Health service accreditation stimulating change in clinical care and human resource management processes: A study of 311 Australian hospitals

OBJECTIVE

This study aimed to establish whether longitudinal participation in an accreditation program is translated into improvement in continuity of quality patient care and human resource management (HRM) processes outcomes.

MATERIALS AND METHODS

This was a secondary data analysis of accreditation panel data from acute hospitals participating in the Australian Council on Healthcare Standards' Evaluation and Quality Improvement Program (EQuIP). EQuIP criteria data from 311 hospitals were collected by external surveyors across 2003-2006 (Time 1) and 2007-2010 (Time 2). Mandatory accreditation criteria ratings at Time 1 were used to determine hospital performance group membership (1 = below moderate, 2 = moderate, 3 = above moderate). Analysis was undertaken of ratings across continuity of quality patient care and HRM process criteria, at Time 1 and 2.

RESULTS

Continuity of quality patient care and HRM processes improved across time in the three performance groups. Lower performing hospitals improved at a greater rate than moderate and higher performing hospitals. The groupings and performance order did not change over time.

CONCLUSIONS

An accreditation program is an external driver that facilitates continual and systemic quality improvement changes to sub-systems with an organisation.

Abstract P6-21-05: Concurrent exercise and chemotherapy in preclinical breast cancer models

The benefits of exercise following a cancer diagnosis is increasingly recognized. Increased physical activity is associated with reduced breast cancer recurrence and breast cancer specific mortality. However, the mechanisms underpinning this effect are still under investigation. The role of exercise as an adjunct to systemic therapy for breast cancer remains unclear. We hypothesize that exercise may exert an anti-tumor effect and a change in tumor immune cell infiltration.

Methods

We evaluated the effect of exercise alone and in combination with chemotherapy in preclinical patient-derived TNBC xenografts (PDX) established in Nude mice and PyMT mouse tumor models. Mice were individually housed in boxes equipped with running wheels and randomized to 1) clamped wheels (sedentary controls), 2) doxorubicin (Dox, 2mg/kg/week), 3) exercise (Ex) and 4) Ex + Dox. Daily distance run was measured. One week after randomization (acclimatization period), the intervention was commenced. Body composition was measured at randomization and at end point. Tumors were harvested after 5 weeks of intervention or at ethical endpoint. Tumor immune infiltrates were analyzed, and transcriptomic analysis performed.

Results

In the TNBC PDX model, there was no difference in tumor volume at randomization (p=0.96), or cumulative distance run after 1 week of acclimatization to the running wheel (p=0.47). At 5 weeks, Ex alone significantly reduced tumor growth rate compared with controls (relative reduction 10%, p=0.025). There was no difference between the other interventions. Mice randomized to Ex + Dox ran a shorter cumulative distance over 5 weeks compared with Ex alone (103.6 ± 16.2km vs 168.8 ±23km, p=0.028). There was no correlation between distance run and tumor volume in either of the treatment cohorts involving exercise (p=0.39). PyMT, transcriptomic and immune cell infiltration analysis will be reported.

At baseline, there was no significant difference in mean total body mass (TBM), lean mass (LM) or fat mass (FM) between the intervention groups (p>0.05). At 5 weeks, the mean TBM and LM in both groups treated with Dox was significantly lower than Ex only and controls. The Ex and the control mice gained weight (11%), compared with Dox only and Ex + Dox mice which did not gain weight (0% and -6% respectively). Therefore exercise had no significant impact on TBM or LM at 5 weeks, but Dox resulted in loss of TBM and LM compared with mice not treated with Dox.

Conclusion

Exercise significantly reduced tumor growth compared with sedentary controls in our preclinical TNBC PDX model, however there was not synergistic effect seen with Dox. Cumulative doses of Dox resulted in weight loss and loss of lean mass, and reduced the cumulative running distance, compared with mice not treated with Dox.

