This editorial discusses recent attacks on scientific evidence by the current US government and the implications this may have for the elderly.
New article by Dr. Susan Slaughter
Construct validity of the Dining Environment Audit Protocol: a secondary data analysis of the Making Most of Mealtimes (M3) study
Non UofA Access
Research has demonstrated the importance of physical environments at mealtimes for residents in long term care (LTC). However, a lack of a standardized measurement to assess physical dining environments has resulted in inconsistent research with potentially invalid and unreliable conclusions. The development of a standardized, construct valid instrument that assesses dining rooms is imperative to systematically examine physical environments in LTC. The purpose of this study was to determine the construct validity of the new Dining Environment Audit Protocol (DEAP) tool. METHODS: Secondary data collected from the Making Most of Mealtimes (M3) study was used for this analysis. Data were collected in 32 long term care homes, which included 82 dining rooms and 639 residents. A variety of resident and dining room level constructs were compared to the summative scales found on the DEAP using Spearman correlations and Student t-tests. A regression analysis identified individual characteristics assessed with DEAP that were associated with the summative scales of homelikeness and functionality. RESULTS: Regression analysis (p < 0.05) identified that the DEAP homelikeness scale was positively associated with a view of the garden/green space, presence of a clock and a posted menu. The functionality scale was positively associated with number of chairs and lighting, while negatively associated with furniture with rounded edges and clutter. Additionally, the functionality scale was positively associated (p < 0.05) with the Mealtime Scan physical scale (rho = 0.52), the dining room Mealtime-Relational Care Checklist (M-RCC) (rho = 0.25), the DEAP total score (rho = 0.56), and the Mini Nutritional Assessment- Short Form (rho = 0.26). Homelikeness was positively associated (p < 0.05) with the DEAP total score (rho = 0.53), staff Person Directed Care score (rho = 0.49) and the resident Cognitive Performance Scale (t = 2.56), while negatively associated with energy (rho = -0.26) and protein intake (rho = -0.24). The homelikeness and functionality scales were also associated with one another (rho = 0.26). CONCLUSION: The construct validity of the DEAP was supported through significant correlations with a variety of measures that are theoretically related to the homelikeness and functionality of LTC dining rooms. This secondary analysis supports the use of the DEAP in future research to quantify the physical environment of LTC dining rooms. Protocol registered with ClinicalTrials.gov ID: NCT02800291; Registered retrospectively June 7, 2016.
New article by Dr. Jo Rycroft-Malone
Exploring the use of Soft Systems Methodology with realist approaches: A novel way to map programme complexity and develop and refine programme theory
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As the use of realist approaches gains momentum, there is a growing interest in how systems approaches can complement realist thinking. In this article, we discuss how the epistemology of Soft Systems Methodology is compatible with realist approaches. Both Soft Systems Methodology and realist approaches emphasize the necessity to engage stakeholders; through models, the description of contingencies and exploring the intricacies of how complex programmes really work. We outline the key elements of realist approaches and Soft Systems Methodology, and report on two novel case studies. Drawing on our own experiences, we make the case that, used in conjunction with a realist approach, Soft Systems Methodology can provide a useful tool to a) map programme complexity, and b) develop and refine stakeholders programme theories, thus increasing the transparency, reliability, validity and accuracy of the theory building and refining process in realist approaches. We highlight Soft Systems Methodology as a novel companion to realist approaches and detail the first case studies of its use.; As the use of realist approaches gains momentum, there is a growing interest in how systems approaches can complement realist thinking. In this article, we discuss how the epistemology of Soft Systems Methodology is compatible with realist approaches. Both Soft Systems Methodology and realist approaches emphasize the necessity to engage stakeholders; through models, the description of contingencies and exploring the intricacies of how complex programmes really work. We outline the key elements of realist approaches and Soft Systems Methodology, and report on two novel case studies. Drawing on our own experiences, we make the case that, used in conjunction with a realist approach, Soft Systems Methodology can provide a useful tool to a) map programme complexity, and b) develop and refine stakeholders programme theories, thus increasing the transparency, reliability, validity and accuracy of the theory building and refining process in realist approaches. We highlight Soft Systems Methodology as a novel companion to realist approaches and detail the first case studies of its use.
Health research is conducted with the expectation that it advances knowledge and eventually translates into improved health systems and population health. However, research findings are often caught in the know-do gap: they are not acted upon in a timely way or not applied at all. Integrated knowledge translation (IKT) is advanced as a way to increase the relevance, applicability and impact of research. With IKT, knowledge users work with researchers throughout the research process, starting with identification of the research question. Knowledge users represent those who would be able to use research results to inform their decisions (e.g. clinicians, managers, policy makers, patients/families and others). Stakeholders are increasingly interested in the idea that IKT generates greater and faster societal impact. Stakeholders are all those who are interested in the use of research results but may not necessarily use them for their own decision-making (e.g. governments, funders, researchers, health system managers and policy makers, patients and clinicians). Although IKT is broadly accepted, the actual research supporting it is limited and there is uncertainty about how best to conduct and support IKT. This paper presents a protocol for a programme of research testing the assumption that engaging the users of research in phases of its production leads to (a) greater appreciation of and capacity to use research; (b) the production of more relevant, useful and applicable research that results in greater impact; and (c) conditions under which it is more likely that research results will influence policy, managerial and clinical decision-making.
Calls for Abstracts
CALL FOR ABSTRACTS:
Cochrane Canada Symposium 2018
The theme of the Symposium this year is “New Horizons in Evidence Synthesis” Cochrane Canada is looking forward to receiving abstracts on a variety of topics relevant to evidence producers and decision makers, including:
-New and innovative methods for producing evidence syntheses, including living systematic reviews, rapid reviews and complex reviews.
-Methods for increasing efficiencies in the production of evidence syntheses (e.g. machine learning).
-Methods or training in tools for creating or interpreting evidence syntheses, such as risk of bias and critical appraisal.
-Strategies to promote the use of evidence by decision makers (consumers, practitioners, researchers, policymakers and others), including methods for involving patients and caregivers in the production and knowledge translation of evidence syntheses.
