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Strout KA, Howard EP. Five dimensions of wellness and predictors of cognitive health protection in community-dwelling older adults: a historical COLLAGE cohort study. J Holist Nurs 2014; 33:6-18. [PMID: 24972928 DOI: 10.1177/0898010114540322] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Wellness is associated with cognitive health protection; however, findings are limited because they only examine variable(s) within one dimension of wellness. This research examined the association between multiple dimensions of wellness and cognition among aging adults. The sample included 5,605 male and female community-dwelling adults 60 years and older. Four dimensions of wellness demonstrated a statistically significant higher mean difference in cognitively healthy older adults compared to cognitively impaired older adults, F(4, 5,595) = 47.57, p < .001. Emotional wellness demonstrated the strongest association with cognitive health, followed by physical and spiritual wellness, F(5, 5,372) = 50.35, p < .001. Future research is needed to examine the cognitive protective benefits of wellness using longitudinal, prospective designs that control for the potential temporal relationship between wellness and cognition.
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Domestic Helpers as Moderators of Spousal Caregiver Distress. J Gerontol B Psychol Sci Soc Sci 2014; 69:966-72. [DOI: 10.1093/geronb/gbu034] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Moss J, Li A, Tobin J, Weinstein IS, Harimoto T, Lanctôt KL. Predictors of readmission to a psychiatry inpatient unit. Compr Psychiatry 2014; 55:426-30. [PMID: 24405773 DOI: 10.1016/j.comppsych.2013.11.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 10/28/2013] [Accepted: 11/26/2013] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To determine predictors of time to readmission to a general psychiatry inpatient unit. METHOD Data from the Minimum Data Set-Mental Health (MDS-MH), a standardized assessment used to collect demographic and clinical information, were retrospectively reviewed from April 2006 through October 2008. A total of 758 patients were eligible for the study. A set of clinically relevant predictors was generated based on a literature review. A Cox regression model was applied to determine which variables were most predictive of shorter time to readmission, and their respective hazard ratios (HR). RESULTS Covariates that were significantly associated with readmission (HR [95% CI]) included receiving a pass (3.48 [2.33, 5.17], p ≤ 0.0005), 1-2 psychiatric admissions in the past two years (15.63 [7.50, 32.55], p ≤ 0.0005), and more than 3 psychiatric admissions in the past two years (24.15 [11.58, 50.36], p ≤ 0.0005). Post hoc analysis indicated that those issued passes were more commonly male (57.1% vs. 43.9%, p=0.03), with a longer length of stay (25.4 ± 21.2 days vs. 18.7 ± 21.1 days, p=0.008), and higher GAF score (62.8 ± 11.1 vs. 57.8 ± 13.9, p=0.003), but were otherwise similar. CONCLUSIONS The factors that were associated with reduced time to readmission were a history of previous admissions and receipt of a pass prior to discharge. These results suggest that while physicians may be able to identify patients at high risk of early readmission, issuing a pass may not fully mitigate this risk. There is a need for critical research evaluating the potential benefits of passes.
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Affiliation(s)
- Jay Moss
- Department of Psychiatry, Faculty of Medicine, University of Toronto.
| | - Abby Li
- Department of Psychiatry and Neuropsychopharmacology Research Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - James Tobin
- Department of Psychiatry and Neuropsychopharmacology Research Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Izak S Weinstein
- Department of Psychiatry and Neuropsychopharmacology Research Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Tetsuhiro Harimoto
- Department of Psychiatry and Neuropsychopharmacology Research Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Krista L Lanctôt
- Department of Psychiatry, Faculty of Medicine, University of Toronto; Department of Pharmacology/Toxicology, Faculty of Medicine, University of Toronto; Department of Psychiatry and Neuropsychopharmacology Research Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Vanneste D, Vermeulen B, Declercq A. Healthcare professionals' acceptance of BelRAI, a web-based system enabling person-centred recording and data sharing across care settings with interRAI instruments: a UTAUT analysis. BMC Med Inform Decis Mak 2013; 13:129. [PMID: 24279650 PMCID: PMC4222843 DOI: 10.1186/1472-6947-13-129] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 11/15/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Healthcare and social care environments are increasingly confronted with older persons with long-term care needs. Consequently, the need for integrated and coordinated assessment systems increases. In Belgium, feasibility studies have been conducted on the implementation and use of interRAI instruments offering opportunities to improve continuity and quality of care. However, the development and implementation of information technology to support a shared dataset is a difficult and gradual process. We explore the applicability of the UTAUT theoretical model in the BelRAI healthcare project to analyse the acceptance of the BelRAI web application by healthcare professionals in home care, nursing home care and acute hospital care for older people with disabilities. METHODS A structured questionnaire containing items based on constructs validated in the original UTAUT study was distributed to 661 Flemish caregivers. We performed a complete case analysis using data from 282 questionnaires to obtain information regarding the effects of performance expectancy (PE), effort expectancy (EE), social influence (SI), facilitating conditions (FC), anxiety (ANX), self-efficacy (SE) and attitude towards using technology (ATUT) on behavioural intention (BI) to use the BelRAI web application. RESULTS The values of the internal consistency evaluation of each construct demonstrated adequate reliability of the survey instrument. Convergent and discriminant validity were established. However, the items of the ATUT construct cross-loaded on PE. FC proved to have the most significant influence on BI to use BelRAI, followed by SE. Other constructs (PE, EE, SI, ANX, ATUT) had no significant influence on BI. The 'direct effects only' model explained 30.8% of the variance in BI to use BelRAI. CONCLUSIONS Critical factors in stimulating the behavioural intention to use new technology are good-quality software, interoperability and compatibility with other information systems, easy access to computers, training facilities, built-in and online help and ongoing IT support. These findings can be used by policy makers to maximise the acceptance and the success of new technology. For researchers, the conclusions of the original UTAUT study with regards to the item and scale construction should not be copied blindly across different information systems. A bottom-up approach is preferred when building upon the UTAUT model.
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Affiliation(s)
- Dirk Vanneste
- Elderly Care Research Unit at LUCAS, KU Leuven, Kapucijnenvoer 39, 3000 Leuven, Belgium.
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Foebel AD, Hirdes JP, Heckman GA, Kergoat MJ, Patten S, Marrie RA. Diagnostic data for neurological conditions in interRAI assessments in home care, nursing home and mental health care settings: a validity study. BMC Health Serv Res 2013; 13:457. [PMID: 24176093 PMCID: PMC3893477 DOI: 10.1186/1472-6963-13-457] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 10/28/2013] [Indexed: 11/28/2022] Open
Abstract
Background The interRAI suite of assessment instruments can provide valuable information to support person-specific care planning across the continuum of care. Comprehensive clinical information is collected with these instruments, including disease diagnoses. In Canada, interRAI data holdings represent some of the largest repositories of clinical information in the country for persons with neurological conditions. This study examined the accuracy of the diagnostic information captured by interRAI instruments designed for use in the home care, long-term care and mental health care settings as compared with national administrative databases. Methods The interRAI assessments were matched with an inpatient hospital record and emergency department (ED) visit record in the preceding 90 days. Diagnoses captured on the interRAI instruments were compared to those recorded in either administrative record for each individual. Diagnostic validity was examined through sensitivity, specificity and positive predictive value analysis for the following conditions: multiple sclerosis, epilepsy, Alzheimer’s disease and other dementias, Parkinson’s disease, traumatic brain injury, stroke, diabetes mellitus, heart failure and reactive airway disease. Results In the three large study samples (home care: n = 128,448; long-term care: n = 26,644; mental health: n = 13,812), interRAI diagnoses demonstrated high specificity when compared to administrative records, for both neurological conditions (range 0.80 – 1.00) and comparative chronic diseases (range 0.83 – 1.00). Sensitivity and positive predictive values (PPV) were more varied by specific diagnosis, with sensitivities and PPV for neurological conditions ranging from 0.23 to 0.94 and 0.14 to 0.77, respectively. The interRAI assessments routinely captured more cases of the diagnoses of interest than the administrative records. Conclusions The interRAI assessment collected accurate information about disease diagnoses when compared to administrative records within three months. Such information is likely relevant to day-to-day care in these three environments and can be used to inform care planning and resource allocation decisions.
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Affiliation(s)
- Andrea D Foebel
- School of Public Health & Health Systems, University of Waterloo, Waterloo, ON, Canada.
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Smeets CHW, Smalbrugge M, Gerritsen DL, Nelissen-Vrancken MHJMG, Wetzels RB, van der Spek K, Zuidema SU, Koopmans RTCM. Improving psychotropic drug prescription in nursing home patients with dementia: design of a cluster randomized controlled trial. BMC Psychiatry 2013; 13:280. [PMID: 24180295 PMCID: PMC3840636 DOI: 10.1186/1471-244x-13-280] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 10/23/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neuropsychiatric symptoms are highly prevalent in nursing home patients with dementia. Despite modest effectiveness and considerable side effects, psychotropic drugs are frequently prescribed for these neuropsychiatric symptoms. This raises questions whether psychotropic drugs are appropriately prescribed. The aim of the PROPER (PRescription Optimization of Psychotropic drugs in Elderly nuRsing home patients with dementia) II study is to investigate the efficacy of an intervention for improving the appropriateness of psychotropic drug prescription in nursing home patients with dementia. METHODS/DESIGN The PROPER II study is a multi-center cluster randomized controlled, pragmatic trial using parallel groups. It has a duration of eighteen months and four six-monthly assessments. Six nursing homes will participate in the intervention and six will continue care as usual. The nursing homes will be located throughout the Netherlands, each participating with two dementia special care units with an average of fifteen patients per unit, resulting in 360 patients. The intervention consists of a structured and repeated multidisciplinary medication review supported by education and continuous evaluation. It is conducted by pharmacists, physicians, and nurses and consists of three components: 1) preparation and education, 2) conduct, and 3) evaluation/guidance. The primary outcome is the proportion of patients with appropriate psychotropic drug use. Secondary outcomes are the overall frequency of psychotropic drug use, neuropsychiatric symptoms, quality of life, activities of daily living, psychotropic drug side effects and adverse events (including cognition, comorbidity, and mortality). Besides, a process analysis on the intervention will be carried out. DISCUSSION This study is expected to improve the appropriateness of psychotropic drug prescription for neuropsychiatric symptoms in nursing home patients with dementia by introducing a structured and repeated multidisciplinary medication review supported by education and continuous evaluation. TRIAL REGISTRATION Netherlands Trial Registry (NTR): NTR3569.
