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Kokorelias KM, Singh H, Nelson MLA, Hitzig SL. "Why Do We Always Have to Focus on the Bad": A Strengths-Based Approach to Identify the Positive Aspects of Care From the Perspective of Older Adults Using a Secondary Qualitative Analysis. J Patient Exp 2023; 10:23743735231188841. [PMID: 37547702 PMCID: PMC10399251 DOI: 10.1177/23743735231188841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
Hospitalization is often viewed as a burdensome and stressful period for older adults and their family caregivers; however, little attention has been given to the positive aspects of the care continuum journey. The purpose of this article is to highlight the positive aspects of healthcare from the perspective of Canadian older adults with complex needs and their family caregivers. This study utilized a strengths-based theoretical perspective to conduct a secondary qualitative analysis of interviews with 12 older adults and seven family caregivers. Four themes relating to positive aspects of care were identified, including: (1) looking beyond illness, (2) emotional support from healthcare providers, (3) timely discharge, and (4) upholding independence. Focusing on the positive aspects can help determine areas of care practice that currently work well. These insights will be valuable for current and future initiatives seeking to restructure and optimize healthcare services for older adults.
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Affiliation(s)
- Kristina M Kokorelias
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Temerty Faculty of Medicine, Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Michelle LA Nelson
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sander L Hitzig
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Temerty Faculty of Medicine, Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
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Robinson ES, Cyarto E, Ogrin R, Green M, Lowthian JA. Quality of life of older Australians receiving home nursing services for complex care needs. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6091-e6101. [PMID: 36200317 DOI: 10.1111/hsc.14046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 08/04/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
Older Australians may live up to 10 years in ill health, most likely chronic disease-related. Those with multimorbidity report more healthcare visits, poorer health and take more medications compared with people with a single chronic disease. They are also at higher risk of hospital admission and poor quality of life. People living with multimorbidity are considered to have "complex care" needs. A person-centred approach to healthcare has led to increasing use of in-home nursing support, enabling older people to receive care at home. Our prospective observational study describes the profile and management of home-based care for older people with complex care needs and examines changes in their quality of life over 12 months. Routinely collected data were analysed, including demographics, medical history, medications and the visit activity of staff providing care to participants. Additional health-related quality of life and hospitalisation data were collected via quarterly surveys and analysed. Fifty-two participants (mean age 76.6 years, 54% female) with an average of eight diagnosed health conditions, received an average of four home care visits per week. Almost half the participants were hospitalised once during the 12-month period and experienced a significant decline in overall quality of life and in the dimensions measuring independent living and relationships over the study period. If ageing in place with good quality of life is to be realised by older adults with multimorbidity, support services including home nursing need to consider both the biomedical and social determinants perspectives when addressing health and social care needs.
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Affiliation(s)
| | - Elizabeth Cyarto
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Faculty of Health and Behavioural Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Rajna Ogrin
- Bolton Clarke Research Institute, Forest Hill, Victoria, Australia
- Department of Business Strategy and Innovation, Griffith University, Nathan, Queensland, Australia
| | - Maja Green
- Bolton Clarke Research Institute, Forest Hill, Victoria, Australia
| | - Judy A Lowthian
- Bolton Clarke Research Institute, Forest Hill, Victoria, Australia
- Faculty of Health and Behavioural Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
- School of Public Health & Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Victoria, Australia
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Ghorbanzadeh K, Ebadi A, Hosseini MA, Madah S, Khankeh H. The Transition in Intensive Care Unit Patients: A Concept Analysis. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2022. [DOI: 10.1016/j.ijans.2022.100498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Schneberk T, Bolshakova M, Sloan K, Chang E, Stal J, Dinalo J, Jimenez E, Motala A, Hempel S. Quality Indicators for High-Need Patients: a Systematic Review. J Gen Intern Med 2022; 37:3147-3161. [PMID: 35260956 PMCID: PMC9485370 DOI: 10.1007/s11606-022-07454-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/03/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Healthcare systems are increasingly implementing programs for high-need patients, who often have multiple chronic conditions and complex social situations. Little, however, is known about quality indicators that might guide healthcare organizations and providers in improving care for high-need patients. We sought to conduct a systematic review to identify potential quality indicators for high-need patients. METHODS This systematic review (CRD42020215917) searched PubMed, CINAHL, and EMBASE; guideline clearing houses ECRI and GIN; and Google scholar. We included publications suggesting, evaluating, and utilizing indicators to