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New article by Dr. Shannon Scott
The potential for nurses to contribute to and lead improvement science in health care
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Aim: A discussion of how nurses can contribute to and lead improvement science activities in health care. Background: Quality failures in health care have led to the urgent need for healthcare quality improvement. However, commonly quality improvement interventions proceed to practice implementation without rigorous methods or sufficient empirical evidence. This lack of evidence for quality improvement has led to the development of improvement science, which embodies quality improvement research and quality improvement practice. This paper discusses how the discipline of nursing and the nursing profession possesses many strengths that enable nurses to lead and to play an integral role in improvement science activities. However, we also discuss that there are insufficiencies in nursing education that require attention for nurses to truly contribute to and lead improvement science in health care. Design: Discussion paper. Data sources: This paper builds on a collection of our previous work, a 12-month scoping review (March 2013-March 2014), baseline study on a quality improvement management system (Lean), interviews with nurses on quality improvement implementation and supporting literature. Implications for nursing: This paper highlights how nurses have the philosophical, theoretical, political and ethical positioning to contribute to and lead improvement science activities. However up to now, the potential for nurses to lead improvement science activities has not been fully used. Conclusion: We suggest that one starting point is to include improvement science in nursing education curricula. Specifically, there needs to be increased focus on the nursing roles and skills needed to contribute to and lead healthcare improvement science activities.
New TREC Newsletter available!
November 2016 Newsletter
Read the latest news from TREC.
Calls for Abstracts
CALL FOR ABSTRACTS: 8-10 August 2018, Toronto
International Federation on Ageing 14th Global Conference 
The Global Conference is a longstanding, highly regarded international forum for world-class experts in the field of ageing. Supported by a network of leading international partner organizations, the 2018 Conference will welcome 1,300 key stakeholders from over 50 countries to downtown Toronto. You can now register for the conference, submit an abstract, propose a master class, and apply for our bursary program. To submit an abstract, you must first register for the 14th Global Conference. Please note that you are able to defer payment while registering, and that the reduced early bird rate expires on October 6, 2017. Once you have registered, you will receive a confirmation e-mail containing a link to the EventsAir Presentation Portal, where you can submit your abstract.
CALL FOR ABSTRACTS: CAHSPR May 24-26 2017, Toronto
Canadian Association for Health Services and Policy Research (CAHSPR)
The Canadian Association for Health Services and Policy Research (CAHSPR) is a multidisciplinary association dedicated to improving health and health care by advancing the quality, relevance, and application of research on health services and health policy. As the largest and most diverse association of its kind in Canada, CAHSPR provides members with unique opportunities for networking, research collaboration, and career advancement. Registration opens in February 2017.
CALL FOR ABSTRACTS: April 5-7 2017, Oxford UK
RCN International Nursing Research conference and exhibition 2017
The RCN Research Society invites the submissions of contemporary research abstracts, which make a fresh contribution to a body of knowledge. Papers which use research to reflect on current issues in nursing are particularly welcome as well as abstracts which, debate developments in research methods, research management and research policy, and innovative methodological papers.
Grants & Awards
FGSR Doctoral Micro-Grants (DMG)
FGSR is committed to improving the quality of graduate education at the University of Alberta. Doctoral Micro-Grants (DMG) support ideas to inspire program innovations which reflect our changing world. The awards will empower University of Alberta faculty members in departments and faculties offering doctoral programs to rethink, revisit, re-develop, re-design, or create new doctoral program elements and delivery methods for the future of doctoral education. Those with innovative ideas for doctoral curriculum changes are encouraged to apply for up to $10,000 to develop prototypes.
Publications
KT
Health Care Administration and Organization
Research Practice and Methodology
Aging
KT
Forging a link between mentoring and collaboration: A new training model for implementation science
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BACKGROUND: Training investigators for the rapidly developing field of implementation science requires both mentoring and scientific collaboration. Using social network descriptive analyses, visualization, and modeling, this paper presents results of an evaluation of the mentoring and collaborations fostered over time through the National Institute of Mental Health (NIMH) supported by Implementation Research Institute (IRI). METHODS: Data were comprised of IRI participant self-reported collaborations and mentoring relationships, measured in three annual surveys from 2012 to 2014. Network descriptive statistics, visualizations, and network statistical modeling were conducted to examine patterns of mentoring and collaboration among IRI participants and to model the relationship between mentoring and subsequent collaboration. RESULTS: Findings suggest that IRI is successful in forming mentoring relationships among its participants, and that these mentoring relationships are related to future scientific collaborations. Exponential random graph network models demonstrated that mentoring received in 2012 was positively and significantly related to the likelihood of having a scientific collaboration 2 years later in 2014 (p = 0.001). More specifically, mentoring was significantly related to future collaborations focusing on new research (p = 0.009), grant submissions (p = 0.003), and publications (p = 0.017). Predictions based on the network model suggest that for every additional mentoring relationships established in 2012, the likelihood of a scientific collaboration 2 years later is increased by almost 7 %. CONCLUSIONS: These results support the importance of mentoring in implementation science specifically and team science more generally. Mentoring relationships were established quickly and early by the IRI core faculty. IRI fellows reported increasing scientific collaboration of all types over time, including starting new research, submitting new grants, presenting research results, and publishing peer-reviewed papers. Statistical network models demonstrated that mentoring was strongly and significantly related to subsequent scientific collaboration, which supported a core design principle of the IRI. Future work should establish the link between mentoring and scientific productivity. These results may be of interest to team science, as they suggest the importance of mentoring for future team collaborations, as well as illustrate the utility of network analysis for studying team characteristics and activities.