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Affiliation(s)
- Claudia HW Smeets
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud university medical center, Code 117 ELG, P.O. Box 9101, 6500, HB Nijmegen, the Netherlands
| | - Martin Smalbrugge
- Department of General Practice and Elderly Care Medicine/EMGO + Institute for Health and Care Research, VU Medical Center, P.O Box 7057, 1007, MB Amsterdam, The Netherlands
| | - Debby L Gerritsen
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud university medical center, Code 117 ELG, P.O. Box 9101, 6500, HB Nijmegen, the Netherlands
| | | | - Roland B Wetzels
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud university medical center, Code 117 ELG, P.O. Box 9101, 6500, HB Nijmegen, the Netherlands
| | - Klaas van der Spek
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud university medical center, Code 117 ELG, P.O. Box 9101, 6500, HB Nijmegen, the Netherlands
| | - Sytse U Zuidema
- Department of General Practice, University of Groningen, University Medical Center Groningen, HPC FA21, P.O. Box 196, 9700, AD Groningen, the Netherlands
| | - Raymond TCM Koopmans
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud university medical center, Code 117 ELG, P.O. Box 9101, 6500, HB Nijmegen, the Netherlands
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Slaughter SE, Estabrooks CA. Optimizing the mobility of residents with dementia: a pilot study promoting healthcare aide uptake of a simple mobility innovation in diverse nursing home settings. BMC Geriatr 2013; 13:110. [PMID: 24138586 PMCID: PMC4016510 DOI: 10.1186/1471-2318-13-110] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 10/08/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Almost 90 percent of nursing home residents have some type of mobility limitation. Many spend most of their waking hours lying in bed or sitting. Such inactivity can negatively affect residents' health and general well-being. This pilot study aimed to assess (1) the effect of the sit-to-stand activity on mobility outcomes of nursing home residents, (2) the effect of an audit-and-feedback intervention on uptake of the sit-to-stand activity by healthcare aides, and (3) the contextual factors influencing uptake of the sit-to-stand activity by healthcare aides. METHODS This quasi-experimental pilot study was conducted in two nursing homes in western Canada. Twenty-six residents with dementia completed the sit-to-stand activity with 56 healthcare aides during daily care; separately, 71 healthcare aides completed a research use and context survey. Preliminary mobility feedback was presented to healthcare aides in one site. Resident mobility was measured using the 30-second sit-to-stand test. Healthcare aide uptake of the activity was measured using documentation flowsheets and a survey-based measure. Context was measured using the Alberta Context Tool. Mobility and uptake outcomes were analyzed over time and by site with analysis of covariance. Spearman and Pearson correlations were used to correlate context data with research use. RESULTS Residents who more frequently completed the sit-to-stand activity were more likely to maintain or improve mobility compared with those who completed it less frequently (F=4.46; p=0.046, after adjustment for age). Uptake for one site was significantly different from the other (t-score=2.67; p=0.01, after adjustment for resident covariates). The audit-and-feedback intervention was associated with increased uptake of the activity from pre-intervention to post-intervention (t-score=-2.48; p=0.02). More context domains correlated significantly with aides' use of conceptual research and information sources in one site than the other. CONCLUSIONS The sit-to-stand activity is a promising means to maintain or improve transfer ability of nursing home residents with dementia. In the nursing home with initially weak uptake, strengthened uptake followed an audit-and-feedback intervention. Activity participation was higher in the site with stronger correlations between context and measured research use. Results are sufficiently promising to warrant proceeding with a full clinical trial.
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Affiliation(s)
- Susan E Slaughter
- Edmonton Clinic Health Academy, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Carole A Estabrooks
- Edmonton Clinic Health Academy, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Santi SM, Hinton S, Berg K, Stolee P. Bridging the information divide: health information sharing in home care. Can J Nurs Res 2013; 45:16-35. [PMID: 23789525 DOI: 10.1177/084456211304500104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
As in many health sectors, in home care there have been significant investments made in electronic health information systems (EHIS) and accompanying standardized assessment instruments. While the potential of these systems to enhance the quality of care has been recognized, it has yet to be fully realized in Canadian home care settings. Data on EHIS barriers and facilitators were collected using a survey (n = 22).The results were discussed at a workshop (n = 30) and a "world café" session was held to consider strategies and interventions for improving health information exchange, with a focus on home care rehabilitation.
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Affiliation(s)
- Selena M Santi
- InfoRehab, School of Public Health and Health Systems, University of Waterloo, Ontario, Canada
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Cook RJ, Berg K, Lee KA, Poss JW, Hirdes JP, Stolee P. Rehabilitation in Home Care Is Associated With Functional Improvement and Preferred Discharge. Arch Phys Med Rehabil 2013; 94:1038-47. [DOI: 10.1016/j.apmr.2012.12.024] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 12/07/2012] [Accepted: 12/22/2012] [Indexed: 11/28/2022]
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Hoogendijk EO, van der Horst HE, Deeg DJH, Frijters DHM, Prins BAH, Jansen APD, Nijpels G, van Hout HPJ. The identification of frail older adults in primary care: comparing the accuracy of five simple instruments. Age Ageing 2013; 42:262-5. [PMID: 23108163 DOI: 10.1093/ageing/afs163] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND many instruments are available to identify frail older adults who may benefit from geriatric interventions. Most of those instruments are time-consuming and difficult to use in primary care. OBJECTIVE to select a valid instrument to identify frail older adults in primary care, five simple instruments were compared. METHODS instruments included clinical judgement of the general practitioner, prescription of multiple medications, the Groningen frailty indicator (GFI), PRISMA-7 and the self-rated health of the older adult. Fried's frailty criteria and a clinical judgement by a multidisciplinary expert panel were used as reference standards. Data were used from the cross-sectional Dutch Identification of Frail Elderly Study consisting of 102 people aged 65 and over from a primary care practice in Amsterdam. In this study, frail older adults were oversampled. We estimated the accuracy of each instrument by calculating the area under the ROC curve. The agreement between the instruments and the reference standards was determined by kappa. RESULTS frailty prevalence rates in this sample ranged from 11.6 to 36.4%. The accuracy of the instruments ranged from poor (AUC = 0.64) to good (AUC = 0.85). CONCLUSION PRISMA-7 was the best of the five instruments with good accuracy. Further research is needed to establish the predictive validity and clinical utility of the simple instruments used in this study.
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Affiliation(s)
- Emiel O Hoogendijk
- Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, Netherlands.
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Perlman CM, Hirdes JP, Barbaree H, Fries BE, McKillop I, Morris JN, Rabinowitz T. Development of mental health quality indicators (MHQIs) for inpatient psychiatry based on the interRAI mental health assessment. BMC Health Serv Res 2013; 13:15. [PMID: 23305286 PMCID: PMC3560122 DOI: 10.1186/1472-6963-13-15] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 01/07/2013] [Indexed: 11/10/2022] Open
Abstract
Background Outcome quality indicators are rarely used to evaluate mental health services because most jurisdictions lack clinical data systems to construct indicators in a meaningful way across mental health providers. As a result, important information about the effectiveness of health services remains unknown. This study examined the feasibility of developing mental health quality indicators (MHQIs) using the Resident Assessment Instrument - Mental Health (RAI-MH), a clinical assessment system mandated for use in Ontario, Canada as well as many other jurisdictions internationally. Methods Retrospective analyses were performed on two datasets containing RAI-MH assessments for 1,056 patients from 7 facilities and 34,788 patients from 70 facilities in Ontario, Canada. The RAI-MH was completed by clinical staff of each facility at admission and follow-up, typically at discharge. The RAI-MH includes a breadth of information on symptoms, functioning, socio-demographics, and service utilization. Potential MHQIs were derived by examining the empirical patterns of improvement and incidence in depressive symptoms and cognitive performance across facilities in both sets of data. A prevalence indicator was also constructed to compare restraint use. Logistic regression was used to evaluate risk adjustment of MHQIs using patient case-mix index scores derived from the RAI-MH System for Classification of Inpatient Psychiatry. Results Subscales from the RAI-MH, the Depression Severity Index (DSI) and Cognitive Performance Scale (CPS), were found to have good reliability and strong convergent validity. Unadjusted rates of five MHQIs based on the DSI, CPS, and restraints showed substantial variation among facilities in both sets of data. For instance, there was a 29.3% difference between the first and third quartile facility rates of improvement in cognitive performance. The case-mix index score was significantly related to MHQIs for cognitive performance and restraints but had a relatively small impact on adjusted rates/prevalence. Conclusions The RAI-MH is a feasible assessment system for deriving MHQIs. Given the breadth of clinical content on the RAI-MH there is an opportunity to expand the number of MHQIs beyond indicators of depression, cognitive performance, and restraints. Further research is needed to improve risk adjustment of the MHQIs for their use in mental health services report card and benchmarking activities.
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Affiliation(s)
- Christopher M Perlman
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave West, Waterloo N2L 3G1, Canada.