assess quality of care for high-need patients. Critical appraisal of the indicators addressed the development process, endorsement and adoption, and characteristics, such as feasibility. We standardized indicators by patient population subgroups to facilitate comparisons across different indicator groups. RESULTS The search identified 6964 citations. Of these, 1382 publications were obtained as full text, and 53 studies met inclusion criteria. We identified over 1700 quality indicators across studies. Quality indicator characteristics varied widely. The scope of the selected indicators ranged from detailed criterion (e.g., "annual eye exam") to very broad categories (e.g., "care coordination"). Some publications suggested disease condition-specific indicators (e.g., diabetes), some used condition-independent criteria (e.g., "documentation of the medication list in the medical record available to all care agencies"), and some publications used a mixture of indicator types. DISCUSSION We identified and evaluated existing quality indicators for a complex, heterogeneous patient group. Although some quality indicators were not disease-specific, we found very few that accounted for social determinants of health and behavioral factors. More research is needed to develop quality indicators that address patient risk factors.
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Affiliation(s)
- Todd Schneberk
- Gehr Center for Health Systems Science and Innovation, Keck School of Medicine, University of Southern California, GNH 1011, 1200 N State Street Rm 1011, Los Angeles, CA, 90033, USA.
| | - Maria Bolshakova
- Southern California Evidence Review Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kylie Sloan
- Southern California Evidence Review Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Evelyn Chang
- VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA
| | - Julia Stal
- Southern California Evidence Review Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jennifer Dinalo
- Southern California Evidence Review Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Elvira Jimenez
- VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA
| | - Aneesa Motala
- Gehr Center for Health Systems Science and Innovation, Keck School of Medicine, University of Southern California, GNH 1011, 1200 N State Street Rm 1011, Los Angeles, CA, 90033, USA
- Southern California Evidence Review Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Susanne Hempel
- Gehr Center for Health Systems Science and Innovation, Keck School of Medicine, University of Southern California, GNH 1011, 1200 N State Street Rm 1011, Los Angeles, CA, 90033, USA
- Southern California Evidence Review Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Ohashi T, Akazawa C. Content Validity of a Self-Management Behavior Assessment Tool for Adult Post-Renal Transplant Recipients Using a Modified Delphi Method. Health (London) 2022. [DOI: 10.4236/health.2022.141007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Glavinovic T, Vinson AJ, Silver SA, Yohanna S. An Environmental Scan and Evaluation of Quality Indicators Across Canadian Kidney Transplant Centers. Can J Kidney Health Dis 2021; 8:20543581211027969. [PMID: 34262781 PMCID: PMC8243101 DOI: 10.1177/20543581211027969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/15/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Kidney transplantation is the optimal treatment for an individual requiring kidney replacement therapy, resulting in improved survival and quality of life while costing the health care system less than maintenance dialysis. Achieving and maintaining a kidney transplant requires extensive coordination of several different health care services. To improve the quality of kidney transplant care, quality metrics or indicators that encompass all aspects of the individual’s journey to transplant should be measured in a standardized fashion. Objective: To identify, categorize, and evaluate strengths and weaknesses of kidney transplant quality indicators currently being used across Canada. Design: An environmental scan of quality indicators being used by kidney organizations and programs. Setting: A 16-member volunteer pan-Canadian panel with expertise in nephrology, transplant, and quality improvement. Sample: Transplant programs, as well as provincial transplant and kidney agencies across Canada. Methods: Indicators were first categorized based on the period of transplant care and then using the Institute of Medicine and Donabedian frameworks. A 4-member subcommittee rated each indicator using a modified version of the Delphi consensus technique based on the American College of Physician/Agency for Healthcare Research and Quality criteria. Consensus ratings were subsequently shared with the entire 16-member panel for additional comments. Results: We identified 46 measures related to transplant care across 7 Canadian provinces (9 referral and evaluation, 9 waitlist activity and outcomes, 6 hospitalization for transplant surgery, 12 posttransplant care, 6 organ utilization, 4 living donor). We rated 24 indicators (52%) as necessary to distinguish high-quality from low-quality care, most of which measured effective (n = 10) or efficient (n = 6) care. Only 7 (15%) of 46 indicators evaluated person-centered or equitable care. Fourteen common indicators were measured by 5 of 7 provinces, 10 of which were deemed “necessary,” measuring safe (n = 2), effective (n = 5), efficient (n = 2), and equitable (n = 1) care. Limitations: The panel lacked patient and allied health representation. Conclusions: There are a large number of kidney transplant quality indicators currently being used in Canada, some of which are common across provinces and focus primarily on measuring effective care. Person-centered and equitable care indicators were lacking, and only half of these indicators were deemed “necessary” for quality improvement. Our results should complement ongoing work to achieve national consensus on the standardization of quality indicators in kidney transplantation.
