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Zhang T, Liu Y, Wang Y, Li C, Yang X, Tian L, Wu Y, Lin L, Li H. Quality indicators for the care of older adults with disabilities in long-term care facilities based on Maslow's hierarchy of needs. Int J Nurs Sci 2022; 9:453-459. [PMID: 36285078 PMCID: PMC9587388 DOI: 10.1016/j.ijnss.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose This study aimed to develop quality indicators for the care of older adults with disabilities in long-term care facilities (LTCFs) based on Maslow’s hierarchy of needs. Methods The draft of the quality indicators was drawn up based on a literature review and research group discussion. The quality indicators were finalized by two rounds of expert consultation (involving 15 experts) using the Delphi method. The Analytic Hierarchy Process was applied to calculate the indicators’ weight. Results The response rates of the two rounds of consultation were 100% and 93%, and the expert authority coefficients were 0.86 and 0.87. After two rounds of consultation, the expert opinion coordination coefficients of the first-, second- and third-level indicators were 0.42, 0.25, and 0.96, respectively (P < 0.05), and the variation coefficient was ≤0.25. The final quality indicators for the care of older adults with disabilities in LTCFs included 7 first-level, 19 second-level, and 107 third-level indicators. Conclusion The quality indicators for the care of older adults with disabilities in LTCFs are reliable, scientific, comprehensive, and practical and specify the content of person-centered care needs. This can provide a reference for evaluating and improving care quality in LTCFs.
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Favez L, Zúñiga F, Sharma N, Blatter C, Simon M. Assessing Nursing Homes Quality Indicators' Between-Provider Variability and Reliability: A Cross-Sectional Study Using ICCs and Rankability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249249. [PMID: 33321952 PMCID: PMC7764139 DOI: 10.3390/ijerph17249249] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 01/14/2023]
Abstract
Nursing home quality indicators are often used to publicly report the quality of nursing home care. In Switzerland, six national nursing home quality indicators covering four clinical domains (polypharmacy, pain, use of physical restraints and weight loss) were recently developed. To allow for meaningful comparisons, these indicators must reliably show differences in quality of care levels between nursing homes. This study’s objectives were to assess nursing home quality indicators’ between-provider variability and reliability using intraclass correlations and rankability. This approach has not yet been used in long-term care contexts but presents methodological advantages. This cross-sectional multicenter study uses data of 11,412 residents from a convenience sample of 152 Swiss nursing homes. After calculating intraclass correlation 1 (ICC1) and rankability, we describe between-provider variability for each quality indicator using empirical Bayes estimate-based caterpillar plots. To assess reliability, we used intraclass correlation 2 (ICC2). Overall, ICC1 values were high, ranging from 0.068 (95% confidence interval (CI) 0.047–0.086) for polypharmacy to 0.396 (95% CI 0.297–0.474) for physical restraints, with quality indicator caterpillar plots showing sufficient between-provider variability. However, testing for rankability produced mixed results, with low figures for two indicators (0.144 for polypharmacy; 0.471 for self-reported pain) and moderate to high figures for the four others (from 0.692 for observed pain to 0.976 for physical restraints). High ICC2 figures, ranging from 0.896 (95% CI 0.852–0.917) (self-reported pain) to 0.990 (95% CI 0.985–0.993) (physical restraints), indicated good reliability for all six quality indicators. Intraclass correlations and rankability can be used to assess nursing home quality indicators’ between-provider variability and reliability. The six selected quality indicators reliably distinguish care differences between nursing homes and can be recommended for use, although the variability of two—polypharmacy and self-reported pain—is substantially chance-driven, limiting their utility.
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Affiliation(s)
- Lauriane Favez
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland; (L.F.); (N.S.); (C.B.); (M.S.)
| | - Franziska Zúñiga
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland; (L.F.); (N.S.); (C.B.); (M.S.)
- Correspondence: ; Tel.: +41-61-207-09-13
| | - Narayan Sharma
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland; (L.F.); (N.S.); (C.B.); (M.S.)
| | - Catherine Blatter
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland; (L.F.); (N.S.); (C.B.); (M.S.)
| | - Michael Simon
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland; (L.F.); (N.S.); (C.B.); (M.S.)