Citation Format: Wahlroos S, Wilkinson A, Gallego-Ortega D, Febbraio M, Lim E. Concurrent exercise and chemotherapy in preclinical breast cancer models [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-21-05.

Using intervention mapping to design a self-management programme for older people with chronic conditions

Self-management programmes provide strategies to optimise health while educating and providing resources for living with enduring illnesses. The current paper describes the development of a community-based programme that combines a transdiagnostic approach to self-management with mindfulness to enhance psychological coping for older people with long-term multimorbidity. The six steps of intervention mapping (IM) were used to develop the programme. From a needs assessment, the objectives of the programme were formulated; the theoretical underpinnings then aligned to the objectives, which informed programme design, decisions on implementation, programme adoption and evaluation steps. Bandura's social cognitive theory informed the methods and practical strategies of delivery. Among the features addressed with participants are transdiagnostic dimensions such as fatigue, pain, breathlessness, sleep disturbances. The programme utilises mindfulness to aid coping and ameliorate the psychological distresses associated with chronicity. Findings from an initial feasibility study and subsequent pilot assisted in conceptualising our programme. In conclusion, applying IM gave the planners confidence the programme is robust and evidence-based with clearly articulated links between the behavioural goals and design elements to obtain the desired outcomes.

The repeatability of cognitive performance: a meta-analysis

Behavioural and cognitive processes play important roles in mediating an individual's interactions with its environment. Yet, while there is a vast literature on repeatable individual differences in behaviour, relatively little is known about the repeatability of cognitive performance. To further our understanding of the evolution of cognition, we gathered 44 studies on individual performance of 25 species across six animal classes and used meta-analysis to assess whether cognitive performance is repeatable. We compared repeatability (R) in performance (1) on the same task presented at different times (temporal repeatability), and (2) on different tasks that measured the same putative cognitive ability (contextual repeatability). We also addressed whether R estimates were influenced by seven extrinsic factors (moderators): type of cognitive performance measurement, type of cognitive task, delay between tests, origin of the subjects, experimental context, taxonomic class and publication status. We found support for both temporal and contextual repeatability of cognitive performance, with mean R estimates ranging between 0.15 and 0.28. Repeatability estimates were mostly influenced by the type of cognitive performance measures and publication status. Our findings highlight the widespread occurrence of consistent inter-individual variation in cognition across a range of taxa which, like behaviour, may be associated with fitness outcomes.This article is part of the theme issue 'Causes and consequences of individual differences in cognitive abilities'.

Views of healthcare professionals on training for and delivery of a fatigue self-management program for persons with multiple sclerosis

Purpose: To explore the experiences and perspectives of the healthcare professionals who were trained to and delivered "Minimise Fatigue, Maximise Life" (MFML), a patient-centered group-based fatigue self-management program for persons with multiple sclerosis.Methods: A qualitative descriptive study with semi-structured individual interviews at two time points. Data were analyzed for themes. Six healthcare professional facilitators who were trained to and delivered "Minimise Fatigue, Maximise Life" participated in a first interview, and five in a second. Participants were all female, aged between 23 and 66 years old and either occupational therapists or physiotherapists.Results: Two themes were evident in the data. The first, "Reciprocity," showed how the healthcare professionals were trained to deliver MFML, then reciprocated in the program delivery as active participants, which then provided feelings of personal reward and expansion of their usual practice. The second, "Enhancements," encompassed suggested directions for future training and deliveries of the program.Conclusion: This study suggests that multidimensional patient centered interventions also benefit the healthcare professionals who provide them because it expands their practice. Healthcare professionals who recognize the benefits of innovative and patient-centered interventions, supports both the patients with whom they work, and adds value to the health services they provide.Implications for rehabilitationHealthcare professionals who undergo training to facilitate delivery of self-management programs, which are based in an empowerment model, report an enhancement or expansion of their traditional practice.An empowerment-based program delivered in a group situation encourages and facilitates people to draw on their own and peers' knowledge and expertise to problem solve for self-management.Healthcare professional education should facilitate the healthcare professional's learning, and ability and willingness to acknowledge the richness in knowledge and expertise held by their patients.

