKGROUND: Infection prevention and control can be seen as a wicked public health problem as there is no consensus regarding problem definition and solution, multiple stakeholders with different needs and values are involved, and there is no clear end-point of the problem-solving process. Co-creation with stakeholders has been proposed as a suitable strategy to tackle wicked problems, yet little information and no clear step-by-step guide exist on how to do this. The objectives of this study were to develop a guideline to assist developers in tackling wicked problems using co-creation with stakeholders, and to apply this guideline to practice with an example case in the field of infection prevention and control. METHODS: A mixed-method approach consisting of the integration of both quantitative and qualitative research was used. Relevant stakeholders from the veterinary, human health, and public health sectors were identified using a literature scan, expert recommendations, and snowball sampling. The stakeholder salience approach was used to select key stakeholders based on 3 attributes: power, legitimacy, and urgency. Key values of stakeholders (N = 20) were derived by qualitative semi-structured interviews and quantitatively weighted and prioritized using an online survey. RESULTS: Our method showed that stakeholder identification and analysis are prerequisites for understanding the complex stakeholder network that characterizes wicked problems. A total of 73 stakeholders were identified of which 36 were selected as potential key stakeholders, and only one was seen as a definite stakeholder. In addition, deriving key stakeholder values is a necessity to gain insights into different problem definitions, solutions and needs stakeholders have regarding the wicked problem. Based on the methods used, we developed a step-by-step guideline for co-creation with stakeholders when tackling wicked problems. CONCLUSIONS: The mixed-methods guideline presented here provides a systematic, transparent method to identify, analyze, and co-create with stakeholders, and to recognize and prioritize their values, problem definitions, and solutions in the context of wicked problems. This guideline consists of a general framework and although it was applied in an eHealth context, may be relevant outside of eHealth as well.
Community nursing quality indicators for end-of-life care in England: identification, preparation, and coordination
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High-quality community nursing is essential to ensure that end-of-life care can be provided in community settings in line with patient preferences. This article examines the quality priorities commissioners sought to incentivise in end-of-life care, by reviewing a survey of Commissioning for Quality and Innovation (CQUIN) indicators for community nursing conducted in England in 2014-2015. Findings from the survey suggest that end-of-life care was not given a high priority with the CQUIN indicators for community nursing. Vigorous quality standards, including training and development, need to be in place to make sure that the potential of community nursing is being used to sensitively engage with people nearing the end of their lives and support them to plan their future care, if they so wish.
Antimicrobial Stewardship in Long-Term Care: Metrics and Risk Adjustment
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An antimicrobial stewardship program (ASP) has been recommended for long-term care facilities because of the increasing problem of antibiotic resistance in this setting to improve prescribing and decrease adverse events. Recommendations have been made for the components of such a program, but there is little evidence to support any specific methodology at the present time. The recommendations make minimal reference to metrics, an essential component of any ASP, to monitor the results of interventions. This article focuses on the role of antibiotic use metrics as part of an ASP for long-term care. Studies specifically focused on development of antibiotic use metrics for long-term care are reviewed. It is stressed that these metrics should be considered as an integral part of an ASP in long-term care. In order to develop benchmarks for antibiotic use for long-term care, there must be appropriate risk adjustment for interfacility comparisons and quality improvement. Studies that have focused on resident functional status as a risk factor for infection and antibiotic use are reviewed. Recommendations for the potentially most useful and feasible metrics for long-term care are provided along with recommendations for future research.
Exploring Environmental Variation in Residential Care Facilities for Older People
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OBJECTIVE: The aim of this study was to explore variation in environmental quality in Swedish residential care facilities (RCFs) using the Swedish version of the Sheffield Care Environment Assessment Matrix (S-SCEAM). BACKGROUND: Well-designed physical environments can positively impact on health and well-being among older persons with frail health living in RCFs and are essential for supporting person-centered care. However, the evidence base for informing the design of RCFs is weak, partly due to a lack of valid and reliable instruments that could provide important information on the environmental quality. METHODS: Twenty RCFs were purposively sampled from several regions, varying in their building design, year of construction, size, and geographic location. The RCFs were assessed using S-SCEAM and the data were analyzed to examine variation in environmental quality between and within facilities. RESULTS: There was substantial variation in the quality of the physical environment between and within RCFs, reflected in S-SCEAM scores related to specific facility locations and with regard to domains reflecting residents’ needs. In general, private apartments and dining areas had high S-SCEAM scores, while gardens had lower scores. Scores on the safety domain were high in the majority of RCFs, whereas scores for cognitive support and privacy were relatively low. CONCLUSIONS: Despite high building standard requirements, the substantial variations regarding environmental quality between and within RCFs indicate the potential for improvements to support the needs of older persons. We conclude that S-SCEAM is a sensitive and unique instrument representing a valuable contribution to evidence-based design that can support person-centered care.
Improving oral health for older people in the home care setting: An exploratory implementation study
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OBJECTIVES: To explore how home care providers can support older people to maintain good oral health through implementing a model called Better Oral Health in Home Care (BOHHC). METHOD: A mixed method, pre- to post-implementation design was used. The Promoting Action on Research Implementation in Health Services framework informed the model’s implementation process. RESULTS: High levels of dental need were identified at pre-implementation. Older people self-reported significant oral health improvements following the introduction of tailored home care strategies by care workers, who in turn reported a better understanding and knowledge of the importance of oral care for older people. CONCLUSION: The BOHHC Model provided an evidence-based approach for community-based prevention and early detection of oral health problems. Improving oral health for older people in the home care setting has significant practice and policy implications which require ongoing intersectoral facilitation involving aged care, vocational health education and dental sectors.
Systems to identify potentially inappropriate prescribing in people with advanced dementia: a systematic review
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BACKGROUND: Systems for identifying potentially inappropriate medications in older adults are not immediately transferrable to advanced dementia, where the management goal is palliation. The aim of the systematic review was to identify and synthesise published systems and make recommendations for identifying potentially inappropriate prescribing in advanced dementia. METHODS: Studies were included if published in a peer-reviewed English language journal and concerned with identifying the appropriateness or otherwise of medications in advanced dementia or dementia and palliative care. The quality of each study was rated using the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist. Synthesis was narrative due to heterogeneity among designs and measures. Medline (OVID), CINAHL, the Cochrane Database of Systematic Reviews (2005 – August 2014) and AMED were searched in October 2014. Reference lists of relevant reviews and included articles were searched manually. RESULTS: Eight studies were included, all of which were scored a high quality using the STROBE checklist. Five studies used the same system developed by the Palliative Excellence in Alzheimer Care Efforts (PEACE) Program. One study used number of medications as an index, and two studies surveyed health professionals’ opinions on appropriateness of specific medications in different clinical scenarios. CONCLUSIONS: Future research is needed to develop and validate systems with clinical utility for improving safety and quality of prescribing in advanced dementia. Systems should account for individual clinical context and distinguish between deprescribing and initiation of medications.
Fidelity to a behavioral intervention to improve goals of care decisions for nursing home residents with advanced dementia
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BACKGROUND/AIMS: Ensuring fidelity to a behavioral intervention implemented in nursing homes requires awareness of the unique considerations of this setting for research. The purpose of this article is to describe the goals of care cluster-randomized trial and the methods used to monitor and promote fidelity to a goals of care decision aid intervention delivered in nursing homes. METHODS: The cluster randomized trial tested whether a decision aid for goals of care in advanced dementia could improve (1) the quality of communication and decision-making, (2) the quality of palliative care, and (3) the quality of dying for nursing home residents with advanced dementia. In 11 intervention nursing homes, family decision-makers for residents with advanced dementia received a two-component intervention: viewing a video decision aid about goals of care choices and then participating in a structured decision-making discussion with the nursing home care plan team, ideally within 3 months after the decision aid was viewed. Following guidelines from the National Institutes of Health Behavior Change Consortium, fidelity was assessed in study design, in nursing home staff training for intervention implementation, and in monitoring and receipt of the intervention. We also monitored the content and timing of goals of care discussions. RESULTS: Investigators enrolled 151 family decision-maker/resident dyads in intervention sites; of those, 136 (90%) received both components of the intervention, and 92%-99% of discussions addressed each of four recommended content areas-health status, goals of care, choice of a goal, and treatment planning. A total of 94 (69%) of the discussions between family decision-makers and the nursing home care team were completed within 3 months. CONCLUSION: The methods we used for intervention fidelity allowed nursing home staff to implement a goals of care decision aid intervention for advanced dementia. Key supports for implementation included design features that aligned with nursing home practice, efficient staff training, and a structured guide for goals of care discussions between family decision-makers and staff. These approaches may be used to promote fidelity to behavioral interventions in future clinical trials.
