April 20, 2021

BACKGROUND: Antipsychotic medications are used to address neuropsychiatric symptoms associated with dementia. Evidence suggests that among older adults with dementia, their harms outweigh their benefits. A quality improvement initiative was conducted to address inappropriate antipsychotic medication use in long-term care (LTC) in the province of Alberta. METHODS: We conducted a multimethod evaluation of the provincial implementation of the project in 170 LTC sites over a 3-year project period incorporating a quasi-experimental before-after design. Using a three-component intervention of education and audit and feedback delivered in a learning workshop innovation collaborative format, local LTC teams were supported to reduce the number of residents receiving antipsychotic medications in the absence of a documented indication. Project resources were preferentially allocated to supporting sites with the highest baseline antipsychotic medication use. Changes in antipsychotic medication use, associated clinical and economic outcomes, and the effects of the project on LTC staff, physicians, leaders and administrators, and family members of LTC residents were assessed at the conclusion of the implementation phase. RESULTS: The province-wide initiative was delivered with a 75% implementation fidelity. Inappropriate antipsychotic medication use declined from 26.8% to 21.1%. The decrease was achieved without unintended consequences in other outcomes including physical restraint use or aggressive behaviours. The project was more expensive but resulted in less inappropriate use of antipsychotics than the pre-project period (incremental cost per inappropriate antipsychotic avoided of $5 678.71). Accounts from family, organisational leaders, and LTC staff were supportive of the project activities and outcomes. CONCLUSION: This quality improvement initiative was successfully delivered across an entire delivery arm of the continuing care sector. Quality of care in LTC was improved.

BACKGROUND: Repeated admission to hospital can be stressful for older people and their families and puts additional pressure on the health care system. While there is some evidence about strategies to better integrate care, improve older patients’ experiences at transitions of care, and reduce preventable hospital readmissions, implementing these strategies at scale is challenging. This program of research comprises multiple, complementary research activities with an overall goal of improving the care for older people after discharge from hospital. The program leverages existing large datasets and an established collaborative network of clinicians, consumers, academics, and aged care providers. METHODS: The program of research will take place in South Australia focusing on people aged 65 and over. Three inter-linked research activities will be the following: (1) analyse existing registry data to profile individuals at high risk of emergency department encounters and hospital admissions; (2) evaluate the cost-effectiveness of existing ‘out-of-hospital’ programs provided within the state; and (3) implement a state-wide quality improvement collaborative to tackle key interventions likely to improve older people’s care at points of transitions. The research is underpinned by an integrated approach to knowledge translation, actively engaging a broad range of stakeholders to optimise the relevance and sustainability of the changes that are introduced. DISCUSSION: This project highlights the uniqueness and potential value of bringing together key stakeholders and using a multi-faceted approach (risk profiling; evaluation framework; implementation and evaluation) for improving health services. The program aims to develop a practical and scalable solution to a challenging health service problem for frail older people and service providers.

ABSTRACTCommunities of Practice (CoPs) are a powerful strategy for supporting knowledge sharing amongst members working in a common field. Information, knowledge and evidence in the field of older adult healthcare and aging have grown exponentially over the past decade. This study reports results from a secondary qualitative analysis of ethnographic data to explore the cultural factors of two CoPs that members perceived to promote and constrain success. The CoPs, housed by the Seniors Health Knowledge Network (SHKN), were composed of stakeholders including formal care givers, and focused on wound care and complex care resolution for older adults. Participants spoke about five themes: 1) Hope and desire to cause real, effective change, 2) Appreciation for bringing together diverse people and experiences, 3) Aspiring to work together as a harmonious team, 4) Striving for strong work ethic and good practices to achieve efficiency and productivity and 5) Responses to tensions, worries and uncertainty. Drawing on the themes and the broader CoP literature, we provide strategies for developing, running and sustaining successful healthcare CoPs as an educational resource for formal care givers and other stakeholders. CoPs must be largely autonomous and self-organizing, and sponsoring bodies will need to restrict their activities to providing resources and support without imposing specific mandates. The most important implication of this work is that passion, work ethic, diversity and communication can help CoPs achieve harmony and success.