Raising Awareness of Research Evidence among Health Professionals Delivering Dementia Care: are Knowledge Translation Workshops Useful?
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Abstract: Providing information about latest research via educational sessions to health professionals caring for people with dementia may be insufficient to drive change. This project explored self-reported impacts on practice change of adding information about knowledge translation (KT) to a national dementia education program. Six national workshop days were held. Each provided the option of participating in a Principles of KT and innovation implementation seminar in addition to a clinical topic update (sexualities and dementia, or managing behavioural and psychological symptoms of dementia). Six months post workshop 321 participants were invited to complete a research utilization survey, 75 responded. KT seminar participants were more likely to report Instrumental outcomes (e.g. changed policies, procedures) than those who did not participate in the KT seminar. Including KT information in educational sessions for health professionals may increase the likelihood of practice change in the field of dementia care, and warrants further research.; AbstractProviding information about latest research via educational sessions to health professionals caring for people with dementia may be insufficient to drive change. This project explored self-reported impacts on practice change of adding information about knowledge translation (KT) to a national dementia education program. Six national workshop days were held. Each provided the option of participating in a Principles of KT and innovation implementation seminar in addition to a clinical topic update (sexualities and dementia, or managing behavioural and psychological symptoms of dementia). Six months post workshop 321 participants were invited to complete a research utilization survey, 75 responded. KT seminar participants were more likely to report Instrumental outcomes (e.g. changed policies, procedures) than those who did not participate in the KT seminar. Including KT information in educational sessions for health professionals may increase the likelihood of practice change in the field of dementia care, and warrants further research.
Knowledge brokering for healthy aging: a scoping review of potential approaches
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Developing a healthcare delivery system that is more responsive to the future challenges of an aging population is a priority in Canada. The World Health Organization acknowledges the need for knowledge translation frameworks in aging and health. Knowledge brokering (KB) is a specific knowledge translation approach that includes making connections between people to facilitate the use of evidence. Knowledge gaps exist about KB roles, approaches, and guiding frameworks. The objective of the scoping review is to identify and describe KB approaches and the underlying conceptual frameworks (models, theories) used to guide the approaches that could support healthy aging.
Implementation, context and complexity
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BACKGROUND: Context is a problem in research on health behaviour change, knowledge translation, practice implementation and health improvement. This is because many intervention and evaluation designs seek to eliminate contextual confounders, when these represent the normal conditions into which interventions must be integrated if they are to be workable in practice. DISCUSSION: We present an ecological model of the ways that participants in implementation and health improvement processes interact with contexts. The paper addresses the problem of context as it affects processes of implementation, scaling up and diffusion of interventions. We extend our earlier work to develop Normalisation Process Theory and show how these processes involve interactions between mechanisms of resource mobilisation, collective action and negotiations with context. These mechanisms are adaptive. They contribute to self-organisation in complex adaptive systems. CONCLUSION: Implementation includes the translational efforts that take healthcare interventions beyond the closed systems of evaluation studies into the open systems of ‘real world’ contexts. The outcome of these processes depends on interactions and negotiations between their participants and contexts. In these negotiations, the plasticity of intervention components, the degree of participants’ discretion over resource mobilisation and actors’ contributions, and the elasticity of contexts, all play important parts. Understanding these processes in terms of feedback loops, adaptive mechanisms and the practical compromises that stem from them enables us to see the mechanisms specified by NPT as core elements of self-organisation in complex systems.
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Health Care Administration and Organization
Dealing with professional misconduct by colleagues in home care: a nationwide survey among nursing staff
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BACKGROUND: Professional misconduct in healthcare, a (generally) lasting situation in which patients are at risk or actually harmed, can jeopardise the health and well-being of patients and the quality of teamwork. Two types of professional misconduct can be distinguished: misconduct associated with incompetence and that associated with impairment. This study aimed to (1) quantify home-care nursing staff’s experiences with actual or possible professional misconduct; (2) provide insight into the difficulty home-care nursing staff experience in reporting suspicions of professional misconduct within the organisation and whether this is related to the individual characteristics of nursing staff; and (3) show which aspects of professional practice home-care nursing staff consider important in preventing professional misconduct. METHODS: A questionnaire survey was held among registered nurses and certified nursing assistants employed in Dutch home-care organisations in 2014. The 259 respondents (60 % response rate; mean age of 51; 95 % female) were members of the Dutch Nursing Staff Panel, a nationwide group of nursing staff members in various healthcare settings. RESULTS: Forty-two percent of the nursing staff in home care noticed or suspected professional misconduct by another healthcare worker during the previous year, predominantly a nursing colleague. Twenty to 52 % of the nursing staff experience difficulty in reporting suspicions of different forms of incompetence or impairment. This is related to educational level (in the case of incompetence), and managerial tasks (both in the case of incompetence and of impairment). Nursing staff consider a positive team climate (75 %), discussing incidents (67 %) and good communication between healthcare workers (57 %) most important in preventing professional misconduct among nursing staff. CONCLUSIONS: Suspicions of professional misconduct by colleagues occur quite frequently among nursing staff. However, many nursing staff members experience difficulty in reporting suspicions of professional misconduct, especially in the case of suspected impairment. Home-care employers and professional associations should eliminate the barriers that nursing staff may encounter when they attempt to raise an issue. Furthermore, advocating a positive team climate within nursing teams, encouraging nursing staff to discuss incidents and facilitating this, and promoting good communication between healthcare workers may be appropriate strategies that help reduce professional misconduct by nursing staff.