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Cummings GG, Reid RC, Estabrooks CA, Norton PG, Cummings GE, Rowe BH, Abel SL, Bissell L, Bottorff JL, Robinson CA, Wagg A, Lee JS, Lynch SL, Masaoud E. Older Persons' Transitions in Care (OPTIC): a study protocol. BMC Geriatr 2012; 12:75. [PMID: 23241360 PMCID: PMC3570479 DOI: 10.1186/1471-2318-12-75] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 11/30/2012] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Changes in health status, triggered by events such as infections, falls, and geriatric syndromes, are common among nursing home (NH) residents and necessitate transitions between NHs and Emergency Departments (EDs). During transitions, residents frequently experience care that is delayed, unnecessary, not evidence-based, potentially unsafe, and fragmented. Furthermore, a high proportion of residents and their family caregivers report substantial unmet needs during transitions. This study is part of a program of research whose overall aim is to improve quality of care for frail older adults who reside in NHs. The purpose of this study is to identify successful transitions from multiple perspectives and to identify organizational and individual factors related to transition success, in order to inform improvements in care for frail elderly NH residents during transitions to and from acute care. Specific objectives are to: 1. define successful and unsuccessful elements of transitions from multiple perspectives; 2. develop and test a practical tool to assess transition success; 3. assess transition processes in a discrete set of transfers in two study sites over a one year period; 4. assess the influence of organizational factors in key practice locations, e.g., NHs, emergency medical services (EMS), and EDs, on transition success; and 5. identify opportunities for evidence-informed management and quality improvement decisions related to the management of NH - ED transitions. METHODS/DESIGN This is a mixed-methods observational study incorporating an integrated knowledge translation (IKT) approach. It uses data from multiple levels (facility, care unit, individual) and sources (healthcare providers, residents, health records, and administrative databases). DISCUSSION Key to study success is operationalizing the IKT approach by using a partnership model in which the OPTIC governance structure provides for team decision-makers and researchers to participate equally in developing study goals, design, data collection, analysis and implications of findings. As preliminary and ongoing study findings are developed, their implications for practice and policy in study settings will be discussed by the research team and shared with study site administrators and staff. The study is designed to investigate the complexities of transitions and to enhance the potential for successful and sustained improvement of these transitions.
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Affiliation(s)
- Greta G Cummings
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
- Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, 11405-87 Ave, Edmonton, AB, T6G 0C1, Canada
| | - R Colin Reid
- School of Health and Exercise Sciences, University of British Columbia’s Okanagan campus, Kelowna, BC, Canada
| | | | - Peter G Norton
- Department of Family Medicine, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Garnet E Cummings
- Department of Emergency Medicine, Faculty of Medicine and Dentistry and School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Brian H Rowe
- Department of Emergency Medicine, Faculty of Medicine and Dentistry and School of Public Health, University of Alberta, Edmonton, AB, Canada
| | | | - Laura Bissell
- School of Health and Exercise Sciences, University of British Columbia’s Okanagan campus, Kelowna, BC, Canada
| | - Joan L Bottorff
- School of Nursing, University of British Columbia’s Okanagan campus, Kelowna, BC, Canada
| | - Carole A Robinson
- School of Nursing, University of British Columbia’s Okanagan campus, Kelowna, BC, Canada
| | - Adrian Wagg
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jacques S Lee
- Department of Emergency Services, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Susan L Lynch
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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Armstrong JJ, Zhu M, Hirdes JP, Stolee P. K-Means Cluster Analysis of Rehabilitation Service Users in the Home Health Care System of Ontario: Examining the Heterogeneity of a Complex Geriatric Population. Arch Phys Med Rehabil 2012; 93:2198-205. [DOI: 10.1016/j.apmr.2012.05.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 05/24/2012] [Accepted: 05/31/2012] [Indexed: 10/28/2022]
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Ismail Z, Arenovich T, Grieve C, Willett P, Sajeev G, Mamo DC, Macqueen GM, Mulsant BH. Predicting hospital length of stay for geriatric patients with mood disorders. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2012; 57:696-703. [PMID: 23149285 DOI: 10.1177/070674371205701107] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine predictors of hospital length of stay (LOS) for adult and geriatric patients with mood disorders admitted to inpatient psychiatric beds. METHOD Admission and discharge data from a large urban mental health centre, from 2005 to 2010 inclusive, were retrospectively analyzed. Using the Resident Assessment Instrument-Mental Health, an assessment that is used to collect demographic and clinical information within 72 hours of hospital admission, 199 geriatric mood disorder admissions were compared with 570 adult mood disorder admissions. Predictors of hospital LOS were determined using a series of general linear models. RESULTS Living alone, number of recent psychiatric admissions, involuntary admission, and close or constant observation level predict longer hospital LOS in geriatric, but not in adult mood disorder, patients. Conversely, pain on admission predicts shorter hospital LOS in geriatric, but not among adult, mood disorder patients. Predictors of longer hospital LOS, irrespective of admission group (adult, compared with geriatric), include incapacity, negative symptoms, and increased dependence for instrumental activities of daily living. CONCLUSIONS Addressing these predictive factors early on during admission and in the community may result in shorter hospital LOS and more optimal use of resources.
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Affiliation(s)
- Zahinoor Ismail
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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Boström AM, Cranley LA, Hutchinson AM, Cummings GG, Norton PG, Estabrooks CA. Nursing home administrators' perspectives on a study feedback report: a cross sectional survey. Implement Sci 2012; 7:88. [PMID: 22974461 PMCID: PMC3499148 DOI: 10.1186/1748-5908-7-88] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 08/08/2012] [Indexed: 12/03/2022] Open
Abstract
Background This project is part of the Translating Research in Elder Care (TREC) program of research, a multi-level and longitudinal research program being conducted in 36 nursing homes in three Canadian Prairie Provinces. The overall goal of TREC is to improve the quality of care for older persons living in nursing homes and the quality of work life for care providers. The purpose of this paper is to report on development and evaluation of facility annual reports (FARs) from facility administrators’ perspectives on the usefulness, meaningfulness, and understandability of selected data from the TREC survey. Methods A cross sectional survey design was used in this study. The feedback reports were developed in collaboration with participating facility administrators. FARs presented results in four contextual areas: workplace culture, feedback processes, job satisfaction, and staff burnout. Six weeks after FARs were mailed to each administrator, we conducted structured telephone interviews with administrators to elicit their evaluation of the FARs. Administrators were also asked if they had taken any actions as a result of the FAR. Descriptive and inferential statistics, as well as content analysis for open-ended questions, were used to summarize findings. Results Thirty-one facility administrators (representing thirty-two facilities) participated in the interviews. Six administrators had taken action and 18 were planning on taking action as a result of FARs. The majority found the four contextual areas addressed in FAR to be useful, meaningful, and understandable. They liked the comparisons made between data from years one and two and between their facility and other TREC study sites in their province. Twenty-two indicated that they would like to receive information on additional areas such as aggressive behaviours of residents and information sharing. Twenty-four administrators indicated that FARs contained enough information, while eight found FARs ‘too short’. Administrators who reported that the FAR contained enough information were more likely to take action within their facilities than administrators who reported that they needed more information. Conclusions Although the FAR was brief, the presentation of the four contextual areas was relevant to the majority of administrators and prompted them to plan or to take action within their facility.
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Affiliation(s)
- Anne-Marie Boström
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
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Kennedy CC, Ioannidis G, Giangregorio LM, Adachi JD, Thabane L, Morin SN, Crilly RG, Marr S, Josse RG, Lohfeld L, Pickard LE, King S, van der Horst ML, Campbell G, Stroud J, Dolovich L, Sawka AM, Jain R, Nash L, Papaioannou A. An interdisciplinary knowledge translation intervention in long-term care: study protocol for the vitamin D and osteoporosis study (ViDOS) pilot cluster randomized controlled trial. Implement Sci 2012; 7:48. [PMID: 22624776 PMCID: PMC3533817 DOI: 10.1186/1748-5908-7-48] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 05/24/2012] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Knowledge translation (KT) research in long-term care (LTC) is still in its early stages. This protocol describes the evaluation of a multifaceted, interdisciplinary KT intervention aimed at integrating evidence-based osteoporosis and fracture prevention strategies into LTC care processes. METHODS AND DESIGN The Vitamin D and Osteoporosis Study (ViDOS) is underway in 40 LTC homes (n = 19 intervention, n = 21 control) across Ontario, Canada. The primary objectives of this study are to assess the feasibility of delivering the KT intervention, and clinically, to increase the percent of LTC residents prescribed ≥800 IU of vitamin D daily. Eligibility criteria are LTC homes that are serviced by our partner pharmacy provider and have more than one prescribing physician. The target audience within each LTC home is the Professional Advisory Committee (PAC), an interdisciplinary team who meets quarterly. The key elements of the intervention are three interactive educational sessions led by an expert opinion leader, action planning using a quality improvement cycle, audit and feedback reports, nominated internal champions, and reminders/point-of-care tools. Control homes do not receive any intervention, however both intervention and control homes received educational materials as part of the Ontario Osteoporosis Strategy. Primary outcomes are feasibility measures (recruitment, retention, attendance at educational sessions, action plan items identified and initiated, internal champions identified, performance reports provided and reviewed), and vitamin D (≥800 IU/daily) prescribing at 6 and 12 months. Secondary outcomes include the proportion of residents prescribed calcium supplements and osteoporosis medications, and falls and fractures. Qualitative methods will examine the experience of the LTC team with the KT intervention. Homes are centrally randomized to intervention and control groups in blocks of variable size using a computer generated allocation sequence. Randomization is stratified by home size and profit/nonprofit status. Prescribing data retrieval and analysis are performed by blinded personnel. DISCUSSION Our study will contribute to an improved understanding of the feasibility and acceptability of a multifaceted intervention aimed at translating knowledge to LTC practitioners. Lessons learned from this study will be valuable in guiding future research and understanding the complexities of translating knowledge in LTC.