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Affiliation(s)
- Tamara Glavinovic
- Department of Medicine, Division of Nephrology, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | - Amanda J Vinson
- Department of Medicine, Division of Nephrology, Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada
| | - Samuel A Silver
- Department of Medicine, Division of Nephrology, Kingston Health Sciences Centre, Queen's University, Kingston, ON, Canada
| | - Seychelle Yohanna
- Department of Medicine, Division of Nephrology, St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, ON, Canada
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Hingwala J, Molnar AO, Mysore P, Silver SA. An Environmental Scan of Ambulatory Care Quality Indicators for Patients With Advanced Kidney Disease Currently Used in Canada. Can J Kidney Health Dis 2021; 8:2054358121991096. [PMID: 33614057 PMCID: PMC7868503 DOI: 10.1177/2054358121991096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/16/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Quality indicators can be used to identify gaps in care and drive frontline improvement activities. These efforts are important to prevent adverse events in the increasing number of ambulatory patients with advanced kidney disease in Canada, but it is unclear what indicators exist and the components of health care quality they measure. Objective: We sought to identify, categorize, and evaluate quality indicators currently in use across Canada for ambulatory patients with advanced kidney disease. Design: Environmental scan of quality indicators currently being collected by various organizations. Setting: We assembled a 16-member group from across Canada with expertise in nephrology and quality improvement. Patients: Our scan included indicators relevant to patients with chronic kidney disease in ambulatory care clinics. Measurements: We categorized the identified quality indicators using the Institute of Medicine and Donabedian frameworks. Methods: A 4-member panel used a modified Delphi process to evaluate the indicators found during the environmental scan using the American College of Physicians/Agency for Healthcare Research and Quality criteria. The ratings were then shared with the full panel for further comments and approval. Results: The environmental scan found 28 quality indicators across 7 provinces, with 8 (29%) rated as “necessary” to distinguish high-quality from poor-quality care. Of these 8 indicators, 3 were measured by more than 1 province (% of patients on a statin, number of patients receiving a preemptive transplant, and estimated glomerular filtration rate at dialysis start); no indicator was used by more than 2 provinces. None of the indicators rated as necessary measured timely or equitable care, nor did we identify any measures that assessed the setting in which care occurs (ie, structure measures). Limitations: Our list cannot be considered as an exhaustive list of available quality indicators at hand in Canada. Our work focused on quality indicators for nephrology providers and programs, and not indicators that can be applied across primary and specialty providers. We also focused on indicator constructs and not the detailed definitions or their application. Last, our panel does not represent the views of other important stakeholders. Conclusions: Our environmental scan provides a snapshot of the scope of quality indicators for ambulatory patients with advanced kidney disease in Canada. This catalog should inform indicator selection and the development of new indicators based on the identified gaps, as well as motivate increased pan-Canadian collaboration on quality measurement and improvement. Trial registration: Not applicable as this article is not a systematic review, nor does it report results of a health intervention on human participants.
