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Wientzek R, Brückner RM, Schönenberg A, Prell T. Instruments for measuring self-management and self-care in geriatric patients - a scoping review. Front Public Health 2023; 11:1284350. [PMID: 38192561 PMCID: PMC10773718 DOI: 10.3389/fpubh.2023.1284350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/22/2023] [Indexed: 01/10/2024] Open
Abstract
Introduction With demographic changes, prioritizing effective care for geriatric patients to maintain functionality, independence, and quality of life is crucial. Well-developed self-management or self-care abilities, which can be maintained and improved through interventions, are of the utmost importance. To implement these interventions tailored and effectively, a thorough assessment of the individual's self-management and self-care abilities is required. Objective This scoping review aimed to identify self-management and self-care instruments suitable for geriatric patients, their underlying theories and definitions of self-management and self-care, and their similarities and differences in item content. Methods A systematic search of the PubMed and CINAHL databases was conducted to identify retrievable full-text articles published in English in the medical and nursing fields since the 1970s, which were validated on a sample with an average age of at least 70 years, used generic rather than disease-specific items, and addressed the broad range of self-management and self-care abilities. Results Of the 20 included articles, six instruments were identified that were based on different theories and offered varying definitions of self-management or self-care. Despite these differences, all emphasize empowered individuals taking an active role in their care. Most address actual behavior and abilities referring to lifestyle factors and (anticipated) adjustment behavior. However, crucial aspects, such as psychological factors, (instrumental) activities of daily living, and social environment are not fully addressed in these instruments, nor are the types of execution to which the items refer, such as wants, feelings, confidence, or attitudes. Conclusion To fully understand how geriatric patients implement daily self-management or self-care, a combination of instruments covering the important factors of self-management and self-care and addressing multiple types of item execution, such as behaviors, abilities, wants, or attitudes, is recommended. This review provides the first comprehensive overview of self-management and self-care instruments suitable for geriatric patients.
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Affiliation(s)
- Rebecca Wientzek
- Department of Geriatrics, Halle University Hospital, Halle (Saale), Germany
| | | | - Aline Schönenberg
- Department of Geriatrics, Halle University Hospital, Halle (Saale), Germany
| | - Tino Prell
- Department of Geriatrics, Halle University Hospital, Halle (Saale), Germany
- Department of Neurology, Jena University Hospital, Jena, Germany
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van Rijckevorsel-Scheele J, Willems RCWJ, Roelofs PDDM, Koppelaar E, Gobbens RJJ, Goumans MJBM. Effects of health care interventions on quality of life among frail elderly: a systematized review. Clin Interv Aging 2019; 14:643-658. [PMID: 31040654 PMCID: PMC6453553 DOI: 10.2147/cia.s190425] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Many health care interventions have been developed that aim to improve or maintain the quality of life for frail elderly. A clear overview of these health care interventions for frail elderly and their effects on quality of life is missing. PURPOSE To provide a systematic overview of the effect of health care interventions on quality of life of frail elderly. METHODS A systematic search was conducted in Embase, Medline (OvidSP), Cochrane Central, Cinahl, PsycInfo and Web of Science, up to and including November 2017. Studies describing health care interventions for frail elderly were included if the effect of the intervention on quality of life was described. The effects of the interventions on quality of life were described in an overview of the included studies. RESULTS In total 4,853 potentially relevant articles were screened for relevance, of which 19 intervention studies met the inclusion criteria. The studies were very heterogeneous in the design: measurement of frailty, health care intervention and outcome measurement differ. Health care interventions described were: multidisciplinary treatment, exercise programs, testosterone gel, nurse home visits and acupuncture. Seven of the nineteen intervention studies, describing different health care interventions, reported a statistically significant effect on subdomains of quality of life, two studies reported a statistically significant effect of the intervention on the overall quality of life score. Ten studies reported no statistically significant difference between the intervention and control groups. CONCLUSION Reported effects of health care interventions on frail elderly persons' quality of life are inconsistent, with most of the studies reporting no differences between the intervention and control groups. As the number of frail elderly persons in the population will continue to grow, it will be important to continue the search for effective health care interventions. Alignment of studies in design and outcome measurements is needed.
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Affiliation(s)
| | - Renate C W J Willems
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands,
| | - Pepijn D D M Roelofs
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands,
| | - Elin Koppelaar
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands,
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands
- Zonnehuisgroep Amstelland, Amstelveen, the Netherlands
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Marleen J B M Goumans
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands,
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Integrated Care Approaches Used for Transitions from Hospital to Community Care: A Scoping Review. Can J Aging 2018; 37:145-170. [PMID: 29631639 DOI: 10.1017/s0714980818000065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
ABSTRACTIntegrated care is a promising approach for improving care transitions for older adults, but this concept is inconsistently defined and applied. This scoping review describes the size and nature of literature on integrated care initiatives for transitions from hospital to community care for older adults (aged 65 and older) and how this literature conceptualizes integrated care. A systematic search of literature from the past 10 years yielded 899 documents that were screened for inclusion by two reviewers. Of the 48 included documents, there were 26 journal articles and 22 grey literature documents. Analysis included descriptive statistics and a content analysis approach to summarize features of the integrated care initiatives. Results suggest that clinical and service delivery integration is being targeted rather than integration of funding, administration, and/or organization. To promote international comparison of integrated care initiatives aiming to improve care transitions, detailed descriptions of organizational context are also needed.