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Affiliation(s)
- Courtney C Kennedy
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Hamilton Health Sciences - St. Peter's Hospital, Juravinski Research Centre, 88 Maplewood Avenue, Hamilton, Ontario L8M 1W9, Canada
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4K1, Canada
| | - George Ioannidis
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Charlton Medical Centre, 25 Charlton Ave East, Hamilton, Ontario, L8N 1Y2, Canada
| | - Lora M Giangregorio
- Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, 200 University Ave West, Waterloo, Ontario, N2L 3G1, Canada
| | - Jonathan D Adachi
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Charlton Medical Centre, 25 Charlton Ave East, Hamilton, Ontario, L8N 1Y2, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4K1, Canada
| | - Suzanne N Morin
- Department of Medicine, Division of General Internal Medicine, MUHC-Montreal General Hospital, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada
| | - Richard G Crilly
- Schulich School of Medicine & Dentistry, The University of Western Ontario, Parkwood Hospital, 801 Commissioners Rd. East, London, Ontario, N6C 5J1, Canada
| | - Sharon Marr
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Hamilton Health Sciences - St. Peter's Hospital, Juravinski Research Centre, 88 Maplewood Avenue, Hamilton, Ontario L8M 1W9, Canada
| | - Robert G Josse
- Department of Medicine, Division of Endocrinology and Metabolism, University of Toronto, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Lynne Lohfeld
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4K1, Canada
| | - Laura E Pickard
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Hamilton Health Sciences - St. Peter's Hospital, Juravinski Research Centre, 88 Maplewood Avenue, Hamilton, Ontario L8M 1W9, Canada
| | - Susanne King
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Hamilton Health Sciences - St. Peter's Hospital, Juravinski Research Centre, 88 Maplewood Avenue, Hamilton, Ontario L8M 1W9, Canada
| | - Mary-Lou van der Horst
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Hamilton Health Sciences - St. Peter's Hospital, Juravinski Research Centre, 88 Maplewood Avenue, Hamilton, Ontario L8M 1W9, Canada
| | - Glenda Campbell
- Medical Pharmacies Group Limited, 590 Granite Court, Pickering, Ontario, L1W 3X6, Canada
| | - Jackie Stroud
- Medical Pharmacies Group Limited, 590 Granite Court, Pickering, Ontario, L1W 3X6, Canada
| | - Lisa Dolovich
- Department of Family Medicine, McMaster Innovation Park, 175 Longwood Road South, Hamilton, Ontario, L8P 0A1, Canada
| | - Anna M Sawka
- Department of Medicine, Division of Endocrinology and Metabolism, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
| | - Ravi Jain
- Ontario Osteoporosis Strategy, Osteoporosis Canada, 1090 Don Mills Road, Suite 301, Toronto, Ontario, M3C 3R6, Canada
| | - Lynn Nash
- Department of Family Medicine, McMaster Innovation Park, 175 Longwood Road South, Hamilton, Ontario, L8P 0A1, Canada
| | - Alexandra Papaioannou
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Hamilton Health Sciences - St. Peter's Hospital, Juravinski Research Centre, 88 Maplewood Avenue, Hamilton, Ontario L8M 1W9, Canada
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Muntinga ME, Hoogendijk EO, van Leeuwen KM, van Hout HPJ, Twisk JWR, van der Horst HE, Nijpels G, Jansen APD. Implementing the chronic care model for frail older adults in the Netherlands: study protocol of ACT (frail older adults: care in transition). BMC Geriatr 2012; 12:19. [PMID: 22545816 PMCID: PMC3464922 DOI: 10.1186/1471-2318-12-19] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 04/30/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Care for older adults is facing a number of challenges: health problems are not consistently identified at a timely stage, older adults report a lack of autonomy in their care process, and care systems are often confronted with the need for better coordination between health care professionals. We aim to address these challenges by introducing the geriatric care model, based on the chronic care model, and to evaluate its effects on the quality of life of community-dwelling frail older adults. METHODS/DESIGN In a 2-year stepped-wedge cluster randomised clinical trial with 6-monthly measurements, the chronic care model will be compared with usual care. The trial will be carried out among 35 primary care practices in two regions in the Netherlands. Per region, practices will be randomly allocated to four allocation arms designating the starting point of the intervention. PARTICIPANTS 1200 community-dwelling older adults aged 65 or over and their primary informal caregivers. Primary care physicians will identify frail individuals based on a composite definition of frailty and a polypharmacy criterion. Final inclusion criterion: scoring 3 or more on a disability case-finding tool. INTERVENTION Every 6 months patients will receive a geriatric in-home assessment by a practice nurse, followed by a tailored care plan. Expert teams will manage and train practice nurses. Patients with complex care needs will be reviewed in interdisciplinary consultations. EVALUATION We will perform an effect evaluation, an economic evaluation, and a process evaluation. Primary outcome is quality of life as measured with the Short Form-12 questionnaire. Effect analyses will be based on the "intention-to-treat" principle, using multilevel regression analysis. Cost measurements will be administered continually during the study period. A cost-effectiveness analysis and cost-utility analysis will be conducted comparing mean total costs to functional status, care needs and QALYs. We will investigate the level of implementation, barriers and facilitators to successful implementation and the extent to which the intervention manages to achieve the transition necessary to overcome challenges in elderly care. DISCUSSION This is one of the first studies assessing the effectiveness, cost-effectiveness and implementation process of the chronic care model for frail community-dwelling older adults. TRIAL REGISTRATION The Netherlands National Trial Register NTR2160.
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Affiliation(s)
- Maaike E Muntinga
- Department of General Practice and Elderly Care Medicine/EMGO + Institute for Health and Care Research, VU University medical center, Amsterdam, the Netherlands.
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Glenny C, Stolee P, Thompson M, Husted J, Berg K. Underestimating physical function gains: comparing FIM motor subscale and interRAI post acute care activities of daily living scale. Arch Phys Med Rehabil 2012; 93:1000-8. [PMID: 22497989 DOI: 10.1016/j.apmr.2011.12.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 09/21/2011] [Accepted: 12/16/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To investigate the construct validity of the activities of daily living (ADLs) sections of 2 major systems developed to measure functional ability in rehabilitation settings. Health assessment systems can inform care planning as well as policy decision-making on service effectiveness. Frailty, comorbidity, and heterogeneity make it difficult to accurately measure health outcomes for older adults. Objective investigation of the value of geriatric rehabilitation services requires assessment systems that are comprehensive, reliable, valid, and sensitive to clinically relevant changes in older patients. DESIGN Trained health care workers assessed patients with both tools at admission and discharge. We used Rasch analysis to compare the instruments' dimensionality, item difficulty, item fit, differential item function, and number of response options. SETTING Musculoskeletal and geriatric rehabilitation units in 2 Ontario hospitals. PARTICIPANTS Older adults receiving rehabilitation (N=209; mean age ± SD, 78.5±9.3; 67% women). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES FIM and the interRAI Post Acute Care Assessment (interRAI PAC). RESULTS For both the FIM motor and the interRAI PAC ADLs items, the difficulty level of the items was much lower than the participant's level of ability, resulting in a large ceiling effect. Also, on both scales, less actual change in functional ability was required to move between the midlevel response options. CONCLUSIONS Both scales have limited ability to discriminate between subjects with higher functional ability, which indicates that they may underestimate the effectiveness of inpatient rehabilitation for this group of patients when used alone.
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Affiliation(s)
- Christine Glenny
- Department of Health Studies and Gerontology, University of Waterloo, Waterloo, ON, Canada
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Sales A, O'Rourke HM, Draper K, Teare GF, Maxwell C. Prioritizing information for quality improvement using resident assessment instrument data: experiences in one canadian province. Healthc Policy 2012; 6:55-69. [PMID: 22294992 DOI: 10.12927/hcpol.2011.22221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To elicit priority rankings of indicators of quality of care among providers and decision-makers in continuing care in Alberta, Canada. METHODS We used modified nominal group technique to elicit priorities and criteria for prioritization among the quality indicators and resident/client assessment protocols developed by the interRAI consortium for use in long-term care and home care. RESULTS The top-ranked items from the long-term care assessment data were pressure ulcers, pain and incontinence. The top-ranked items from the home care data were pain, falls and proportion of clients at high risk for residential placement. Participants considered a variety of issues in deciding how to rank the indicators. IMPLICATIONS This work reflects the beginning of a process to better understand how providers and policy makers can work together to assess priorities for quality improvement within continuing care.