Nursing Home Administrator Quality Improvement Self-Efficacy Scale
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BACKGROUND: Nursing home (NH) quality improvement (QI) is challenging. The critical role of NH leaders in successful QI is well established; however, current options for assessing the QI capabilities of leaders such as the licensed NH administrator are limited. PURPOSE: This article presents the development and preliminary validation of an instrument to measure NH administrator self-efficacy in QI. METHODOLOGY/APPROACH: We used a mixed-methods cross-sectional design to develop and test the measure. For item generation, 39 NH leaders participated in qualitative interviews. Item reduction and content validity were established with a sample of eight subject matter experts. A random sample of 211 administrators from NHs with the lowest and highest Centers for Medicare and Medicaid Services Five-Star Quality ratings completed the measure. We conducted exploratory and confirmatory factor analyses and tested the measure for internal reliability and convergent, discriminant, and known group validity. FINDINGS: The final measure included five subscales and 32 items. Confirmatory factor analysis reaffirmed the factorial structure with good fit indices. The new measure’s subscales correlated with valid measures of self-efficacy and locus of control, supporting the measure’s convergent and discriminant validity. Significant differences in most of the subscales were found between the objective (Centers for Medicare and Medicaid Services Five-Star Quality rating) and subjective (Self-Rated Facility QI Index) quality outcomes, supporting the measure’s known group validity. PRACTICE IMPLICATIONS: The instrument has usefulness to both NH organizations and individual NH administrators as a diagnostic tool to identify administrators with higher/lower chances of successfully implementing QI. Organizations and individuals can use this diagnostic to identify the administrator’s professional development needs for QI, in general, and specific to the instrument’s five subscales, informing directions for in-house training, mentoring, and outside professional development. Attending to NH administrators’ QI professional development needs prior to implementing QI holds promise to enhance the chances for successful implementation of QI, which is urgently needed in many NHs.
Psychometric Testing of a Person-Centred Care Scale – the Eden Warmth Survey in a Long-Term Care Home in New Zealand
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BACKGROUND: Internationally and in New Zealand, traditional nursing homes have been viewed as places for long-term treatment and therapy dominated by the medical model. Since the 1990s, the Eden AlternativeTM which incorporates person-centred care and systemic transformations in nursing homes to promote autonomy and self-determination, and overall wellbeing for aged care residents has become a significant model. The purpose of this study was to evaluate the psychometric performance of the 20 items of the Eden Warmth Survey – Residents (EWS-R) in an aged care home, adopting person-centred care practices. DESIGN: A cross-sectional survey design was used to distribute a residents’ satisfaction survey to a sample of 85 long-term care home residents in May, 2015. METHODS: Psychometric evaluation included item analyses, reliability including internal consistency and stability, criterion-related validity and construct validity. RESULTS: The reduced 13 items demonstrated adequate internal consistency reliability, with a Cronbach’s alpha of 0.82. Two factors, namely Trust and Connectedness with Others and Care Practices, were extracted using exploratory factor analysis and they contributed to 57.9% of the total variance. CONCLUSIONS: The 13-item of EWS-R can be considered as a reliable, valid and predictive scale for assessing quality of life and overall satisfaction on people living in long-term care facilities. Construct validity was confirmed and showed two factors. However, future studies are required to conduct test-retest reliability of the instrument and also to undergo confirmatory factor analysis with a new sample in order to obtain estimates of the fit of the data to the constructs that emerged.
Does evidence-based practice improve patient outcomes? An analysis of a natural experiment in a Spanish hospital
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RATIONALE, AIMS AND OBJECTIVES: Evidence-based practice (EBP) is widely promoted, but does EBP produce better patient outcomes? We report a natural experiment when part of the internal medicine service in a hospital was reorganized in 2003 to form an EBP unit, the rest of the service remaining unchanged. The units attended similar patients until 2012 permitting comparisons of outcomes and activity. METHODS: We used routinely collected statistics (2004-11) to compare the two different methods of practice and test whether patients being seen by the EBP unit differed from standard practice (SP) patients. Data were available by doctor and year. To check for differences between the EBP and SP doctors prior to reorganization, we used statistics from 2000 to 2003. We looked for changes in patient outcomes or activity following reorganization and whether the EBP unit was achieving significantly different results from SP. Data across the periods were combined and tested using Mann-Whitney test. RESULTS: No statistically significant differences in outcomes were detected between the EBP and the SP doctors prior to reorganization. Following the unit’s establishment, the mortality of patients being treated by EBP doctors compared with their previous performance dropped from 7.4% to 6.3% (P < 0.02) and length of stay from 9.15 to 6.01 days (P = 0.002). No statistically significant improvements were seen in SP physicians’ performance. No differences in the proportion of patients admitted or their complexity between the services were detected. Despite this, EBP patients had a clinically significantly lower risk of death 6.27% versus 7.75% (P < 0.001) and a shorter length of stay 6.01 versus 8.46 days (P < 0.001) than SP patients. Readmission rates were similar: 14.4% (EBP); 14.5% (SP). EBP doctors attended twice as many patients/doctor as SP doctors. CONCLUSION: The EBP unit was associated with better patient outcomes and more efficient performance than achieved by the same physicians previously or by SP concurrently.
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Organizational Change
Does Nursing Home Ownership Change Affect Family Ratings on Experience with Care?
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Person-centeredness may suffer in nursing homes (NHs) with recent ownership changes. This study identifies associations between ownership change and reported care experiences, important measures of person-centered care for long-term residents in Maryland NHs. Care experience measures and ownership change data were collected from Maryland Health Care Commission reports, which reported data on 220 Maryland NHs from 2011 and 2012. Facility and market covariates were obtained from 2011 NH Compare and Area Health Resource Files. Linear regression was used to examine whether ownership change in 2011 was associated with lower care experience ratings reported during April to June 2012. Dependent variables were overall care rating (scale 1-10), percentage of respondents answering that they would recommend the NH, and assessments of five care and resident life domains (scale 1-4). Care experiences reported in 2012 were high; however, after controlling for covariates, ownership change was associated with significant decreases in 6 out of 7 measures, including a 0.39-point decrease in overall care rating (p = .001). NH managers and policy makers should consider strategies to improve patient-centeredness after ownership change.
TeamCare: Development and Evaluation of an Evidence Based Model for Supporting Safer, Quality Care Delivery to Residents in Aged Care Facilities
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This paper reports on the evaluation of a teamwork intervention designed to introduce four evidence-based teamwork protocols. The aim of the intervention was to standardize and improve team communication and team leadership in care delivered in a residential aged care facility. The evaluation framework examined changes in understanding and practice of the new teamwork protocols, as well as evolution of leadership from hierarchical, command-and-control style of traditional nursing, to a preferred distributed leadership. Of the four teams involved in training, only one successfully transitioned to working with the new protocols. This outcome is analyzed in terms of whole of organization factors impacting on practice change at the care delivery interface.”.