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Affiliation(s)
- Jay Hingwala
- Division of Nephrology, Winnipeg Health Sciences Centre, University of Manitoba, Winnipeg, Canada
| | - Amber O Molnar
- Division of Nephrology, St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Priyanka Mysore
- Division of Nephrology, Winnipeg Health Sciences Centre, University of Manitoba, Winnipeg, Canada
| | - Samuel A Silver
- Division of Nephrology, Kingston Health Sciences Center, Queen's University, Kingston, ON, Canada
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Dubrofsky L, Ibrahim A, Tennankore K, Poinen K, Shah S, Silver SA. An Environmental Scan and Evaluation of Home Dialysis Quality Indicators Currently Used in Canada. Can J Kidney Health Dis 2020; 7:2054358120977391. [PMID: 33354332 PMCID: PMC7734484 DOI: 10.1177/2054358120977391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 10/29/2020] [Indexed: 11/16/2022] Open
Abstract
Background Quality indicators are important tools to measure and ultimately improve the quality of care provided. Performance measurement may be particularly helpful to grow disciplines that are underutilized and cost-effective, such as home dialysis (peritoneal dialysis and home hemodialysis). Objective To identify and catalog home dialysis quality indicators currently used in Canada, as well as to evaluate these indicators as a starting point for future collaboration and standardization of quality indicators across Canada. Design An environmental scan of quality indicators from provincial organizations, quality organizations, and stakeholders. Setting Sixteen-member pan-Canadian panel with expertise in both nephrology and quality improvement. Patients Our environmental scan included indicators relevant to patients on home dialysis. Measurements We classified existing indicators based on the Institute of Medicine (IOM) and Donabedian frameworks. Methods To evaluate the indicators, a 6-person subcommittee conducted a modified version of the Delphi consensus technique based on the American College of Physicians/Agency for Healthcare Research and Quality criteria. We shared these consensus ratings with the entire 16-member panel for further examination. We rated items from 1 to 9 on 6 domains (1-3 does not meet criteria to 7-9 meets criteria) as well as a global final rating (1-3 unnecessary to 7-9 necessary) to distinguish high-quality from low-quality indicators. Results Overall, we identified 40 quality indicators across 7 provinces, with 22 (55%) rated as "necessary" to distinguish high quality from poor quality care. Ten indicators were measured by more than 1 province, and 5 of these indicators were rated as necessary (home dialysis prevalence, home dialysis incidence, anemia target achievement, rates of peritonitis associated with peritoneal dialysis, and home dialysis attrition). None of these indicators captured the IOM domains of timely, patient-centered, or equitable care. Limitations The environmental scan is a nonexhaustive list of quality indicators in Canada. The panel also lacked representation from patients, administrators, and allied health professionals. Conclusions These results provide Canadian home dialysis programs with a starting point on how to measure quality of care along with the current gaps. This work is an initial and necessary step toward future collaboration and standardization of quality indicators across Canada, so that home dialysis programs can access a smaller number of highly rated balanced indicators to motivate and support patient-centered quality improvement initiatives.
