BACKGROUND: Audit and feedback is effective in improving the quality of care. However, methods and results of international studies are heterogeneous, and studies have been criticized for a lack of systematic use of theory. In TREC (Translating Research in Elder Care), a longitudinal health services research program, we collect comprehensive data from care providers and residents in Canadian nursing homes to improve quality of care and life of residents, and quality of worklife of caregivers. The study aims are to a) systematically feed back TREC research data to nursing home care units, and b) compare the effectiveness of three different theory-based feedback strategies in improving performance within care units. METHODS: INFORM (Improving Nursing Home Care through Feedback On PerfoRMance Data) is a 3.5-year pragmatic, three-arm, parallel, cluster-randomized trial. We will randomize 67 Western Canadian nursing homes with 203 care units to the three study arms, a standard feedback strategy and two assisted and goal-directed feedback strategies. Interventions will target care unit managerial teams. They are based on theory and evidence related to audit and feedback, goal setting, complex adaptive systems, and empirical work on feeding back research results. The primary outcome is the increased number of formal interactions (e.g., resident rounds or family conferences) involving care aides – non-registered caregivers providing up to 80% of direct care. Secondary outcomes are a) other modifiable features of care unit context (improved feedback, social capital, slack time) b) care aides’ quality of worklife (improved psychological empowerment, job satisfaction), c) more use of best practices, and d) resident outcomes based on the Resident Assessment Instrument – Minimum Data Set 2.0. Outcomes will be assessed at baseline, immediately after the 12-month intervention period, and 18 months post intervention. DISCUSSION: INFORM is the first study to systematically assess the effectiveness of different strategies to feed back research data to nursing home care units in order to improve their performance. Results of this study will enable development of a practical, sustainable, effective, and cost-effective feedback strategy for routine use by managers, policy makers and researchers. The results may also be generalizable to care settings other than nursing homes.
Our study examined care aide attributes, organizational context, and frequency of dementia-related resident responsive behaviours associated with burnout. Burnout is defined as the experience of emotional exhaustion, cynicism, and lack of professional efficacy. Care aide burnout has implications for turnover, staff health, and quality of care. We used surveys collected from 1194 care aides from 30 urban nursing homes in 3 Western Canadian provinces. We used a mixed-effects regression analysis to assess individual and organizational predictors of care aide burnout. We measured burnout using the Maslach Burnout Inventory, Short Form. We found that care aides were at high risk for emotional exhaustion and cynicism, but report high professional efficacy. Statistically significant predictors of emotional exhaustion include English as a second language, medium facility size, organizational slack-staff, organizational slack-time, health (mental and physical) and dementia-related responsive behaviours. Statistically significant predictors of cynicism include age, English as a second language, unit culture, evaluation (feedback of data), formal interactions, health (mental and physical) and dementia-related responsive behaviours. Statistically significant predictors of professional efficacy were unit culture and structural resources. Greater care aide job satisfaction was significantly associated with increased professional efficacy. This study suggests that care aide attributes and organization context are both predictive of care aide burnout. Unlike care aide or facility characteristics, elements of the organizational context are potentially modifiable, and were associated with each of the three burnout sub scales.
New article by Dr. Greta Cummings
Examining Aged Care Transitions (Exact): Decisions to Transfer From Long-term Care to Emergency
Non UofA Access
The Examining Aged Care Transitions (EXACT) study is a two-phase, mixed-methods study that explores decision-making regarding transitions of residents from long term care (LTC) facilities to the emergency department (ED). LTC residents are typically frail elderly, who can suffer from iatrogenic effects of unnecessary or avoidable transitions. The purpose of the study is to: define avoidable transitions, identify factors that influence decisions to transfer or not, and identify modifiable attributes of avoidable transitions. Phase 1 involved in-depth individual and focus group interviews in 6 LTC facilities in Alberta, Canada. The sample consisted of 71 Registered Nurses (RNs), Licensed Practical Nurses (LPNs), Healthcare Aides, managers, and family members of LTC residents. In Phase 2, an online survey was distributed among staff and physicians in 18 LTC facilities, in addition to regional Emergency Medical Services Personnel. This paper draws on Phase 1 results and Phase 2 preliminary findings. Primary factors contributing to avoidable LTC-ED transfer decisions include: healthcare providers’ lack of familiarity with residents, a shortage of diagnostic and treatment resources in LTCs, limitations in the staff-family relationship, and varied interpretations of the Advanced Care Planning policy. We also present a conceptual definition of avoidable transitions created based on Phase 1 results and validated in Phase 2. The implications of these findings lead to recommendations for changes to policies and decision-making regarding LTC-ED transitions.
New TREC Newsletter
Read the latest January 2017 newsletter from TREC
Calls for Abstracts
CALL FOR ABSTRACTS: Evidence & Policy Special Issue
Evidence & Policy: A journal of research, debate & practice
This special issue will bring together theoretical, methodological and contemporary empirical work exploring the use of network approaches to understand the relationship between evidence and policy. We seek to provoke discussion on the utility of network approaches for understanding policy and evidence, the limitations to such approaches, and the likely next steps for collaborative research.
CALL FOR ABSTRACTS: KT Canada Scientific Meeting
15-16 June, Quebec City
We invite you to join the discussion on KT in Primary Care through attendance at the KT Canada Annual Scientific Meeting. We invite interested people to submit an abstract on any topic related to advancing KT science. For more information, please contact Gail Klein (email@example.com).
CALL FOR ABSTRACTS: 4th Biennial Society for Implementation Research Collaboration Conference (SIRC 2017)
8-9 September, Seattle, Washington
Organizers for the 4th Biennial Society for Implementation Science Collaboration Conference will be accepting abstracts beginning January 20th. The theme for SIRC 2017 is “Implementation Mechanisms: What Makes Implementation Work and Why?”
CALL FOR ABSTRACTS: Deadline Alert! Late Breaker Poster Abstracts
IAGG 2017 July 23-27, San Francisco
There are three weeks left to submit a Late Breaker Poster Abstract for the IAGG 2017 World Congress. Take advantage of this opportunity to present your most compelling research to a global audience. Individuals interested in sharing their findings are encouraged to submit a proposal by Wednesday, February 15, 2017.