Work-Family Conflict, Sleep, and Mental Health of Nursing Assistants Working in Nursing Homes
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Work-family conflict is challenging for workers and may lead to depression, anxiety, and overall poor health. Sleep plays an important role in the maintenance of mental health; however, the role of sleep in the association between work-family conflict and mental health is not well-studied. Questionnaires were collected from 650 nursing assistants in 15 nursing homes. Multivariate linear regression modeling demonstrated that increased work-family conflict was associated with lower mental health scores (beta = -2.56, p < .01). More work-family conflict was correlated with more job demands, less job control, less social support, and longer work hours. Poor sleep quality, but not short sleep duration, mediated the association between work-family conflict and mental health. Workplace interventions to improve nursing assistants’ mental health should increase their control over work schedules and responsibilities, provide support to meet their work and family needs, and address healthy sleep practices.
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Research Practice and Methodology
Improving the Peer review process: Capturing more information and enabling high-risk/high-return research
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The Black-Scholes model and the peer-review process are combined to offer more insight into the apparent value of research projects. In doing so high-risk/high-return research is found to be more attractive and financially rational than under the traditional peer review approach. In other words projects with the highest disagreement amongst panel members should sometimes be selected even though the average panel score may not be the highest under consideration. This finding is important as it improves the existing peer review process by utilizing not only the mean value of peer reviews, but also their standard deviation. This note also opens the consideration of the potential of Real Options approaches for decision support for project selection and management of research.
Which gender gap? Factors affecting researchers’ scientific impact in science and medicine
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The article examines whether scientific production, research funding, Impact Factor of journals and size of collaborative teams have an influence on the propensity to receive more citations, and whether the influence of these factors differs across genders. Using a very complete database of funding, scientific papers and citations compiled at the individual researchers’ level, we estimate panel data regressions on the discipline-normalised citation rates of individual academics in Quebec. Our results show that although most of the indicators examined have a positive influence on the relative citation rate, when it comes to gender differences, not having enough public funding and raising private funding appear slightly detrimental for women in the health sciences. In addition, when women collaborate with the same number of co-authors as men, or target similar Impact Factor journals, their articles are less cited then those of their male colleagues. Almost no gender effect is found in the natural sciences and engineering where women are still a minority. Our results worryingly show that academics who publish with a larger proportion of female co-authors are less cited. Furthermore, when targeting similar Impact Factor journals, researchers who collaborate with a higher proportion of female co-authors are consistently less cited in both the health and NSE fields than if they were publishing with a male dominated group of co-authors.
Preparing Nursing Home Data from Multiple Sites for Clinical Research – A Case Study Using Observational Health Data Sciences and Informatics
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Introduction: A potential barrier to nursing home research is the limited availability of research quality data in electronic form. We describe a case study of converting electronic health data from five skilled nursing facilities to a research quality longitudinal dataset by means of open-source tools produced by the Observational Health Data Sciences and Informatics (OHDSI) collaborative. Methods: The Long-Term Care Minimum Data Set (MDS), drug dispensing , and fall incident data from five SNFs were extracted, translated, and loaded into version 4 of the OHDSI common data model. Quality assurance involved identifying errors using the Achilles data characterization tool and comparing both quality measures and drug exposures in the new database for concordance with externally available sources. Findings: Records for a total 4,519 patients (95.1%) made it into the final database. Achilles identified 10 different types of errors that were addressed in the final dataset. Drug exposures based on dispensing were generally accurate when compared with medication administration data from the pharmacy services provider. Quality measures were generally concordant between the new database and Nursing Home Compare for measures with a prevalence ≥ 10%. Fall data recorded in MDS was found to be more complete than data from fall incident reports. Conclusions: The new dataset is ready to support observational research on topics of clinical importance in the NH including patient-level prediction of falls. The extraction, translation, and loading process enabled the use of OHDSI data characterization tools that improved the quality of the final dataset.