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de Vos A, Cramm J, van Wijngaarden JDH, Bakker TJEM, Mackenbach JP, Nieboer AP. Understanding implementation of comprehensive geriatric care programs: a multiple perspective approach is preferred. Int J Health Plann Manage 2017; 32:608-636. [PMID: 27682420 PMCID: PMC5716249 DOI: 10.1002/hpm.2383] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 08/10/2016] [Accepted: 08/22/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The Prevention and Reactivation Care Program (PReCaP) provides a novel approach targeting hospital-related functional decline among elderly patients. Despite the high expectations, the PReCaP was not effective in preventing functional decline (ADL and iADL) among older patients. Although elderly PReCaP patients demonstrated slightly better cognitive functioning (Mini Mental State Examination; 0.4 [95% confidence interval (CI) 0.2-0.6]), lower depression (Geriatric Depression Scale 15; -0.9 [95% -1.1 to -0.6]), and higher perceived health (Short-form 20; 5.6 [95% CI 2.8-8.4]) 1 year after admission than control patients, the clinical relevance was limited. Therefore, this study aims to identify factors impacting on the effectiveness of the implementation of the PReCaPand geriatric care 'as usual'. METHODS We conducted semi-structured interviews with 34 professionals working with elderly patients in three hospitals, selected for their comparable patient case mix and different levels of geriatric care. Five non-participatory observations were undertaken during multidisciplinary meetings. Patient files (n = 42), hospital protocols, and care plans were screened for elements of geriatric care. Clinical process data were analysed for PReCaP components. RESULTS The establishment of a geriatric unit and employment of geriatricians demonstrates commitment to geriatric care in hospital A. Although admission processes are comparable, early identification of frail elderly patients only takes place in hosptial A. Furthermore, nursing care in the hospital A geriatric unit excels with regard to maximizing patient independency, an important predictor for hospital-related functional decline. Transfer nurses play a key role in arranging post-discharge geriatric follow-up care. Geriatric consultations are performed by geriatricians, geriatric nurses, and PReCaP case managers in hospital A. Yet hospital B consultative psychiatric nurses provide similar consultation services. The combination of standardized procedures, formalized communication channels, and advanced computerization contributes significantly to geriatric care in hospital B. Nevertheless, a small size hospital (hospital C) provides informal opportunities for information sharing and decision making, which are essential in geriatric care, given its multidisciplinary nature. CONCLUSIONS Geriatric care for patients with multimorbidity requires a multidisciplinary approach in a geriatric unit. Geriatric care, which integrates medical and reactivation treatment, by means of early screening of risk factors for functional decline, promotion of physical activity, and adequate discharge planning, potentially reduces the incidence of functional decline in elderly patients. Yet low treatment fidelity played a major role in the ineffective implementation of the PReCaP. Treatment fidelity issues are caused by various factors, including the complexity of projects, limited attention for implementation, and inadequate interdisciplinary communication. © 2016 The Authors The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd.
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Cramm JM, Nieboer AP. Self-management abilities and quality of life among frail community-dwelling individuals: the role of community nurses in the Netherlands. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:394-401. [PMID: 26732088 DOI: 10.1111/hsc.12318] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/18/2015] [Indexed: 06/05/2023]
Abstract
The objective of the study was to determine whether community nurses in the Netherlands improve self-management abilities and quality of life of frail community-dwelling people. This longitudinal study was performed in the context of a larger evaluation study of the 'Zichtbare Schakels'(Visible Link) programme, conducted to determine the quality of care provided by community nurses to community-dwelling frail people in Rotterdam, the Netherlands. For the current study, clients seen by community workers in Rotterdam between July 2013 and November 2014 participated. Data were gathered via personal interviews by the community nurses as part of care delivery at the start (T0; n = 220) and end of care delivery (T1; n = 111 - the remaining 109 clients were still receiving care) to evaluate and improve quality of care. We measured client's quality of life (using the EQ5D), self-management abilities (using the Self-Management Ability Scale) and background characteristics. Results showed that clients seen by the community nurses especially experience problems when it comes to usual activities and pain/discomfort. Furthermore, quality of life was much worse among clients of the community nurses (0.51) than among frail older (aged ≥70 years) people in Rotterdam (0.61), Dutch patients with chronic illnesses [CVD (0.83), COPD (0.79) or diabetes (0.83)] and older (aged ≥65 years) people who had recently been hospitalised (0.80). Significant improvements were seen in client's self-management and quality of life over time. Self-management abilities at T0 and changes in self-management abilities (T1 - T0) clearly predicted quality of life at T1. Investing in community health nurses may be beneficial for the improvement of self-management abilities and quality of life among very frail people in the community.