Grants & Awards
This Funding Opportunity Announcement (FOA) encourages investigators to submit research grant applications that will identify, develop, test, evaluate and/or refine 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.
This Funding Opportunity Announcement (FOA) encourages investigators to submit research grant applications that will identify, develop, evaluate and refine effective and efficient methods, systems, infrastructures, and strategies to disseminate and implement evidence-based health behavior change interventions, evidence-based prevention, early detection, diagnostic, treatment and management, and quality of life improvement services into public health, clinical practice, and community settings.
This Funding Opportunity Announcement (FOA) encourages investigators to submit research grant applications that will identify, develop, test, evaluate and/or refine 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. In addition, studies to advance dissemination and implementation research methods and measures are encouraged.
The purpose of this funding opportunity is to build capacity in ethics as it applies to health (including health research, health promotion and maintenance, clinical care, population and public health, health systems and services, policy and governance) by encouraging applications from new investigators as well as established investigators new to the field of health ethics.
The Joint Programming Initiative (JPI) “More Years, Better Lives – The Potential and Challenges of Demographic Change” seeks to enhance coordination and collaboration between European and national research programmes related to demographic change. This funding opportunity “Aging and place in a digitising world” is concerned with the ways in which the health and wellbeing of older people, at all stages of later life, is supported and promoted through the design of the social and physical environment, access to opportunities to learn, and the use of technologies of all kinds. Innovative, transnational and interdisciplinary collaborative projects that investigate the potential of technology, place and learning in relation with the older adult.
The purpose of the Personalized Health Catalyst Grant funding opportunity is to support researchers to maximize and leverage previous collaborative investments in personalized medicine, e-health and data platforms by driving evidence-based implementation of personalized health solutions that can contribute to more cost-effective and sustainable health care.
The Implementation Science Institute provides participants with the tools to design and study rigorous implementation science research. The Institute will give an introduction to the foundations of implementation science and students will also receive an overview of advanced topics. Registration accepted through March 3, 2017 (or until full). Scholarship deadline is coming up fast – apply by February 1, 2017.
Technology, innovation, and a demand for the safest, value – added healthcare have led to the proliferation of research studies. Unfortunately the evidence from most of those studies has yet to be applied to evidence – based practice (EBP) projects. Much of this research and many of EBP projects remain waiting to be retrieved, analyzed, translated, and applied to everyday practice.
Clean cooking has emerged as a major concern for global health and development because of the enormous burden of disease caused by traditional cookstoves and fires. The World Health Organization has developed new indoor air quality guidelines that few homes will be able to achieve without replacing traditional methods with modern clean cooking technologies, including fuels and stoves. However, decades of experience with improved stove programs indicate that the challenge of modernizing cooking in impoverished communities includes a complex, multi-sectoral set of problems that require implementation research. The National Institutes of Health, in partnership with several government agencies and the Global Alliance for Clean Cookstoves, has launched the Clean Cooking Implementation Science Network that aims to address this issue. In this article, our focus is on building a knowledge base to accelerate scale-up and sustained use of the cleanest technologies in low- and middle-income countries. Implementation science provides a variety of analytical and planning tools to enhance effectiveness of clinical and public health interventions. These tools are being integrated with a growing body of knowledge and new research projects to yield new methods, consensus tools, and an evidence base to accelerate improvements in health promised by the renewed agenda of clean cooking.
BACKGROUND: Over 60 implementation frameworks exist. Using multiple frameworks may help researchers to address multiple study purposes, levels, and degrees of theoretical heritage and operationalizability; however, using multiple frameworks may result in unnecessary complexity and redundancy if doing so does not address study needs. The Consolidated Framework for Implementation Research (CFIR) and the Theoretical Domains Framework (TDF) are both well-operationalized, multi-level implementation determinant frameworks derived from theory. As such, the rationale for using the frameworks in combination (i.e., CFIR + TDF) is unclear. The objective of this systematic review was to elucidate the rationale for using CFIR + TDF by (1) describing studies that have used CFIR + TDF, (2) how they used CFIR + TDF, and (2) their stated rationale for using CFIR + TDF. METHODS: We undertook a systematic review to identify studies that mentioned both the CFIR and the TDF, were written in English, were peer-reviewed, and reported either a protocol or results of an empirical study in MEDLINE/PubMed, PsycInfo, Web of Science, or Google Scholar. We then abstracted data into a matrix and analyzed it qualitatively, identifying salient themes. FINDINGS: We identified five protocols and seven completed studies that used CFIR + TDF. CFIR + TDF was applied to studies in several countries, to a range of healthcare interventions, and at multiple intervention phases; used many designs, methods, and units of analysis; and assessed a variety of outcomes. Three studies indicated that using CFIR + TDF addressed multiple study purposes. Six studies indicated that using CFIR + TDF addressed multiple conceptual levels. Four studies did not explicitly state their rationale for using CFIR + TDF. CONCLUSIONS: Differences in the purposes that authors of the CFIR (e.g., comprehensive set of implementation determinants) and the TDF (e.g., intervention development) propose help to justify the use of CFIR + TDF. Given that the CFIR and the TDF are both multi-level frameworks, the rationale that using CFIR + TDF is needed to address multiple conceptual levels may reflect potentially misleading conventional wisdom. On the other hand, using CFIR + TDF may more fully define the multi-level nature of implementation. To avoid concerns about unnecessary complexity and redundancy, scholars who use CFIR + TDF and combinations of other frameworks should specify how the frameworks contribute to their study. TRIAL REGISTRATION: PROSPERO CRD42015027615.