How older adults and their informal carers prevent falls: An integrative review of the literature

Falls in older persons are prevalent and costly for the individual and the health system. Falls prevention guidelines have been developed from best evidence to minimise falls in older persons.

AIM

To synthesise the literature on falls prevention strategies used by community dwelling older persons and/or their informal carers and to compare the commonly adopted strategies with those recommended by falls prevention guidelines.

DATA SOURCES

Health sciences databases for full text articles published in English plus reference list searching of included articles.

REVIEW METHOD

An integrative review approach. Studies were included if they identified fall prevention management strategies used by community dwelling older adults and/or their informal carers. Quality appraisal was undertaken using appropriate Joanna Briggs Institute critical appraisal tools. Information relevant to the aim of the review were extracted and coded into categories then inductively sorted into sub-themes and themes.

RESULTS

Of the seventeen studies included in the review, eleven identified older adults' falls prevention strategies, two investigated fall prevention strategies used by carers, and four explored perspectives of older persons together with their carers, representing the perspectives of an estimated 501 older persons and 102 carers. Strategies used by older adults arose because of self-awareness about their changing physical ability, and advice and support mainly from family or friends. Carer fall prevention strategy was predominantly around protection of the older adult from falling by discouraging independence.

CONCLUSIONS

The fall self-management strategies adopted by older adults and their carers to prevent falls, in the main, do not align with international best practice fall prevention guidelines.

Engaging 'communities': anthropological insights from the West African Ebola epidemic

The recent Ebola epidemic in West Africa highlights how engaging with the sociocultural dimensions of epidemics is critical to mounting an effective outbreak response. Community engagement was pivotal to ending the epidemic and will be to post-Ebola recovery, health system strengthening and future epidemic preparedness and response. Extensive literatures in the social sciences have emphasized how simple notions of community, which project solidarity onto complex hierarchies and politics, can lead to ineffective policies and unintended consequences at the local level, including doing harm to vulnerable populations. This article reflects on the nature of community engagement during the Ebola epidemic and demonstrates a disjuncture between local realities and what is being imagined in post-Ebola reports about the lessons that need to be learned for the future. We argue that to achieve stated aims of building trust and strengthening outbreak response and health systems, public health institutions need to reorientate their conceptualization of 'the community' and develop ways of working which take complex social and political relationships into account.This article is part of the themed issue 'The 2013-2016 West African Ebola epidemic: data, decision-making and disease control'.

Integrative modelling for One Health: pattern, process and participation

This paper argues for an integrative modelling approach for understanding zoonoses disease dynamics, combining process, pattern and participatory models. Each type of modelling provides important insights, but all are limited. Combining these in a '3P' approach offers the opportunity for a productive conversation between modelling efforts, contributing to a 'One Health' agenda. The aim is not to come up with a composite model, but seek synergies between perspectives, encouraging cross-disciplinary interactions. We illustrate our argument with cases from Africa, and in particular from our work on Ebola virus and Lassa fever virus. Combining process-based compartmental models with macroecological data offers a spatial perspective on potential disease impacts. However, without insights from the ground, the 'black box' of transmission dynamics, so crucial to model assumptions, may not be fully understood. We show how participatory modelling and ethnographic research of Ebola and Lassa fever can reveal social roles, unsafe practices, mobility and movement and temporal changes in livelihoods. Together with longer-term dynamics of change in societies and ecologies, all can be important in explaining disease transmission, and provide important complementary insights to other modelling efforts. An integrative modelling approach therefore can offer help to improve disease control efforts and public health responses.This article is part of the themed issue 'One Health for a changing world: zoonoses, ecosystems and human well-being'.