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Aging
Development of a caregiver-reported measure to support systematic assessment of people with dementia in long-term care: The Integrated Palliative care Outcome Scale for Dementia
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Background: Symptom burden is common for long-term care residents with dementia which if untreated compromises quality of life. Measurement tools can support assessment of symptoms and problems but are not widely used in long-term care settings. We developed the Integrated Palliative care Outcome Scale for Dementia derived from the Palliative care Outcome Scale, Palliative care Outcome Scale–Symptom and Integrated Palliative care Outcome Scale.Aim: To examine the content validity, acceptability and comprehension of Integrated Palliative care Outcome Scale for Dementia for routine use in long-term care settings for people with dementia and to refine Integrated Palliative care Outcome Scale for Dementia.Design: A multi-method qualitative study consisting of focus groups, semi-structured interviews and cognitive interviews.Setting/participants: Three residential long-term care settings in London, UK. Focus group and semi-structured interview participants included caregiver staff, family, general practitioners and district nurses. Caregiver staff were sampled purposively for cognitive interviews.Results: A total of 26 respondents participated in the focus groups (n = 21) or semi-structured interviews (n = 5) and 10 caregiver staff completed cognitive interviews. Additional symptoms and problems included agitation, wandering, sleep problems, communication problems and diarrhoea. Refinements or lay terms were required to improve comprehension and consistency of item response for nausea, drowsiness, delusions/hallucinations, agitation, loss of interest, communication problems and interaction. A video presentation was required to support comprehension of instructions and assessment of verbally compromised residents.Conclusion: Integrated Palliative care Outcome Scale for Dementia is a comprehensive and acceptable caregiver-reported measure to detect symptoms and problems in dementia. It is suitable for caregiver staff without professional training as it has been refined and tailored to maximise caregiver expertise, ready for further psychometric testing.
“Could We Hold Hands?” Older Lesbian and Gay Couples’ Perceptions of Long-Term Care Homes and Home Care
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This qualitative study describes expectations, concerns, and needs regarding long-term care (LTC) homes and home care services of 12 older lesbian and gay couples living in Canada. Our findings reflect four major themes: discrimination, identity, expenditure of energy, and nuanced care. Discrimination involved concerns about covert discrimination; loss of social buffers as one ages; and diminished ability to advocate for oneself and one’s partner. Identity involved anticipated risk over disclosing one’s sexual identity; the importance of being identified within a coupled relationship; and the importance of access to reference groups of other gay seniors. We conclude that partners were burdened by the emotional effort expended to hide parts of their identity, assess their environments for discrimination, and to placate others. Nuanced care involved a mutual level of comfort experienced by participants and their health care providers. These themes inform understandings of LTC homes and home care services for lesbian and gay older couples.
‘Singing for the Brain’: A qualitative study exploring the health and well-being benefits of singing for people with dementia and their carers
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Dementia has detrimental effects on cognitive, psychological and behavioural functioning, as well as significant impact on those who provide care. There is a need to find suitable psychosocial interventions to help manage the condition, enhance well-being, and to provide support for caregivers. This study explored the impact of Singing for the Brain, an intervention based on group singing activities developed by The Alzheimer’s Society for people with dementia and their carers. This qualitative study used semi-structured interviews with people with dementia and their carers. Ten interviews involving 20 participants were analysed thematically. Social inclusiveness and improvements in relationships, memory and mood were found to be especially important to participants. As well as enjoying the sessions, participants found that attending Singing for the Brain helped in accepting and coping with dementia.
Evaluation of the antipsychotic medication review process at four long-term facilities in Alberta
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PURPOSE: The goal of this evaluation was to understand how four long-term care (LTC) facilities in Alberta have implemented medication reviews for the Appropriate Use of Antipsychotics (AUA) initiative. We aimed to determine how interprofessional (IP) collaboration was incorporated in the antipsychotic medication reviews and how the reviews had been sustained. METHODS: Four LTC facilities in Alberta participated in this evaluation. We conducted semistructured interviews with 18 facility staff and observed one antipsychotic medication review at each facility. We analyzed data according to the following key components that we identified as relevant to the antipsychotic medication reviews: the structure of the reviews, IP interactions between the staff members, and strategies for sustaining the reviews. RESULTS: The duration of antipsychotic medication reviews ranged from 1 to 1.5 hours. The number of professions in attendance ranged from 3 to 9; a pharmacist led the review at two sites, while a registered nurse led the review at one site and a nurse practitioner at the remaining site. The number of residents discussed during the review ranged from 6 to 20. The process at some facilities was highly IP, demonstrating each of the six IP competencies. Other facilities conducted the review in a less IP manner due to challenges of physician involvement and staff workload, particularly of health care aides. Facilities that had an nurse practitioner on site were more efficient with the process of implementing recommendations resulting from the medication reviews. CONCLUSION: The LTC facilities were successful in implementing the medication review process and the process seemed to be sustainable. A few challenges were observed in the implementation process at two facilities. IP practice moved forward the goals of the AUA initiative to reduce the inappropriate use of antipsychotics.
Frailty Levels in Residential Aged Care Facilities Measured Using the Frailty Index and FRAIL-NH Scale
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OBJECTIVES: To compare the FRAIL-NH scale with the Frailty Index in assessing frailty in residential aged care facilities. DESIGN: Cross-sectional. SETTING: Six Australian residential aged care facilities. PARTICIPANTS: Individuals aged 65 and older (N = 383, mean aged 87.5 +/- 6.2, 77.5% female). MEASUREMENTS: Frailty was assessed using the 66-item Frailty Index and the FRAIL-NH scale. Other measures examined were dementia diagnosis, level of care, resident satisfaction with care, nurse-reported resident quality of life, neuropsychiatric symptoms, and professional caregiver burden. RESULTS: The FRAIL-NH scale was significantly associated with the Frailty Index (correlation coefficient = 0.81, P < .001). Based on the Frailty Index, 60.8% of participants were categorized as frail and 24.4% as most frail. Based on the FRAIL-NH, 37.5% of participants were classified as frail and 35.9% as most frail. Women were assessed as being frailer than men using both tools (P = .006 for FI; P = .03 for FRAIL-NH). Frailty Index levels were higher in participants aged 95 and older (0.39 +/- 0.13) than in those aged younger than 85 (0.33 +/- 0.13; P = .008) and in participants born outside Australia (0.38 +/- 0.13) than in those born in Australia (0.34 +/- 0.13; P = .01). Both frailty tools were associated with most characteristics that would indicate higher care needs, with the Frailty Index having stronger associations with all of these measures. CONCLUSION: The FRAIL-NH scale is a simple and practical method to screen for frailty in residential aged care facilities.