BACKGROUND: There is increasing awareness that regardless of the proven value of clinical interventions, the use of effective strategies to implement such interventions into clinical practice is necessary to ensure that patients receive the benefits. However, there is often confusion between what is the clinical intervention and what is the implementation intervention. This may be caused by a lack of conceptual clarity between ‘intervention’ and ‘implementation’, yet at other times by ambiguity in application. We suggest that both the scientific and the clinical communities would benefit from greater clarity; therefore, in this paper, we address the concepts of intervention and implementation, primarily as in clinical interventions and implementation interventions, and explore the grey area in between. DISCUSSION: To begin, we consider the similarities, differences and potential greyness between clinical interventions and implementation interventions through an overview of concepts. This is illustrated with reference to two examples of clinical interventions and implementation intervention studies, including the potential ambiguity in between. We then discuss strategies to explore the hybridity of clinical-implementation intervention studies, including the role of theories, frameworks, models, and reporting guidelines that can be applied to help clarify the clinical and implementation intervention, respectively. CONCLUSION: Semantics provide opportunities for improved precision in depicting what is ‘intervention’ and what is ‘implementation’ in health care research. Further, attention to study design, the use of theory, and adoption of reporting guidelines can assist in distinguishing between the clinical intervention and the implementation intervention. However, certain aspects may remain unclear in analyses of hybrid studies of clinical and implementation interventions. Recognizing this potential greyness can inform further discourse.
BACKGROUND: Economic considerations and the requirement to ensure the quality, safety and integration of research with health and social care provision have given rise to local developments of collaborative organisational forms and strategies to span the translational gaps. One such model – the Health Integration Team (HIT) model in Bristol in the United Kingdom (UK) – brings together National Health Service (NHS) organisations, universities, local authorities, patients and the public to facilitate the systematic application of evidence to promote integration across healthcare pathways. This study aimed to (1) provide empirical evidence documenting the evolution of the model; (2) to identify the social and organisational processes and theory of change underlying healthcare knowledge and practice; and (3) elucidate the key aspects of the HIT model for future development and translation to other localities. METHODS: Contemporaneous documents were analysed, using procedures associated with Framework Analysis to produce summarised data for descriptive accounts. In-depth interviews were undertaken with key informants and analysed thematically. Comparative methods were applied to further analyse the two data sets. RESULTS: One hundred forty documents were analysed and 10 interviews conducted with individuals in leadership positions in the universities, NHS commissioning and provider organisations involved in the design and implementation of the HIT model. Data coalesced around four overarching themes: ‘Whole system’ engagement, requiring the active recruitment of all those who have a stake in the area of practice being considered, and ‘collaboration’ to enable coproduction were identified as ‘process’ themes. System-level integration and innovation were identified as potential ‘outcomes’ with far-reaching impacts on population health and service delivery. CONCLUSION: The HIT model emerged as a particular response to the perceived need for integration of research and practice to improve public health and healthcare delivery at a time of considerable organisational turmoil and financial constraints. The concept gained momentum and will likely be of interest to those involved in setting up similar arrangements, and researchers in the social and implementation sciences with an interest in their evaluation.
Health Care Administration and Organization
BACKGROUND: registered Nurses (RNs) working in UK care homes receive most of their training in acute hospitals. At present the role of care home nursing is underdeveloped and it is seen as a low status career. We describe here research to define core competencies for RNs working in UK care homes. METHODS: a two-stage process was adopted. A systematic literature review and focus groups with stakeholders provided an initial list of competencies. The competency list was modified over three rounds of a Delphi process with a multi-disciplinary expert panel of 28 members. RESULTS: twenty-two competencies entered the consensus process, all competencies were amended and six split. Thirty-one competencies were scored in round two, eight were agreed as essential, one competency was split into two. Twenty-four competencies were submitted for scoring in round three. In total, 22 competencies were agreed as essential for RNs working in care homes. A further 10 competencies did not reach consensus. CONCLUSION: the output of this study is an expert-consensus list of competencies for RNs working in care homes. This would be a firm basis on which to build a curriculum for this staff group.
BACKGROUND: Nursing home residents are mainly inactive. Nursing staff can encourage residents to perform functional activities during daily care activities. This study examines 1) the extent to which nursing staff perceive that they encourage functional activity in nursing home residents and 2) the associations between these nursing behaviors and professional characteristics, contextual factors, and information-seeking behaviors. METHODS: In this cross-sectional study, 368 registered nurses and certified nurse assistants, working in somatic and psychogeriatric wards of forty-one nursing homes throughout the Netherlands participated. Self-reported data were collected with a questionnaire, comprising the MAINtAIN-behaviors, which assesses the extent to which nursing staff encourage functional activities, including different activities of daily living (ADL), household activities, and miscellaneous encouraging activities (e.g., discouraging informal caregivers from taking over activities residents can do themselves). Additional data collected included professional characteristics (e.g., age), contextual factors (e.g., ward type), and information-seeking behaviors (e.g., reading professional journals). Descriptive statistics were used to determine the extent to which functional activities were encouraged. Hierarchical linear regression analyses were performed to determine the associations between the encouragement of functional activities and other factors. RESULTS: Nursing staff perceived that household activities (mean 4.1 (scale range 1-9), SD 1.9) were less often encouraged than ADL (mean 6.9, SD 1.2) or miscellaneous activities (mean 6.7, SD 1.5). The percentage of nursing staff stating that different household activities, ADL, or miscellaneous activities were almost always encouraged ranged from 11 to 45%, 41 to 86%, and 50 to 83% per activity, respectively. The extent to which these activities were encouraged differed for some of the professional characteristics, contextual factors, or information-seeking behaviors, but no consistent pattern in associations emerged. CONCLUSIONS: According to nursing staff, household activities are not as often encouraged as ADL or miscellaneous activities. Professional characteristics, contextual factors, and information-seeking behaviors are not consistently associated with the encouragement of functional activity. Nursing staff should also focus on improving the encouragement of household activities. Future research could examine the role of other factors in encouraging functional activity, such as experienced barriers, and assess to what extent the perception of nursing staff corresponds with their actual behavior.
BACKGROUND: Improvement of communication skills in nursing home staff is key to provide better care for dementia patients and decrease occupational mental stress. OBJECTIVES: An innovative train-the-trainer program to improve and maintain professional caregivers’ social competencies in nursing home dementia care is described. DESIGN AND METHODS: Over a period of 6 months, a group of 6 senior staff members were qualified as program trainers (multiplicators) for the TANDEM training program, which qualified them to design, deliver, and evaluate training sessions that foster specific social competencies in dementia care. In a subsequent intervention study with 116 geriatric caregivers in 14 nursing homes, training was provided either by multiplicators (intervention group) or directly by project coworkers (control group). RESULTS: Participants in both groups improved their dementia-specific communication skills. In a follow-up survey, the intervention group also reported lasting reductions in mental stressors at work (p < 0.05) and occupational mental stress (p < 0.01) compared with the control group. CONCLUSIONS: The qualification of staff members in German nursing homes to be multiplicators for the TANDEM train-the-trainer program for dementia-specific communication skills has a beneficial influence on social competencies, mental stressors at work, and occupational mental stress of staff who care for dementia patients and may contribute to a sustainable implementation of dementia-specific social competencies.