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Research Practice and Methodology
Evaluating Technical Efficiency of Nursing Care Using Data Envelopment Analysis and Multilevel Modeling
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Data envelopment analysis (DEA) is an advantageous non-parametric technique for evaluating relative efficiency of performance. This article describes use of DEA to estimate technical efficiency of nursing care and demonstrates the benefits of using multilevel modeling to identify characteristics of efficient facilities in the second stage of analysis. Data were drawn from LTCFocUS.org, a secondary database including nursing home data from the Online Survey Certification and Reporting System and Minimum Data Set. In this example, 2,267 non-hospital-based nursing homes were evaluated. Use of DEA with nurse staffing levels as inputs and quality of care as outputs allowed estimation of the relative technical efficiency of nursing care in these facilities. In the second stage, multilevel modeling was applied to identify organizational factors contributing to technical efficiency. Use of multilevel modeling avoided biased estimation of findings for nested data and provided comprehensive information on differences in technical efficiency among counties and states.
Quality of conduct and reporting in rapid reviews: an exploration of compliance with PRISMA and AMSTAR guidelines
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BACKGROUND: Rapid reviews are an accelerated evidence synthesis approach intended to meet the timely needs of decision-makers in healthcare settings. Quality of conduct and reporting has been described in the rapid review literature; however, no formal assessment has been carried out using available instruments. The objective of this study was to explore compliance with conduct and reporting guidelines in rapid reviews published or posted online during 2013 and 2014. METHODS: We performed a comprehensive literature search for rapid reviews using multiple bibliographic databases (e.g. PubMed, MEDLINE, EMBASE, the Cochrane Library) through December 31, 2014. Grey literature was searched thoroughly, and health technology assessment agencies were surveyed to identify additional rapid review products. Candidate reviews were assessed for inclusion using pre-specified eligibility criteria. Detailed data was collected from the included reviews on study and reporting characteristics and variables significant to rapid reviews (e.g. nomenclature, definition). We evaluated the quality of conduct and reporting of included rapid reviews using the A Measurement Tool to Assess Systematic Reviews (AMSTAR) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklists. Compliance with each checklist item was examined, and the sum of adequately reported items was used to describe overall compliance. Rapid reviews were stratified to explore differences in compliance related to publication status. The association between compliance and time to completion or length of publication was explored through univariate regression. RESULTS: Sixty-six rapid reviews were included. There were heterogeneous nomenclature, research questions and approaches to rapid reviews. Compliance with AMSTAR and PRISMA checklists was poor. Published rapid reviews were compliant with individual PRISMA items more often than unpublished reviews, but no difference was seen in AMSTAR item compliance overall. There was evidence of an association between length of publication and time to completion and the number of adequately reported PRISMA or AMSTAR items. CONCLUSIONS: Transparency and inadequate reporting are significant limitations of rapid reviews. Scientific editors, authors and producing agencies should ensure that the reporting of conduct and findings is accurate and complete. Further research may be warranted to explore reporting and conduct guidelines specific to rapid reviews and how these guidelines may be applied across the spectrum of rapid review approaches.
Overcoming challenges of conducting research in nursing homes
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In the UK, one third of the 850,000 people with dementia live in care homes. This article explores the process of carrying out research in nursing homes, identifying barriers and enabling factors, and making recommendations for researchers. The authors’ experiences derive from an ongoing study investigating the effect of educational interventions to promote and embed person-centred care, designed for nurses caring for the people with dementia in nursing homes. Design issues arose from the need to use cluster randomisation which requires a large sample size, implementation fidelity, poor compliance and high numbers of participants lost to follow up. Further difficulties included gaining ethical approval, recruitment, raising concerns and the practicalities of participant retention. There are many benefits of conducting research in care homes, for the homes themselves, their staff and residents. These include training and education, networking and empowerment of staff and subsequent improved standards of care. For the research team, benefits include opportunities to contribute to an underserved setting, to advance care standards and improve nurses’ working lives.
Discrepancies between qualitative and quantitative evaluation of randomised controlled trial results: achieving clarity through mixed methods triangulation
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BACKGROUND: Mixed methods are commonly used in health services research; however, data are not often integrated to explore complementarity of findings. A triangulation protocol is one approach to integrating such data. A retrospective triangulation protocol was carried out on mixed methods data collected as part of a process evaluation of a trial. The multi-country randomised controlled trial found that a web-based training in communication skills (including use of a patient booklet) and the use of a C-reactive protein (CRP) point-of-care test decreased antibiotic prescribing by general practitioners (GPs) for acute cough. The process evaluation investigated GPs’ and patients’ experiences of taking part in the trial. METHODS: Three analysts independently compared findings across four data sets: qualitative data collected view semi-structured interviews with (1) 62 patients and (2) 66 GPs and quantitative data collected via questionnaires with (3) 2886 patients and (4) 346 GPs. Pairwise comparisons were made between data sets and were categorised as agreement, partial agreement, dissonance or silence. RESULTS: Three instances of dissonance occurred in 39 independent findings. GPs and patients reported different views on the use of a CRP test. GPs felt that the test was useful in convincing patients to accept a no-antibiotic decision, but patient data suggested that this was unnecessary if a full explanation was given. Whilst qualitative data indicated all patients were generally satisfied with their consultation, quantitative data indicated highest levels of satisfaction for those receiving a detailed explanation from their GP with a booklet giving advice on self-care. Both qualitative and quantitative data sets indicated higher patient enablement for those in the communication groups who had received a booklet. CONCLUSIONS: Use of CRP tests does not appear to engage patients or influence illness perceptions and its effect is more centred on changing clinician behaviour. Communication skills and the patient booklet were relevant and useful for all patients and associated with increased patient satisfaction. A triangulation protocol to integrate qualitative and quantitative data can reveal findings that need further interpretation and also highlight areas of dissonance that lead to a deeper insight than separate analyses.
Challenges in Patient Recruitment, Implementation, and Fidelity in a Mobile Telehealth Study
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INTRODUCTION: Mobile telehealth (MTH) evaluations in diabetes have been conducted, but few report details and issues related to recruitment, implementation (intervention delivery), fidelity, and context. These have important implications on the interpretation of the findings and effectiveness of the intervention. This article reports these data from an MTH study and describes the challenges experienced in running an intervention such as this in an active clinical environment. MATERIALS AND METHODS: We conducted a mixed-methods MTH study that included a 9-month randomized controlled trial in people with poorly controlled diabetes. Detailed recruitment data were recorded during the study. Data on contacts between MTH participants and the MTH team were collected and used to report on intervention delivery and fidelity. Meeting and field notes, as well as communications between research team members during the study, were used to report on the contextual factors that affected recruitment, implementation, and fidelity. RESULTS: The recruited sample size represented 6% of the total clinic population (n = 1,360) and 10.7% of the number of potentially eligible people at the clinic (n = 802) identified at the beginning of the study. Contextual factors related to patients, healthcare providers, the institution, or the recruitment protocol contributed to influence access to study participants and the number of participants randomized (n = 81). Technical and device-related aspects of the MTH intervention were delivered successfully, but the expected education and clinical feedback by the MTH nurse were not delivered according to the protocol. Although 92.5% of introductory calls were made by the MTH nurses, only 13.3% of expected educational calls were performed. Changes to the MTH nursing staff affected intervention participants differently and contributed to the low fidelity of intervention delivery. CONCLUSIONS: The current article presents data on the influence of contextual factors on the conduct of this MTH study and underlines the need for these processes to be assessed and reported adequately in future MTH research.
Organised crime against the academic peer review system
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Editorials are generally about what we did right in our journal and we do not often publish about our failures. Yet, in this Editorial we feel we have to convey the full story of how we went entirely off track with the publication of a paper.
Collecting Research Impact Evidence
The guidance document, published 14 June 2016, is about the collection, management and use of sources of impact evidence and is a result of a HEFCE-commissioned activity to produce a guidance document for the sector. The webinar summarises current practice in the collection, management and use of impact evidence.