CALL FOR ADDITIONAL ABSTRACTS:
IFA 14th Global Conference on Ageing
Due to the demand to present at the 14th Global Conference on Ageing, the IFA is pleased to announce that additional spaces have opened up for abstract submission. To balance the program and deliver on a range of key global issues, the IFA is seeking additional abstracts under the themes/sub-themes of Combating Ageism, Toward Healthy Ageing, and Addressing Inequalities. Further abstracts under the theme of Age-Friendly Environments are also welcome.
Grants & Awards
An estimated $170 billion of research funding is wasted each year because its outcomes cannot be used. To stimulate and promote research in this area, Cochrane announces the Cochrane-REWARD prize.
New for 2018, the IST Program is MSFHR’s first implementation science award program, designed based on extensive environmental scanning and consultation with BC’s researchers, health system decision-makers, and national and international experts in implementation science.
Despite increased attention for palliative care in dementia, recent studies found burdensome symptoms and unmet family caregiver needs in the last phase of life. Feedback is being used to improve the quality of palliative care, but we do not know how effective it is. AIM: To assess the effect of two feedback strategies on perceived quality of end-of-life care and comfort in dying nursing home residents with dementia. METHODS: In a cluster-randomized controlled trial, the End-of-Life in Dementia-Satisfaction With Care and the End-of-Life in Dementia-Comfort Assessment in Dying scales were completed by bereaved family caregivers of residents with dementia of 18 Dutch nursing homes. Two feedback strategies, generic feedback with mean End-of-Life in Dementia-scores and feedback with individual (patient-specific) End-of-Life in Dementia-scores, were compared to no feedback provided. The intervention groups discussed End-of-Life in Dementia-ratings in team meetings and formulated actions to improve care. Multi-level analyses assessed effects. RESULTS: A total of 668 families rated the End-of-Life in Dementia-instruments. Compared to no feedback, the generic strategy resulted in lower quality of end-of-life care in unadjusted ( B = -1.65, confidence interval = -3.27; -0.21) and adjusted analyses ( B = -2.41, confidence interval = -4.07; -0.76), while there was no effect on comfort. The patient-specific strategy did not affect the quality of end-of-life care, but it increased comfort in unadjusted analyses (only, B = 2.20, confidence interval = 0.15; 4.39; adjusted: B = 1.88, confidence interval = -0.34; 4.10). CONCLUSION: Neither feedback strategy improved end-of-life outcome. Perhaps, skills to translate the feedback into care improvement actions were insufficient. Feedback with favorable family ratings might even have triggered opposite effects. Trial number: NTR3942.
Translation encompasses the continuum from clinical efficacy to widespread adoption within the healthcare service and ultimately routine clinical practice. The Parenting, Eating and Activity for Child Health (PEACH) program has previously demonstrated clinical effectiveness in the management of child obesity, and has been recently implemented as a large-scale community intervention in Queensland, Australia. This paper aims to describe the translation of the evaluation framework from a randomised controlled trial (RCT) to large-scale community intervention (PEACH QLD). Tensions between RCT paradigm and implementation research will be discussed along with lived evaluation challenges, responses to overcome these, and key learnings for future evaluation conducted at scale. METHODS: The translation of evaluation from PEACH RCT to the large-scale community intervention PEACH QLD is described. While the CONSORT Statement was used to report findings from two previous RCTs, the REAIM framework was more suitable for the evaluation of upscaled delivery of the PEACH program. Evaluation of PEACH QLD was undertaken during the project delivery period from 2013 to 2016. RESULTS: Experiential learnings from conducting the evaluation of PEACH QLD to the described evaluation framework are presented for the purposes of informing the future evaluation of upscaled programs. Evaluation changes in response to real-time changes in the delivery of the PEACH QLD Project were necessary at stages during the project term. Key evaluation challenges encountered included the collection of complete evaluation data from a diverse and geographically dispersed workforce and the systematic collection of process evaluation data in real time to support program changes during the project. CONCLUSIONS: Evaluation of large-scale community interventions in the real world is challenging and divergent from RCTs which are rigourously evaluated within a more tightly-controlled clinical research setting. Constructs explored in an RCT are inadequate in describing the enablers and barriers of upscaled community program implementation. Methods for data collection, analysis and reporting also require consideration. We present a number of experiential reflections and suggestions for the successful evaluation of future upscaled community programs which are scarcely reported in the literature. TRIALS REGISTRATION: PEACH QLD was retrospectively registered with the Australian New Zealand Clinical Trials Registry on 28 February 2017 (ACTRN12617000315314).
Children’s service systems are faced with a critical need to disseminate evidence-based mental health interventions. Despite the proliferation of comprehensive implementation models, little is known about the key active processes in effective implementation strategies. This proof of concept study focused on the effect of change agent interactions as conceptualized by Rogers’ diffusion of innovation theory on providers’ (N = 57) use of a behavioral intervention in a child welfare agency. An experimental design compared use for providers randomized to training as usual or training as usual supplemented by change agent interactions after the training. Results indicate that the enhanced condition increased use of the intervention, supporting the positive effect of change agent interactions on use of new practices. Change agent types of interaction may be a key active process in implementation strategies following training.
Advance Care Planning (ACP) is the repeated communication and decision-making process between the patient, family, and healthcare professionals. This study describes an ACP intervention in nursing homes and evaluates the outcomes of the implementation process. METHODS: The ACP intervention was part of a 4-month complex, cluster randomized controlled trial (COSMOS). 37 Norwegian nursing homes with 72 units (1 cluster = 1 unit) and 765 patients were invited to participate and eligible units were randomised to the intervention group or control. Nursing home staff in the intervention group was offered a standardized education programme to learn early and repeated communication with patients and families and to implement ACP in their units. We used a train-the-trainer approach to educate staff in the units, supported by regular telephone calls and a midway seminar after two months. Individual patient logs consisting of different communication deliverables were used to evaluate the implementation process. Supported by Qualitative Content Analyses, we identified facilitators and barriers of the ACP implementation based on feedback during midway seminars and individual patient logs. RESULTS: The ACP intervention was conducted in 36 NH units (n = 297); 105 healthcare providers participated at the education seminar prior to the study, and 3-4 employees from each unit participated in the midway seminar. NH staff reported the educational material relevant for the implementation strategy. The patient logs showed that ACP was successfully implemented in 62% (n = 183) of the patients using our predefined implementation criteria. The staff emphasized the clear communication of the relevance of ACP addressed to leaders and staff as important facilitators, along with the clearly defined routines, roles and responsibilities. Identified barriers included lack of competence, perceived lack of time, and conflicting culture and staff opinions. CONCLUSION: Monthly communication with the family was the most frequently conducted communication, and the predefined criteria of successfully implemented ACP were largely achieved. Nursing home routines and engagement of leaders and staff were crucial facilitators, whereas lack of time and competence reduced the implementation success.