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Affiliation(s)
- Anne Sales
- Faculty of Nursing, University of Alberta, Edmonton, AB
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Slaughter SE, Estabrooks CA, Jones CA, Wagg AS. Mobility of Vulnerable Elders (MOVE): study protocol to evaluate the implementation and outcomes of a mobility intervention in long-term care facilities. BMC Geriatr 2011; 11:84. [PMID: 22176583 PMCID: PMC3264506 DOI: 10.1186/1471-2318-11-84] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 12/16/2011] [Indexed: 11/17/2022] Open
Abstract
Background Almost 90% of residents living in long-term care facilities have limited mobility which is associated with a loss of ability in activities of daily living, falls, increased risk of serious medical problems such as pressure ulcers, incontinence and a significant decline in health-related quality of life. For health workers caring for residents it may also increase the risk of injury. The effectiveness of rehabilitation to facilitate mobility has been studied with dedicated research assistants or extensively trained staff caregivers; however, few investigators have examined the effectiveness of techniques to encourage mobility by usual caregivers in long-term care facilities. Methods/Design This longitudinal, quasi-experimental study is designed to demonstrate the effect of the sit-to-stand activity carried out by residents in the context of daily care with health care aides. In three intervention facilities health care aides will prompt residents to repeat the sit-to-stand action on two separate occasions during each day and each evening shift as part of daily care routines. In three control facilities residents will receive usual care. Intervention and control facilities are matched on the ownership model (public, private for-profit, voluntary not-for-profit) and facility size. The dose of the mobility intervention is assessed through the use of daily documentation flowsheets in the health record. Resident outcome measures include: 1) the 30-second sit-to-stand test; 2) the Functional Independence Measure; 3) the Health Utilities Index Mark 2 and 3; and, 4) the Quality of Life - Alzheimer's Disease. Discussion There are several compelling reasons for this study: the widespread prevalence of limited mobility in this population; the rapid decline in mobility after admission to a long-term care facility; the importance of mobility to quality of life; the increased time (and therefore cost) required to care for residents with limited mobility; and, the increased risk of injury for health workers caring for residents who are unable to stand. The importance of these issues is magnified when considering the increasing number of people living in long-term care facilities and an aging population. Trial Registration This clinical trial is registered with ClinicalTrials.gov (trial registration number: NCT01474616).
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Beyond the 'iron lungs of gerontology': using evidence to shape the future of nursing homes in Canada. Can J Aging 2011; 30:371-90. [PMID: 21851753 DOI: 10.1017/s0714980811000304] [Citation(s) in RCA: 145] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Institutionalization of the Elderly in Canada suggested that efforts to address the underlying causes of age-related declines in health might negate the need for nursing homes. However, the prevalence of chronic disease has increased, and conditions like dementia mean that nursing homes are likely to remain important features of the Canadian health care system. A fundamental problem limiting the ability to understand how nursing homes may change to better meet the needs of an aging population was the lack of person-level clinical information. The introduction of interRAI assessment instruments to most Canadian provinces/territories and the establishment of the national Continuing Care Reporting System represent important steps in our capacity to understand nursing home care in Canada. Evidence from eight provinces and territories shows that the needs of persons in long-term care are highly complex, resource allocations do not always correspond to needs, and quality varies substantially between and within provinces.
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Leung DYP, Leung AYM, Chi I. An Evaluation of the Factor Structure of the Instrumental Activities of Daily Living Involvement and Capacity Scales of the Minimum Data Set for Home Care for Elderly Chinese Community Dwellers in Hong Kong. Home Health Care Serv Q 2011; 30:147-59. [DOI: 10.1080/01621424.2011.592421] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Boorsma M, Frijters DHM, Knol DL, Ribbe ME, Nijpels G, van Hout HPJ. Effects of multidisciplinary integrated care on quality of care in residential care facilities for elderly people: a cluster randomized trial. CMAJ 2011; 183:E724-32. [PMID: 21708967 DOI: 10.1503/cmaj.101498] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Sophisticated approaches are needed to improve the quality of care for elderly people living in residential care facilities. We determined the effects of multidisciplinary integrated care on the quality of care and quality of life for elderly people in residential care facilities. METHODS We performed a cluster randomized controlled trial involving 10 residential care facilities in the Netherlands that included 340 participating residents with physical or cognitive disabilities. Five of the facilities applied multidisciplinary integrated care, and five provided usual care. The intervention, inspired by the disease management model, consisted of a geriatric assessment of functional health every three months. The assessment included use of the Long-term Care Facility version of the Resident Assessment Instrument by trained nurse-assistants to guide the design of an individualized care plan; discussion of outcomes and care priorities with the family physician, the resident and his or her family; and monthly multidisciplinary meetings with the nurse-assistant, family physician, psychologist and geriatrician to discuss residents with complex needs. The primary outcome was the sum score of 32 risk-adjusted quality-of-care indicators. RESULTS Compared with the facilities that provided usual care, the intervention facilities had a significantly higher sum score of the 32 quality-of-care indicators (mean difference - 6.7, p = 0.009; a medium effect size of 0.72). They also had significantly higher scores for 11 of the 32 indicators of good care in the areas of communication, delirium, behaviour, continence, pain and use of antipsychotic agents. INTERPRETATION Multidisciplinary integrated care resulted in improved quality of care for elderly people in residential care facilities compared with usual care. TRIAL REGISTRATION www.controlled-trials.com trial register no. ISRCTN11076857.
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Affiliation(s)
- Marijke Boorsma
- Department of General Practice, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Nutrition Status Among Residents Living in a Veterans’ Long-Term Care Facility in Western Canada: A Pilot Study. J Am Med Dir Assoc 2011; 12:217-25. [DOI: 10.1016/j.jamda.2010.07.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 07/21/2010] [Accepted: 07/26/2010] [Indexed: 11/30/2022]
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The use of data for process and quality improvement in long term care and home care: a systematic review of the literature. J Am Med Dir Assoc 2011; 13:103-13. [PMID: 21450243 DOI: 10.1016/j.jamda.2011.01.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Standardized resident or client assessments, including the Resident Assessment Instrument (RAI), have been available in long term care and home care settings (continuing care sector) in many jurisdictions for a number of years. Although using these data can make quality improvement activities more efficient and less costly, there has not been a review of the literature reporting quality improvement interventions using standardized data. OBJECTIVES To address 2 questions: (1) How have RAI and other standardized data been used in process or quality improvement activities in the continuing care sector? and (2) Has the use of RAI and similar data resulted in improvements to resident or other outcomes? DATA SOURCES Searches using a combination of keyword and controlled vocabulary term searches were conducted in MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, the Cochrane Library, and PsychINFO. ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: English language publications from database inception to October 2008 were included. Eligibility criteria included the following: (1) set in continuing care (long-term care facility or home care), (2) involved some form of intervention designed to improve quality or process of care, and (3) used standardized data in the quality or process improvement intervention. STUDY APPRAISAL AND SYNTHESIS METHODS After reviewing the articles, we grouped the studies according to the type of intervention used to initiate process improvement. Four different intervention types were identified. We organized the results and discussion by these 4 intervention types. RESULTS Key word searches identified 713 articles, of which we excluded 639 on abstract review because they did not meet inclusion criteria. A further 50 articles were excluded on full-text review, leaving a total of 24 articles. Of the 24 studies, 10 used a defined process improvement model, 8 used a combination of interventions (multimodal), 5 implemented new guidelines or protocols, and 1 used an education intervention. CONCLUSIONS/IMPLICATIONS The most frequently cited issues contributing to unsuccessful quality improvement interventions were lack of staff, high staff turnover, and limited time available to train staff in ways that would improve client care. Innovative strategies and supporting research are required to determine how to intervene successfully to improve quality in these settings characterized by low staffing levels and predominantly nonprofessional staff. Research on how to effectively enable practitioners to use data to improve quality of care, and ultimately quality of life, needs to be a priority.
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Tjam EY, Heckman GA, Smith S, Arai B, Hirdes J, Poss J, McKelvie RS. Predicting heart failure mortality in frail seniors: comparing the NYHA functional classification with the Resident Assessment Instrument (RAI) 2.0. Int J Cardiol 2011; 155:75-80. [PMID: 21292334 DOI: 10.1016/j.ijcard.2011.01.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Accepted: 01/11/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Though the NYHA functional classification is recommended in clinical settings, concerns have been raised about its reliability particularly among older patients. The RAI 2.0 is a comprehensive assessment system specifically developed for frail seniors. We hypothesized that a prognostic model for heart failure (HF) developed from the RAI 2.0 would be superior to the NYHA classification. The purpose of this study was to determine whether a HF-specific prognostic model based on the RAI 2.0 is superior to the NYHA functional classification in predicting mortality in frail older HF patients. METHODS Secondary analysis of data from a prospective cohort study of a HF education program for care providers in long-term care and retirement homes. Univariate analyses identified RAI 2.0 variables predicting death at 6 months. These and the NYHA classification were used to develop logistic models. RESULTS Two RAI 2.0 models were derived. The first includes six items: "weight gain of 5% or more of total body weight over 30 days", "leaving 25% or more food uneaten", "unable to lie flat", "unstable cognitive, ADL, moods, or behavioural patterns", "change in cognitive function" and "needing help to walk in room"; the C statistic was 0.866. The second includes the CHESS health instability scale and the item "requiring help walking in room"; the C statistic was 0.838. The C statistic for the NYHA scale was 0.686. CONCLUSIONS These results suggest that data from the RAI 2.0, an instrument for comprehensive assessment of frail seniors, can better predict mortality than the NYHA classification.
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Affiliation(s)
- Erin Y Tjam
- St Mary's General Hospital, Kitchener, Ontario, Canada
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Comparison of the Responsiveness of the FIM and the interRAI Post Acute Care Assessment Instrument in Rehabilitation of Older Adults. Arch Phys Med Rehabil 2010; 91:1038-43. [DOI: 10.1016/j.apmr.2010.03.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 03/12/2010] [Accepted: 03/16/2010] [Indexed: 11/18/2022]
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Sales AE, Estabrooks CA, Valente TW. The impact of social networks on knowledge transfer in long-term care facilities: Protocol for a study. Implement Sci 2010; 5:49. [PMID: 20573254 PMCID: PMC2900220 DOI: 10.1186/1748-5908-5-49] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2010] [Accepted: 06/23/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Social networks are theorized as significant influences in the innovation adoption and behavior change processes. Our understanding of how social networks operate within healthcare settings is limited. As a result, our ability to design optimal interventions that employ social networks as a method of fostering planned behavior change is also limited. Through this proposed project, we expect to contribute new knowledge about factors influencing uptake of knowledge translation interventions. OBJECTIVES Our specific aims include: To collect social network data among staff in two long-term care (LTC) facilities; to characterize social networks in these units; and to describe how social networks influence uptake and use of feedback reports. METHODS AND DESIGN In this prospective study, we will collect data on social networks in nursing units in two LTC facilities, and use social network analysis techniques to characterize and describe the networks. These data will be combined with data from a funded project to explore the impact of social networks on uptake and use of feedback reports. In this parent study, feedback reports using standardized resident assessment data are distributed on a monthly basis. Surveys are administered to assess report uptake. In the proposed project, we will collect data on social networks, analyzing the data using graphical and quantitative techniques. We will combine the social network data with survey data to assess the influence of social networks on uptake of feedback reports. DISCUSSION This study will contribute to understanding mechanisms for knowledge sharing among staff on units to permit more efficient and effective intervention design. A growing number of studies in the social network literature suggest that social networks can be studied not only as influences on knowledge translation, but also as possible mechanisms for fostering knowledge translation. This study will contribute to building theory to design such interventions.