- Nursing and Midwifery Research Unit, Inselspital Bern University Hospital, Freiburgstrasse, 3010 Bern, Switzerland
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Ibrahim JE. Royal Commission into Aged Care Quality and Safety: the key clinical issues. Med J Aust 2019; 210:439-441.e1. [DOI: 10.5694/mja2.50168] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Joseph E Ibrahim
- Victorian Institute of Forensic MedicineMonash University Melbourne VIC
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Jeon YH, Casey AN, Vo K, Rogers K, Poole B, Fethney J. Associations between clinical indicators of quality and aged-care residents’ needs and consumer and staff satisfaction: the first Australian study. AUST HEALTH REV 2019; 43:133-141. [DOI: 10.1071/ah17213] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/13/2017] [Indexed: 11/23/2022]
Abstract
Objectives
To ascertain Australian multistate prevalence and incidence of five commonly collected clinical indicators of aged-care home quality and to measure associations between these clinical indicators and levels of care needs and consumer and staff satisfaction.
Methods
A retrospective analysis of national audit data collected from 426 facilities between 2015 and 2016 was performed. Regression models were used to examine associations between five clinical indicators (falls, pressure injury, physical restraint, unplanned weight loss and polypharmacy) and level of care needs measured by the Aged Care Funding Instrument (ACFI) and consumer and care staff survey responses.
Results
With the exception of polypharmacy, commonly collected negative clinical outcomes were rare events. Compared with care homes with <25% of residents having high-level care needs (high ACFI), homes with 25<75% high-ACFI residents had more occurrences of all negative clinical outcomes except pressure injury. Homes with ≥75% high-ACFI residents reported the highest rates of polypharmacy (odds ratio 1.48, 95% confidence interval 1.39 – 1.57). Falls, unplanned weight loss and pressure injury were inversely associated with satisfaction scores adjusted for residents’ level of care needs.
Conclusions
This first Australian study of multistate clinical indicator data suggests interpretation of clinical indicators of aged-care home quality requires consideration of the level of residents’ care needs.
What is known about the topic?
Many Australian aged-care providers use quality indicators (QI) through benchmarking companies or in-house programs. The five most widely used aged-care clinical QIs in Australia are falls, pressure injury, physical restraint, unplanned weight loss and polypharmacy. Prevalence and incidence of these QIs are highly variable among Australian studies. A consistent message in the international literature is that residents’ clinical characteristics influence QI outcomes at baseline and may continue to influence outcomes over time. Study of associations between Australian aged-care home characteristics and QI outcomes has been limited.
What does this paper add?
This is the first Australian study of multistate clinical QI data. It is also the first to consider the level of resident care needs in the interpretation of clinical QI outcomes and exploration of the association between level of consumer and staff satisfaction and QI outcomes.
What are the implications for practitioners?
Understanding the connections between aged-care home characteristics, consumer and staff perceptions and clinical QIs is crucial in the meaningful interpretation of QI outcomes in context. With the recent introduction of the National Aged Care Quality Indicator Program, it is timely to review national policy, to gauge current quality of care and the measure of care quality in the sector, and to develop directions for possible research to inform and resolve debates regarding the potential influence and unplanned effects that such a program may have.
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Medication management by informal caregivers – Under-recognized and under-supported. Res Social Adm Pharm 2018; 14:215-217. [DOI: 10.1016/j.sapharm.2017.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 11/01/2017] [Indexed: 11/18/2022]
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Sluggett JK, Hendrix I, Bell JS. Evidence-based deprescribing of proton pump inhibitors in long-term care. Res Social Adm Pharm 2017; 14:124-126. [PMID: 28424148 DOI: 10.1016/j.sapharm.2017.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 04/01/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Janet K Sluggett
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.
| | - Ivanka Hendrix
- NHMRC Centre of Research Excellence in Frailty and Healthy Ageing, The University of Adelaide, Adelaide, South Australia, Australia; Adelaide Geriatrics Training and Research with Aged Care (GTRAC), School of Medicine, University of Adelaide, Adelaide, South Australia, Australia; School of Nursing, University of Adelaide, Adelaide, South Australia, Australia; Department of Pharmacy, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia.
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; NHMRC Centre of Research Excellence in Frailty and Healthy Ageing, The University of Adelaide, Adelaide, South Australia, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia.