Health Care Administration and Organization
Escalating health care spending is a concern in Western countries, given the lack of evidence of a direct connection between spending and improvements in health. We aimed to determine the association between spending on health care and social programs and health outcomes in Canada.METHODS: We used retrospective data from Canadian provincial expenditure reports, for the period 1981 to 2011, to model the effects of social and health spending (as a ratio, social/health) on potentially avoidable mortality, infant mortality and life expectancy. We used linear regressions, accounting for provincial fixed effects and time, and controlling for confounding variables at the provincial level.RESULTS: A 1-cent increase in social spending per dollar spent on health was associated with a 0.1% (95% confidence interval [CI] 0.04% to 0.16%) decrease in potentially avoidable mortality and a 0.01% (95% CI 0.01% to 0.02%) increase in life expectancy. The ratio had a statistically nonsignificant relationship with infant mortality (p = 0.2).INTERPRETATION: Population-level health outcomes could benefit from a reallocation of government dollars from health to social spending, even if total government spending were left unchanged. This result is consistent with other findings from Canada and the United States.
This article aims to examine RCAs’ own experiences of personhood in dementia care settings. BACKGROUND: Conceptually, person-centred care entails fostering the personhood of residents and the residential care aides (RCAs) who provide much of their hands-on care. To date, however, staff personhood has been overlooked in the empirical literature. DESIGN: The study was part of a larger focused ethnographic project exploring how the organisational care environment impedes or facilitates the provision of quality dementia care. METHODS: Semi-structured interviews with 23 RCAs and more than 230 hours of participant observation were conducted in two nursing homes with specialised dementia units in British Columbia, Canada. RESULTS: Two overarching themes, “personhood undermined-management-staff relations” and “personhood undermined-workplace policies and practices” emerged, illustrating how, despite exposure to features believed beneficial to their working environment (e.g., favourable staffing ratios, relatively good remuneration), RCAs encountered repeated affronts to their personhood. The first theme encompasses the importance of being known (i.e., as persons and of their job demands) and valued (i.e., appreciated for their work in non-monetary terms). The second highlights the salience of work-life balance, full-staffing coverage and supportive human resource practices. CONCLUSIONS: RCAs’ experiences reveal how the ongoing search for cost-efficiencies, cost-containment and cost-accountability overshadows their individuality, indicating a key disconnect between conceptual ideals and workplace realities. IMPLICATIONS FOR PRACTICE: Organisations are encouraged to consider creating person-centred management and workplace practices that provide tangible evidence that RCAs, and their work, matter.
To determine the resident and facility characteristics associated with residents’ care-need level deterioration in long-term care welfare facilities in Japan. METHODS: A nationally representative sample of 358 886 residents who lived in 3774 long-term care welfare facilities for at least 1 year from October 2012 was obtained from long-term care insurance claims data. Facility characteristics were linked with a survey of institutions and establishments for long-term care in 2012. We used a multilevel logistic regression according to the inclusion and exclusion of lost to follow-up to define the resident and facility characteristics associated with resident care-need level deteriorations (lost to follow-up: the majority were hospitalized residents or had died; were treated as deterioration in the including loss to follow-up model). RESULTS: Adjusting for the covariates, at the resident level, older age and lower care-need level at baseline were more likely to show deterioration in the care-need level. At the facility level, metropolitan facilities, unit model (all private room settings) and mixed-model facilities (partly private room settings) were less likely to experience care-need level deterioration. A higher proportion of registered nurses among all nurses was negatively related to care-need level deterioration only in the model including lost to follow-up. A higher proportion of registered dietitians among all dietitians and the facilities in business for fewer years were negatively associated with care-need level deterioration only in the model excluding lost to follow-up. CONCLUSIONS: The present study could help identify residents who are at risk of care-need level deterioration, and could contribute to improvements in provider quality performance and enhance competence in the market.
Although sleep is a critical health outcome providing insight into overall health, well-being, and role functioning, little is known about the sleep consequences of simultaneously occupying paid and unpaid caregiving roles. This study investigated the frequency with which women employed in U.S.-based nursing homes entered and exited unpaid caregiving roles for children (double-duty-child caregivers), adults (double-duty-elder caregivers), or both (triple-duty caregivers), as well as examined how combinations of and changes in these caregiving roles related to cross-sectional and longitudinal sleep patterns. Research Design and Methods: The sample comprised 1,135 women long-term care employees who participated in the baseline wave of the Work, Family, and Health Study and were assessed at three follow-up time points (6-, 12-, and 18-months). Sleep was assessed with items primarily adapted from the Pittsburgh Sleep Quality Index and wrist actigraphic recordings. Multilevel models with data nested within persons were applied. Results: Women long-term care employees entered and exited the unpaid elder caregiving role most frequently. At baseline, double-duty-child and triple-duty caregivers reported shorter sleep quantity and poorer sleep quality than their counterparts without unpaid caregiving roles, or workplace-only caregivers. Double-duty-elder caregivers also reported shorter sleep duration compared to workplace-only caregivers. Over time, double-duty-elder caregiving role entry was associated with negative changes in subjective sleep quantity and quality. Discussion and Implications: Simultaneously occupying paid and unpaid caregiving roles has negative implications for subjective sleep characteristics. These results call for further research to advance understanding of double-and-triple-duty caregivers’ sleep health and facilitate targeted intervention development.