Life-balance self-management programme for community-based older adults living with chronic disease: a feasibility study

Rationale, aims and objectives: Health management strategies are aimed at promoting self-management, healthy lifestyle choices to improve health status and quality of life while addressing cost-effectiveness in health services. We aimed to develop a Life-balance Self-management Programme (LBSP) to test whether taking a trans-diagnostic approach to education combined with presenting mindfulness concepts would enhance self-management with older people with at least one long term condition. This study aimed to test the feasibility of the LBSP in terms of its recruitment strategies, suitability of data collection tools and procedures and if it was acceptable to those receiving it via surveys. Methods: The study utilized a descriptive pre/post-test intervention design. Participants sought were community-based older adults (aged 65+) living with at least one long-term condition and resident in Canterbury, New Zealand. The data analysis was descriptive, correlation between baseline and follow-up were determined.Results: Participants (n=10) reported that they had learnt from the intervention, had adjusted approaches for healthier living and improved self-managing skills. Nil attrition supported the feasibility and acceptability of the intervention.A high correlation was found between measures taken at baseline and at 3 month post-intervention, suggesting meaningful change could be detected within a modest sample size. Conclusion The LBSP, based on empirical and theoretical knowledge, is feasible for trans-diagnostic groups of community-based older adults living with chronic disease. A larger intervention study is planned to test quality of life and functioning as the main outcomes of the programme promoting self-management and to adequately assess effectiveness

Evaluation of a Fatigue Self-Management Program for People with Multiple Sclerosis

BACKGROUND

Fatigue is one of the most common and debilitating symptoms of multiple sclerosis (MS). The program "Minimise Fatigue, Maximise Life: Creating Balance with Multiple Sclerosis" (MFML) was created in New Zealand because of the lack of a fatigue management program for people with MS in that country. This program aims to empower individuals with MS to manage their own symptoms of fatigue. The objective of this study was to evaluate the MFML fatigue self-management program.

METHODS

Self-report questionnaires were used to measure impact of fatigue (5-item Modified Fatigue Impact Scale), self-efficacy (MS Self-efficacy Scale), and quality of life (12-item Short Form Health Status Survey [SF-12]) 1 month before (T1), at commencement of (T2) (to investigate the stability of questionnaire scores before the intervention), and at the end of (T3) the 6-week group-based program. Increased self-efficacy and quality of life scores and a decrease in reported impact of fatigue were the anticipated primary outcomes, with participants acting as their own controls.

RESULTS

Twenty-five women (aged 37-63 years) participated. Stability of scores for all the questionnaires was evidenced between T1 and T2. After the intervention (T3), scores showed a significant improvement in self-efficacy and impact of fatigue, with large effect sizes, but no change in either the physical or mental component summary of the SF-12.

CONCLUSIONS

Despite the small sample size, this study showed an organized approach to the management of fatigue for people living with MS, and its outcomes demonstrated benefits for participants.

Perceived Impact of a Self-Management Program for Fatigue in Multiple Sclerosis: A Qualitative Study

BACKGROUND

Fatigue in multiple sclerosis (MS) is reported to be one of its most debilitating symptoms, affecting personal, family, and community participation. Despite a high incidence of MS in New Zealand, there was no cohesive approach to support people with MS to manage their fatigue. This prompted the development of Minimise Fatigue, Maximise Life: Creating Balance with Multiple Sclerosis (MFML), a group-based, 6-week fatigue self-management program. This study explored the perceived impact of MFML for participants who attended the program.

METHODS

We undertook semistructured individual telephone interviews 1 (n = 23) and 3 (n = 11) months after delivery of the program. Data were analyzed for themes.

RESULTS

Two themes emerged from the data: achieving behavior change to manage fatigue and whole of life effects. These themes represent participants' perceived benefits of the program.

CONCLUSIONS

This study provides evidence that the MFML fatigue self-management program positively affected the lives of participants. The findings suggest that participants had begun to successfully develop and integrate self-management skills into their everyday lives. This affected the individual personally and also their participation in family and community life. This study adds to the current knowledge and understanding of the positive effect that delivery of a fatigue self-management intervention can have for people with MS.