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Affiliation(s)
- Jane Murray Cramm
- Institute of Health Policy & Management (iBMG), Erasmus University, Rotterdam, The Netherlands
| | - Anna Petra Nieboer
- Institute of Health Policy & Management (iBMG), Erasmus University, Rotterdam, The Netherlands
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Lette M, Baan CA, van den Berg M, de Bruin SR. Initiatives on early detection and intervention to proactively identify health and social problems in older people: experiences from the Netherlands. BMC Geriatr 2015; 15:143. [PMID: 26518369 PMCID: PMC4628317 DOI: 10.1186/s12877-015-0131-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 10/14/2015] [Indexed: 12/18/2022] Open
Abstract
Background Over the last years, several initiatives on early detection and intervention have been put in place to proactively identify health and social problems in (frail) older people. An overview of the initiatives currently available in the Netherlands is lacking, and it is unknown whether they meet the preferences and needs of older people. Therefore, the objectives of this study were threefold: 1. To identify initiatives on early detection and intervention for older people in the Netherlands and compare their characteristics; 2. To explore the experiences of professionals with these initiatives; and 3. To explore to what extent existing initiatives meet the preferences and needs of older people. Methods We performed a qualitative descriptive study in which we conducted semi-structured interviews with seventeen experts in preventive elderly care and three group interviews with volunteer elderly advisors. Data were analysed using the framework analysis method. Results We identified eight categories of initiatives based on the setting (e.g. general practitioner practice, hospital, municipality) in which they were offered. Initiatives differed in their aims and target groups. The utilization of peers to identify problems and risks, as was done by some initiatives, was seen as a strength. Difficulties were experienced with identifying the target group that would benefit from proactive delivery of care and support most, and with addressing prevalent issues among older people (e.g. psychosocial issues, self-reliance issues). Conclusion Although there is a broad array of initiatives available, there is a discrepancy between supply and demand. Current initiatives insufficiently address needs of (frail) older people. More insight is needed in “what should be done by whom, for which target group and at what moment”, in order to improve current practice in preventive elderly care.
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Affiliation(s)
- Manon Lette
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
| | - Caroline A Baan
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment, Bilthoven, The Netherlands. .,Scientific Centre for Transformation in Care and Welfare (Tranzo), University of Tilburg, Tilburg, The Netherlands.
| | - Matthijs van den Berg
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
| | - Simone R de Bruin
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
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Lette M, Baan CA, van den Berg M, de Bruin SR. Initiatives on early detection and intervention to proactively identify health and social problems in older people: experiences from the Netherlands. BMC Geriatr 2015. [PMID: 26518369 DOI: 10.1186/s12877-12015-10131-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND Over the last years, several initiatives on early detection and intervention have been put in place to proactively identify health and social problems in (frail) older people. An overview of the initiatives currently available in the Netherlands is lacking, and it is unknown whether they meet the preferences and needs of older people. Therefore, the objectives of this study were threefold: 1. To identify initiatives on early detection and intervention for older people in the Netherlands and compare their characteristics; 2. To explore the experiences of professionals with these initiatives; and 3. To explore to what extent existing initiatives meet the preferences and needs of older people. METHODS We performed a qualitative descriptive study in which we conducted semi-structured interviews with seventeen experts in preventive elderly care and three group interviews with volunteer elderly advisors. Data were analysed using the framework analysis method. RESULTS We identified eight categories of initiatives based on the setting (e.g. general practitioner practice, hospital, municipality) in which they were offered. Initiatives differed in their aims and target groups. The utilization of peers to identify problems and risks, as was done by some initiatives, was seen as a strength. Difficulties were experienced with identifying the target group that would benefit from proactive delivery of care and support most, and with addressing prevalent issues among older people (e.g. psychosocial issues, self-reliance issues). CONCLUSION Although there is a broad array of initiatives available, there is a discrepancy between supply and demand. Current initiatives insufficiently address needs of (frail) older people. More insight is needed in "what should be done by whom, for which target group and at what moment", in order to improve current practice in preventive elderly care.
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Affiliation(s)
- Manon Lette
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
| | - Caroline A Baan
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
- Scientific Centre for Transformation in Care and Welfare (Tranzo), University of Tilburg, Tilburg, The Netherlands.
| | - Matthijs van den Berg
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
| | - Simone R de Bruin
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
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de Vos AJBM, Asmus-Szepesi KJE, Bakker TJEM, de Vreede PL, van Wijngaarden JDH, Steyerberg EW, Mackenbach JP, Nieboer AP. [INTEGRATED APPROACH TO PREVENT FUNCTIONAL DECLINE IN HOSPITALIZED ELDERLY]. Tijdschr Gerontol Geriatr 2015; 46:12-27. [PMID: 25403322 DOI: 10.1007/s12439-014-0100-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Hospital related functional decline in older patients is an underestimated problem. Thirty-five procent of 70-year old patients experience functional decline during hospital admission in comparison with pre-illness baseline. This percentage increases considerably with age. METHODS/DESIGN To address this issue, the Vlietland Ziekenhuis in The Netherlands has implemented the Prevention and Reactivation Care Programme (PReCaP), an innovative program aimed at reducing hospital related functional decline among elderly patients by offering interventions that are multidisciplinary, integrated and goal-oriented at the physical, social, and psychological domains of functional decline. DISCUSSION This paper presents a detailed description of the intervention, which incorporates five distinctive elements: (1) Early identification of elderly patients with a high risk of functional decline, and if necessary followed by the start of the reactivation treatment within 48 h after hospital admission; (2) Intensive follow-up treatment for a selected patient group at the prevention and Reactivation Centre; (3) Availability of multidisciplinary geriatric expertise; (4) Provision of support and consultation of relevant professionals to informal caregivers; (5) Intensive follow-up throughout the entire chain of care by a casemanager with geriatric expertise. Outcome and process evaluations are ongoing and results will be published in a series of forthcoming papers. This article is an edited translation of the previously published article 'Integrated approach to prevent functional decline in hospitalized elderly: the Prevention and Reactivation Care Program (PReCaP), BMC Geriatrics 2012;12:7, AJBM de Vos, KJE Asmus-Szepesi, TJEM Bakker, PL de Vreede, JDH van Wijngaarden, EW Steyerberg, JP Mackenbach, AP Nieboer.