This article is one in a series of articles in this supplement addressing best practice for quality dementia care. The Alzheimer’s Association, in revising their Dementia Care Practice Recommendations for 2017 has identified staff across the long-term care spectrum as a distinct and important determinant of quality dementia care. The purpose of this article is to highlight areas for developing and supporting a dementia-capable workforce. Methods: The Alzheimer’s Association Principles For Advocacy To Assure Quality Dementia Care Across Settings provide a framework to examine interventions to support the dementia care workforce in long-term care settings. Evidence-based approaches that represent these principles are discussed: (a) staffing, (b) staff training, (c) compensation, (d) supportive work environments, (e) career growth and retention, and (f) engagement with family. Results: Although not all settings currently require attention to the principles described, this article proposes these principles as best practice recommendations. Recommendations and future research considerations to further improve the lives of those who live and work in nursing homes, assisted living, hospice, and home care, are proposed. Additional areas to improve the quality of a dementia care workforce person-centered care information, communication and interdepartmental teamwork, and ongoing evaluation are discussed.
Leadership in health care is instrumental to creating a supportive organizational environment and positive staff attitudes for implementing evidence-based practices to improve patient care and outcomes. The purpose of this study is to demonstrate the alignment of the Ottawa Model of Implementation Leadership (O-MILe), a theoretical model for developing implementation leadership, with the Implementation Leadership Scale (ILS), an empirically validated tool for measuring implementation leadership. A secondary objective is to describe the methodological process for aligning concepts of a theoretical model with an independently established measurement tool for evaluating theory-based interventions. Methods: Modified template analysis was conducted to deductively map items of the ILS onto concepts of the O-MILe. An iterative process was used in which the model and scale developers (n=5) appraised the relevance, conceptual clarity, and fit of each ILS items with the O-MILe concepts through individual feedback and group discussions until consensus was reached. Results: All 12 items of the ILS correspond to at least one O-MILe concept, demonstrating compatibility of the ILS as a measurement tool for the O-MILe theoretical constructs. Conclusion: The O-MILe provides a theoretical basis for developing implementation leadership, and the ILS is a compatible tool for measuring leadership based on the O-MILe. Used together, the O-MILe and ILS provide an evidence- and theory-based approach for developing and measuring leadership for implementing evidence-based practices in health care. Template analysis offers a convenient approach for determining the compatibility of independently developed evaluation tools to test theoretical models.
The nursing care of hospitalized patients with dementia is planned and supervised by registered nurses. This care is delivered using a team approach, including certified nursing assistants, who may lack the knowledge and skills to properly provide care and manage the challenging behaviors associated with dementia. This article describes an innovative, multimodal education program designed to help certified nursing assistants acquire this knowledge and skill. Use of post-then-pre evaluation showed the positive results of this program.
Health Care Innovation and Quality Assurance
The growing use of social media creates opportunities for patients and families to provide feedback and rate individual healthcare providers. Whereas previous studies have examined this emerging trend in hospital and physician settings, little is known about user ratings of nursing homes (NHs) and how these ratings relate to other measures of quality. OBJECTIVE: To examine the relationship between Facebook user-generated NH ratings and other measures of NH satisfaction/experience and quality. METHODS: This study compared Facebook user ratings of NHs in Maryland (n=225) and Minnesota (n=335) to resident/family satisfaction/experience survey ratings and the Centers for Medicare and Medicaid (CMS) 5-star NH report card ratings. RESULTS: Overall, 55 NHs in Maryland had an official Facebook page, of which 35 provided the opportunity for users to rate care in the facility. In Minnesota, 126 NHs had a Facebook page, of which 78 allowed for user ratings. NHs with higher aid staffing levels, not affiliated with a chain and located in higher income counties were more likely to have a Facebook page. Facebook ratings were not significantly correlated with the CMS 5-star rating or survey-based resident/family satisfaction ratings. CONCLUSIONS: Given the disconnect between Facebook ratings and other, more scientifically grounded measures of quality, concerns about the validity and use of social media ratings are warranted. However, it is likely consumers will increasingly turn to social media ratings of NHs, given the lack of consumer perspective on most state and federal report card sites. Thus, social media ratings may present a unique opportunity for healthcare report cards to capture real-time consumer voice.
The health care system in Saudi Arabia has serious problems with quality and safety that can be reduced through systematic quality improvement (QI) activities. Despite the use of different QI models to improve health care in Saudi hospitals during the last 2 decades, consistent improvements have not yet been achieved and the results are still far below expectations. This may reflect a problem in introducing and implementing the QI models in the local contexts. The objective of this study is to assess the extent of QI implementation in Saudi hospitals and to identify the organizational characteristics that make Saudi hospitals particularly challenging for QI. Understanding these characteristics can inform efforts to improve them and may lead to more successful implementation. METHODS: A mixed-methods approach was conducted using 2 data collection tools: questionnaires and interviews. The quantitative phase (questionnaires) aimed to uncover the current level of QI implementation in Saudi hospital as measured by 7 critical dimensions adapted from the literature. The qualitative phase (interviews) aimed to understand the organizational characteristics that impede or underpin QI in Saudi hospitals. RESULTS AND DISCUSSION: The QI implementation was found to be significantly poor across the 7 dimensions with average score ranging between 22.80 +/- 0.57 and 2.11 +/- 0.69 on a 5-point Likert scale and with P value of less than .05. We also found that the current level of QI implementation helped Saudi hospitals neither to improve “customer satisfaction” nor to achieve measurable improvements in “quality results” scoring significantly low at 2.11 +/- 0.69 with P value of .000 and 2.47 +/- 0.57 with P value of .000, respectively. Our study confirms the presence of a multitude of organizational barriers that impede QI in Saudi hospitals. These are related to organizational culture, human resources management, processes and systems, and structure. These 4 were found to have the strongest impact on QI in Saudi hospitals. CONCLUSION: It appears that the most important contributing factors to the successful implementation of QI in Saudi hospitals are proper human resources utilization and effective quality management. Through careful planning, change management, proper utilization of human resources, supportive quality information systems, focus on processes and systems, structural support, and an organizational culture that is compatible with QI philosophy, Saudi hospitals will be more capable in achieving sustained measureable improvements in the quality and safety of patient care.