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Aging
Loneliness in Nursing Homes
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Loneliness is a geriatric syndrome associated with impaired health, poor quality of life, cognitive decline, and increased mortality. Loneliness has been defined as a subjective feeling, a discrepancy between a person’s own expectations and one’s actual social network. Therefore, one can suffer from loneliness even if surrounded by others. Feelings of loneliness are common among older people. Approximately 4% to 9% of community-dwelling older people suffer from constant loneliness, and an additional one-third may experience some degree of loneliness.
A knowledge synthesis of culturally- and spiritually-sensitive end-of-life care: findings from a scoping review
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BACKGROUND: Multiple factors influence the end-of-life (EoL) care and experience of poor quality services by culturally- and spiritually-diverse groups. Access to EoL services e.g. health and social supports at home or in hospices is difficult for ethnic minorities compared to white European groups. A tool is required to empower patients and families to access culturally-safe care. This review was undertaken by the Canadian Virtual Hospice as a foundation for this tool. METHODS: To explore attitudes, behaviours and patterns to utilization of EoL care by culturally and spiritually diverse groups and identify gaps in EoL care practice and delivery methods, a scoping review and thematic analysis of article content was conducted. Fourteen electronic databases and websites were searched between June-August 2014 to identify English-language peer-reviewed publications and grey literature (including reports and other online resources) published between 2004-2014. RESULTS: The search identified barriers and enablers at the systems, community and personal/family levels. Primary barriers include: cultural differences between healthcare providers; persons approaching EoL and family members; under-utilization of culturally-sensitive models designed to improve EoL care; language barriers; lack of awareness of cultural and religious diversity issues; exclusion of families in the decision-making process; personal racial and religious discrimination; and lack of culturally-tailored EoL information to facilitate decision-making. CONCLUSIONS: This review highlights that most research has focused on decision-making. There were fewer studies exploring different cultural and spiritual experiences at the EoL and interventions to improve EoL care. Interventions evaluated were largely educational in nature rather than service oriented.
Quantitative Systematic Review of the effects of Non-pharmacological Interventions on Reducing Apathy in Persons with Dementia
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AIM: To review the quantitative evidence concerning the effects of non-pharmacological interventions on reducing apathy in persons with dementia. BACKGROUND: Apathy, a prevalent behavioral symptom among persons with Alzheimer Disease, is defined as a disorder of motivation with deficits in behavioral, emotional and cognitive domains and is associated with serious social and physical obstacles. Non-pharmacological interventions show promise as symptom control modalities among persons with dementia. DESIGN: Quantitative systematic review. DATA SOURCES: CINAHL, PubMed, PSYCHinfo and Cochrane Trials databases were searched for published English-language research inclusive through December 2014, with no early year limiters set. REVIEW METHODS: Comprehensive searches yielded sixteen international randomized controlled trials or quasi-experimental studies based on inclusion criteria and a rigorous quality appraisal process. RESULTS: A narrative summary analysis revealed that non-pharmacological interventions for apathy varied substantially and lacked specificity, conceptual clarity and were methodologically heterogeneous. Select interventions demonstrated effectiveness, but lacked systematic long-term follow-up. Limitations include publication bias and lack of a meta-analytic approach due to the methodological heterogeneity of included studies. CONCLUSION: Study results demonstrate promise for the use of non-pharmacological interventions, particularly music-based interventions, in reducing apathy levels in individuals with dementia. Intervening to reduce apathy may have a positive clinical impact and health care providers should be encouraged to incorporate positive sources of interest and intellectual stimulation into care. However, future research is needed to examine the etiologic mechanism and predictors of apathy, to improve evidence-based interventions and specificity and to optimize dosage and timing of non-pharmacological interventions across the disease trajectory.
The PiTSTOP study: a feasibility cluster randomized trial of delirium prevention in care homes for older people
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BACKGROUND AND OBJECTIVES: delirium is a distressing but potentially preventable condition common in older people in long-term care. It is associated with increased morbidity, mortality, functional decline, hospitalization and significant healthcare costs. Multicomponent interventions, addressing delirium risk factors, have been shown to reduce delirium by one-third in hospitals. It is not known whether this approach is also effective in long-term care. In previous work, we designed a bespoke delirium prevention intervention, called ‘Stop Delirium!’ In preparation for a definitive trial of Stop Delirium, we sought to address key aspects of trial design for the particular circumstances of care homes. DESIGN: a cluster randomized feasibility study with an embedded process evaluation. SETTING AND PARTICIPANTS: residents of 14 care homes for older people in one metropolitan district in the UK. INTERVENTION: Stop Delirium!: a 16-month-enhanced educational package to support care home staff to address key delirium risk factors. Control homes received usual care. MEASUREMENTS: we collected data to determine the following: recruitment and attrition; delirium rates and variability between homes; feasibility of measuring delirium, resource use, quality of life, hospital admissions and falls; and intervention implementation and adherence. RESULTS: two-thirds (215) of eligible care home residents were recruited. One-month delirium prevalence was 4.0% in intervention and 7.1% in control homes. Proposed outcome measurements were feasible, although our approach appeared to underestimate delirium. Health economic evaluation was feasible using routinely collected data. CONCLUSION: a definitive trial of delirium prevention in long-term care is needed but will require some further design modifications and pilot work.
‘Not on the radar’: dentists’ perspectives on the oral health care of dependent older people
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OBJECTIVES: We explored the following research questions: (i) what challenges do dentists face when providing oral health care to dependent older adults; and (ii) to overcome those challenges, what recommendations would dentists providing care give those planning and implementing oral health policy and services for dependent older adults? BACKGROUND: The dentate older population is steadily increasing, and about half will end up in residential care, where dental caries rates over time are at least twice as great as those observed elsewhere. MATERIALS AND METHODS: A qualitative study was used, with semi-structured interviews conducted by a single interviewer. Dental examiners in a recent national survey of oral health in dependent older people in New Zealand were interviewed about their experiences and perspectives of that. RESULTS: The challenges participants identified stemmed from three areas – the patient, the care facility and the oral health sector. To address those challenges, the participants recommended actions at the patient, system and sector levels. Each of the challenges and recommendations had a number of subthemes. Overall, the dentists felt that it is a very complex situation urgently requiring policy development, cross-sectoral collaboration and upskilling of the dental profession, carers, the private sector and the State to ensure a care environment which supports achieving and maintaining oral health among frail elders. CONCLUSIONS: Urgent attention to frail older New Zealanders’ oral health is needed. Such attention needs to focus on not only the narrow dental clinical preventive and therapeutic implications of those needs, but also on the broader health system and policy development challenges.
Transitional care of older adults in skilled nursing facilities: A systematic review
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Transitional care may be an effective strategy for preparing older adults for transitions from skilled nursing facilities (SNF) to home. In this systematic review, studies of patients discharged from SNFs to home were reviewed. Study findings were assessed (1) to identify whether transitional care interventions, as compared to usual care, improved clinical outcomes such as mortality, readmission rates, quality of life or functional status; and (2) to describe intervention characteristics, resources needed for implementation, and methodologic challenges. Of 1082 unique studies identified in a systematic search, the full texts of six studies meeting criteria for inclusion were reviewed. Although the risk for bias was high across studies, the findings suggest that there is promising but limited evidence that transitional care improves clinical outcomes for SNF patients. Evidence in the review identifies needs for further study, such as the need for randomized studies of transitional care in SNFs, and methodological challenges to studying transitional care for SNF patients.