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Affiliation(s)
- A J B M de Vos
- Instituut Beleid & Management Gezondheidszorg, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands,
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Hartgerink JM, Cramm JM, Bakker TJ, Mackenbach JP, Nieboer AP. The importance of older patients' experiences with care delivery for their quality of life after hospitalization. BMC Health Serv Res 2015; 15:311. [PMID: 26253521 PMCID: PMC4529729 DOI: 10.1186/s12913-015-0982-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 07/29/2015] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Older patients' experiences with care delivery may be important for their quality of life over time. Evidence is however lacking. Therefore, this study aims to identify the longitudinal relationship between older patients' experiences with hospital care, perceived quality of integrated care and quality of life after hospitalization. METHODS Our longitudinal research was based on a pilot study of older people who had recently been admitted to a hospital. In the pilot study, all patients (≥ 65 years of age) who were admitted to the Vlietland hospital between June and October 2010 were asked to participate, which led to the inclusion of 500 older patients at baseline. A total of 291 patients (58% response rate) were interviewed 3 months after admission. Measures included quality of life, patients' perceptions of quality of integrated care delivery and patients' experiences with hospital care. We used descriptive statistics, correlations, and multilevel analyses. RESULTS Being married (p ≤ 0.05), patients' experiences with hospital care, perceived quality of integrated care delivery (both p ≤ 0.01), and quality of life within 48 h of hospital admission (p ≤ 0.001) significantly correlated with quality of life 3 months after hospital admission. After controlling for background characteristics, multilevel analysis indicated a longitudinal relationship between patients' experiences with hospital care (p ≤ 0.05), perceived quality of integrated care delivery (p ≤ 0.01) and patients' quality of life 3 months after hospitalization. CONCLUSIONS This study found a longitudinal relationship between patients' perceived quality of integrated care delivery, experiences with hospital care and quality of life of older patients after hospitalization. These results underscore the importance of enhancing older patients' experiences with care delivery.
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Affiliation(s)
- Jacqueline M Hartgerink
- Institute of Health Policy & Management (iBMG), Erasmus University, Rotterdam, The Netherlands.
| | - Jane M Cramm
- Institute of Health Policy & Management (iBMG), Erasmus University, Rotterdam, The Netherlands.
| | | | | | - Anna P Nieboer
- Institute of Health Policy & Management (iBMG), Erasmus University, Rotterdam, The Netherlands.
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Asmus-Szepesi KJ, Flinterman LE, Koopmanschap MA, Nieboer AP, Bakker TJ, Mackenbach JP, Steyerberg EW. Evaluation of the Prevention and Reactivation Care Program (PreCaP) for the hospitalized elderly: a prospective nonrandomized controlled trial. Clin Interv Aging 2015; 10:649-61. [PMID: 25878492 PMCID: PMC4388098 DOI: 10.2147/cia.s77677] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The hospitalized elderly are at risk of functional decline. We evaluated the effects and care costs of a specialized geriatric rehabilitation program aimed at preventing functional decline among at-risk hospitalized elderly. Methods The prospective nonrandomized controlled trial reported here was performed in three hospitals in the Netherlands. One hospital implemented the Prevention and Reactivation Care Program (PReCaP), while two other hospitals providing usual care served as control settings. Within the PReCaP hospital we compared patients pre-implementation with patients post-implementation of the PReCaP (“within-hospital analysis”), while our nonrandomized controlled trial compared patients of the PReCaP hospital post-implementation with patients from the two control hospitals providing usual care (“between-hospital analysis”). Hospitalized patients 65 years or older and at risk of functional decline were interviewed at baseline and at 3 and 12 months using validated questionnaires to score functioning, depression, and health-related quality of life (HRQoL). We estimated costs per unit of care from hospital information systems and national data sources. We used adjusted general linear mixed models to analyze functioning and HRQoL. Results Between-hospital analysis showed no difference in activities of daily living (ADL) or instrumental activities of daily living (IADL) between PReCaP patients and control groups. PReCaP patients did have slightly better cognitive functioning (Mini Mental State Examination; 0.4 [95% confidence interval (CI) 0.2–0.6]), lower depression (Geriatric Depression Scale 15; −0.9 [95% −1.1 to −0.6]) and higher perceived health (Short-Form 20; 5.6 [95% CI 2.8–8.4]) than control patients. Analyses within the PReCaP hospital comparing patients pre-and post-implementation of the PReCaP showed no improvement over time in functioning, depression, and HRQoL. One-year health care costs were higher for PReCaP patients, both for the within-hospital analysis (+€7,000) and the between-hospital analysis (+€2,500). Conclusion We did not find any effect of the PReCaP on ADL and IADL. The PReCaP may possibly provide some benefits to hospitalized patients at risk of functional decline with respect to cognitive functioning, depression, and perceived health. Further evaluations of integrated intervention programs to limit functional decline are therefore required.