Favorable nursing practice environments have been associated with lower patient mortality, failure to rescue, nurse-administered medication errors, infections, patient complaints, and patient falls. Favorable environments have also been associated with higher nurse-reported care quality and patient satisfaction in civilian hospitals. However, limited information exists on the relationship between favorable nursing practice environments and positive outcomes in military facilities. Using 4 years of secondary data collected from 45 units in 10 Army hospitals, generalized estimating equations were used to test the associations between nurses’ scores on the Practice Environment Scale of the Nursing Work Index (PES-NWI) and patient outcomes of falls with and without injury, medication administration errors with and without harm, and patient experience. Four significant associations were found between the PES-NWI subscales and the patient outcomes under study. The Staffing and Resource Adequacy subscale was significantly associated with patient falls, the Collegial Nurse Physician Relations subscale was significantly associated with the rate of nurse-administered medication errors, and the Nursing Foundations for Quality Care and Collegial Nurse Physician Relations subscales were both significantly associated with patient experience with nursing care. As in civilian hospitals, favorable nursing practice environment was associated with improved patient outcomes within these military nursing units.
The quality of nursing homes (NHs) has attracted a lot of interest in recent years and is one of the most challenging issues for policy-makers. Nutritional care should be considered an important variable to be measured from the perspective of quality management. The aim of this systematic review is to describe the use of structural, process, and outcome indicators of nutritional care in NHs and the relationship among them. METHODS: The literature search was carried out in Pubmed, Embase, Scopus, and Web of Science. A temporal filter was applied in order to select papers published in the last 10 years. All types of studies were included, with the exception of reviews, conference proceedings, editorials, and letters to the editor. Papers published in languages other than English, Italian, and Spanish were excluded. RESULTS: From the database search, 1063 potentially relevant studies were obtained. Of these, 19 full-text articles were considered eligible for the final synthesis. Most of the studies adopted an observational cross-sectional design. They generally assessed the quality of nutritional care using several indicators, usually including a mixture of many different structural, process, and outcome indicators. Only one of the 19 studies described the quality of care by comparing the results with the threshold values. Nine papers assessed the relationship between indicators and six of them described some significant associations-in the NHs that have a policy related to nutritional risk assessment or a suitable scale to weigh the residents, the prevalence or risk of malnutrition is lower. Finally, only four papers of these nine included risk adjustment. This could limit the comparability of the results. CONCLUSION: Our findings show that a consensus must be reached for defining a set of indicators and standards to improve quality in NHs. Establishing the relationship between structural, process, and outcome indicators is a challenge. There are grounds for investigating this theme by means of prospective longitudinal studies that take the risk adjustment into account.
Growing old entails an increased risk of disabilities and illnesses such as dementia. The orientation in Sweden on national level is that individuals remain in their own homes if desired and receive person-centred home care. The aim of this study was to describe the experience of an educational program and its influence on daily provision of care to persons with dementia. A life-world approach was used. Data were collected through group interviews with care providers in the context of home. The findings are presented in five themes: Increased knowledge about dementia and treatment, Relationship-building in order to provide good care, Open and flexible approach conveys calm, Continuity and flexibility are cornerstones in the care and Perceived improvements. This person-centred educational intervention resulted in a care that was based on each individual’s personality, preferences and priorities in life. Education given with continuity over time is key to improving provision of care to person with dementia.
Rationale, aims, and objectives As the Sustainable Development Goals are rolled out worldwide, development leaders will be looking to the experiences of the past to improve implementation in the future. Systems thinking and complexity science (ST/CS) propose that health and the health system are composed of dynamic actors constantly evolving in response to each other and their context. While offering practical guidance for steering the next development agenda, there is no consensus as to how these important ideas are discussed in relation to health. This systematic review sought to identify and describe some of the key terms, concepts, and methods in recent ST/CS literature.
In an era of rising clinical costs and shrinking federal research dollars, the survival of the academic health center may depend on its capacity to cultivate high-impact innovations in care delivery on an accelerated basis. Yet, the health sciences literature offers little guidance regarding the key organizational determinants most likely to facilitate such innovation. We report on the conceptualization, development, and preliminary testing of a new 21-item Accelerated Healthcare Innovation Capacity scale for addressing that knowledge gap. Instrument development followed a standardized process, including expert panel testing of the new scale’s content relevance validity. A sample (N = 53) of academic health center administrators, clinicians, and faculty affiliated with a single organization volunteered to complete the Accelerated Healthcare Innovation Capacity scale in survey form. Data were analyzed to evaluate scale reliability, internal consistency, and construct validity. High-expert agreement (overall S-CVI of 0.91) was obtained on content relevance validity. Cronbach alpha for the scale was 0.941. Exploratory factor analysis confirmed the theoretical soundness of the scale’s conceptual framework, which showed high-impact health care innovation support to be a complex, multidimensional concept involving key facilitating factors across 3 major constructs-that is, Culture, Structure, and Policy-with implications for future research and managerial practice, particularly for staff development educators engaged in evaluating quality management and organizational change strategies.
Faster and more widespread implementation could help more patients to benefit more quickly from known effective treatments. So could more effective implementation of better assessment methods, service delivery models, treatments and services. Implementation at scale and ‘descaling’ are ways for hospitals and health systems to respond to rising demands and costs. The paper proposes ways to provide leaders with the information that would help them to decide whether and how to scale up a proven improvement. We draw on our knowledge of the improvement and implementation literature on the subject and on our experience of scale up programs in Kaiser Permanente, in Swedish county health systems, and in international health. We describe a ‘3S’ scale up infrastructure and other ingredients that appear necessary for successful widespread improvement, and list the resources that we have found useful for developing scale up programs. The paper aims to encourage more actionable research into scale up, and shows the opportunities for researchers to both advance implementation and improvement science and contribute to reducing suffering and costs in a more timely and effective way.