Functional Decline in Residents Living in Nursing Homes: A Systematic Review of the Literature
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OBJECTIVES: To describe the functional dependence progression over time in older people living in nursing homes (NHs). DESIGN: A systematic review of the literature was performed. Studies involving individuals 65 years and older living in NHs, describing their functional decline, improvement or stability in activities of daily living (ADLs), were eligible. The search strategy was applied in MedLine, Cochrane, CINAHL, and SCOPUS databases; aimed at identifying an unbiased and complete list of studies, searching by hand was also performed. The methodological quality of the 27 studies included was assessed. RESULTS: Functional trajectories were documented mainly through multicenter study design including sample size ranging from 2 to 9336 NHs, from 1983 to 2011 throughout a single or multiple follow-ups (>20). The average rate of decline was expressed in different metrics and periods of time: from 3 months with a decline of -0.13 points of 28, to 6 months (-1.78 points of 2829) to 1.85 years (-0.5 points of 6). Eating and toileting were the most documented ADLs and the decline is approximately 0.4 points and 0.2 to 0.4 points of 5 a year, respectively. Among the covariates, individual factors, such as cognitive status, were mainly considered, whereas only 13 studies considered facility-level factors. CONCLUSIONS: Findings report the slow functional decline mainly in women living in US NHs, in years when residents were admitted with a low or medium degree of functional dependence. Considering that in recent years residents have been admitted to NHs with higher-level functional dependence, studies measuring each single ADL, using standardized instruments capable of capturing the signs of decline, stability, or improvement are strongly recommended. Among the covariates, evaluation of both individual and facility-level factors, which may affect functional decline, is also suggested.
Successful Aging and Frailty: Opposite Sides of the Same Coin?
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OBJECTIVES: Operational definitions of successful aging place a strong emphasis on functional capacity, and strategies for successful aging include many factors common to frailty research. We explore the hypothesis that frailty and successful aging are two sides of the same coin and that walking speed may be an objective indicator of successful aging. DESIGN: Observational study of two Chinese cohorts using one to define “fast walkers” and applying this criteria to another cohort to examine associated factors. SETTING: Community survey in cities in China. PARTICIPANTS: A total of 1929 men and women aged 25 to 89 years of age in four cities in China and 4000 men and women 65 years old in Hong Kong SAR China. MEASUREMENTS: The top 25th percentile of walking speed for the whole cohort of 1929 men was determined, and the cutoff value was used to define “fast walkers.” This value was applied to the Hong Kong Chinese population to examine factors associated with fast walking speed. These factors include age, gender, socioeconomic and lifestyle factors, medical history, quality of life, cognitive function, depressive symptoms, body mass index, body composition, and telomere length. RESULTS: Fast walkers had better self-rated health, lower prevalence of stroke, hypertension, cataracts, osteoporosis, and impaired cognitive function. They were more likely to be current alcohol users, more physically active, consumed more vegetables, had better physical component of health-related quality of life, and received more education. They also had lower body mass index, percentage whole body fat as well as appendicular fat, and higher appendicular muscle mass index. In multivariate analysis, the significant contributing variables were age, gender, current alcohol use, physical activity level, vegetable intake, quality of life, and appendicular fat. The area under the curve value on receiver-operating characteristic analysis was 0.77 for these seven variables. CONCLUSIONS: Frailty and successful aging may be considered two sides of the same entity, and fast walking speed may be used as an objective indicator of successful aging.
Care staff training based on person-centered care and dementia care mapping, and its effects on the quality of life of nursing home residents with dementia
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OBJECTIVES: To assess the effects of care staff training based on person-centered care (PCC) and dementia care mapping (DCM) on the quality of life (QOL) of residents with dementia in a nursing home. METHODS: An intervention of staff training based on PCC and DCM was conducted with 40 care staff members at a geriatric nursing home. The effects of the staff training on the QOL of residents with dementia were evaluated by the DCM measurements of 40 residents with dementia three times at about one-month intervals (first, baseline; second, pre-intervention; third, post-intervention). RESULTS: The well-being and ill-being values (WIB values) of the residents with dementia measured by DCM were not different between the first and second rounds before the staff training (p = 0.211). Meanwhile, the WIB values increased from the first and second rounds to the third post-intervention round (p = 0.035 and p < 0.001, respectively); over 50% of the residents had better WIB values. The behavior category ‘interactions with others’ in DCM also demonstrated a significant increase in the third round compared to the first round (p = 0.041). CONCLUSION: Staff training based on PCC and DCM could effectively improve the QOL of residents with dementia.
Identifying and Managing Pain in People with Alzheimer’s Disease and Other Types of Dementia: A Systematic Review
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BACKGROUND AND OBJECTIVE: Pain in patients with Alzheimer’s disease is a complex issue; these patients suffer from the common causes of acute and chronic pain, and some also have neuropathic or nociceptive pain. Whatever the mechanism of pain in these patients, their pain will require careful assessment and management, to insure the correct type and level of analgesia is given. The objective of this systematic review was the identification of studies that have investigated the efficacy of different analgesics on pain intensity or pain-related behavior during nursing home stay and at the end of life. METHODS: A search using pain, pain treatment, and dementia MESH terms and keywords was conducted (October 15, 2015) in MEDLINE, EMBASE, PsychINFO, CINAHL, and Cochrane libraries. RESULTS: Our search yielded 3138 unique hits, published between 1990 and October 2015. We read titles and abstracts, identified 124 papers for full-text evaluation, and included 12 papers to reflect and synthesize the following questions: (1) Which pain assessment tools for people with dementia are responsive to change in pain intensity scores? (2) Which analgesics are efficacy-tested by controlled trials including people with dementia living in nursing homes, including at the end of life? (3) Which outcome measures have been used to identify pain, pain behavior, and/or treatment efficacy in people with dementia? CONCLUSION: Despite increased use of analgesics, pain is still prevalent in people with dementia. Validated pain tools are available but not implemented and not fully tested on responsiveness to treatment. Official guidelines for pain assessment and treatment addressing people with dementia living in a nursing home are lacking. The efficacy of analgesic drug use on pain or neuropsychiatric behavior related to dementia has been hardly investigated.
Dental Hygienist Providers in Long-Term Care: Meeting the Need
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Dental hygienists with expertise in the policies, protocols, and practices of long-term care settings can provide oral health care services that complement the health complexities of residents. BACKGROUND: Adults in the United States are living longer and retaining more teeth, creating an increased demand for oral health care within long-term care facilities. Oral health has, in the past, been perceived as less important than other aspects of daily care and focused more on comfort than control of potential pathogens of oral origin. The concept in medicine of a care continuum from cradle to grave has not generally included provisions for oral health because historically few private dental practices have had provisions for continuation of care once an individual is unable to access the private office. This article supports the inclusion of dental hygienist care team members in long-term care settings. METHODS: The author has provided oral health care services in long-term care for many years, modeling this important career path for dental hygienists. Examples of the personal contributions of the dental hygienist author in helping to meet the extreme needs of this population illustrate this viable career option for dental hygienists. Resources used include federal and state health care publications, data from the American Dental Hygienists Association and selected state dental hygiene associations, published literature, and interviews with dental hygiene business owners, as well as the author’s years of expertise. CONCLUSION: Oral health is a significant health concern for elders and others in long-term care settings. Daily oral care practices and optimal oral health are related to the well-being and quality of life that long-term care residents deserve. Pathways to providing preventive oral health services will gain momentum as dental hygienists become an integral part of the long-term care setting health care team.
Are Obese Residents More Likely to Be Admitted to Nursing Homes That Have More Deficiencies in Care?
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OBJECTIVES: To determine whether obese older adults who qualify for nursing home (NH) placement are as likely as nonobese adults to be admitted to NHs that provide adequate quality of care. DESIGN: Retrospective study. SETTING: NHs in New York State. PARTICIPANTS: Individuals aged 65 and older newly admitted to a NH in New York State in 2006-07. MEASUREMENTS: Total and healthcare-related deficiency citations for each facility were obtained from the Online Survey, Certification, and Reporting file. Bivariate and multivariate regression analyses were used to assess the association between obesity (body mass index (BMI) 30.0-39.9 kg/m(2) ) and morbid obesity (BMI >/= 40.0 kg/m(2) ) separately and admission to facilities with more deficiencies. RESULTS: NHs that admitted a higher proportion of morbidly obese residents were more likely to have more deficiencies, whether total or healthcare related. These NHs also had greater odds of having severe deficiencies, or falling in the top quartile ranking of total deficiencies. After sequentially controlling for the choice of facilities within the inspection region, resident characteristics, and facility covariates, the association between morbid obesity and admission to higher-deficiency NHs persisted. CONCLUSION: Residents with morbid obesity were more likely to be admitted to NHs of poorer quality based on deficiency citations. The factors driving these disparities and their impact on the care of obese NH residents require further elucidation.