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Medication management policy, practice and research in Australian residential aged care: Current and future directions. Pharmacol Res 2016; 116:20-28. [PMID: 27965033 DOI: 10.1016/j.phrs.2016.12.011] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 12/08/2016] [Accepted: 12/09/2016] [Indexed: 01/30/2023]
Abstract
Eight percent of Australians aged 65 years and over receive residential aged care each year. Residents are increasingly older, frailer and have complex care needs on entry to residential aged care. Up to 63% of Australian residents of aged care facilities take nine or more medications regularly. Together, these factors place residents at high risk of adverse drug events. This paper reviews medication-related policies, practices and research in Australian residential aged care. Complex processes underpin prescribing, supply and administration of medications in aged care facilities. A broad range of policies and resources are available to assist health professionals, aged care facilities and residents to optimise medication management. These include national guiding principles, a standardised national medication chart, clinical medication reviews and facility accreditation standards. Recent Australian interventions have improved medication use in residential aged care facilities. Generating evidence for prescribing and deprescribing that is specific to residential aged care, health workforce reform, medication-related quality indicators and inter-professional education in aged care are important steps toward optimising medication use in this setting.
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Chadwick LM, MacPhail A, Ibrahim JE, McAuliffe L, Koch S, Wells Y. Senior staff perspectives of a quality indicator program in public sector residential aged care services: a qualitative cross-sectional study in Victoria, Australia. AUST HEALTH REV 2016; 40:54-62. [PMID: 26164160 DOI: 10.1071/ah14197] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 05/10/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aims of the present study were to describe the views of senior clinical and executive staff employed in public sector residential aged care services (RACS) about the benefits and limitations of using quality indicators (QIs) for improving care, and to identify any barriers or enablers to implementing the QI program. METHODS A cross-sectional qualitative study using semistructured interviews and direct observation of key informants involved in the QI program was performed across 20 public sector RACS in Victoria, Australia. Participants included senior clinical, executive and front-line staff at the RACS. The main outcome measures were perceived benefits and the enablers or barriers to the implementation of a QI program. RESULTS Most senior clinical and executive staff respondents reported substantive benefits to using the QIs and the QI program. A limited number of staff believed that the QI program failed to improve the quality of care and that the resource requirements outweighed the benefits of the program, resulting in disaffected staff. CONCLUSIONS The QIs and QI program acted as a foundation for improving standards of care when used at the front line or point of care. Senior executive engagement in the QI program was vital to successful implementation.
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Affiliation(s)
- Liam M Chadwick
- National University of Ireland, Galway, Irish Centre for Patient Safety, University Road, Galway, Ireland. Email
| | - Aleece MacPhail
- Ballarat Health Services, Ballarat, Vic. 3350, Australia. Email
| | | | - Linda McAuliffe
- Australian Centre for Evidence Based Aged Care, La Trobe University, Melbourne, Vic. 3086, Australia. Email
| | - Susan Koch
- Royal District Nursing Service Research Institute, Melbourne, Vic. 3182, Australia. Email
| | - Yvonne Wells
- Australian Institute for Primary Care and Ageing, La Trobe University, Melbourne, Vic. 3086, Australia. Email
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Davis J, Morgans A, Burgess S. Information management in the Australian aged care setting. HEALTH INF MANAG J 2016; 46:3-14. [DOI: 10.1177/1833358316639434] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Information management systems and processes have an impact on quality and safety of care in any setting and particularly in the complex care setting of aged care. Few studies have comprehensively examined information management in the Australian aged care setting. Objective: To (i) critically analyse and synthesize evidence related to information management in aged care, (ii) identify aged care data collection frameworks and (iii) identify factors impacting information management. Methods: An integrative review of Australian literature published between March 2008 and August 2014 and data collection frameworks concerning information management in aged care were carried out. Results: There is limited research investigating the information-rich setting of aged care in Australia. Electronic systems featured strongly in the review. Existing research focuses on residential settings with community aged care largely absent. Information systems and processes in the setting of aged care in Australia are underdeveloped and poorly integrated. Conclusions: Data quality and access are more problematic within community aged care than residential care settings. The results of this review represent an argument for a national approach to information management in aged care to address multiple stakeholder information needs and more effectively support client care.
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Affiliation(s)
- Jenny Davis
- Benetas, Victoria, Australia
- Monash University, Australia
| | - Amee Morgans
- Monash University, Australia
- Royal District Nursing Service, Victoria, Australia
| | - Stephen Burgess
- Benetas, Victoria, Australia
- Monash University, Australia
- Royal District Nursing Service, Victoria, Australia
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