This report explores what it takes to scale innovation successfully in the NHS. We look in depth at 10 innovations that have spread over the past 20 years. The case studies are rich in insight, and from them we have drawn a set of provocations (see From insights to practice) for the reader to consider how these insights build on, and challenge, existing wisdom on how to scale innovation in the NHS.
External change agents can play an essential role in healthcare organizational change efforts. This systematic review examines the role that external change agents have played within the context of multifaceted interventions designed to promote organizational change in healthcare-specifically, in primary care settings. METHODS: We searched PubMed, CINAHL, Cochrane, Web of Science, and Academic Search Premier Databases in July 2016 for randomized trials published (in English) between January 1, 2005 and June 30, 2016 in which external agents were part of multifaceted organizational change strategies. The review was conducted according to PRISMA guidelines. A total of 477 abstracts were identified and screened by 2 authors. Full text articles of 113 studies were reviewed. Twenty-one of these studies were selected for inclusion. RESULTS: Academic detailing (AD) is the most prevalently used organizational change strategy employed as part of multi-component implementation strategies. Out of 21 studies, nearly all studies integrate some form of audit and feedback into their interventions. Eleven studies that included practice facilitation into their intervention reported significant effects in one or more primary outcomes. CONCLUSIONS: Our results demonstrate that practice facilitation with regular, tailored follow up is a powerful component of a successful organizational change strategy. Academic detailing alone or combined with audit and feedback alone is ineffective without intensive follow up. Provision of educational materials and use of audit and feedback are often integral components of multifaceted implementation strategies. However, we didn’t find examples where those relatively limited strategies were effective as standalone interventions. System-level support through technology (such as automated reminders or alerts) is potentially helpful, but must be carefully tailored to clinic needs.
Research Practice and Methodology
The GRADE-CERQual (‘Confidence in the Evidence from Reviews of Qualitative research’) approach provides guidance for assessing how much confidence to place in findings from systematic reviews of qualitative research (or qualitative evidence syntheses). The approach has been developed to support the use of findings from qualitative evidence syntheses in decision-making, including guideline development and policy formulation. This article is the first of a seven-part series providing guidance on how to apply the CERQual approach. In this paper, we describe the rationale and conceptual basis for CERQual, the aims of the approach, how the approach was developed, and its main components. We also outline the purpose and structure of this series and discuss the growing role for qualitative evidence in decision-making. The other papers in this series are the following:
The pragmatic-explanatory continuum indicator summary version 2 (PRECIS-2) tool has recently been developed to classify randomized clinical trials (RCTs) as pragmatic or explanatory based on their design characteristics. Given that treatment effects in explanatory trials may be greater than those obtained in pragmatic trials, conventional meta-analytic approaches may not accurately account for the heterogeneity among the studies and may result in biased treatment effect estimates. This study investigates if the incorporation of PRECIS-2 classification of published trials can improve the estimation of overall intervention effects in meta-analysis. METHODS: Using data from 31 published trials of intervention aimed at reducing obesity in children, we evaluated the utility of incorporating PRECIS-2 ratings of published trials into meta-analysis of intervention effects in clinical trials. Specifically, we compared random-effects meta-analysis, stratified meta-analysis, random-effects meta-regression, and mixture random-effects meta-regression methods for estimating overall pooled intervention effects. RESULTS: Our analyses revealed that mixture meta-regression models that incorporate PRECIS-2 classification as covariate resulted in a larger pooled effect size (ES) estimate (ES = – 1.01, 95%CI = [- 1.52, – 0.43]) than conventional random-effects meta-analysis (ES = – 0.15, 95%CI = [- 0.23, – 0.08]). CONCLUSIONS: In addition to the original intent of PRECIS-2 tool of aiding researchers in their choice of trial design, PRECIS-2 tool is useful for explaining between study variations in systematic review and meta-analysis of published trials. We recommend that researchers adopt mixture meta-regression methods when synthesizing evidence from explanatory and pragmatic trials.
This paper examines recently admitted nursing home residents’ practical autonomy, their remaining social environment and their social functioning. METHOD: In a cross-sectional design, 391 newly admitted residents of 67 nursing homes participated. All respondents were >/=65 years old, had mini-mental state examination >/=18 and were living in the nursing home for at least 1 month. Data were collected using a structured questionnaire and validated measuring tools. RESULTS: The mean age was 84, 64% were female, 23% had a partner, 80% children, 75% grandchildren and 59% siblings. The mean social functioning score was 3/9 (or 33%) and the autonomy and importance of autonomy score 6/9 (or 67%). More autonomy was observed when residents could perform activities of daily living more independently, and cognitive functioning, quality of life and social functioning were high. Residents with depressive feelings scored lower on autonomy and social functioning compared to those without depressive feelings. Having siblings and the frequency of visits positively correlated with social functioning. In turn, social functioning correlated positively with quality of life. Moreover, a higher score on social functioning lowered the probability of depression. CONCLUSION: Autonomy or self-determination and maintaining remaining social relationships were considered to be important by the new residents. The remaining social environment, social functioning, quality of life, autonomy and depressive feelings influenced each other, but the cause–effect relation was not clear.
Objective: Develop and test a stigma awareness and education curriculum targeted to non-medical staff of a local Alzheimer’s Association chapter. Methods The curriculum, developed in collaboration with leadership and educational staff from the Cleveland Chapter of the Alzheimer’s Association, included a definition, types, and domains of stigma; effects of stigma on individuals with dementia and their families; stigma evaluation studies; tips to address the topic of dementia-related stigma with individuals and families. Lastly, an interactive discussion of real-life scenarios facilitated stigma recognition and management. Results Most staff felt the training improved their ability to identify Alzheimer’s disease stigma, made them more comfortable talking about stigma, and would change the way they interacted with people and families impacted by Alzheimer’s disease. Conclusions This brief, practical educational curriculum has potential to improve awareness of dementia stigma in Alzheimer’s Association staff. Research is needed to expand stigma awareness in individuals and groups with varying levels of dementia knowledge.