Social and behavioural factors associated with frailty trajectories in a population-based cohort of older adults
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OBJECTIVE: The goal of this study was to identify distinct frailty trajectories (clusters of individuals following a similar progression of frailty over time) in an ageing population and to determine social and behavioural factors associated with frailty trajectories. DESIGN: Population-based cohort study. SETTING: Olmsted County, Minnesota. PARTICIPANTS: Olmsted County, Minnesota residents aged 60-89 in 2005. PRIMARY OUTCOME MEASURE: Changes in frailty over an 8-year period from 2005 to 2012, measured by constructing a yearly frailty index. Frailty trajectories by decade of age were determined using k-means cluster modelling for longitudinal data. RESULTS: After adjustment for age and sex, all social and behavioural factors (education, marital status, living arrangements, smoking status and alcohol use) were significantly associated with frailty trajectories in those aged 60-69 and 70-79 years. After further adjustment for baseline frailty, the likelihood of being in the high frailty trajectory was greatest among those reporting concerns from relatives/friends about alcohol consumption (OR (95% CI) 2.26 (1.19 to 4.29)) and those with less than a high school education (OR (95% CI) 1.98 (1.32 to 2.96)) in the 60-69 year olds. In the 70-79 year olds, the largest associations were observed among those with concerns from oneself about alcohol consumption (OR (95% CI) 1.92 (1.23 to 3.00)), those with less than a high school education (OR (95% CI) 1.57 (1.12 to 2.22)), and those living with family (vs spouse; OR (95% CI) 1.76 (1.05 to 2.94)). No factors remained associated with frailty trajectories in the 80-89 year olds after adjustment for baseline frailty. CONCLUSIONS: Social and behavioural factors are associated with frailty, with stronger associations observed in younger ages. Recognition of social and behavioural factors associated with increasing frailty may inform interventions for individuals at risk of worsening frailty, specifically when targeted at younger individuals.
Pain Management in the Elderly
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In general, pain medications are most effective in the nursing home when given on a scheduled basis, rather than as needed, as residents are often unable to ask for as-needed medications, and pain control is difficult to achieve when it reaches increasingly high levels.
Ethical implications of the perception and portrayal of dementia
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The way we perceive and portray dementia has implications for how we act towards people with dementia and how we address the issue of dementia within society. As a multi-disciplinary working group, established within the framework of the European Dementia Ethics Network of Alzheimer Europe, we aimed to describe the different ways that people with dementia are perceived and portrayed within society and to consider the moral implications of this. In the current paper, we address perceptions of dementia as reflected in explanatory models of its cause and nature, descriptions of characteristics of people with dementia, the use of language, media portrayals and the views of people living with dementia. Academics and professionals could use this exploration to reflect on their behaviour and their use of language regarding people with dementia.
Management of Apathy in the Long-Term Care Setting
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Management of apathy is a very important issue in long-term care because many residents suffer from this syndrome. Apathy is present in many residents with neurodegenerative disorders. In Alzheimer disease, apathy is the most common behavioral syndrome. It may occur already in people with mild cognitive impairment (MCI) and could indicate elevated risk of progression into dementia, especially in people with apolipoprotein E ε4. The severity of apathy increases with progression of dementia, and it may be a behavioral marker of a more aggressive dementia, characterized by a faster progression of cognitive, functional, and emotional impairment.
A different ending: Addressing inequalities in end of life care
This month we published a report looking at different people’s experiences of end of life care across England. The report highlights many examples of good practice, but shows that the quality of end of life care for some groups is still not good enough.
Resident Patient Safety Practices in Nursing Home Settings
BACKGROUND: Resident safety issues are common in nursing homes. Relevant literature reports a range of poor clinical outcomes thought to be preventable if specific care processes were consistently implemented. PURPOSE: To describe the state of the science around nursing home safety in order to establish a research agenda for moving the field forward. METHODS: We developed Guiding Questions (GQs) broadly encompassing issues related to resident safety via discussions with Key Informants representing multiple stakeholder groups and expert clinicians and researchers. To address GQs related to identifying and characterizing contextual factors potentially affecting safety issues in the nursing home setting, applicability of hospital-based safety interventions to the nursing home, uptake of safety interventions, and future research areas related to safety in this setting and the overall long-term care landscape (GQs 1, 2, 4), we used input from conversations with Key Informants and conducted targeted literature searches to inform our discussion. To develop a high-level map of relevant evidence (GQ3), we conducted searches of the literature published between 2005 and October 2015 to identify systematic reviews of interventions addressing safety areas in nursing homes. We also searched the published literature for studies of interventions published after the completion of systematic reviews discussed in this brief.
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Events
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Canadian Knowledge Mobilization Forum
The theme for 2016 is: Systems and Sustainability – Creating enduring Knowledge Mobilization. This theme will challenge us all to consider our interests in knowledge mobilization in the context of the world around us. Being the fifth annual Forum, we invite participation that will push thinking and engagement of the knowledge mobilization community further. The Forum will be hosted by York University at The Hospital for Sick Children’s Peter Gilgan Centre for Research and Learning. This world class venue will facilitate active participation, networking, reflection and learning.
Putting Evidence to Work: What Works Global Summit 2016
The What Works Global Summit (WWGS) is an international culture-shifting event, putting evidence at the heart of policy and practice. The conference will share experience from around the world and across sectors on measuring policy impact, experiences in the use of evidence, promoting policy uptake, knowledge translation, and critical appraisal of evidence, as well as discussions of new evidence and study methods.
The CARES conference planning committee has assembled a diverse range of pre-conference workshops and a post-conference day to be held at the University of Liverpool, London Campus.
Programme Grants for Applied Research (PGfAR): Information Events
We are running a series of information events which offer an opportunity to gain a greater understanding of the NIHR Programme Grants for Applied Research (PGfAR) funding stream. Registration to these events will be FREE and refreshments will be provided. Professor Paul Little, Director of the PGfAR programme will be joined by staff from the NIHR Central Commissioning Facility (CCF) and a local PGfAR funding panel member to give a presentation followed by a Q&A session Researchers currently developing, or considering developing, a proposal for submission to PGfAR for funding are invited to take advantage of a one to one session with PGfAR programme and RDS staff to discuss their proposed study. Other dates available.
Online
Learning How to Get the Help You Need: How Caregivers can Navigate the Health & Social Care System
Robert TerSteege, CIRS & Valerie Borggard, Navigator for the MS Knowledge Network provided an overview of how care partners can navigate different systems and shared different resources that care partners can use to help support themselves and their loved ones living with chronic health conditions.
The Center on Knowledge Translation for Disability and Rehabilitation Research (KTDRR) sponsors an annual Online KT Conference for NIDILRR-funded grantees and others, by invitation. This conference is designed to address strategies in the planning and implementation of effective and efficient KT approaches.
What kind of knowledge mobiliser are you?
The Toronto chapter of KTECOP invites you to a presentation by Vicky Ward, Associate Professor of Knowledge Mobilisation at the University of Leeds, UK. Free webinar available for only part one of the presentation. We all know that the field of knowledge mobilisation is awash with confusing terminology, diverse definitions, fragmented literature and unhelpful models and frameworks. This means that many of us with ambitions to help people share knowledge find that our initial enthusiasm can quickly turn into bewilderment and bafflement. This is certainly something which I have faced and often continue to struggle with. In this session I will share something of my journey into the world of knowledge mobilisation and brokering and offer a simple framework designed to help us reflect on and clarify our aims and objectives and identify helpful models for our work as knowledge mobilisers. In the second part of the session I will provide a space for attendees to critically and thoughtfully reflect on their experiences of sharing and brokering knowledge and develop some radical ideas for future action. To do this we will form a temporary ‘community of enquiry’ where we will explore, discuss and debate a question about knowledge brokering, using a method which draws on the principles and practices of community philosophy. This approach, originally developed in educational settings, aims to develop thinking communities, deepen understanding and support communities to take thoughtful action.