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Affiliation(s)
- Lisa Dubrofsky
- Division of Nephrology, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | - Ali Ibrahim
- Division of Nephrology, Department of Medicine, University Health Network, University of Toronto, ON, Canada
| | - Karthik Tennankore
- Division of Nephrology, Department of Medicine, Dalhousie University & Nova Scotia Health Authority, Halifax, Canada
| | - Krishna Poinen
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Sachin Shah
- Division of Nephrology, Department of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Samuel A Silver
- Division of Nephrology, Kingston Health Sciences Center, Queen's University, ON, Canada
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Blum D, Thomas A, Harris C, Hingwala J, Beaubien-Souligny W, Silver SA. An Environmental Scan of Canadian Quality Metrics for Patients on In-Center Hemodialysis. Can J Kidney Health Dis 2020; 7:2054358120975314. [PMID: 33343910 PMCID: PMC7727051 DOI: 10.1177/2054358120975314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/24/2020] [Indexed: 11/15/2022] Open
Abstract
Background: Quality metrics or indicators help guide quality improvement work by reporting on measurable aspects of health care upon which improvement efforts can focus. For recipients of in-center hemodialysis (ICHD) in Canada, it is unclear what ICHD quality indicators exist and whether they adequately cover different domains of health care quality. Objectives: To identify and evaluate current Canadian ICHD quality metrics to document a starting point for future collaborations and standardization of quality improvement in Canada. Design: Environmental scan of quality metrics in ICHD, and subsequent indicator evaluation using a modified Delphi approach. Setting: Canadian ICHD units. Participants: Sixteen-member pan-Canadian working group with expertise in ICHD and quality improvement. Measurements: We classified the existing indicators based on the Institute of Medicine (IOM) and Donabedian frameworks. Methods: Each metric was rated by a 5-person subcommittee using a modified Delphi approach based on the American College of Physicians/Agency for Healthcare Research and Quality criteria. We shared these consensus ratings with the entire 16-member panel for additional comments. Results: We identified 27 metrics that are tracked across 8 provinces, with only 9 (33%) tracked by multiple provinces (ie, more than 1 province). We rated 9 metrics (33%) as “necessary” to distinguish high-quality from low-quality care, of which only 2 were tracked by multiple provinces (proportion of patients by primary access and rate of vascular access-related bloodstream infections). Most (16/27, 59%) indicators assessed the IOM domains of safe or effective care, and none of the “necessary” indicators measured the IOM domains of timely, patient-centered, or equitable care. Limitations: The environmental scan is a nonexhaustive list of quality indicators in Canada. The panel also lacked representation from patients, administrators, and allied health professionals, with more representation from academic sites. Conclusions: Quality indicators in Canada mainly focus on safe and effective care, with little provincial overlap. These results highlight current gaps in quality of care measurement for ICHD, and this initial work should provide programs with a starting point to combine highly rated indicators with newly developed indicators into a concise balanced scorecard that supports quality improvement initiatives across all aspects of ICHD care. Trial Registration: not applicable.
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Affiliation(s)
- Daniel Blum
- Division of Nephrology, Jewish General Hospital, Montreal, QC, Canada
- Daniel Blum, Division of Nephrology, Jewish General Hospital, 3755 Cote Sainte Catherine, D-070, Montreal, QC, Canada H3T 1E2.
| | - Alison Thomas
- Division of Nephrology, St. Michael’s Hospital, Toronto, ON, Canada
| | - Claire Harris
- Division of Nephrology, The University of British Columbia, Vancouver, Canada
| | - Jay Hingwala
- Division of Nephrology, University of Manitoba, Winnipeg, Canada
| | | | - Samuel A. Silver
- Division of Nephrology, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
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Inter-Professional Collaboration and Patient Mortality: Protocol for a Systematic Review and Meta-Analysis. NURSING REPORTS 2020; 10:15-22. [PMID: 34968260 PMCID: PMC8608100 DOI: 10.3390/nursrep10010003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 11/17/2022] Open
Abstract
Inter-professional collaboration is a process in which health professionals from different disciplines work together, sharing their ideas and opinions to plan evidence-based care. Nurses and doctors spend most of their time providing direct patient care. Therefore, effective interprofessional collaboration may be important in ensuring safe and effective patient care. There are no systematic reviews that have evaluated the association between nurse–doctor collaboration and patient outcomes in medical and surgical settings. We will conduct a systematic search of five key databases MEDLINE, EMBASE, PsycInfo, CINAHL, and the Cochrane register. We will include observational and experimental research that tests the association between levels of inter-professional collaboration and medical and surgical inpatient mortality. Two reviewers will independently conduct title and abstract, full-text screening, and data extraction. The Effective Public Health Practice (EPHPP) tool will be used to determine the quality of the included studies. If sufficient studies are available, we will undertake a meta-analysis. The protocol is registered with the international prospective register of systematic reviews (PROSPERO-CRD42019133543).