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Affiliation(s)
| | - Linda E Flinterman
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Marc A Koopmanschap
- Institute of Health Policy and Management, Erasmus University, Rotterdam, the Netherlands
| | - Anna P Nieboer
- Institute of Health Policy and Management, Erasmus University, Rotterdam, the Netherlands
| | - Ton J Bakker
- Stichting Wetenschap Balans, Rotterdam, the Netherlands
| | - Johan P Mackenbach
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
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Hartgerink JM, Cramm JM, de Vos AJBM, Bakker TJEM, Steyerberg EW, Mackenbach JP, Nieboer AP. Situational awareness, relational coordination and integrated care delivery to hospitalized elderly in the Netherlands: a comparison between hospitals. BMC Geriatr 2014; 14:3. [PMID: 24410889 PMCID: PMC3890569 DOI: 10.1186/1471-2318-14-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 01/06/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is known that interprofessional collaboration is crucial for integrated care delivery, yet we are still unclear about the underlying mechanisms explaining effectiveness of integrated care delivery to older patients. In addition, we lack research comparing integrated care delivery between hospitals. Therefore, this study aims to (i) provide insight into the underlying components 'relational coordination' and 'situational awareness' of integrated care delivery and the role of team and organizational context in integrated care delivery; and (ii) compare situational awareness, relational coordination, and integrated care delivery of different hospitals in the Netherlands. METHODS This cross-sectional study took place in 2012 among professionals from three different hospitals involved in the delivery of care to older patients. A total of 215 professionals filled in the questionnaire (42% response rate).Descriptive statistics and paired-sample t-tests were used to investigate the level of situational awareness, relational coordination, and integrated care delivery in the three different hospitals. Correlation and multilevel analyses were used to investigate the relationship between background characteristics, team context, organizational context, situational awareness, relational coordination and integrated care delivery. RESULTS No differences in background characteristics, team context, organizational context, situational awareness, relational coordination and integrated care delivery were found among the three hospitals. Correlational analysis revealed that situational awareness (r = 0.30; p < 0.01), relational coordination (r = 0.17; p < 0.05), team climate (r = 0.29; p < 0.01), formal internal communication (r = 0.46; p < 0.01), and informal internal communication (r = 0.36; p < 0.01) were positively associated with integrated care delivery. Stepwise multilevel analyses showed that formal internal communication (p < 0.001) and situational awareness (p < 0.01) were associated with integrated care delivery. Team climate was not significantly associated with integrated care delivery when situational awareness and relational coordination were included in the equation. Thus situational awareness acted as mediator between team climate and integrated care delivery among professionals delivering care to older hospitalized patients. CONCLUSIONS The results of this study show the importance of formal internal communication and situational awareness for quality of care delivery to hospitalized older patients.
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Affiliation(s)
- Jacqueline M Hartgerink
- Department of Social Medical Sciences, Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, DR 3000, The Netherlands
| | - Jane M Cramm
- Department of Social Medical Sciences, Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, DR 3000, The Netherlands
| | - Annemarie JBM de Vos
- Department of Social Medical Sciences, Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, DR 3000, The Netherlands
| | - Ton JEM Bakker
- Argos Zorggroep, P.O. Box 4023, Schiedam, GA 3102, The Netherlands
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus Medical Center Rotterdam, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands
| | - Johan P Mackenbach
- Department of Public Health, Erasmus Medical Center Rotterdam, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands
| | - Anna P Nieboer
- Department of Social Medical Sciences, Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, DR 3000, The Netherlands
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Hartgerink JM, Cramm JM, van Wijngaarden JDH, Bakker TJEM, Mackenbach JP, Nieboer AP. A framework for understanding outcomes of integrated care programs for the hospitalised elderly. Int J Integr Care 2013; 13:e047. [PMID: 24363635 PMCID: PMC3860580 DOI: 10.5334/ijic.1063] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 08/27/2013] [Accepted: 09/04/2013] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Integrated care has emerged as a new strategy to enhance the quality of care for hospitalised elderly. Current models do not provide insight into the mechanisms underlying integrated care delivery. Therefore, we developed a framework to identify the underlying mechanisms of integrated care delivery. We should understand how they operate and interact, so that integrated care programmes can enhance the quality of care and eventually patient outcomes. THEORY AND METHODS Interprofessional collaboration among professionals is considered to be critical in integrated care delivery due to many interdependent work requirements. A review of integrated care components brings to light a distinction between the cognitive and behavioural components of interprofessional collaboration. RESULTS Effective integrated care programmes combine the interacting components of care delivery. These components affect professionals' cognitions and behaviour, which in turn affect quality of care. Insight is gained into how these components alter the way care is delivered through mechanisms such as combining individual knowledge and actively seeking new information. CONCLUSION We expect that insight into the cognitive and behavioural mechanisms will contribute to the understanding of integrated care programmes. The framework can be used to identify the underlying mechanisms of integrated care responsible for producing favourable outcomes, allowing comparisons across programmes.