BACKGROUND: The increasingly complex nature of care home residents’ health status means that this population requires significant multidisciplinary team input from health services. To address this, a multisector and multiprofessional enhanced healthcare programme was implemented in nursing homes across Gateshead Council in Northern England. STUDY AIMS: To explore the views and experiences of practitioners, social care officers, and carers involved in the enhanced health care in care home programme, in order to develop understanding of the service delivery model and associated workforce needs for the provision of health care to older residents. METHODS: A qualitative constructivist methodology was adopted. The study had two stages. Stage 1 explored the experiences of the programme enhanced healthcare workforce through group, dyad, and individual interviews with 45 participants. Stage 2 involved two workshops with 28 participants to develop Stage 1 findings (data were collected during February-March 2016). Thematic and content analysis were applied. FINDINGS: The enhanced healthcare programme provides a whole system approach to the delivery of proactive and responsive care for nursing home residents. The service model enables information exchange across organizational and professional boundaries that support effective decision making and problem solving. CLINICAL RELEVANCE: Understanding of the processes and outcomes of a model of integrated health care between public and independent sector care home services for older people.
Health Care Innovation and Quality Assurance
The benefits of Person- and Family-Centred Care (PFCC) are well documented, and many healthcare organizations have expressed their commitment to take this approach. Yet, it can be a difficult endeavour, with common barriers identified at the point-of-care, organizational and system levels. We implemented a PFCC education program with healthcare leaders, providers, and support staff working in home, community, and long-term care organizations across Canada. Focus groups were then conducted with almost 200 workshop participants and 20 long-term care home residents and family members. Five key opportunities for healthcare leaders to better support the provision of PFCC were revealed. In this article, specific recommendations from focus group participants for addressing each of these five opportunities are provided. These findings can assist healthcare leaders to proactively ensure the supports and processes are in place to enable staff to provide care in a more person- and family-centred way.; The benefits of Person- and Family-Centred Care (PFCC) are well documented, and many healthcare organizations have expressed their commitment to take this approach. Yet, it can be a difficult endeavour, with common barriers identified at the point-of-care, organizational and system levels. We implemented a PFCC education program with healthcare leaders, providers, and support staff working in home, community, and long-term care organizations across Canada. Focus groups were then conducted with almost 200 workshop participants and 20 long-term care home residents and family members. Five key opportunities for healthcare leaders to better support the provision of PFCC were revealed. In this article, specific recommendations from focus group participants for addressing each of these five opportunities are provided. These findings can assist healthcare leaders to proactively ensure the supports and processes are in place to enable staff to provide care in a more person- and family-centred way.
Governments around the world are investing in large scale information and communication technology projects that are intended to modernize and streamline healthcare through the provision of nationally accessible electronic health records. In this way, they hope to ‘tame’ the complex ‘wicked’ problems facing healthcare, such as rising costs and fragmented delivery. However, these projects often encounter difficulties. Using a case study of Australia’s 20-year journey towards a national electronic health record system, we show how these projects can ironically take on the characteristics of the ‘wicked problems’ they are intended to solve, and how a failure to recognize and cope with these ‘wicked’ characteristics can lead to waste, conflict and frustration among potential users. We suggest some alternative approaches to the management of large-scale ICT projects in healthcare and other public service sectors that deal with complex, sensitive data.
Effect of training and structured medication review on medication appropriateness in nursing home residents and on cooperation between health care professionals: the InTherAKT study protocol
Non UofA Access
BACKGROUND: Pharmacotherapy in residents of nursing homes is critical due to the special vulnerability of this population. Medical care and interprofessional communication in nursing homes are often uncoordinated. As a consequence, polypharmacy and inappropriate medication use are common and may lead to hospitalizations and health hazards. The aim of this study is to optimize communication between the involved professional groups by specific training and by establishing a structured medication review process, and to improve medication appropriateness and patient-relevant health outcomes for residents of nursing homes. METHODS/DESIGN: The trial is designed as single-arm study. It involves 300 nursing home residents aged >/= 65 years and the members of the different professional groups practising in nursing home care (15-20 general practitioners, nurses, pharmacists). The intervention consists of interprofessional education on safe medication use in geriatric patients, and a systematic interprofessional therapy check (recording, reviewing and adapting the medication of the participating residents by means of a specific online platform). The intervention period is divided into two phases; total project period is 3 years. Primary outcome measure is the change in medication appropriateness according to the Medication Appropriateness Index. Secondary outcomes are cognitive performance, occurrence of delirium, agitation, tendency of falls, total number of drugs, number of potentially dangerous drug-drug interactions and appropriateness of recorded analgesic therapy regimens according to the Medication Appropriateness Index. Data are collected at t0 (before the start of the intervention), t1 (after the first intervention period) and t2 (after the second intervention period). Cooperation and communication between the professional groups are investigated twice by qualitative interviews. DISCUSSION: The project aims to establish a structured system for monitoring of drug therapy in nursing home residents. The newly developed online platform is designed to systematize and to improve the communication between the professional groups and, thus, to enhance quality and safety of drug therapy. Limitations of the study are the lack of a control group and the non-randomly recruited study sample. TRIAL REGISTRATION: DRKS Data Management, DRKS-ID: DRKS00007900.