The aim of this study is to evaluate the relationship of leading causes of death with gradients of cognitive impairment and multimorbidity. METHOD: This is a population-based study using data from the linked 1992-2010 Health and Retirement Study and National Death Index ( n = 9,691). Multimorbidity is defined as a combination of chronic conditions, functional limitations, and geriatric syndromes. Regression trees and Random Forest identified which combinations of multimorbidity associated with causes of death. RESULTS: Multimorbidity is common in the study population. Heart disease is the leading cause in all groups, but with a larger percentage of deaths in the mild and moderate/severe cognitively impaired groups than among the noncognitively impaired. The different “paths” down the regression trees show that the distribution of causes of death changes with different combinations of multimorbidity. DISCUSSION: Understanding the considerable heterogeneity in chronic conditions, functional limitations, geriatric syndromes, and causes of death among people with cognitive impairment can target care management and resource allocation.
Engagement in activities is crucial to improve quality of life in dementia. Yet, its measurement relies exclusively on behavior observation and the influence that behavioral and psychological symptoms of dementia (BPSD) have on it is overlooked. This study investigated whether quantity of movement, gauged with a wrist-worn accelerometer, could be a sound measure of engagement and whether apathy and depression negatively affected engagement. Fourteen participants with dementia took part in 6 sessions of activities: 3 of cognitive games (eg, jigsaw puzzles) and 3 of robot play (Pleo). Results highlighted significant correlations between quantity of movement and observational scales of engagement and a strong negative influence of apathy and depression on engagement. Overall, these findings suggest that quantity of movement could be used as an ancillary measure of engagement and underline the need to profile people with dementia according to their concurrent BPSD to better understand their engagement in activities.
To evaluate the effectiveness of a nurse-supported self-management programme to improve social participation of dual sensory impaired older adults in long-term care homes. DESIGN: Cluster randomised controlled trial. SETTING: Thirty long-term care homes across the Netherlands. PARTICIPANTS: Long-term care homes were randomised into intervention clusters (n=17) and control clusters (n=13), involving 89 dual sensory impaired older adults and 56 licensed practical nurses. INTERVENTION: Nurse-supported self-management programme. MEASUREMENTS: Effectiveness was evaluated by the primary outcome social participation using a participation scale adapted for visually impaired older adults distinguishing four domains: instrumental activities of daily living, social-cultural activities, high-physical-demand and low-physical-demand leisure activities. A questionnaire assessing hearing-related participation problems was added as supportive outcome. Secondary outcomes were autonomy, control, mood and quality of life and nurses’ job satisfaction. For effectiveness analyses, linear mixed models were used. Sampling and intervention quality were analysed using descriptive statistics. RESULTS: Self-management did not affect all four domains of social participation; however. the domain ‘instrumental activities of daily living’ had a significant effect in favour of the intervention group (P=0.04; 95% CI 0.12 to 8.5). Sampling and intervention quality was adequate. CONCLUSIONS: A nurse-supported self-management programme was effective in empowering the dual sensory impaired older adults to address the domain ‘instrumental activities of daily living’, but no differences were found in addressing the other three participation domains. Self-management showed to be beneficial for managing practical problems, but not for those problems requiring behavioural adaptations of other persons. TRIAL REGISTRATION NUMBER: NCT01217502
This study aimed to identify screening tools, technologies and strategies that vision and hearing care specialists recommend to front-line healthcare professionals for the screening of older adults in long-term care homes who have dementia.Setting An environmental scan of healthcare professionals took place via telephone interviews between December 2015 and March 2016. All interviews were audio recorded, transcribed, proofed for accuracy, and their contents thematically analysed by two members of the research team.Participants A convenience sample of 11 professionals from across Canada specialising in the fields of vision and hearing healthcare and technology for older adults with cognitive impairment were included in the study.Outcome measures As part of a larger mixed-methods project, this qualitative study used semistructured interviews and their subsequent content analysis.Results Following a two-step content analysis of interview data, coded citations were grouped into three main categories: (1) barriers, (2) facilitators and (3) tools and strategies that do or do not work for sensory screening of older adults with dementia. We report on the information offered by participants within each of these themes, along with a summary of tools and strategies that work for screening older adults with dementia.Conclusions Recommendations from sensory specialists to nurses working in long-term care included the need for improved interprofessional communication and collaboration, as well as flexibility, additional time and strategic use of clinical intuition and ingenuity. These suggestions at times contradicted the realities of service provision or the need for standardised and validated measures.
With mounting concerns about the severe emotional and physical impact that loneliness can have – especially on older people – United Neighborhood Houses (UNH) has released a new report “Aging in the Shadows: An Update on Social Isolation Among Older Adults in NYC.” The report examines changing trends since the release of the first “Aging in the Shadows” report, defines isolation and its risk factors, and recommends changes to form and implement a prevention strategy.
The report provides a unique exploration of the existing ecosystem of music for people with dementia and brings together for the first time a wide range of evidence, including academic papers and written and oral evidence. Site visits to observe projects in action were also fundamental in bringing to light the value of this field of work.
Living systematic reviews are a new approach to systematic reviews in which evidence is continually updated, incorporating relevant new evidence as it becomes available. It produces evidence that is both trustworthy and current.
Being clear about the type and scope of the review that best fits your project will save you time and possibly future regret! This webinar will help you focus in on the review type you need to do to best support your research.
Getting started on a literature search for comprehensive review can seem daunting. Dr. Sampson gives some important tips for novice reviewers, including:
-looking for previous SRs or registered SR protocols on the same topic
-searching on your own for really truly eligible studies to see if your study parameters are viable, before you lock in the search
-making sure there really are no trials before you open up eligibility to all study designs
-why your librarian might insist on seeing your protocol before designing your final search
-scoping your topic to your resources / scoping your resources to your topic
For people with dementia, receiving a diagnosis is just the first step to accessing the health system. As their needs increase, they will often need care in other settings, compelling a transition or move. While some of these transitions are required, people with dementia may experience unwanted or unnecessary transitions that can be traumatic and pose serious challenges to continuity of care and patient safety. In this webinar Dr. Sivananthan will share ‘big data’ for an entire population to understand what some of these transitions look like long term, and whether receiving good dementia and primary care has an influence on the number of moves experienced.