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Smith HN, Fields SM. Changes in older adults’ impairment, activity, participation and wellbeing as measured by the AusTOMs following participation in a Transition Care Program. Aust Occup Ther J 2020; 67:517-527. [DOI: 10.1111/1440-1630.12667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 04/06/2020] [Accepted: 04/12/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Haley N. Smith
- Faculty of Health Sciences and Medicine – Occupational Therapy Bond University Gold Coast Qld Australia
| | - Sally M. Fields
- Faculty of Health Sciences and Medicine – Occupational Therapy Bond University Gold Coast Qld Australia
- Transition Care Program Gold Coast Health Gold Coast Qld Australia
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12
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„Rapid sequence induction and intubation“ beim aspirationsgefährdeten Patienten. Anaesthesist 2018; 67:568-583. [DOI: 10.1007/s00101-018-0460-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 04/23/2018] [Accepted: 05/03/2018] [Indexed: 12/19/2022]
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Johnson S, Bacsu J. Understanding complex care for older adults within Canadian home care: a systematic literature review. Home Health Care Serv Q 2018; 37:232-246. [PMID: 29578846 DOI: 10.1080/01621424.2018.1456996] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In the context of an aging population, both the need for home care services and its complexity of care have increased in many high-income countries. Yet, the definition of what constitutes complex care is largely elusive. This systematic review examined the conceptual definition of complex care within the home care environment using several social and health science databases for research published from 2000 to 2017. Of the 25 articles and reports identified, only 16 addressed complex care specifically and included older adults, aging, and/or home care. The results showed that complex care for older adults is primarily defined from a biomedical approach focusing on chronic disease and management and less commonly from the perspective of the social determinants of health. Future studies should consider the importance of the continuum of care needs from both the biomedical and the social determinants to adequately plan and provide care for older adults.
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Affiliation(s)
- Shanthi Johnson
- a Faculty of Kinesiology and Health Studies and Saskatchewan Population Health and Evaluation Research Unit , University of Regina , Regina , Canada
| | - Juanita Bacsu
- a Faculty of Kinesiology and Health Studies and Saskatchewan Population Health and Evaluation Research Unit , University of Regina , Regina , Canada
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Jeffs L, Kuluski K, Law M, Saragosa M, Espin S, Ferris E, Merkley J, Dusek B, Kastner M, Bell CM. Identifying Effective Nurse-Led Care Transition Interventions for Older Adults With Complex Needs Using a Structured Expert Panel. Worldviews Evid Based Nurs 2017; 14:136-144. [DOI: 10.1111/wvn.12196] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Lianne Jeffs
- St. Michael's Hospital Volunteer Association Chair in Nursing Research Scientist, Keenan Research Centre of the Li Ka Shing Knowledge Institute St. Michael's Hospital, Associate Professor, Lawrence S. Bloomberg Faculty of Nursing and Institute of Health, Policy, Management and Evaluation; University of Toronto; Toronto ON Canada
| | - Kerry Kuluski
- Research Scientist, Sinai Health System; Lunenfeld-Tanenbaum Research Institute; Toronto ON Canada
| | - Madelyn Law
- Associate Professor; Brock University; St. Catherines ON Canada
| | | | - Sherry Espin
- Associate Professor; Ryerson University; Toronto ON Canada
| | - Ella Ferris
- Former Executive Vice-President-Programs; Chief Nursing Executive, and Chief Health Disciplines Executive; St. Michael's Hospital Toronto ON Canada
| | - Jane Merkley
- Executive Vice President Patient Care; Quality and Chief Nurse Executive Sinai Health System; Toronto ON Canada
| | - Brenda Dusek
- Former Program Manager; Registered Nurses’ Association of Ontario; Toronto ON Canada
| | - Monika Kastner
- Scientist, Keenan Research Centre of the Li Ka Shing Knowledge Institute; St. Michael's Hospital; Toronto ON Canada
| | - Chaim M. Bell
- Clinician Scientist; Sinai Health System; Toronto ON Canada
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16