Determining Nurse Aide Staffing Requirements to Provide Care Based on Resident Workload: A Discrete Event Simulation Model
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BACKGROUND: Nursing aides provide most of the labor-intensive activities of daily living (ADL) care to nursing home (NH) residents. Currently, most NHs do not determine nurse aide staffing requirements based on the time to provide ADL care for their unique resident population. The lack of an objective method to determine nurse aide staffing requirements suggests that many NHs could be understaffed in their capacity to provide consistent ADL care to all residents in need. Discrete event simulation (DES) mathematically models key work parameters (eg, time to provide an episode of care and available staff) to predict the ability of the work setting to provide care over time and offers an objective method to determine nurse aide staffing needs in NHs. OBJECTIVES: This study had 2 primary objectives: (1) to describe the relationship between ADL workload and the level of nurse aide staffing reported by NHs; and, (2) to use a DES model to determine the relationship between ADL workload and nurse aide staffing necessary for consistent, timely ADL care. DESIGN: Minimum Data Set data related to the level of dependency on staff for ADL care for residents in over 13,500 NHs nationwide were converted into 7 workload categories that captured 98% of all residents. In addition, data related to the time to provide care for the ADLs within each workload category was used to calculate a workload score for each facility. The correlation between workload and reported nurse aide staffing levels was calculated to determine the association between staffing reported by NHs and workload. Simulations to project staffing requirements necessary to provide ADL care were then conducted for 65 different workload scenarios, which included 13 different nurse aide staffing levels (ranging from 1.6 to 4.0 total hours per resident day) and 5 different workload percentiles (ranging from the 5th to the 95th percentile). The purpose of the simulation model was to determine the staffing necessary to provide care within each workload percentile based on resident ADL care needs and compare the simulated staffing projections to the NH reported staffing levels. MEASURES: The percentage of scheduled care time that was omitted was estimated by the simulation model for each of the 65 workload scenarios using optimistic assumptions about staff productivity and efficiency. RESULTS: There was a low correlation between ADL workload and reported nurse aide staffing (Pearson = .11; P < .01), which suggests that most of the 13,500 NHs were not using ADL acuity to determine nurse aide staffing levels. Based on the DES model, the nurse aide staffing required for ADL care that would result in a rate of care omissions below 10% ranged from 2.8 hours/resident/day for NHs with a low workload (5th percentile) to 3.6 hours/resident/day for NHs with a high workload (95th percentile). In contrast, NHs reported staffing levels that ranged from an average of 2.3 to 2.5 hours/resident/day across all 5 workload percentiles. Higher workload NHs had the largest discrepancies between reported and predicted nurse aide staffing levels. CONCLUSIONS: The average nurse aide staffing levels reported by NHs falls below the level of staffing predicted as necessary to provide consistent ADL care to all residents in need. DES methodology can be used to determine nurse aide staffing requirements to provide ADL care and simulate management interventions to improve care efficiency and quality.
Implementation of Telemedicine Consultation to Assess Unplanned Transfers in Rural Long-Term Care Facilities, 2012-2015: A Pilot Study
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INTRODUCTION: Public and private entities in the United States spend billions of dollars each year on potentially avoidable hospitalizations. This is a common occurrence in long-term care (LTC) facilities, especially in rural jurisdictions. This article details the creation of a telemedicine approach to assess residents from rural LTC facilities for potential transfer to hospitals. METHODS: An electronic LTC (eLTC) pilot was conducted in 20 pilot LTC facilities from 2012-2015. Each site underwent technologic assessment and upgrading to ensure that 2-way video communication was possible. A new central “hub” was staffed with advanced practice providers and registered nurses. Long-term care pilot sites were trained and rolled out over 3 years. This article reports development and implementation of the pilot, as well as descriptive statistics associated with provider assessments and averted transfers. RESULTS: Over 3 years, 736 eLTC consultations occurred in pilot sites. One-quarter of consultations occurred between 10 pm and 9 am. Overall, approximately 31% of cases were transferred. This decreased from 54% of cases in 2013 to 17% in 2015. Rural pilot facilities had an average of 23 eLTC consults per site per year. DISCUSSION: Averted transfers represent a dramatic benefit to the residents, as potentially avoidable hospitalizations cause undue stress and allow for nosocomial infections, among other risks. In addition, averting these unnecessary transfers likely saved the taxpayers of the United States over $5 million in admission-related charges to Centers for Medicare and Medicaid Services (511 avoided transfers x $11,000 per average hospitalization from a LTC facility). CONCLUSIONS: Overall, the eLTC pilot showed promise as a proof-of-concept. The pilot’s implementation resulted in increasing utilization and promising reductions in unnecessary transfers to emergency departments and hospitalizations.