When Someone You Know Has Dementia
This talk focuses on what is practical and makes a difference, based on the evidence that exists.
Courses
Cochrane Author Training Workshop
Take this three-day session to learn the basic skills of conducting a Cochrane review. Topics include protocols, setting your question, literature searching, study selection, assessing bias, data and analysis, formulating conclusions, and a hands-on session with the Review Manager software.
Knowledge Translation Professional Certificate (KTPC)
Applications due Friday July 8th! KTPC is a five-day professional development initiative for knowledge translation (KT) professionals (ie. knowledge brokers, KT specialists, KT managers, and the like). Participation in this week-long intensive requires some background in KT. The curriculum focuses on the core competencies of KT work in Canada, as identified by a survey of KT practitioners. These competencies include KT Planning, KT Theories and Frameworks, Implementation and Evaluation, among others. The course includes a balance of theory and practical application and we invite active participation by employers/mentors to help build organizational culture for KT. For tuition fee details and additional information please contact Kelly Warmington, Program Manager, Knowledge Translation, Learning Institute, The Hospital for Sick Children, at (416) 813-7654 Ext. 228189 or kelly.warmington@sickkids.ca.
Online
Behavioral Health Integration: Beyond the Basics (US)
The IHI Virtual Expedition: Behavioral Health Integration – Beyond the Basics is a five-session training that teaches best practices, provides the opportunity to learn from experts in the field (as well as from peers), and presents actionable changes and tools needed to move beyond the basics of your behavioral health integration work. Participants will leave knowing how to sustainably implement the clinical, operational, and financial changes required to make meeting patients’ medical and behavioral health needs a standard part of primary care and begin testing changes to put ideas into action.
News
Looking for Clues to Improve SNF Patient Safety (US)
Research indicates that 59 percent of adverse events during skilled nursing facility (SNF) stays are preventable. In this interview, Lee Adler, DO, Adventist Health System Senior Advisor for Safety, Quality, and Innovation, explains how this alarming data led to the development of the IHI Skilled Nursing Facility Trigger Tool for Measuring Adverse Events. Dr. Adler is one of the co-authors of the tool and faculty for the IHI Virtual Expedition: SNF Trigger Tool – Measuring Patient Harm in Skilled Nursing Facilities.
Baby Boomers Will Become Sicker Seniors Than Earlier Generations (US)
The next generation of senior citizens will be sicker and costlier to the health care system over the next 14 years than previous generations, according to a new report from the United Health Foundation.
Care ‘has improved for 12,000 in homes’ in England
More than 12,000 people in England are now safer and being looked after better in care homes than they were two years ago, the Care Quality Commission says.
Ethnic Seniors Wait for Long-Term Care
A report released last week by the Wellesley Institute has found that seniors from ethnic communities in Toronto have even more difficulty getting placed in ethnic long-term care homes. Seniors waiting for an ethno-specific long-term care home wait for 18 months on average for placement into an ethno-specific long-term care home. The report noted that some of the longest waits for these high-demand services can be as high as eight years.
Exercise may slow brain aging by 10 years (US)
Older men and women who got regular exercise had slower rates of decline in thinking skills with age, a new study reports.
Why don’t doctors screen more for frailty?
This is important because frailty, far more than age, is associated with a poor response to treatment, poor prognosis, and poor restoration of function. Frailty is associated with longer length of stay in hospital, greater risk of delirium, admission to residential care, and death. Additionally, many of the rules based on scientific evidence that guide our practice in medicine don’t apply to frail seniors. And when we do apply these guidelines to frail patients, our treatment recommendations may cause them substantial harm.
Could Thinking Positively About Aging Be The Secret Of Health? (US)
It’s not something a doctor can prescribe as easily as a change in diet. But whether it’s doctor’s orders or society at large, attitudes do change. And Levy’s and Boyles’ research suggests that if people don’t assume that they’ll be useless when they’re older, the payoff could be huge.
Reducing Antipsychotic Medication Use in Long Term Care
In 2014-2015, CFHI worked with 56 long term care homes that agreed to curb the inappropriate prescribing of antipsychotic medication to seniors. Participants received seed funding and training to implement programs to reduce and eliminate antipsychotic use, along with coaching and mentoring, educational materials, tools, and forums for sharing with other sites. The goal was to lower the use of antipsychotics, and improve the quality of care and quality of life for residents.
Companion Animals and the Health of Older Persons
Produced by the International Federation of Ageing, this report is the most extensive literature review to date of research undertaken in the field of companion animals and the health of older people. Encompassing published research from 1980 to 2013, it considers the impact on the physical, psychological, emotional and social health of older people, both in the community as pet owners and as residents of care facilities and other institutions to whom animals are introduced for recreational and therapeutic purposes. The economic impact of companion animals is also considered. Despite limitations and gaps in the research caused by weak project design or poorly-controlled studies, the positive indicators of improvements to the health and well-being of older people are encouraging and affirm the value of future research in this field.
New Brunswick Appropriate Use of Antipsychotics Collaborative
The Canadian Foundation for Healthcare Improvement and the New Brunswick Association of Nursing Homes (NBANH) are working together, with funding support from the Government of New Brunswick, to improve dementia care through the appropriate use of antipsychotic medications in New Brunswick nursing homes.
Ontario unveils proposal for community and home care overhaul
The proposed changes are designed to make it easier for patients to access the health-care system, regardless of where they live. According to the Ontario Ministry of Health and Long-Term Care, this would be accomplished by establishing a formal link between local health units and LHINs, establishing a single phone number for residents to call when they need to find a new care provider closer to home and making transitions between the hospital, community care, mental health services and other services easier.
Access to advice line expanded to assist Albertans with dementia
A specialized service that was rolled out to rural zones in the province in 2015 is now being expanded to provide dementia patients and their families in the Calgary and Edmonton areas with access to immediate advice from healthcare professionals.
Doctors urge improvement in end-of-life care
Palliative care doctors are urging the Canadian government to improve and standardize end-of-life care across the country. A big bulge of the population is getting old and as they do so medical problems increase. The Canadian Society of Palliative Care Physicians says the medical system is poorly equipped to handle the increasing demand.
Older women more likely to be prescribed inappropriate drugs: study
More than a quarter of people between the ages of 65 and 74 receive inappropriate medications, a study from the University of British Columbia has found. But women are much more likely than men to be prescribed drugs that older patients should avoid.
The future of healthy aging is… yesterday
The road to healthy aging is long, starting as early as conception and birth. In fact, the future of our healthy aging is a trajectory, which goes back into our yesterdays and moves forward with us as we advance. Major research efforts are being made to better understand the determinants of healthy aging. If public health programs and campaigns would support them, we would see a much brighter future of aging.
Public health must address our most ‘wicked problems’
Upstream’s Ryan Meili caught Dr. Butler-Jones on the phone recently to chat about the state of Public Health and it’s role in addressing the ‘wicked problems’ our society faces.
Alzheimer’s research funding on path for additional $400 million increase (US)
Today, the call for increased Alzheimer’s research funding from Alzheimer’s Association advocates reached a critical milestone, as the Senate Labor-HHS Appropriations Subcommittee announced a proposed $400 million increase for Alzheimer’s research at the NIH. This bipartisan effort was led by Alzheimer’s champions Chairman Roy Blunt (R-Mo.) and Ranking Member Patty Murray (D-Wash.), who also oversaw last year’s historic funding increase.
What’s the best way to talk to someone with Alzheimer’s? (US)
Marano suggests that relatives or friends of people with Alzheimer’s take the lead from the patient, even if it seems repetitive or not focused.
What kind of health workforce will be needed to serve our aging population?