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Thomas A, Silver SA, Rathe A, Robinson P, Wald R, Bell CM, Harel Z. Feasibility of a hemodialysis safety checklist for nurses and patients: a quality improvement study. Clin Kidney J 2016; 9:335-42. [PMID: 27274816 PMCID: PMC4886914 DOI: 10.1093/ckj/sfw019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/29/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Patients with end-stage renal disease are at high risk for medical errors given their comorbidities, polypharmacy and coordination of care with other hospital departments. We previously developed a hemodialysis safety checklist (Hemo Pause) to be jointly completed by nurses and patients. Our objective was to determine the feasibility of using this checklist during every hemodialysis session for 3 months. METHODS We conducted a single-center, prospective time series study. A convenience sample of 14 nurses and 22 prevalent in-center hemodialysis patients volunteered to participate. All participants were trained in the administration of the Hemo Pause checklist. The primary outcome was completion of the Hemo Pause checklist, which was assessed at weekly intervals. We also measured the acceptability of the Hemo Pause checklist using a local patient safety survey. RESULTS There were 799 hemodialysis treatments pre-intervention (13 January-5 April 2014) and 757 post-intervention (5 May-26 July 2014). The checklist was completed for 556 of the 757 (73%) treatments. Among the hemodialysis nurses, 93% (13/14) agreed that the checklist was easy to use and 79% (11/14) agreed it should be expanded to other patients. Among the hemodialysis patients, 73% (16/22) agreed that the checklist made them feel safer and should be expanded to other patients. CONCLUSIONS The Hemo Pause safety checklist was acceptable to both nurses and patients over 3 months. Our next step is to spread this checklist locally and conduct a mixed methods study to determine mechanisms by which its use may improve safety culture and reduce adverse events.
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Affiliation(s)
- Alison Thomas
- Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Samuel A. Silver
- Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Andrea Rathe
- Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Pamela Robinson
- Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Ron Wald
- Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Department of Medicine and Keenan Research Center, Li Ka Shing Knowledge Institute of St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Chaim M. Bell
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Ziv Harel
- Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Department of Medicine and Keenan Research Center, Li Ka Shing Knowledge Institute of St Michael's Hospital, University of Toronto, Toronto, ON, Canada
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Malik N, Alvaro C, Kuluski K, Wilkinson AJ. Measuring patient satisfaction in complex continuing care/rehabilitation care. Int J Health Care Qual Assur 2016; 29:324-36. [DOI: 10.1108/ijhcqa-07-2015-0084] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
To develop a psychometrically validated survey to assess satisfaction in complex continuing care/rehabilitation patients.
Design/methodology/approach
A paper or computer-based survey was administered to 252 complex continuing care/ rehabilitation patients (i.e., post-acute hospital care setting for people who require ongoing care before returning home) across two hospitals in Toronto, Ontario, Canada.
Findings
Using factor analysis, five domains were identified with loadings above 0.4 for all but one item. Behavioral intention and information/communication showed the lowest patient satisfaction, while patient centredness the highest. Each domain correlated positively and significantly predicted overall satisfaction, with quality and safety showing the strongest predictive power and the healing environment the weakest. Gender made a significant contribution to predicting overall satisfaction, but age did not.
Research limitations/implications
Results provide evidence of the survey’s psychometric properties. Owing to a small sample, supplemental testing with a larger patient-group is required to confirm the five-factor structure and to assess test-retest reliability.
Originality/value
Improving the health system requires integrating patient perspectives. The patient experience, however, will vary depending on the population being served. This is the first psychometrically validated survey specific to a smaller speciality patient group receiving care at a complex continuing care/rehabilitation facility in Canada.