Improving the provision of person-centred care practices during mealtimes is essential to the quality of life for persons with dementia living in residential care homes. This webinar will describe the Feasible and Sustainable Culture Change Intervention (FASSCI) Model—a unique and innovative model for culture change in residential care homes that improves collaboration, accountability, mutual understanding, and knowledge sharing among all stakeholders (e.g., licensing inspectors, family members, and formal care team members).
Science Outside the Lab (SOtL) North is a deep-dive, immersive introduction to science, policy, and societal impacts. During the week-long workshop, students meet and interact with the people who fund, regulate, shape, critique, publicize, and study science, including government scientists, funding agency officers, science-focused interest groups, science communicators, academics, museum curators, and others. It’s a high-paced, high-intensity opportunity to build a professional network, learn about the wide-range of opportunities for scientists to affect policy and government, and to develop the skills needed to succeed in professional lives outside the lab.
The IHI Quick Course Back to Basics: Building Essential QI Skills is a one-day workshop that will provide a jump start for those who are new to quality improvement, and a refresher for those who are feeling stalled in their improvement efforts. Built around the Model for Improvement, this course will demonstrate how to link the three questions related to aim, measurement, and change concepts to the sequence for success.
This new online learning module from the National Collaborating Centre for Methods and Tools (NCCMT) provides public health leaders with an overview of areas to consider when planning organizational change. With this module, you will:
-Learn about a model for organizational change
-Discover tools that can be used for organizational assessment
-Develop knowledge and skills in planning organizational change
-Learn about strategies for implementing organizational change
-Become familiar with process, structure and outcome indicators and their measurement
A dementia-specific advance directive maps out the effects of mild, moderate and severe dementia, and asks patients to specify which medical interventions they would want — and not want — at each phase of the illness.
There are different ways in which evidence exists or is reported and this creates differences in the degree to which that knowledge is brokered or translated for use in policy and practice.
In Dallas, a 93-year-old is worried about the woman who, for years, has come to her house four days a week to help with shopping, laundry, housecleaning and driving. “She’s just a wonderful person, someone I feel I can trust completely,” said the older woman. But because her helper is an undocumented immigrant from Mexico, both women increasingly fear that she’ll be detained and deported
CBC investigation uncovers dramatic rise in reports of resident-on-resident abuse in Ontario homes
A study published recently in Age and Ageing, the scientific journal of the British Geriatrics Society, reports that the number of older people diagnosed with four or more diseases will double between 2015 and 2035.
One of the most frustrating traits of the Canadian health-care system is its failure to recognize and embrace success. But believe it or not, there is a lot of innovation in health care.
The ImpleMentAll project aims to bridge the gap between development of eHealth interventions and their uptake into routine care through the development, application, and evaluation of tailored implementation strategies in a natural laboratory of ongoing eHealth implementation initiatives in the EU and beyond. ImpleMentAll will use this natural laboratory to develop, test, and evaluate a toolkit for tailored implementation strategies expected to more implementation trajectories more efficient for eHealth and eMental health alike.
To meet the challenges of increasing numbers of Canadians living with frailty, we’ll need to begin to reorganize how we provide both social supports and restructure the health care system to meet their needs — a tall order.
But female scientists suffer when their research proposals are judged primarily on the strength of their CVs.
The culture shock is about more than just role anxiety.
Pay for performance, the catchall term for policies that purport to pay doctors and hospitals based on quality and cost measures, has been taking a bashing.
A new UK institute dedicated to researching quality improvement will focus on “unglamorous” problems, says its director, Mary Dixon-Woods.
With this background in mind, Dr Nils Muiznieks, Commissioner for Human Rights for the Council of Europe, has released a formal human rights comment on the need for – and fundamental human right to – long-term care for older people in Europe.
A new approach to older patients as U.S. emergency rooms adapts to serve the complex needs of a graying population. That means asking more questions, asking them earlier and, when possible, avoiding a hospital stay for many older patients.
The Implementation Station is a new podcast that launched on December 15, 2017 and is dedicated to enhancing the dissemination and discussion around topics ranging across improvement and implementation sciences. The podcast covers emerging topics, innovative research, and pragmatic applications with experts.
Dementia Advisor is a mobile app that helps family caregivers learn how to deal with difficult dementia behaviours and improve communication and problem-solving skills through interactive, chat-based role playing.
For people living in care homes, infections can be serious, and in some cases, life-threatening. They can also make existing medical conditions worse. It is therefore vital to take the steps that can help prevent infection occurring. Managers and staff in care homes will find this guide very useful as a reminder of the most important methods of preventing infection.
They are looking for a student who is enthusiastic about health services research and can become part of the research endeavour within CHSS. Applicants will have completed a health-related postgraduate training course at Master’s level equivalent to merit or distinction with a substantial research training component. The studentship will cover tuition fees at the standard postgraduate home/EU rate plus an annual maintenance stipend £14,553 per annum (2017-2018 rate). In addition, there is an annual Research Training Support allowance of £750 to cover conference attendance, training courses, equipment and books.
The Frank Porter Graham (FPG) Child Development Institute at University of North Carolina at Chapel Hill is seeking applications for four Implementation Specialists. The implementation Specialists will serve as project area leaders on funded implementation science project(s) at the Institute.
The Cancer Prevention & Control Program at Fox Chase Cancer Center (FCCC) invites applications for a full-time assistant or early associate professor with an active research program in intervention development and/or dissemination and implementation science. Applicants should have a strong reputation in scholarship, as evidenced by a track record of independent cancer research funding and peer-reviewed publications. Academic rank will be commensurate with qualifications and experience.
In this full-time, 2-year contract, reporting to the CEI Director, you will be responsible for leading a portfolio of CEI projects across a range of key CEI strategic activities, including research synthesis, translating and disseminating evidence, implementation science and evaluation. You will also contribute to the development of CEI to grow the Centre’s business and organisational capacity.