Is a Skilled Nursing Facility’s Rehospitalization Rate a Valid Quality Measure?
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OBJECTIVE: To determine whether the observed differences in the risk-adjusted rehospitalization rates across skilled nursing facilities (SNFs) reflect true differences or merely differences in patient severity. SETTINGS: Elderly Medicare beneficiaries newly admitted to an SNF following hospitalization. STUDY DESIGN: We used 2009-2012 Medicare data to calculate SNFs’ risk-adjusted rehospitalization rate. We then estimated the effect of these rehospitalization rates on the rehospitalization of incident patients in 2013, using an instrumental variable (IV) method and controlling for patient’s demographic and clinical characteristics and residential zip code fixed effects. We used the number of empty beds in a patient’s proximate SNFs during hospital discharge to create the IV. PRINCIPAL FINDINGS: The risk-adjusted rehospitalization rate varies widely; about one-quarter of the SNFs have a rehospitalization rate lower than 17 percent, and for one-quarter, it is higher than 23 percent. All the IV models result in a robust finding that an increase in a SNF’s rehospitalization rate of 1 percentage point over the period 2009-2012 leads to an increase in a patient’s likelihood of rehospitalization by 0.8 percentage points in 2013. CONCLUSIONS: Treatment in SNFs with historically low rehospitalization causally reduces a patient’s likelihood of rehospitalization. Observed differences in rehospitalization rates reflect true differences and are not an artifact of selection.
Personalizing Nursing Home Compare and the Discharge from Hospitals to Nursing Homes
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OBJECTIVE: To test whether use of a personalized report card, Nursing Home Compare Plus (NHCPlus), embedded in a reengineered discharge process, can lead to better outcomes than the usual discharge process from hospitals to nursing homes. DATA SOURCES/SETTING: Primary data collected in the Departments of Medicine and Surgery at a University Medical Center between March 2014 and August 2015. STUDY DESIGN: A randomized controlled trial in which patients in the intervention group were given NHCPlus. Participants included 225 patients or their family members/surrogates. DATA COLLECTION: Key strokes of NHCPlus users were recorded to obtain information about usage. Users were surveyed about usability and satisfaction with NHCPlus. All participants were surveyed at discharge from the hospital. Survey data were merged with medical records. PRINCIPAL FINDINGS: About 85 percent of users indicated satisfaction with NHCPlus. Compared to controls, intervention patients were more satisfied with the choice process (by 40 percent of the standard deviation p < .01), more likely to go to higher ranked five-star nursing homes (OR = 1.8, p < .05), traveled to further nursing homes (IRR = 1.27, p < .10), and had shorter hospital stays (IRR = 0.84, p < .05). CONCLUSIONS: Personalizing report cards and reengineering the discharge process may improve quality and may lower costs compared to the usual discharge process.
Polypharmacy and Medication Regimen Complexity as Risk Factors for Hospitalization Among Residents of Long-Term Care Facilities: A Prospective Cohort Study
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OBJECTIVES: To investigate the association between polypharmacy and medication regimen complexity with time to first hospitalization, number of hospitalizations, and number of hospital days over a 12-month period. DESIGN: A 12-month prospective cohort study. PARTICIPANTS AND SETTING: A total of 383 residents of 6 Australian long-term care facilities (LTCFs). MEASUREMENTS: The primary exposures were polypharmacy (>/=9 regular medications) and the 65-item Medication Regimen Complexity Index (MRCI). Cox proportional hazards regression was used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between polypharmacy and MRCI with time to first hospitalization. Poisson regression was used to compute incident rate ratios (IRR) and 95% CIs for the association between polypharmacy and MRCI with number of hospitalizations and number of hospital days. Models were adjusted for age, sex, length of stay in LTCF, comorbidities, activities of daily living, and dementia severity. RESULTS: There were 0.56 (95% CI 0.49-0.65) hospitalizations per person-year and 4.52 (95% CI 4.31-4.76) hospital days per person-year. In adjusted analyses, polypharmacy was associated with time to first hospitalization (HR 1.84; 95% CI 1.21-2.79), number of hospitalizations (IRR 1.51; 95% CI 1.09-2.10), and hospital days per person-year (IRR 1.39; 95% CI 1.24-1.56). Similarly, in adjusted analyses a 10-unit increase in MRCI was associated with time to first hospitalization (HR 1.17; 95% CI 1.06-1.29), number of hospitalizations (IRR 1.15; 95% CI 1.06-1.24), and hospital days per person-year (IRR 1.19; 95% CI 1.16-1.23). CONCLUSIONS: Polypharmacy and medication regimen complexity are associated with hospitalizations from LTCFs. This highlights the importance of regular medication review for residents of LTCFs and the need for further research into the risk-to-benefit ratio of prescribing in this setting.