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Affiliation(s)
- Anne E Sales
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
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Armstrong J, Glenny C, Stolee P, Berg K. A comparison of two assessment systems in predicting functional outcomes of older rehabilitation patients. Age Ageing 2010; 39:394-9. [PMID: 20308190 DOI: 10.1093/ageing/afq030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Joshua Armstrong
- Department of Health Studies and Gerontology, University of Waterloo, Waterloo, ON N2L 3G1 Canada.
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The Relationship of 60 Disease Diagnoses and 15 Conditions to Preference-Based Health-Related Quality of Life in Ontario Hospital-Based Long-Term Care Residents. Med Care 2010; 48:380-7. [DOI: 10.1097/mlr.0b013e3181ca2647] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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81
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Health, Psycho-social and Cultural Determinants of Medication Use by Chinese-Canadian Older Persons. Can J Aging 2010. [DOI: 10.1017/s0714980800000647] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
ABSTRACTVariations in health and medication use exist across cultures. Medication use among Chinese-Canadian older persons is complicated by many factors including combined use of Western and traditional Chinese medicines (TCM). There is little research on health, psycho-social and cultural determinants of medication use in the Chinese. A cross-sectional census study of community-based Chinese-Canadian older persons in the Kitchener/Waterloo area was conducted using the Minimum Data Set for Home Care and a supplementary questionnaire for cultural issues. The response rate was 89.1 per cent with 106 participants using face-to-face assessments. Socio-demographic and cultural variables were summarized. The multivariate logistic model for TCM use included pain symptoms and being hospitalized, and a curvilinear association between TCM use and health beliefs. For combined medicine use, living with a child, pain symptoms, hospitalization, and social isolation problems were the main effects. Living with a child, physical health problems and number of diseases were associated with Western medicine use. Health, psycho-social and cultural factors were significant determinants for medication use. Education programs for both Chinese-Canadian older persons and health care providers are necessary to understand the appropriate use of Western and TCM treatments.
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82
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Thein HH, Gomes T, Krahn MD, Wodchis WP. Health status utilities and the impact of pressure ulcers in long-term care residents in Ontario. Qual Life Res 2009; 19:81-9. [PMID: 20033300 PMCID: PMC2804787 DOI: 10.1007/s11136-009-9563-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2009] [Indexed: 11/21/2022]
Abstract
Purpose To estimate health status utilities in long-term care (LTC) residents in Ontario, both with and without pressure ulcers (PUs), and to determine the impact of PU on health-related quality of life (HRQOL). Methods A retrospective population-based study was carried out using Minimum Data Set (MDS) health assessment data among all residents in 89 LTC homes in Ontario who had a full MDS assessment between May 2004 and November 2007. The Minimum Data Set-Health Status Index (MDS-HSI) was used to measure HRQOL. A stepwise regression was used to determine the impact of PU on MDS-HSI scores. Results A total of 1,498 (9%) of 16,531 LTC residents had at least one stage II PU or higher. The mean ± SD MDS-HSI scores of LTC residents without PU and those with PU were 0.36 ± 0.17 and 0.26 ± 0.13, respectively (p < 0.001). Factors associated with lower MDS-HSI scores included: older age; being female; having a PU; recent hip fracture; multiple comorbid conditions; bedfast; incontinence; Changes in Health, End-stage disease and Symptoms and Signs; clinically important depression; treated with a turning/repositioning program; taking antipsychotic medications; and use of restraints. Conclusions LTC residents with PU had slightly though statistically significantly lower HRQOL than those without PU. Comorbidity contributed substantially to the low HRQOL in these populations. Community-weighted MDS-HSI utilities for LTC residents are useful for cost-effectiveness analyses and help guide health policy development.
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Affiliation(s)
- Hla-Hla Thein
- Toronto General Research Institute, University Health Network, Toronto, ON, Canada.
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83
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Glenny C, Stolee P. Comparing the functional independence measure and the interRAI/MDS for use in the functional assessment of older adults: a review of the literature. BMC Geriatr 2009; 9:52. [PMID: 19943969 PMCID: PMC2795323 DOI: 10.1186/1471-2318-9-52] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Accepted: 11/29/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The rehabilitation of older persons is often complicated by increased frailty and medical complexity - these in turn present challenges for the development of health information systems. Objective investigation and comparison of the effectiveness of geriatric rehabilitation services requires information systems that are comprehensive, reliable, valid, and sensitive to clinically relevant changes in older persons. The Functional Independence Measure is widely used in rehabilitation settings - in Canada this is used as the central component of the National Rehabilitation Reporting System of the Canadian Institute of Health Information. An alternative system has been developed by the interRAI consortium. We conducted a literature review to compare the development and measurement properties of these two systems. METHODS English language literature published between 1983 (initial development of the FIM) and 2008 was searched using Medline and CINAHL databases, and the reference lists of retrieved articles. Relevant articles were summarized and charted using the criteria proposed by Streiner. Additionally, attention was paid to the ability of the two systems to address issues particularly relevant to older rehabilitation clients, such as medical complexity, comorbidity, and responsiveness to small but clinically meaningful improvements. RESULTS In total, 66 articles were found that met the inclusion criteria. The majority of FIM articles studied inpatient rehabilitation settings; while the majority of interRAI/MDS articles focused on nursing home settings. There is evidence supporting the reliability of both instruments. There were few articles that investigated the construct validity of the interRAI/MDS. CONCLUSION Additional psychometric research is needed on both the FIM and MDS, especially with regard to their use in different settings and with different client groups.
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Affiliation(s)
- Christine Glenny
- Department of Health Studies and Gerontology, University of Waterloo (200 University Avenue East), Waterloo (N2L 3G1), Canada.
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84
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Martin L, Hirdes JP, Morris JN, Montague P, Rabinowitz T, Fries BE. Validating the Mental Health Assessment Protocols (MHAPs) in the Resident Assessment Instrument Mental Health (RAI-MH). J Psychiatr Ment Health Nurs 2009; 16:646-53. [PMID: 19689558 DOI: 10.1111/j.1365-2850.2009.01429.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
For persons with mental illness and addictions, comprehensive assessment of their strengths, preferences and needs is central to person-centred care planning. In this study, the validity of the Mental Health Assessment Protocols (MHAPs) embedded in the Resident Assessment Instrument Mental Health instrument (the mandated assessment system for Ontario adult inpatient psychiatry) is examined, and triggering rates are compared in inpatient and community-based mental health settings. The sample is based on adults admitted to a psychiatric facility (n = 963) and to community mental health programmes (n = 1505) participating in the study. An international panel of mental health experts further evaluated study results. Among the 27 MHAPs, all but one had sensitivity rates above 80%, and the specificity was over 80% for 74% of the MHAPs. The expert panel found that the MHAPs worked well and could be used to support mental health care. The present study found that the MHAPs are valid measures, though more complex triggering algorithms capable of differentiating individuals based on outcomes were suggested to enhance their clinical relevance to care planning. Further, the use of compatible instrumentation in community-based mental health settings was promoted to enhance continuity of care.
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Affiliation(s)
- L Martin
- Lakehead University, 955 Oliver Road, Thunder Bay, Ontario P7B 5E1, Canada.
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85
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Giangregorio LM, Jantzi M, Papaioannou A, Hirdes J, Maxwell CJ, Poss JW. Osteoporosis management among residents living in long-term care. Osteoporos Int 2009; 20:1471-8. [PMID: 19209376 PMCID: PMC5101051 DOI: 10.1007/s00198-009-0837-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Accepted: 11/24/2008] [Indexed: 01/06/2023]
Abstract
UNLABELLED Fractures in long-term care (LTC) residents have substantial economic and human costs. Osteoporosis management in residents with fractures or osteoporosis is low, and certain subgroups are less likely to receive therapy, e.g., those with >5 comorbidities, dementia, and wheelchair use. Many LTC residents who are at risk of fracture are not receiving optimal osteoporosis management. INTRODUCTION The objective of this study was to describe the prevalence and predictors of osteoporosis management among LTC residents with osteoporosis or fractures. METHODS In a retrospective study, LTC residents of 17 facilities in Ontario and Manitoba, Canada were investigated. The participants were 65+ years old with osteoporosis, history of hip fracture, or recent fracture. Comprehensive assessments were conducted by trained nurse assessors between June 2005 and June 2006 using a standardized instrument, known as the Resident Assessment Instrument 2.0. RESULTS Among residents (n = 525) with osteoporosis or fractures, 177 (34%) had had a recent fall. Bisphosphonate use was reported in 199 (38%) residents, calcitonin use in six (1%), and raloxifene use in six (1%). Calcium and vitamin D supplementation were reported in 140 (27%) residents. Fifty-four (10.3%) residents were on a bisphosphonate but were not taking vitamin D or multivitamin. Variables negatively associated with osteoporosis therapy [OR (95% CI)]: six or more comorbidities [0.46 (0.28-0.77), p = 0.028], wheelchair use [0.62 (0.40-0.95), p = 0.003], cognitive impairment [0.71 (0.55-0.92), p = 0.009], depression [0.54 (0.34-0.87), p = 0.01], swallowing difficulties [0.99 (0.988-0.999), p = 0.034] or Manitoba residence [0.47 (0.28-0.78), p = 0.004]. Prescription of 10+ medications was positively associated with therapy [3.34 (2.32-4.84), p < 0.001]. CONCLUSION Osteoporosis management is not optimal among residents at risk of future fracture. Identifying at-risk subgroups of residents that are not receiving therapy may facilitate closing the osteoporosis care gap.