Research Practice and Methodology
Implementation research (IR) is growing in recognition as an important generator of practical knowledge that can be translated into health policy. With its aim to answer questions about how to improve access to interventions that have been shown to work but have not reached many of the people who could benefit from them, IR involves a range of particular ethical considerations that have not yet been comprehensively covered in international guidelines on health research ethics. The fundamental ethical principles governing clinical research apply equally in IR, but the application of these principles may differ depending on the IR question, context, and the nature of the proposed intervention. IR questions cover a broad range of topics that focus on improving health system functioning and improving equitable and just access to effective health care interventions. As such, IR designs are flexible and often innovative, and ethical principles cannot simply be extrapolated from their applications in clinical research. Meaningful engagement with all stakeholders including communities and research participants is a fundamental ethical requirement that cuts across all study phases of IR and links most ethical concerns. Careful modification of the informed consent process may be required in IR to permit study of a needed intervention. The risks associated with IR may be difficult to anticipate and may be very context-specific. The benefits of IR may not accrue to the same groups who participate in the research, therefore justifying the risks versus benefits of IR may be ethically challenging. The expectation that knowledge generated through IR should be rapidly translated into health policy and practice necessitates up-front commitments from decision-makers to sustainability and scalability of effective interventions. Greater awareness of the particular ethical implications of the features of IR is urgently needed to facilitate optimal ethical conduct of IR and uniform ethical review.
Background: The worldwide number of dementia cases is increasing, and this is a trend that is expected to continue as a growing proportion of the population ages. However, conducting research with persons suffering from dementia can be fraught due to fears surrounding research risks in vulnerable populations. This can make seeking approval for studies difficult. As research directly involving persons with dementia is key for the development of evidence-based best practice, the development of a coherent ethical strategy to perform such research feasibly and effectively is of paramount importance.
OBJECTIVE: this paper aims to investigate the nature and extent of physical restraint deaths reported to Coroners in Australia over a 13-year period. METHODS: the study comprised a retrospective cohort study of residents dwelling in accredited nursing homes in Australia whose deaths were reported to the Coroners between 1 July 2000 and 30 June 2013 and was attributed to physical restraint. RESULTS: five deaths in nursing home residents due to physical restraint were reported in Australia over a 13-year period. The median age of residents was 83 years; all residents had impaired mobility and had restraints applied for falls prevention. Neck compression and entrapment by the restraints was the mechanism of harm in all cases, resulting in restraint asphyxia and mechanical asphyxia, respectively. CONCLUSIONS: this national study confirms that the use of physical restraint does cause fatalities, although rare. Further research is still needed to identify which alternatives strategies to restraint are most effective, and to examine the reporting system for physical restraint-related deaths.
PURPOSE OF THE STUDY: To identify and examine the published qualitative research evidence relative to the experience of living with dementia. DESIGN AND METHODS: Metasynthesis was used as the methodological framework to guide data collection and analysis. RESULTS: Three themes were identified. The first theme considered the main condition-related changes experienced by people with dementia (PWD) and showed how these are interlinked and impact upon various areas of people’s lives. The second theme indicated that amidst these changes, PWD strive to maintain continuity in their lives by employing various resources and coping strategies. The third theme underlined the role of contextual factors. The reviewed evidence indicates that, the emerging experience of PWD and their potential to adjust to the continuous changes is influenced by access to and quality of both personal and contextual resources which remain in a constant, transactional relationship to each other. IMPLICATIONS: The findings were interpreted and discussed in the context of relevant theoretical frameworks and research evidence. It was considered that current evidence and findings presented in this review can be further explored and expanded upon in a more systematic way through research conducted within the theoretical framework of dynamic systems theory. Further research would be also beneficial to explore the subjective experience of dementia from a participatory perspective. Exploring the application of these theoretical standpoints would contribute to the current state of knowledge and offer both PWD and carers fresh perspective on the nature of change and potential for adaptability in dementia.
PURPOSE OF THE STUDY: A scoping review was conducted to develop an understanding of Montessori-based programing (MBP) approaches used in dementia care and to identify optimal ways to implement these programs across various settings. DESIGN AND METHODS: Six peer-reviewed databases were searched for relevant abstracts by 2 independent reviewers. Included articles and book chapters were those available in English and published by the end of January 2016. Twenty-three articles and 2 book chapters met the inclusion criteria. RESULTS: Four approaches to implementing MBP were identified: (a) staff assisted (n = 14); (b) intergenerational (n = 5); (c) resident assisted (n = 4); and (d) volunteer or family assisted (n = 2). There is a high degree of variability with how MBP was delivered and no clearly established “best practices” or standardized protocol emerged across approaches except for resident-assisted MBP. IMPLICATIONS: The findings from this scoping review provide an initial road map on suggestions for implementing MBP across dementia care settings. Irrespective of implementation approach, there are several pragmatic and logistical issues that need to be taken into account for optimal implementation.
PURPOSE: This policy study analyzed states’ residential care and assisted living (RC/AL) regulations for dementia care requirements. Estimates suggest that at least half of RC/AL residents have dementia, and 22% of settings provide or specialize in dementia care. Residents with dementia might benefit from regulations that account for specific behaviors and needs associated with dementia, making states’ RC/AL regulations address dementia care an important policy topic. DESIGN AND METHODS: This study examined RC/AL regulations in all 50 states and the District of Columbia for regulatory requirements on five topics important to the quality of life of RC/AL residents with dementia: pre-admission assessment, consumer disclosure, staffing types and levels, administrator training, and physical environment. RESULTS: Sixteen states license or certify dementia care units within RC/AL settings. All states had at least one dementia care requirement, though only four states had requirements for all five of the topics reviewed. Most states addressed administrator training, consumer disclosure, and physical environment, 17 addressed staffing types and levels, and 14 addressed pre-admission assessment for dementia. Thus, most states rely on general RC/AL regulations to cover dementia care policies and practices. IMPLICATIONS: This policy study provides a resource for researchers who do cross-state studies of dementia care in RC/AL settings and state policymakers who are updating RC/AL regulations, including those responding to a 2014 Centers for Medicare and Medicaid Services rule change.
My father moved from his home of 92 years to a care community in a distant location. This is the story of his move, from the perspective of a gerontologist and soon-to-be young-old daughter. I describe the events that prompted my father’s decision to make the move, how I chose the care community, the transition arrangements, and the outcomes. I discuss key factors that contributed to the successful transition, all with a focus on readiness. Other factors included drawing on my knowledge as a gerontologist, using informal networks to identify a care community, visiting the care community repeatedly, and communicating openly and often with family. I briefly describe my father’s quality of life after the move. I examine my experiences in the context of relevant research in gerontology, recommend how gerontologists can manage transitions to care communities for their aging parents, and offer suggestions for research.