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Affiliation(s)
- Jacqueline M Hartgerink
- Department of Social Medical Sciences, Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jane M Cramm
- Department of Social Medical Sciences, Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jeroen D H van Wijngaarden
- Department of Health Service and Management of Organizations, Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - Johan P Mackenbach
- Department of Public Health, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Anna P Nieboer
- Department of Social Medical Sciences, Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Asmus-Szepesi KJE, de Vreede PL, Flinterman LE, Nieboer AP, Bakker TJEM, Borsboom GJJM, Mackenbach JP, Steyerberg EW. Prognosis of hospitalised older people with different levels of functioning: a prospective cohort study. Age Ageing 2013; 42:803-9. [PMID: 23974209 DOI: 10.1093/ageing/aft126] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND hospitalised older people are at risk for poor functioning after hospital discharge. We aimed to validate the predictive ability of the Identification Seniors At Risk-Hospitalized Patients (ISAR-HP) screening questionnaire to identify older patients at risk for functional dependence by comparing groups with different ISAR-HP scores on cognitive and physical functioning, mortality, health-related quality of life (HRQoL) and loneliness. DESIGN a longitudinal prospective cohort study. SETTING a 450-bed hospital in the Netherlands. SUBJECTS four hundred and sixty patients 65 years or older admitted between June 2010 and October 2010. METHODS participants were classified into five risk groups at hospital admission using the ISAR-HP. We interviewed patients at hospital admission and at 3 and 12 months after admission using validated questionnaires to score HRQoL, physical functioning, cognitive functioning and loneliness. Differences in survival were quantified by a concordance statistic (c). RESULTS cognitive functioning, physical functioning, loneliness and HRQoL differed significantly between groups during the 1-year follow-up after hospital admission (all comparisons P < 0.05), with high-risk groups having lower scores than low-risk groups for functioning and loneliness, although not always for HRQoL. The lowest risk group (ISAR-HP = 0) scored consistently higher on functioning and HRQoL than all other groups. Mortality differed significantly between groups (P < 0.001, c = 0.67). CONCLUSIONS the ISAR-HP can readily distinguish well-functioning older patients from patients with low functioning and low HRQoL after hospital admission. The ISAR-HP may hence assist in selecting patients who may benefit from individually tailored reactivation treatment that is provided next to treatment of their medical condition.
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Affiliation(s)
- Kirsten J E Asmus-Szepesi
- Erasmus University Medical Center-Public Health, Dr. Molewaterplein 50 3015 GE, Rotterdam, Netherlands
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14
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Hoefman RJ, van Exel J, Brouwer WBF. Measuring the impact of caregiving on informal carers: a construct validation study of the CarerQol instrument. Health Qual Life Outcomes 2013; 11:173. [PMID: 24139439 PMCID: PMC4015499 DOI: 10.1186/1477-7525-11-173] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 10/11/2013] [Indexed: 11/22/2022] Open
Abstract
Background Informal caregivers provide a significant part of the total care needed by ill or disabled persons. Although informal care is often the preferred option of those who provide and those who receive informal care, caring can nevertheless be very straining. This study investigates construct validation of an instrument of the impact of caregiving, the CarerQol. Methods Data was collected among adult caregivers (n = 1,244) selected from the general population using an online questionnaire in October 2010, in the Netherlands. The CarerQol measures and values the impact of informal care. The CarerQol measures subjective burden (CarerQol-7D) and well-being (CarerQol-VAS). Construct validation comprised clinical, convergent and discriminative validity tests. Results Clinical validity was supported by statistically significant associations of CarerQol-VAS and caregivers’ health, income and employment status, care recipients’ health, and the relationship between caregiver and care recipient. Convergent validity was supported by positive associations of CarerQol-VAS with the two positive CarerQol-7D dimensions (fulfillment and support) and negative associations with the five negative CarerQol-7D dimensions (relational problems, mental health problems, problems combining daily activities, financial problems and physical health problems). Moreover, CarerQol-VAS was negatively associated with other instruments measuring caregiving burden. Conclusions Construct validity tests in a large, heterogeneous sample of caregivers show that the CarerQol validly measures the impact of caregiving. The CarerQol can be used in informal care research and economic evaluations of health care interventions. Hence, its use can facilitate informed decision making in health care.
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Affiliation(s)
- Renske J Hoefman
- Erasmus University Rotterdam, Institute of Health Policy and Management, P,O, Box 1738, 3000 DR Rotterdam, The Netherlands.
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15
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Hartgerink JM, Cramm JM, Bakker TJEM, van Eijsden AM, Mackenbach JP, Nieboer AP. The importance of multidisciplinary teamwork and team climate for relational coordination among teams delivering care to older patients. J Adv Nurs 2013; 70:791-9. [PMID: 23980594 PMCID: PMC4282281 DOI: 10.1111/jan.12233] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2013] [Indexed: 11/30/2022]
Abstract
Aim To identify predictors of relational coordination among professionals delivering care to older patients. Background Relational coordination is known to enhance quality of care in hospitals. The underlying mechanisms, however, remain poorly understood. Design This cross-sectional study was part of a larger evaluation study examining the opportunity to prevent loss of function in older patients due to hospitalization in the Netherlands. Methods This study was performed in spring 2010 among team members delivering care to older hospitalized patients (192 respondents; 44% response rate) in one hospital. Relational coordination was measured by the Relational Coordination survey; team climate by the Team Climate Inventory and questions were asked about participation in multidisciplinary team meetings and disciplines represented in these meetings. To account for the hierarchical structure, a multilevel analysis was performed. Results Correlation analysis revealed a positive relationship among being female, being a nurse and relational coordination; medical specialists showed a negative relationship. The number of disciplines represented during multidisciplinary team meetings and team climate were positively related with relational coordination. The multilevel analysis showed a positive relationship between the number of disciplines represented during multidisciplinary team meetings and team climate with relational coordination. Conclusions The enhancement of team climate and attendance of diverse professionals during multidisciplinary team meetings are expected to improve relational coordination. Furthermore, this study underscores the importance of enhancing relational coordination between medical specialists and other professionals.