Psychosocial Intervention Use in Long-Stay Dementia Care
A Classic Grounded Theory
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The objective of this study was to develop a substantive grounded theory of staff psychosocial intervention use with residents with dementia in long-stay care. “Becoming a person again” emerged as the core category accounting for staffs’ psychosocial intervention use within long-stay care. Interview data were collected from participants in nine Irish long-stay settings: 14 residents with dementia, 19 staff nurses, one clinical facilitator, seven nurse managers, 21 nursing assistants, and five relatives. Constant comparative method guided the data collection and analysis. The researcher’s theoretical memos, based on unstructured observation, and applicable extant literature were also included as data. By identifying the mutuality of the participants’ experiences, this classic grounded theory explains staff motivation toward psychosocial intervention use within long-stay care. It also explains how institutional factors interact with those personal factors that incline individuals toward psychosocial intervention use.
Shared decision-making for people living with dementia in extended care settings: protocol for a systematic review
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INTRODUCTION: Approximately 450 000 people in the UK are living in care homes, 70% of whom are thought to have dementia or significant memory problems. This means that they may need support with day-to-day decisions about their health and care. Shared decision-making interventions can have a positive impact on patient outcomes. They recognise an individual’s rights to make decisions about their care or treatment and support person-centred approaches to care delivery. METHODS: A systematic review of studies designed to assess, implement, measure and/or explore shared decision-making with cognitively impaired adults in (or transferrable to) an extended care setting, with a view to answering the research question: How can people living with dementia and cognitive impairment be included in day-to-day decisions about their health and care in extended care settings? The systematic review will be started in May 2016. Studies are excluded that focus on advance decision-making. The search strategy is limited to a 20-year timeframe and English language and includes electronic databases; CINAHL, PubMed, the Cochrane Library, NICE Evidence, OpenGrey, Autism Data, Google Scholar, Scopus and MedicinesComplete. ETHICS AND DISSEMINATION: Ethical approval not required. Planned dissemination routes for protocol and systematic review through conference presentations, peer-reviewed journals and research networks including the East of England CLAHRC, INTERDEM, and the National Care Homes Research and Development Forum. DISCUSSION: The review will explore how shared decision-making is characterised and constructed in extended care settings for people living with cognitive impairment and their staff and family carers, in relation to their preferences and desires, the roles people play, facilitators, barriers, risk and benefits. The findings will inform an intervention study facilitating shared decision-making for people living with dementia in care homes and have the potential to inform future policy and practice.
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Events
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International Federation on Ageing 14th Global Conference
The Global Conference is a longstanding, highly regarded international forum for world-class experts in the field of ageing. Supported by a network of leading international partner organizations, the 2018 Conference will welcome 1,300 key stakeholders from over 50 countries to downtown Toronto. You can now register for the conference, submit an abstract, propose a master class, and apply for our bursary program.
CIHR Summer Program in Aging: Save the date!
This unique, interactive training program will run from May 15-19, 2017 and will be held in Montreal, Quebec. Graduate students and post-doctoral fellows working in, or interested in learning about, research related to the area of physical activity and aging are encouraged to apply. Trainees will have the opportunity to participate in advanced training that crosses disciplines and brings together trainees, researchers, and members of the public and private sector from Canada and abroad. The program will be launched in December 2016 on the CIHR ResearchNet. More information will follow in the coming months.
IAGG 2017 – Mark Your Calendar: Registration and Accommodation Open December 15
Plan now to attend the largest, most significant worldwide conference on aging. Share in the latest science, research, training, technology, and policy development presented by experts from around the world. Discover all that’s new, waiting for you in a single venue.
Online
Interventions for preventing elder abuse: What’s the evidence?
Join Philip Baker, Australia Regional Director APACPH, School of Public Health and Social Work Queensland University of Technology, as he discusses the findings of his team’s systematic review of the effectiveness of interventions for preventing elder abuse in the home, in institutions and in community settings.
Courses
The objective of this skills-building satellite session is to engage participants in a high-level overview of the foundational components of the Practicing Knowledge Translation course: using the knowledge-to-action process model and relevant KT theories, frameworks, and models to develop evidence-informed, theory-driven programs (ETPs); assessing barriers and facilitators to change; and guiding the process of selecting implementation strategies that directly address barriers and facilitators to changing practice. The session will enhance participants’ understanding related to ETP development and will enable them to begin to apply these principles to their own work.
Executive Training Program (EXTRA)
EXTRA is the only fully bilingual improvement fellowship of its kind in Canada. It is grounded in the complex reality of leading and managing change in today’s health and healthcare environments. EXTRA is CFHI’s most intensive quality improvement program. Upon completion of the program Fellows are well versed in quality improvement methods and tools, and know how to apply it in the design, implementation and evaluation of improvement.
Cochrane Standard Author Training
Are you thinking of undertaking a Cochrane review? Have you recently registered a review title with a Cochrane group? If so, please join us at the University of Alberta for Cochrane’s standard author training course in November 2016, presented by the KT Platform of the Alberta SPOR SUPPORT Unit. Take this 2.5-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.
News
Overcoming the challenges to improve health and wellbeing in care homes (UK)
Although these facilities are sometimes used for temporary respite, rehabilitation or end-of-life care, the term ‘homes’ is crucial. They are places where people live. And although average length of stay in a nursing home is only 15 months, it’s important to make what is often a person’s last home as comfortable as possible. It’s increasingly rare for anyone to enter a care home now without very high levels of frailty, complex health care needs, dementia or disability. The fact that the number of care home places has reduced even during a period of rapid population ageing and significant reduction in hospital bed capacity shows the pressure that care providers must be under.