In contrasting health care structures, we each served as caregivers to elderly parents where a shared and unexpected theme in our experiences was the substantial burden of negotiating and managing long-term care (LTC) services within our respective health and social care systems. In this article, we introduce and elucidate an under recognized source of caregiver burden in the United States and Canada: the structural burden of caregiving. We draw on shared and unique experiences cross-nationally, along with the literature, to illustrate that (a) today’s caregiving is increasingly characterized by interactions with formal health and social systems in negotiating and managing services, (b) these systems are hampered by discontinuous and fragmented care which increase caregiver stress, and (c) this structural burden likely exacerbates inequity for both care recipients and caregivers. In conclusion, we call for theoretical models of caregiving to highlight health and social systems as creating burden and for measurement of caregiver burden to explicitly consider the time and stress stemming from interactions with formal health and social systems. Finally, we call for future policy evaluation to incorporate structural burden as an additional outcome in considering changes to LTC provisions and funding.
As professionals in geriatric medicine and social work, we are caregivers for our widowed mother of 90 years, a woman with neurocognitive disorder and multiple medical conditions. She has had repeated, problematic encounters with the health care system over the past 4 years. Caring successfully for an aging parent requires a comprehensive understanding of her unique medical, psychological, and functional status; need for social support; and overall goals of care. Poor communication between and among clinical teams-and with patients and families-is ubiquitous. The patient and family are not consistently listened to, or integrated, into the clinical team. We recount our experiences of one hospitalization and how we addressed the recurring obstacles we faced. Our training and experience gave us a firm understanding of the hazards of hospitalizing an elderly person and the need to be present, engaged, attentive, active, and vigilant. We caught and corrected major mistakes: failure to follow-up abnormal test results, multiple medication errors, undertreatment of pain, poor fall prevention, and inappropriate assessment and placement for rehabilitation. In a dysfunctional health care system, the family is, and must be, the ultimate fail-safe mechanism. We identify potentially effective solutions for the problems we encountered: adoption of dementia-sensitive and patient- and family-centered care, improved communication, better management of information (including better systems for monitoring lab results and for dispensing and reconciling medications), expediting care, changing reimbursement and regulation, and improving discharge planning and placement.
PURPOSE OF THE STUDY: Janus, the two-faced, Roman god of beginnings and transitions, is used as a metaphor to explore our personal narratives and our quantitative research on the experiences of older women with dementia in long-term care (LTC). Two research questions are addressed: (a) How do our quantitative data map onto our mothers’ experiences? (b) What lessons do our mothers’ experiences offer for the care of older women with dementia? DESIGN AND METHODS: Informed by a life-course perspective, we triangulate administrative data on 3,717 women with dementia receiving LTC in British Columbia, Canada, with personal narratives-the stories of our mothers who made the transition from home care into residential (nursing home) care. RESULTS: Our quantitative data reveal that the home care to residential care transition is the most common LTC trajectory for women with dementia who are most likely to be widowed and living alone in suburban areas. On entry into residential care, they exhibit greater frailty in terms of activities of daily living, cognition, aggression, and incontinence. Our personal narrative data on our mothers reveals that the relatively straightforward pathways through LTC for women with dementia, are often considerably more complex in a real-world context. Attention is drawn to the public and private services, hospitalization patterns, and substantial communication gaps experienced by our moms and families. IMPLICATIONS: A life-course perspective, and qualitative and quantitative data facilitate understanding the care journeys-health and service trajectories of older women with dementia.
BACKGROUND: Older adults living in long term care (LTC) homes are nutritionally vulnerable, often consuming insufficient energy, macro- and micronutrients to sustain their health and function. Multiple factors are proposed to influence food intake, yet our understanding of these diverse factors and their interactions are limited. The purpose of this paper is to fully describe the protocol used to examine determinants of food and fluid intake among older adults participating in the Making the Most of Mealtimes (M3) study. METHODS: A conceptual framework that considers multi-level influences on mealtime experience, meal quality and meal access was used to design this multi-site cross-sectional study. Data were collected from 639 participants residing in 32 LTC homes in four Canadian provinces by trained researchers. Food intake was assessed with three-days of weighed food intake (main plate items), as well as estimations of side dishes, beverages and snacks and compared to the Dietary Reference Intake. Resident-level measures included: nutritional status, nutritional risk; disease conditions, medication, and diet prescriptions; oral health exam, signs of swallowing difficulty and olfactory ability; observed eating behaviours, type and number of staff assisting with eating; and food and foodservice satisfaction. Function, cognition, depression and pain were assessed using interRAI LTCF with selected items completed by researchers with care staff. Care staff completed a standardized person-directed care questionnaire. Researchers assessed dining rooms for physical and psychosocial aspects that could influence food intake. Management from each site completed a questionnaire that described the home, menu development, food production, out-sourcing of food, staffing levels, and staff training. Hierarchical regression models, accounting for clustering within province, home and dining room will be used to determine factors independently associated with energy and protein intake, as proxies for intake. Proportions of residents at risk of inadequate diets will also be determined. DISCUSSION: This rigorous and comprehensive data collection in a large and diverse sample will provide, for the first time, the opportunity to consider important modifiable factors associated with poor food intake of residents in LTC. Identification of factors that are independently associated with food intake will help to develop effective interventions that support food intake. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT02800291 , retrospectively registered June 7, 2016.
BACKGROUND: Nursing home (NH) residents are frequently transferred to the emergency department (ED) but there is little data on inter-facility variation, which has implications for intervention planning and implementation. OBJECTIVES: To describe variation in ED transfer rates (TRs) across NHs and the association with NH characteristics. DESIGN/SETTING: Retrospective cohort study using linked administrative data from Ontario. PARTICIPANTS: 71,780 residents of 604 NHs in 2010 and followed for one year. MEASUREMENTS: Funnel plots were used to identify high transfer NHs and logistic regression to test the association with NH location, size, ownership and historical ED transfer rate. RESULTS: One-year ED transfer rates ranged from 4.3% to 58.6% (mean 28.4%); 115 (19%) NHs were considered high. Being within five minutes of an ED, larger size and high historical ED transfer rate were associated with being a high ED transfer home. CONCLUSION: There was substantial variation across NHs. Consideration of characteristics such as proximity to an ED may be important in the development and targeting of different interventions for NHs.