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Affiliation(s)
- J M Hartgerink
- Department of Social Medical Sciences, Institute of Health Policy and Management, Erasmus University Rotterdam, The Netherlands
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16
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Palacios-Ceña D, Hernández-Barrera V, Jiménez-García R, Valle-Martín B, Fernández-de-las-Peñas C, Carrasco-Garrido P. Has the prevalence of health care services use increased over the last decade (2001-2009) in elderly people? A Spanish population-based survey. Maturitas 2013; 76:326-33. [PMID: 23972333 DOI: 10.1016/j.maturitas.2013.07.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 07/18/2013] [Accepted: 07/27/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES (1) To describe the prevalence of general practitioner visits and hospitalization according to sex and age groups; (2) to identify which factors are independently associated with a higher use of health care services among elderly Spanish; and (3) to study the time trends in the prevalence of use of health care services 2001-2009. STUDY DESIGN Observational study. We analyzed data from the Spanish National Health Surveys conducted in 2001 (n=21,058), 2003 (n=21,650), 2006 (n=29,478) and 2009 (n=22,188). We included responses from adults aged 65 years and older. OUTCOME MEASURES The main variables were the number of general practitioner visits in the last 4 weeks and hospitalization in the past year. We stratified the adjusted models by the main variables. We analyzed socio-demographic characteristics, health related variables, using multivariate logistic regression models. RESULTS The total number of subjects was 24,349 (15,041 woman, 9309 men). Women were significantly older than men (P<0.001). Women had higher prevalence of general practitioner visits than men in all surveys. Men had significantly higher prevalence of hospitalizations than women in the years 2001, 2006 and 2009. When we adjusted the hospitalization by possible confounders using logistic regressions, men had a higher probability of being hospitalized than women (OR 1.53, 1.39-1.69). The variables that were significantly associated with a higher use of health care services were lower educational level, worse self-rated health, chronic conditions, polypharmacy, and the level of disability. The number of general practitioner visits among women and men significantly increased from 2001 to 2009 (women: OR 1.43, 1.27-1.61; men: OR 1.71, 1.49-1.97). CONCLUSIONS The current study revealed an increase in health care services utilization from 2001 to 2009 in the older Spanish population.
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Affiliation(s)
- Domingo Palacios-Ceña
- Department of Health Sciences, Universidad Rey Juan Carlos, Avenida Atenas s/n, 28922 Alcorcon, Madrid, Spain.
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Hoefman RJ, van Exel J, Rose JM, van de Wetering EJ, Brouwer WBF. A discrete choice experiment to obtain a tariff for valuing informal care situations measured with the CarerQol instrument. Med Decis Making 2013; 34:84-96. [PMID: 23771881 DOI: 10.1177/0272989x13492013] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND / OBJECTIVE Economic evaluations adopting a societal perspective need to include informal care whenever relevant. However, in practice, informal care is often neglected, because there are few validated instruments to measure and value informal care for inclusion in economic evaluations. The CarerQol, which is such an instrument, measures the impact of informal care on 7 important burden dimensions (CarerQol-7D) and values this in terms of general quality of life (CarerQol-VAS). The objective of the study was to calculate utility scores based on relative utility weights for the CarerQol-7D. These tariffs will facilitate inclusion of informal care in economic evaluations. METHODS The CarerQol-7D tariff was derived with a discrete choice experiment conducted as an Internet survey among the general adult population in the Netherlands (N = 992). The choice set contained 2 unlabeled alternatives described in terms of the 7 CarerQol-7D dimensions (level range: "no,""some," and "a lot"). An efficient experimental design with priors obtained from a pilot study (N = 104) was used. Data were analyzed with a panel mixed multinomial parameter model including main and interaction effects of the attributes. RESULTS The utility attached to informal care situations was significantly higher when this situation was more attractive in terms of fewer problems and more fulfillment or support. The interaction term between the CarerQol-7D dimensions physical health and mental health problems also significantly explained this utility. The tariff was constructed by adding up the relative utility weights per category of all CarerQol-7D dimensions and the interaction term. CONCLUSIONS We obtained a tariff providing standard utility scores for caring situations described with the CarerQol-7D. This facilitates the inclusion of informal care in economic evaluations.