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Affiliation(s)
- L M Giangregorio
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada.
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86
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Estabrooks CA, Squires JE, Cummings GG, Teare GF, Norton PG. Study protocol for the translating research in elder care (TREC): building context - an organizational monitoring program in long-term care project (project one). Implement Sci 2009; 4:52. [PMID: 19671166 PMCID: PMC2744651 DOI: 10.1186/1748-5908-4-52] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Accepted: 08/11/2009] [Indexed: 11/19/2022] Open
Abstract
Background While there is a growing awareness of the importance of organizational context (or the work environment/setting) to successful knowledge translation, and successful knowledge translation to better patient, provider (staff), and system outcomes, little empirical evidence supports these assumptions. Further, little is known about the factors that enhance knowledge translation and better outcomes in residential long-term care facilities, where care has been shown to be suboptimal. The project described in this protocol is one of the two main projects of the larger five-year Translating Research in Elder Care (TREC) program. Aims The purpose of this project is to establish the magnitude of the effect of organizational context on knowledge translation, and subsequently on resident, staff (unregulated, regulated, and managerial) and system outcomes in long-term care facilities in the three Canadian Prairie Provinces (Alberta, Saskatchewan, Manitoba). Methods/Design This study protocol describes the details of a multi-level – including provinces, regions, facilities, units within facilities, and individuals who receive care (residents) or work (staff) in facilities – and longitudinal (five-year) research project. A stratified random sample of 36 residential long-term care facilities (30 urban and 6 rural) from the Canadian Prairie Provinces will comprise the sample. Caregivers and care managers within these facilities will be asked to complete the TREC survey – a suite of survey instruments designed to assess organizational context and related factors hypothesized to be important to successful knowledge translation and to achieving better resident, staff, and system outcomes. Facility and unit level data will be collected using standardized data collection forms, and resident outcomes using the Resident Assessment Instrument-Minimum Data Set version 2.0 instrument. A variety of analytic techniques will be employed including descriptive analyses, psychometric analyses, multi-level modeling, and mixed-method analyses. Discussion Three key challenging areas associated with conducting this project are discussed: sampling, participant recruitment, and sample retention; survey administration (with unregulated caregivers); and the provision of a stable set of study definitions to guide the project.
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Egan M, Wells J, Byrne K, Jaglal S, Stolee P, Chesworth BM, Hillier LM. The process of decision-making in home-care case management: implications for the introduction of universal assessment and information technology. HEALTH & SOCIAL CARE IN THE COMMUNITY 2009; 17:371-378. [PMID: 19187422 DOI: 10.1111/j.1365-2524.2008.00835.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Increasingly, jurisdictions are adopting universal assessment procedures and information technology to aid in healthcare data collection and care planning. Before their potential can be realised, a better understanding is needed of how these systems can best be used to support clinical practice. We investigated the decision-making process and information needs of home-care case managers in Ontario, Canada, prior to the widespread use of universal assessment, with a view of determining how universal assessment and information technology could best support this work. Three focus groups and two individual interviews were conducted; questioning focused on decision-making in the post-acute care of individuals recovering from a hip fracture. We found that case managers' decisional process was one of a clinician-broker, combining clinical expertise and information about local services to support patient goals within the context of limited resources. This process represented expert decision-making, and the case managers valued their ability to carry out non-standardised interviews and override system directives when they noted that data may be misleading. Clear information needs were found in four areas: services available outside of their regions, patient medical information, patient pre-morbid functional status and partner/spouse health and functional status. Implications for the use of universal assessment are discussed. Recommendations are made for further research to determine the impact of universal assessment and information technology on the process and outcome of home-care case manager decision-making.
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Affiliation(s)
- Mary Egan
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada.
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88
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Gray LC, Berg K, Fries BE, Henrard JC, Hirdes JP, Steel K, Morris JN. Sharing clinical information across care settings: the birth of an integrated assessment system. BMC Health Serv Res 2009; 9:71. [PMID: 19402891 PMCID: PMC2685125 DOI: 10.1186/1472-6963-9-71] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Accepted: 04/29/2009] [Indexed: 12/02/2022] Open
Abstract
Background Population ageing, the emergence of chronic illness, and the shift away from institutional care challenge conventional approaches to assessment systems which traditionally are problem and setting specific. Methods From 2002, the interRAI research collaborative undertook development of a suite of assessment tools to support assessment and care planning of persons with chronic illness, frailty, disability, or mental health problems across care settings. The suite constitutes an early example of a "third generation" assessment system. Results The rationale and development strategy for the suite is described, together with a description of potential applications. To date, ten instruments comprise the suite, each comprising "core" items shared among the majority of instruments and "optional" items that are specific to particular care settings or situations. Conclusion This comprehensive suite offers the opportunity for integrated multi-domain assessment, enabling electronic clinical records, data transfer, ease of interpretation and streamlined training.
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Affiliation(s)
- Leonard C Gray
- The University of Queensland, c/- Academic Unit in Geriatric Medicine, University Department of Medicine, Princess Alexandra Hospital, Brisbane, Australia.
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Hadjistavropoulos T, Marchildon GP, Fine PG, Herr K, Palley HA, Kaasalainen S, Béland F. Transforming long-term care pain management in north america: the policy-clinical interface. PAIN MEDICINE 2009; 10:506-20. [PMID: 19254336 DOI: 10.1111/j.1526-4637.2009.00566.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND The undertreatment of pain in older adults who reside in long-term care (LTC) facilities has been well documented, leading to clinical guideline development and professional educational programs designed to foster better pain assessment and management in this population. Despite these efforts, little improvement has occurred, and we postulate that focused attention to public policy and cost implications of systemic change is required to create positive pain-related outcomes. OBJECTIVE Our goal was to outline feasible and cost-effective clinical and public policy recommendations designed to address the undermanagement of pain in LTC facilities. METHODS We arranged a 2-day consensus meeting of prominent United States and Canadian pain and public policy experts. An initial document describing the problem of pain undermanagement in LTC was developed and circulated prior to the meeting. Participants were also asked to respond to a list of relevant questions before arriving. Following formal presentations of a variety of proposals and extensive discussion among clinicians and policy experts, a set of recommendations was developed. RESULTS AND CONCLUSIONS We outline key elements of a transformational model of pain management in LTC for the United States and Canada. Consistent with previously formulated clinical guidelines but with attention to readily implementable public policy change in both countries, this transformational model of LTC has important implications for LTC managers and policy makers as well as major quality of life implications for LTC residents.
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Affiliation(s)
- Thomas Hadjistavropoulos
- Department of Psychology & Centre on Aging and Health, University of Regina, Regina, SK, Canada.
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90
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Stolee P, Poss J, Cook RJ, Byrne K, Hirdes JP. Risk factors for hip fracture in older home care clients. J Gerontol A Biol Sci Med Sci 2009; 64:403-10. [PMID: 19196903 DOI: 10.1093/gerona/gln035] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Little information is available on hip fracture risks among community-dwelling persons receiving home care. Our aim was to identify risk factors for hip fracture from health information routinely collected for older home care clients. METHODS This was a cohort study involving secondary analysis of data on 40,279 long-stay (>60 days) home care clients aged 65 and older in Ontario, Canada; occurrence of hip fracture as well as potential risk factor information were measured using the Resident Assessment Instrument (RAI)/Minimum Data Set-Home Care assessment instrument. RESULTS In all, 1,003 clients (2.5%) had hip fracture on follow-up assessment. Older (85+ vs 65-74, relative risk [95% confidence interval]: 0.52 [0.43-0.64]) clients are at increased risk; males are at reduced risk [0.60 (0.51-0.70)]. Other risk factors include osteoporosis (1.19 [1.03-1.36]), falls (1.31 [1.15-1.49]), unsteady gait (1.18 [1.03-1.36]), use of ambulation aide (1.39 [1.21-1.59]), tobacco use (1.42, [1.13-1.80]), severe malnutrition (2.61 [1.67-4.08]), and cognitive impairment (1.30 [1.12-1.51]). Arthritis (0.86 [0.76-0.98]) and morbid obesity (0.34 [0.16-0.72]) were associated with reduced risk. Males and females demonstrated different risk profiles. CONCLUSIONS Important risk factors for hip fracture can be identified from routinely collected data; these could be used to identify at-risk clients for further investigation and prevention strategies.
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Affiliation(s)
- Paul Stolee
- Department of Health Studies and Gerontology, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, Canada N2L 3G1.
