Data Sharing in the New Real-World

Resident-to-resident elder mistreatment (R-REM) intervention for direct care staff in assisted living residences: study protocol for a cluster randomized controlled trial

Background

Resident-to-resident elder mistreatment (R-REM) is defined as negative and aggressive physical, sexual, or verbal interactions between (long-term care) residents that in a community setting would likely be construed as unwelcome and have high potential to cause physical and/or psychological harm and distress. R-REM has been established as a serious problem that has a negative impact on the safety, physical well-being, and quality-of-life of residents living in nursing homes. Although there are no in-depth studies, there is evidence that it is prevalent in assisted living residences and associated with a variety of person, environmental, and facility characteristics. The authors conducted the first systematic, prospective study of resident-to-resident elder mistreatment in nursing homes and developed an intervention for direct care staff to enhance knowledge of R-REM and increase reporting and resident safety by reducing falls and associated injuries. The study aim was to examine the effects of this intervention in assisted living residences. The primary distal outcome is falls and injuries, and the key process outcomes are staff knowledge and reporting.

Methods

Twelve larger licensed assisted living residences with special care dementia units in two New York State regions will be enrolled on a rolling basis and randomized to intervention or usual care. Data derived from five sources, (1) resident interviews, (2) staff informants, (3) observational data, (4) chart, and (5) incident/accident report data, will be collected at baseline and 6 and 12 months with respect to 1050 residents (750 “downstate” and 300 “upstate”). The intervention is three training modules delivered on-site after baseline data collection for front line staff on all shifts in facilities randomized to the intervention. Modules relate to recognition, management, and reporting of resident-to-resident elder mistreatment.

Discussion

Given the movement toward alternative congregate living arrangements for older individuals with significant comorbidities, including cognitive impairment; it is critical to enhance resident safety measured by falls, accidents, and injuries and staff knowledge related to recognition, reporting, and treatment of resident-to-resident aggressive and related negative interactions in such settings. This project is important in developing approaches for ameliorating and preventing R-REM in assisted living residences and enhancing resident safety and quality of life.

Trial registration

ClinicalTrials.gov NCT03383289. Registered on 26 December 2017

Data Sharing and Data Registries in Physical Medicine and Rehabilitation

The field of physical medicine & rehabilitation (PM&R), along with all the disciplines it encompasses, has evolved rapidly in the past 50 years. The number of controlled trials, systematic reviews, and meta-analyses in PM&R increased 5-fold from 1998 to 2013. In recent years, professional, private, and governmental institutions have identified the need to track function and functional status across providers and settings of care and on a larger scale. Because function and functional status are key aspects of PM&R, access to and sharing of reliable data will have an important impact on clinical practice. We reviewed the current landscape of PM&R databases and data repositories, the clinical applicability and practice implications of data sharing, and challenges and future directions. We included articles that (1) addressed any aspect of function, disability, or participation; (2) focused on recovery or maintenance of any function; and (3) used data repositories or research databases. We identified 398 articles that cited 244 data sources. The data sources included 66 data repositories and 179 research databases. We categorized the data sources based on their purposes and uses, geographic distribution, and other characteristics. This study collates the range of databases, data repositories, and data-sharing mechanisms that have been used in PM&R internationally. In recent years, these data sources have provided significant information for the field, especially at the population-health level. Implications and future directions for data sources also are discussed.