Abstract The aim of this study was to explore the relationship of coexisting severe frailty and malnutrition with all-cause mortality among the oldest old in nursing homes. This study was conducted among all subjects (n = 160) aged 85 years and older who lived in two nursing homes of Japan. Information about the health status of participants was gathered from history, medical documentation, test assessing frailty, according to the Canadian Study of Health and Aging-Clinical Frailty Scale (CSHA-CFS) and the Mini Nutritional Assessment Short Form (MNA-SF). Seventy five residents (46.9%) were identified as affected by coexisting severe frailty and malnutrition. After a 12-month follow-up period, 42 (26.3%) residents died. In the Cox regression analysis, coexisting severe frailty and malnutrition, and heart failure were associated with mortality during the 12-month follow-up period among the oldest old nursing home residents (adjusted HR 10.89, 95% CI 4.04–29.33, p < 0.0001; and adjusted HR 7.83, 95% CI 3.25–18.88, p < 0.0001, respectively). The present study suggests that coexisting severe frailty and malnutrition are very frequent, and coexisting severe frailty and malnutrition are associated with all-cause mortality among the oldest old in nursing homes.
PURPOSE: The quality of drug therapy is an important issue for nursing homes. This study aimed to assess the prevalence of polypharmacy and potentially inappropriate medications (PIMs) in a large sample of nursing home residents by using the data recorded during the preparation of pill dispensers. METHODS: This is a cross-sectional study that included 451 nursing homes across France. Information about the medications received by the 30,702 residents (73.8% women) living in these nursing homes was extracted from the system that assists in the preparation of pill dispensers in pharmacies. The anonymized database included age, sex, and medications prescribed to residents, as well as nursing home characteristics (capacity, legal status). Factors associated with excessive polypharmacy (>/=10 different drugs) and PIMs according to the Laroche list were studied using multilevel regression models. RESULTS: The average number of drugs prescribed was 6.9 +/- 3.3, and excessive polypharmacy concerned 21.1% of the residents (n = 6468). According to the Laroche list, 47.4% of residents (n = 14,547) received at least one PIM. Benzodiazepines (excessive doses, long-acting benzodiazepines, and combination of benzodiazepines) and anticholinergic medications (hydroxyzine, cyamemazine, alimemazine) accounted for a large part of PIMs. Individual characteristics (age, gender) influenced the risk of receiving PIMs whereas nursing home characteristics (capacity, legal status) influenced the risk of excessive polypharmacy. CONCLUSIONS: This study shows that polypharmacy and PIMs remain highly prevalent among nursing home residents. Main PIMs concerned psychotropic and anticholinergic medications.
Applications are now open for the KT Canada Summer Institute. The purpose of this Summer Institute is to provide participants with the opportunity to increase their understanding of knowledge translation research as well as opportunities and challenges in this field. The Summer Institute will provide participants with the chance to network with colleagues including national and international KT experts. Application is available here. For more information, please contact Gail Klein (firstname.lastname@example.org).
The meeting theme for the 4th Biennial Global Implementation Conference is “Expanding Implementation Perspectives: Engaging Systems.” This meeting is jointly sponsored by the Global Implementation Initiative (GII) and the Hospital for Sick Children.
Here are five good reasons why you should register today to be part of something big. #5 – action-packed days in San Francisco to sharpen your skills. #4 – 6,000+ like minded individuals including global aging professionals, industry thought leaders, speakers, exhibitors, tech experts, artists, press, and more. #3 – Over 650 scientific sessions, workshops, poster sessions, and keynotes. #2 – 100s of new ideas and approaches to elevate your effectiveness and efficiency at work. #1 – More than 70 countries will be represented in the program.
Dr. Amanda (Mandi) Newton, Associate Professor for the University of Alberta’s Department of Pediatrics and a Canadian Institutes Health Research (CIHR) funded Clinician Scientist with advanced clinical training in psychiatry and post-doctoral training in Knowledge Translation, will be presenting on the topic of Realist Reviews.
The 9th Annual conference took place December 14-15, 2016 in Washington, D.C. and focused on high priority areas in D&I research. If you weren’t able to attend the conference or didn’t get to attend every session that interested you, you can now view and download presentations from the conference.
The Frailty Assessment of Older Canadians Using Emergency Services (FOCUS) study tested the real-world implementation of a user-friendly tablet based technology to identify high-risk older adults with frailty or problems with their thinking such as delirium or dementia.
Dr. Urquhart is an Assistant Professor and Knowledge Translation Scientist in the Department of Surgery, Dalhousie University, with cross appointments in Community Health and Epidemiology and Medical Education. She is also a Senior Scientist at the Beatrice Hunter Cancer Research Institute and Affiliate Scientist at the Nova Scotia Health Authority. Dr. Urquhart’s research expertise lies in health services research and implementation science, related to cancer and palliative care. She has built an active research program investigating how new tools, technologies, and practices move into cancer care practice and policy. Dr. Urquhart also holds a graduate degree in Exercise Sciences, and bachelor degrees in Kinesiology and Journalism.
The School of Healthcare Sciences Health Services Research Summer School offers you a unique opportunity to gain access to internationally renowned experts in a range of topic areas, including complex interventions and their evaluation (including clinical trials); realist synthesis and evaluation; health economics, implementation, ageing and dementia, primary care, language awareness and the service user perspective.
Planning for Implementation and Sustainability is a 3-day workshop designed for professionals in any health-related discipline aiming to gain knowledge on how to apply the science of knowledge translation (KT) to real-world implementation projects.
The objective of the course is to foster exchanges on foundational, clinical-ethical and organisational-ethical approaches to dementia care. During the course, national and international experts will give presentations on various ethical topics in the domain of dementia care. Time will be provided for intensive discussion and interaction. Canadians are eligible to attend. Space is limited to 30 participants. Early bird registration deadline May 15.
Victoria Shepherd, NIHR Doctoral Research Fellow, Centre for Trials Research at Cardiff University shares details of a study to look at the most important areas of research needed in Care Homes.