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Abstract
BACKGROUND This exploratory study examines factors associated with isolation from informal social ties among geriatric psychiatry inpatients. Specifically, it examines the associations of diagnoses, psychiatric history, and measures of current functioning with social isolation. METHODS Analyses rely upon data derived from the Resident Assessment Instrument-Mental Health (RAI-MH), which is a patient focused, multidimensional, comprehensive assessment instrument designed to be a component of a larger, integrated health information system linking mental health with home care, long-term care, acute care, rehabilitation, and palliative care. RESULTS Controlling for age, multivariate results show that being married or widowed was associated with a lower odds of being isolated. Mood disorders were also associated with a lower odds of isolation, while a history of a personality disorder and a personal biography of institutionalization were both clearly associated with an increased odds for isolation. Although significant bivariate predictors in the multivariate model, both schizophrenic and organic diagnoses failed to reach statistical significance. In addition, patients hospitalized at an earlier age and/or predicted to have a longer stay on the current admission were much less likely to have contact with informal supports. Of the study variables indexing functional status, only activities of daily living (ADLs) remained a significant predictor for isolation in the final multivariate model. CONCLUSIONS The analyses demonstrate the detrimental effects of an earlier life experience with mental illness. Having an earlier age of illness onset may lead to a potentially greater impairment in establishing and maintaining informal social ties throughout the life course into older age. These analyses reinforce the need for comprehensive assessment of patients on admission and over time.
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Abstract
This study uses data from the Resident Assessment Instrument Mental Health (RAI-MH) on everyone admitted to an Ontario inpatient psychiatric facility between October 2005 and June 2007 to describe patients characteristics and service utilization, and to determine whether these differ based on prioritization of mental health issues in the Integrated Health Service Plan (IHSP) put forth by the Local Health Integration Network (LHIN) providing service.
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Affiliation(s)
- Lynn Martin
- Lakehead University, Centre for Education and Research on Aging and Health, Homewood Research Institute
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93
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Hirdes JP, Ljunggren G, Morris JN, Frijters DHM, Finne Soveri H, Gray L, Björkgren M, Gilgen R. Reliability of the interRAI suite of assessment instruments: a 12-country study of an integrated health information system. BMC Health Serv Res 2008; 8:277. [PMID: 19115991 PMCID: PMC2631461 DOI: 10.1186/1472-6963-8-277] [Citation(s) in RCA: 408] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Accepted: 12/30/2008] [Indexed: 11/28/2022] Open
Abstract
Background A multi-domain suite of instruments has been developed by the interRAI research collaborative to support assessment and care planning in mental health, aged care and disability services. Each assessment instrument comprises items common to other instruments and specialized items exclusive to that instrument. This study examined the reliability of the items from five instruments supporting home care, long term care, mental health, palliative care and post-acute care. Methods Paired assessments on 783 individuals across 12 nations were completed within 72 hours of each other by trained assessors who were blinded to the others' assessment. Reliability was tested using weighted kappa coefficients. Results The overall kappa mean value for 161 items which are common to 2 or more instruments was 0.75. The kappa mean value for specialized items varied among instruments from 0.63 to 0.73. Over 60% of items scored greater than 0.70. Conclusion The vast majority of items exceeded standard cut-offs for acceptable reliability, with only modest variation among instruments. The overall performance of these instruments showed that the interRAI suite has substantial reliability according to conventional cut-offs for interpreting the kappa statistic. The results indicate that interRAI items retain reliability when used across care settings, paving the way for cross domain application of the instruments as part of an integrated health information system.
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Affiliation(s)
- John P Hirdes
- University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada.
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94
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Jónsson PV, Noro A, Finne-Soveri H, Jensdóttir AB, Ljunggren G, Bucht G, Grue EV, Björnson J, Jonsén E, Schroll M. Admission profile is predictive of outcome in acute hospital care. Aging Clin Exp Res 2008; 20:533-9. [PMID: 19179837 DOI: 10.1007/bf03324881] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS The purpose of this study is to describe predictors for discharge and one-year outcomes of acute-care hospital patients, 75 years of age or over, based on admission status information. We carried out a prospective study of a randomly selected patient population, from one urban acute-care hospital in each of the Nordic countries. 763 persons aged 75+ were randomly selected from acute admissions to the participating hospitals. 749 observations at discharge and 655 observations at one year were used in analyses. METHODS Data were collected with the MDS-AC 1.1 instrument within 24 hours of admission, and at day 7 or discharge, whichever came first. Outcome information was collected either by interviewing the patient or from patient records or registers. Discharge and one-year outcome (home, institution, death) were modeled by multinomial logistic regression, with admission status variables as predictors. RESULTS At discharge, 84% of subjects returned home, 11% went to an institution and 5.6% had died. At one year, 64% were still living at home, 24% had died, and 12% had moved to an institution. For discharge outcome, those having hospital admission due to a new problem or exacerbation of an old one had a higher risk of dying (OR 3.3) than returning home. Moderate to severe cognitive problems predicted death (OR 2.2) and institutionalization (OR 8.6) compared with discharge home. Problems in instrumental activities of daily living predicted death (OR 3.1) and institutionalization (OR 6.0). At one year, those with exacerbation of an old problem (OR 2.1) or with a new or exacerbated existing problem (OR 2.3) had a higher risk of dying than of institutionalization or discharge home. Having some cognitive problems (OR 2.8) or moderate to severe cognitive problems (OR 6.6) predicted institutionalization, but not dying or discharge home. Those with some problems in activities of daily living had a higher risk of both dying (OR 1.7) and of institutional care (OR 2.7). Those with moderate to severe problems in activities of daily living had also a higher risk of institutional care (OR 4.7) compared with those living at home. CONCLUSIONS Evidence predictive of discharge and one-year outcomes in older acute hospital medical care patients seems to be visible from the beginning of the hospital stay. In order to increase the efficient use of health care services and quality of care, systematic standardized and streamlined assessment should be performed during the admission process.
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Affiliation(s)
- Pálmi V Jónsson
- Department of Geriatrics, Landspitali University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
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Perlman CM, Hirdes JP. The Aggressive Behavior Scale: A New Scale to Measure Aggression Based on the Minimum Data Set. J Am Geriatr Soc 2008; 56:2298-303. [DOI: 10.1111/j.1532-5415.2008.02048.x] [Citation(s) in RCA: 158] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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97
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Boyd M, Koziol-McLain J, Yates K, Kerse N, McLean C, Pilcher C, Robb G. Emergency department case-finding for high-risk older adults: the Brief Risk Identification for Geriatric Health Tool (BRIGHT). Acad Emerg Med 2008; 15:598-606. [PMID: 18691210 DOI: 10.1111/j.1553-2712.2008.00157.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective was to test the ability of the Brief Risk Identification for Geriatric Health Tool (BRIGHT) to identify older emergency department (ED) patients with functional and physical impairment. METHODS This was a cross-sectional study in which 139 persons > or = 75 years, who presented to an urban New Zealand ED over a 12-week period, completed the 11-item BRIGHT case-finding tool. Then, within 10 days of their index ED visit, 114 persons completed a comprehensive geriatric assessment. A "yes" response to at least 3 of the 11 BRIGHT items was considered "positive." Primary outcome measures were instrumental activities of daily living (IADL), cognitive performance scale (CPS), and activities of daily living (ADL). RESULTS The BRIGHT-identified IADL deficit (64% prevalence) with a sensitivity of 0.76, specificity of 0.79, and receiver operating characteristic (ROC) of 0.83 (95% confidence interval [CI] = 0.74 to 0.91, p < 0.01); cognitive deficit (35% prevalence) sensitivity of 0.78, specificity of 0.54, and ROC of 0.66 (95% CI = 0.55 to 0.76, p = 0.006); and ADL deficit (29% prevalence) sensitivity of 0.83, specificity of 0.53, and ROC of 0.64 (95% CI = 0.53 to 0.75, p = 0.020). Positive likelihood ratios (LR+) for the three outcomes of interest were 3.6, 1.7, and 1.8, respectively. Negative likelihood ratios (LR-) were 0.3, 0.4, and 0.3. CONCLUSIONS The 11-item BRIGHT successfully identifies older adults in the ED with decreased function and may be useful in differentiating elder patients in need of comprehensive assessment.
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Affiliation(s)
- Michal Boyd
- Division of Home and Older Adult Services, Waitemata District Health Board, North Shore City.
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McAiney CA, Haughton D, Jennings J, Farr D, Hillier L, Morden P. A unique practice model for Nurse Practitioners in long-term care homes. J Adv Nurs 2008; 62:562-71. [DOI: 10.1111/j.1365-2648.2008.04628.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gerritsen DL, Steverink N, Frijters DHM, Hirdes JP, Ooms ME, Ribbe MW. A Revised Index for Social Engagement for Long-Term Care. J Gerontol Nurs 2008; 34:40-8. [PMID: 18429378 DOI: 10.3928/00989134-20080401-04] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Debby L Gerritsen
- Heyendaal Institute, Radboud University Nijmegen, Nijmegen, The Netherlands.
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Hirdes JP, Poss JW, Curtin-Telegdi N. The Method for Assigning Priority Levels (MAPLe): a new decision-support system for allocating home care resources. BMC Med 2008; 6:9. [PMID: 18366782 PMCID: PMC2330052 DOI: 10.1186/1741-7015-6-9] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Accepted: 03/26/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Home care plays a vital role in many health care systems, but there is evidence that appropriate targeting strategies must be used to allocate limited home care resources effectively. The aim of the present study was to develop and validate a methodology for prioritizing access to community and facility-based services for home care clients. METHODS Canadian and international data based on the Resident Assessment Instrument - Home Care (RAI-HC) were analyzed to identify predictors for nursing home placement, caregiver distress and for being rated as requiring alternative placement to improve outlook. RESULTS The Method for Assigning Priority Levels (MAPLe) algorithm was a strong predictor of all three outcomes in the derivation sample. The algorithm was validated with additional data from five other countries, three other provinces, and an Ontario sample obtained after the use of the RAI-HC was mandated. CONCLUSION The MAPLe algorithm provides a psychometrically sound decision-support tool that may be used to inform choices related to allocation of home care resources and prioritization of clients needing community or facility-based services.
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Affiliation(s)
- John P Hirdes
- Department of Health Studies and Gerontology, University of Waterloo, University Avenue West, Waterloo, Ontario, N2L 3G1, Canada.
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