There has been much discussion about how to prepare for this bulge of aging baby boomers. Indeed, there has been no shortage of media and policy reports on this topic. These include aging strategies, dementia strategies, aging-at-home strategies; home care strategies, integrated care strategies, end-of-life strategies and more. While most of these are well thought out, they frequently overlook one very important implication: what kind of health workforce will be needed to deliver on these strategies?
Delays in Spotting Dementia Can Bring Dangers
People who have signs of probable dementia but haven’t yet been formally diagnosed are nearly twice as likely as those who’ve been diagnosed to be performing potentially unsafe activities such as cooking, driving, and managing their medications and finances.
Halifax ER doctor says elder ‘abandonment’ a growing issue
An elderly woman spent more than a week in a Halifax emergency room because her family refused to take her home, according to the chief of Nova Scotia’s largest ER. Dr. Samuel Campbell said the woman was not ill, but her grandchildren were looking after her and felt they could no longer cope with her mild dementia.
Nursing home residents fall frequently. About 1,800 older adults living in nursing homes die each year from fall-related injuries and those who survive frequently sustain injuries that result in permanent disability and reduced quality of life.
The following reflections are from speakers at today’s one-day workshop, Communicating impact: the role of news and media hosted by The London School of Economics and Political Science (LSE) and the Institute for Fiscal Studies (IFS). The workshop is part of the ESRC’s capacity-building programme for the Impact Acceleration Account (IAA) community and focuses on ways in which the research community can communicate research findings and expert analysis most effectively, and to connect with non-academic audiences to maximise opportunities for impact.
Academic Job Hunts From Hell: Why You Weren’t Picked (US)
Your attempts at intel gathering will draw a blank. In this series on the dark sides of the academic job hunt so far we have dissected fake searches, bad fits, inappropriate questions, scheduling challenges, interview snafus, contract-negotiations woes, and multiple-offer challenges.
My Writing Productivity Pipeline (US)
Write a lot, and often, we are told — but no one shows us how to keep track of all that work.
How junior researchers can write effectively and simply
Early career researchers have many competing responsibilities. They’re trying to please superiors, be available to colleagues and at the same time be perfect mentors, scholars and parents. They should not be blamed if they don’t “omit the needless words” which make their writing long and hard to read. But who is thinking of the readers’ time?
UCU report: ‘academics work two days a week unpaid’
The average academic is working unpaid for the equivalent of two days every week, says a new study on the growth of “unreasonable, unsafe and excessive” workloads. Academic staff work an average of 50.9 hours per week, according to the latest University and College Union workload survey, Workload is an Education Issue. The study is based on responses from about 12,100 university staff, most of whom work full time.
Female scientists less likely to receive CIHR grants, stats show
At a time when getting more women into science is a Canadian government priority, there are new questions about whether gender bias is making it harder for female scientists to get financial support for research and training.
Academic Publishing: Toward a New Model (US)
When faced with a choice of publishing within the traditional models or in an open-access venue that may have little (or, rightly or wrongly, suspect) review, most academics choose to sacrifice the potential of a larger audience for more certainty in furthering their careers. How, then, might we rethink academic publishing to increase accessibility while maintaining the benefits of peer review? More important, how might we do this while recognizing the fundamental dual realities that (1) universities are already too stretched to devote significant resources to peer reviewing and (2) publishers are companies whose right to thrive financially should be respected? One solution is to cut the Gordian knot of review and dissemination.
Resources
New Alzheimer’s and Dementia Conversation Starter Kit (US)
The Alzheimer’s Disease and Other Forms of Dementia Conversation Starter Kit is the latest resource developed by IHI and The Conversation Project. This new Starter Kit provides guidance for starting conversations about end-of-life care in the early stages of decline, and for using the Kit to speak on your loved one’s behalf when advanced illness occurs.
KT Tools, Toolkits and Resources
The list includes General KT Tools and Toolkits, resources for developing a KT plan, evaluating KT, and many other resources.
I2S provides a growing repository of resources drawing from related approaches, including systems thinking, transdisciplinarity, implementation science, action research and more. I2S books and reports present original concepts, methods and applications.
Communication and Optimal Resolution (CANDOR) Toolkit (US)
The Agency for Healthcare Research and Quality (AHRQ) released a new online toolkit to help hospital and health system leaders and clinicians communicate with patients and their families when something goes wrong with their care. The toolkit will help expand use of an AHRQ-developed communication and resolution process called Communication and Optimal Resolution, or CANDOR, which gives hospitals and health systems the tools to respond immediately when a patient is harmed and to promote candid, empathetic communication and timely resolution for patients and caregivers.
Webcast: Plain Language Strategies
In this webcast, Kelly Warmington, program manager of Knowledge Translation at the Hospital for Sick Children (Toronto, Ontario) discusses the importance of creating materials in plain language. She shares concrete tips and tools for writing websites, research briefs, consent forms, and other educational materials in plain language. This webcast originally aired with a live audience at Transitions Research and Training Center.
Do you need to evaluate a public health program or policy?
This toolkit outlines a three-phase process for planning, doing, and using a program evaluation. With itemized lists and steps, along with templates and worksheets, this workbook is a useful tool for evaluating public health initiatives.
New video! Using Evidence in Public Health Decisions: Why it Matters
In this video, four Canadian experts explain why evidence-informed decision making is essential for public health. David Mowat, Carol Timmings, Gaynor Watson-Creed and Jocelyne Sauvé talk candidly about the impact that using evidence has had on their practices.
Opportunities
Can you be an improvement science leader? Fellowships open for application
We are looking for up to five talented individuals to develop into future leaders of improvement science. Our Improvement Science Fellowships programme offers a unique post-doctoral research and personal development opportunity with three years’ funding to lead original, applied research dedicated to improving health care in the UK.
Tenured/Tenure Track Faculty in Dissemination and Implementation Science
The Institute for Health, Health Care Policy and Aging Research, a unit of Rutgers Biomedical and Health Sciences (RBHS), is developing a program in Dissemination and Implementation Science and seeks tenured/tenure track faculty with a research focus in this area. Funding is anticipated to be available for two positions, one at the Full or Associate Professor level and one at the Assistant Professor level.
ACCORDS is hiring a Health Services Researcher (Assistant Professor) to develop and expand health care delivery science research programs and federally funded research grants. This researcher will develop his/her own research agenda and serve as a resource and mentor to faculty and trainees for developing health services research at the Center on Aging, ACCORDS and across campus.
Implementation Scientist, Center for Clinical Quality and Implementation Research
Vanderbilt University Medical Center is seeking qualified researchers to join the Center for Clinical Quality and Implementation Research. Located in Nashville, TN, Vanderbilt is a leading academic medical center with strong traditions in health services research, quality improvement, biomedical informatics, and health system innovation. The medical center is a site for the VA National Quality Scholars Fellowship Program, as well as the IHI Open School.
For More Information Contact: Sunil Kripalani, MD, MSc, SFHM
Director, Center for Clinical Quality and Implementation Research
sunil.kripalani@vanderbilt.edu
This full-time, fixed term grant funded position works in the CanSOLVE CKD Knowledge Tool Laboratory, located in the Cumming School of Medicine (CSM) at the University of Calgary. The Lab is funded through a five year, national CIHR SPOR Network grant in Chronic Disease. The Lab provides support to researchers within and outside the CSM.
Job ID#: 8718. The successful candidate will be responsible for: building capacity for evidence use in public health at both organizational and individual levels; developing active and sustainable networks and partnerships with the aim of identifying gaps and advancing evidence-informed decision making across Canada.
The Knowledge Translation (KT) Program at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital is currently looking for Research Coordinator 1 to join the dynamic and growing team. The primary role of the Research Coordinator is to support ongoing research and implementation projects. Currently we are seeking an individual to take on a full time (1.0 FTE) two-year contract to support the Team of Implementation, Evaluation and Sustainability (TIES) within the Knowledge Translation Program.