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Poulose BK, Roll S, Murphy JW, Matthews BD, Todd Heniford B, Voeller G, Hope WW, Goldblatt MI, Adrales GL, Rosen MJ. Design and implementation of the Americas Hernia Society Quality Collaborative (AHSQC): improving value in hernia care. Hernia 2016; 20:177-89. [DOI: 10.1007/s10029-016-1477-7] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 02/16/2016] [Indexed: 02/04/2023]
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Miller EL, Alexander GL, Madsen RW. Effects of Staffing and Regional Location on Influenza and Pneumococcal Vaccination Rates in Nursing Home Residents. J Gerontol Nurs 2016; 42:38-44. [DOI: 10.3928/00989134-20151124-05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 10/13/2015] [Indexed: 11/20/2022]
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20
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Saito T, Izawa KP, Omori Y, Watanabe S. Functional Independence and Difficulty Scale: Instrument development and validity evaluation. Geriatr Gerontol Int 2015; 16:1127-1137. [DOI: 10.1111/ggi.12605] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Takashi Saito
- Department of Rehabilitation; Visiting Nursing and Rehabilitation Network; Kawasaki-shi Kanagawa Japan
- Doctoral Course of Gerontology; Kobe University; Kobe Japan
| | | | - Yutaka Omori
- Department of Rehabilitation; Visiting Nursing and Rehabilitation Network; Kawasaki-shi Kanagawa Japan
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Silver SA, Thomas A, Rathe A, Robinson P, Wald R, Harel Z, Bell CM. Development of a hemodialysis safety checklist using a structured panel process. Can J Kidney Health Dis 2015; 2:5. [PMID: 25780628 PMCID: PMC4349476 DOI: 10.1186/s40697-015-0039-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 01/27/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The World Health Organization created a Surgical Safety Checklist with a pause or "time out" to help reduce preventable adverse events and improve communication. A similar tool might improve patient safety and reduce treatment-associated morbidity in the hemodialysis unit. OBJECTIVE To develop a Hemodialysis Safety Checklist (Hemo Pause) for daily use by nurses and patients. DESIGN A modified Delphi consensus technique based on the RAND method was used to evaluate and revise the checklist. SETTING University-affiliated in-center hemodialysis unit. PARTICIPANTS A multidisciplinary team of physicians, nurses, and administrators developed the initial version of the Hemo Pause Checklist. The evaluation team consisted of 20 registered hemodialysis nurses. MEASUREMENTS The top 5 hemodialysis safety measures according to hemodialysis nurses. A 75% agreement threshold was required for consensus. METHODS The structured panel process was iterative, consisting of a literature review to identify safety parameters, individual rating of each parameter by the panel of hemodialysis nurses, an in-person consensus meeting wherein the panel refined the parameters, and a final anonymous survey that assessed panel consensus. RESULTS The literature review produced 31 patient safety parameters. Individual review by panelists reduced the list to 25 parameters, followed by further reduction to 19 at the in-person consensus meeting. The final round of scoring yielded the following top 5 safety measures: 1) confirmation of patient identity, 2) measurement of pre-dialysis weight, 3) recognition and transcription of new medical orders, 4) confirmation of dialysate composition based on prescription, and 5) measurement of pre-dialysis blood pressure. Revision using human factors principles incorporated the 19 patient safety parameters with greater than or equal to 75% consensus into a final checklist of 17-items. LIMITATIONS The literature review was not systematic. This was a single-center study, and the panel lacked patient and family representation. CONCLUSIONS A novel 17-item Hemodialysis Safety Checklist (Hemo Pause) for use by nurses and patients has been developed to standardize the hemodialysis procedure. Further quality improvement efforts are underway to explore the feasibility of using this checklist to reduce adverse events and strengthen the safety culture in the hemodialysis unit.
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Affiliation(s)
- Samuel A Silver
- />Division of Nephrology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Alison Thomas
- />Division of Nephrology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Andrea Rathe
- />Division of Nephrology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Pamela Robinson
- />Division of Nephrology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Ron Wald
- />Division of Nephrology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
- />Department of Medicine and Keenan Research Center, Li Ka Shing Knowledge Institute of St Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Ziv Harel
- />Division of Nephrology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
- />Department of Medicine and Keenan Research Center, Li Ka Shing Knowledge Institute of St Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Chaim M Bell
- />Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- />Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada
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Abstract
Within the Canadian healthcare system, the term population-accountable health network defines the use of collective resources to optimize the health of a population through integrated interventions. The leadership of these networks has also been identified as a critical factor, highlighting the need for creative management of resources in determining effective, balanced sets of interventions. In this article, using specific principles embedded in the Accreditation Canada program, the benefits of a network approach are highlighted, including knowledge sharing, improving the consistency of practice through standards, and a broader systems-and-population view of healthcare delivery across the continuum of care. The implications for Canadian health leaders to leverage the benefits of interorganizational networks are discussed.
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