Ontario nurse faces eight counts of first-degree murder
A 49-year-old woman once employed at two long-term care facilities in southwestern Ont. has been charged with eight counts of first-degree murder in connection with the deaths of elderly patients, police say, following a “multi-jurisdictional” homicide investigation.
Seniors Calling. Public or Private Pursuit in Long-Term Care
A research paper published earlier this year in the journal PLOS Medicine, found that, ‘For-profit nursing homes provide “inferior” care to seniors, and though the evidence isn’t perfect it’s strong enough to suggest that policy makers should pay attention.’
Putting Our Money Where Our Mouth Is on Oral Health Care for Older Adults (US)
The point of the meeting, held in Arlington, VA, was this: 10,000 Americans reach the age of 65 each day and discover that Medicare does not cover dental care. As a nation, we are leaving our older adults bare of basic benefits to ensure continued oral health.
Report says Alberta seniors suffer as care industry shifts more to private model
The report, produced by the Parkland Institute and funded in part by the Canadian Union of Public Employees, says the government’s promise to open 2,000 more public long-term care beds for seniors by 2019 is behind schedule and not a big enough goal.
The challenge and potential of improving whole system flow across health and social care (UK)
Anyone who’s been a patient, or had an elderly relative go through the health care system, will know what a lack of flow looks like: frustrating delays and wasted resources. Sometimes patients and families can feel like they are the only people pulling the different parts of the system together. That absence of a smooth effective flow of patients, information, resources and staff has big knock on implications for patient experience, but also for safety, outcomes, and productivity.
‘Dementia link to sudden low blood pressure and dizziness’ (UK)
People who experience frequent drops in blood pressure or dizziness when suddenly standing up are at increased risk of dementia, scientists say.
MRC awards £4.3m to boost UK research base in dementia
Six universities have been awarded a total of £4.3m by the MRC to grow and develop the UK’s research base in dementia science.
The Postdoctoral Bait and Switch
We need to talk about fake postdoctoral fellowships. The positions are real enough, but they’re not actually postdoctoral fellowships. The ads for fake fellowships say things like “must have expertise in comparative genomics, genome analysis, assembly, and RNA sequence data analysis,” and “$40K per year; 9 month position (note, that means that you won’t actually be paid the full $40K) ,” and “cannot provide moving expenses.” If your aim is to acquire professional research skills and scholarly mentoring so that you can carve out a successful career in the sciences, those kinds of fellowships can be hazardous to your future.
The three tips to engage faculty members include making sure the stakes are real, and meaningful to them; don’t change the rules without warning; and don’t try to win them over with your view.
How to Survive Rejection … Repeatedly
To write is to be rejected. All writers must learn, not only to accept that dictum as an ironclad truth, but also to embrace it as an unavoidable part of a writing life. Most of us will be on the receiving end of umpteen rejections, often from different journals or presses for the same piece of writing. If it’s not easy getting a single rejection — and let’s face it, it isn’t — then collecting them is exponentially more painful.
Resources
The report summarizes and compares results from three surveys to long-term care residents, family members, and administrators/staff assistants to give an overview of the actions the councils are currently taking within LTC homes, the time commitments involved, and how their role, effectiveness and impact are being perceived.
The paper, developed by the project’s PCMH Network, provides a roadmap to guide primary care practices in how to enhance care for older, complex patients and their families.
Nursing Home Antimicrobial Stewardship Guide
AHRQ’s new Nursing Home Antimicrobial Stewardship Guide is a research-based resource that offers step-by-step instructions and materials to help nursing homes improve antibiotic use and decrease harms caused by inappropriate prescribing. The guide, which is consistent with CDC core elements of antibiotic stewardship, can also help health care providers meet CMS’ new Infection Prevention and Control Program requirements.
Behavioural Symptoms of Dementia
Quality standards are a go-to resource for quality care. They are concise sets of easy-to-understand statements based on the best evidence. This quality standard addresses care of behavioural symptoms for people living with dementia. It focuses on care for people who are in an emergency department, admitted to a hospital, or in a long-term care home.
Nursing Home Survey on Patient Safety Culture: 2016 User Comparative Database Report
AHRQ’s Nursing Home Survey on Patient Safety Culture: 2016 User Comparative Database Report is now available and provides results from 209 nursing homes and 12,395 nursing home staff respondents. Results are compared by characteristics of the participating nursing home including nursing home bed size, ownership, urban/rural status, and census region, and respondent characteristics that include job title, work area, interaction with residents, hours worked per week, shift, and tenure with the nursing home.
Involving patients and citizens: I Statements for research and innovation
The Accelerated Access Review was established to speed up access to innovative products for NHS patients. National Voices was invited to provide advice on how patients and citizens should be involved, and Hilary Newiss, chair of National Voices, acted as patient champion in the review. The processes of research and innovation in health can be complex, opaque, and are driven by a mix of scientific, commercial and regulatory factors that do not necessarily align with what really matters to people. National Voices’ aim was to bring real people and ‘what matters’ into the heart of innovation. We worked with patients, patient organisations and charities, research organisers and central government to develop a clear and shared view of how this should be done. The result is a set of ‘I Statements’. They set out patient and citizen expectations, and can be used by those involved in research and innovation to help meet these expectations. They set a standard for what ‘good’ looks and feels like.