Danielle Wilson, Clinical Trials Facility Manager at West London Mental Health Trust shares her experience of the research world. “I first dipped my toe into the world of research almost 10 years ago when conducting a randomised control trial investigating infection control in care homes. We were specifically looking at MRSA infection rates in care homes, when MRSA was an extremely hot topic in the media.”
Since conducting a qualitative dementia study in care homes, a PhD researcher has observed a positive shift in the behaviour of care home staff. Ann Scott found that involving staff in a study improved their knowledge of dementia care and treatment, boosted their confidence and empowered them to influence other colleagues’ clinical practice. This case study examines the importance Ann placed on clinical engagement, enthusiasm and working closely with staff, patients, carers and family members to conduct a study.
Anna Hicks is a peripatetic (roaming) Home Manager for the Orders of St John Care Trust in Oxfordshire. One of the homes where Anna works took part in the Improving Well-being and Health for People with Dementia (WHELD) study. In a Q&A with Anna, she describes her experience of taking part in research, and the advice she’d give to other care homes and care home researchers.
I work on a team that has just kicked off a new quality improvement project, but the IT people are telling me it takes six months to set up a database to collect the data we need to measure. Should I wait for the technology, or is there a way to move this along faster?
Study will follow 50,000 men and women, aged 45 to 85, until 2033. It is massive in scope, logistically challenging and runs until 2033, but the Canadian Longitudinal Study on Aging is already providing insights into the process of aging, says its lead investigator.
A large and growing number of Americans require care in skilled nursing facilities, inpatient rehabilitation facilities, or long-term acute care hospitals, often after an acute hospitalization. Data indicates that more than 20% of patients in these settings experience an adverse event during their stay.
Elizabeth Wettlaufer, the former nurse already charged with the alleged murder of eight care-home residents in Southwestern Ontario, has been charged with attempting to murder four more patients by injecting them with insulin. She is also charged with aggravated assault on two other people, also by allegedly plying them with insulin.
Not many patients would be happy to hear that there’s a lag of about 17 years between when health scientists learn something significant from rigorous research and when health practitioners change their patient care as a result, but that’s what a now famous study from the Institute of Medicine (now known as the National Academy of Medicine) uncovered in 2001. The study reflects a major problem that has plagued health care systems for decades – namely, the timely integration of high quality scientific evidence into daily patient care practices.
This is not to say that academics, researchers and doctoral students are particularly prone to anxiety, but that it helps to acknowledge that the apparently simple first step of starting to write brings uncertainty, and that knowing this does not make anxiety go away. Maybe it’s not always ‘anxiety’ but uncertainty, and uncertainty can trigger anxiety, and anxiety is one of the causes of writer’s block.
More than 46 million people over the age of 65 years were living in the United States in 2014 and more than 70 million are predicted by 2060. Education, living arrangements, and other demographic characteristics of this older population are changing, with noted variability by sex and race/ethnicity. The National Academies of Sciences, Engineering, and Medicine’s Food Forum convened a workshop with five objectives: to examine trends and patterns in aging and factors related to healthy aging in the United States with a focus on nutrition; to examine how nutrition can sustain and promote healthy aging, to highlight the role of nutrition in the aging process at various stages in life; to discuss changes in organ systems over the lifespan, and to explore opportunities to move forward in promoting healthy aging in the United States.
The website, created by the Canadian Institutes of Health Research (CIHR), offers a series of PowerPoint presentations based upon a book titled Knowledge Translation in Health Care: Moving from Evidence to Practice. The presentations are intended to be used as a companion to the book.
Canada’s aging population will continue to increase, which is cause for celebration – but only if the lives of older people are not compromised by poor health. Policymakers must prioritize effective supports for the growing number of people with dementia. By 2031, the number of Canadians with some form of dementia will be 1.4 million, nearly twice as many as those who suffered from the disease in 2011.
This learning zone introduces the knowledge and skills needed to provide high-quality end of life care. It is for generalist health and social care staff who don’t have specialist-level training in caring for people with a terminal illness and the issues associated with end of life care.
The Dissemination and Implementation (D&I) Core of the Military Suicide Research Consortium (MSRC) is seeking applicants for a psychology post-doctoral fellowship at the University of Washington focused on rigorous, efficient, and innovative approaches to D&I interventions for military settings and D&I research and evaluation. First review will take place for applications received by January 31, 2017. Position will remain open until filled.
The Palo Alto Veterans Institute for Research (PAVIR) is seeking applications for a Clinical Research Postdoctoral Fellow. The appointment is a regular, full time, exempt position.
The UCSF RISE program consists of a Summer Institute on both Implementation Science and Careers-In-Progress. Junior faculty and transitioning post-doctorates are encouraged to apply.
The Behavioural Supports Ontario (BSO) Knowledge to Practice Community of Practice (CoP) brings together professionals across Ontario who have a shared passion for capacity building and fostering knowledgeable healthcareteams. Under the umbrella of BSO, this CoP will be specifically focused on enhancing care for older adults with complex and responsive behaviours associated with dementia, mental health, substance use and/or other neurological conditions. To support members in the complex task of putting knowledge into practice, the CoP has adopted the ‘Knowledge to Practice Process Framework’. This is a framework that can be used in many ways, for example: capacity building, program development, and clinical work. The 4 stages of this framework are: 1) Creation; 2) Transfer; 3) Translation; and 4) Implementation. Through webinars (live and archived), documents, idea exchanges and experiences, innovations and stories are shared to collectively enhance services for older adults with complex and responsive behaviours. Anyone interested in being part of the CoP is welcome to join! Please complete the survey to indicate your interest.
We invite researchers to tell us about their experiences using an integrated knowledge translation approach in their work. The most interesting and well-told examples will compiled into a CHIPS (CAHSPR) IKT Casebook that will be published for wider distribution. We also intend to host a session at the 2017 CAHSPR meeting and invite the authors of the chosen cases to present them (if they plan to attend).
Several positions are open for Junior Service Fellows in AHRQ’s Summer Intramural Fellowship program. Applicants should hold at least a master’s degree and have a strong interest in working with health services researchers on health care improvement initiatives. Selected fellows will work on administrative protocols, gain access to AHRQ-sponsored datasets and apply statistical analysis methods to broaden understanding of health services research. Topics for this summer’s research projects include work in quality improvement, patient safety and health care disparities.