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Affiliation(s)
- Renske J Hoefman
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands (RJH, JVE, EJVDW, WBFB)
| | - Job van Exel
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands (RJH, JVE, EJVDW, WBFB)
| | - John M Rose
- Institute of Transport Studies, The University ofSydney, Sydney, Australia (JMR)
| | - E J van de Wetering
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands (RJH, JVE, EJVDW, WBFB)
| | - Werner B F Brouwer
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands (RJH, JVE, EJVDW, WBFB)
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Makai P, Koopmanschap MA, Brouwer WBF, Nieboer AAP. A validation of the ICECAP-O in a population of post-hospitalized older people in the Netherlands. Health Qual Life Outcomes 2013; 11:57. [PMID: 23566342 PMCID: PMC3626700 DOI: 10.1186/1477-7525-11-57] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 03/26/2013] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Various healthcare and social services may impact not only health, but wellbeing as well. Such effects may be more fully captured by capability-wellbeing instruments than with Health-related Quality of Life (HrQol) instruments. The aim of this study is to validate the ICEpop (Investigating Choice Experiments for the Preferences of Older People) CAPability measure for Older people (ICECAP-O) capability wellbeing instrument in a population of post-hospitalized older people admitted to a hospital 3 months earlier. METHODS 296 post-hospitalized older people in the Netherlands were interviewed 3 months after admission between September 2010 and January 2011. We investigated the convergent validity of the ICECAP-O and overall wellbeing measures (Cantril's ladder and Social Production Function: Instrument for Level of Well-being (SPF-IL)), as well as with various health measures (EQ5D, Katz-15 Instrumental Activities of Daily Living (IADL) scale, Geriatric Depression Scale (GDS) and the Medical Outcomes Study Short form (SF-20) social functioning dimension). Additionally, we assessed discriminant validity by comparing several relevant subgroups in our sample (based on age, depression, IADL dependency, living situation, etc.). We also investigated the relationship between overall wellbeing and the ICECAP-O, controlling for HrQol and background characteristics. RESULTS This study suggests that the ICECAP-O has good convergent validity with wellbeing measures as well as health measures and discriminates between various groups of post-hospitalized older people. Wellbeing measured by both Cantril's ladder and SPF-IL is associated with the ICECAP-O in a multivariate analysis controlling for HRQoL as well. CONCLUSION The ICECAP-O seems to be a valid instrument of capability-wellbeing in older, post-hospitalized people, showing good convergent validity with health and wellbeing instruments, and is able to discriminate between elderly with various health profiles. The ICECAP-O measure seems to capture both health and wellbeing. Therefore it is a promising instrument for assessing the outcomes of health and social services aimed at older people.
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Affiliation(s)
- Peter Makai
- Department of Geriatrics, Radboud University Nijmegen Medical Centre Nijmegen, Renier Postlaan 4, Nijmegen 6525GC, The Netherlands
| | - Marc A Koopmanschap
- Institute of Health Policy and Management, Erasmus University Rotterdam Burgemeester, Oudlaan 50, Rotterdam 3062, PA, The Netherlands
| | - Werner BF Brouwer
- Institute of Health Policy and Management, Erasmus University Rotterdam Burgemeester, Oudlaan 50, Rotterdam 3062, PA, The Netherlands
| | - Anna AP Nieboer
- Institute of Health Policy and Management, Erasmus University Rotterdam Burgemeester, Oudlaan 50, Rotterdam 3062, PA, The Netherlands
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Cramm JM, Hartgerink JM, Steyerberg EW, Bakker TJ, Mackenbach JP, Nieboer AP. Understanding older patients' self-management abilities: functional loss, self-management, and well-being. Qual Life Res 2013; 22:85-92. [PMID: 22350532 PMCID: PMC3548107 DOI: 10.1007/s11136-012-0131-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2012] [Indexed: 12/21/2022]
Abstract
PURPOSE This study aimed to increase our understanding of self-management abilities and identify better self-managers among older individuals. METHODS Our cross-sectional research was based on a pilot study of older people who had recently been admitted to a hospital. In the pilot study, all patients (>65 years of age) who were admitted to the Vlietland hospital between June and October 2010 were asked to participate, which led to the inclusion of 456 older patients at baseline. A total of 296 patients (65% response rate) were interviewed in their homes 3 months after admission. Measures included social, cognitive, and physical functioning, self-management abilities, and well-being. We used descriptive, correlations, and multiple regression analyses. In addition, we evaluated the mediation effect of self-management abilities on well-being. RESULTS Social, cognitive, and physical functioning significantly correlated with self-management abilities and well-being (all p ≤ 0.001). After controlling for background characteristics, multiple regression analysis indicated that social, cognitive, and physical functioning still related to self-management abilities (β = 0.17-0.25; all p ≤ 0.001). Older people with low levels of social, cognitive, and physical functioning were worse self-managers than were those with higher levels of functioning. CONCLUSIONS Self-management abilities mediate the relationship between social, cognitive, and physical functioning and well-being. Interventions to improve self-management abilities may help older people better deal with function losses as they age further.
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Affiliation(s)
- J. M. Cramm
- Institute of Health Policy and Management (iBMG), Erasmus University, Burgemeester Oudlaan 50, 3062 PA Rotterdam, The Netherlands
| | - J. M. Hartgerink
- Institute of Health Policy and Management (iBMG), Erasmus University, Burgemeester Oudlaan 50, 3062 PA Rotterdam, The Netherlands
| | - E. W. Steyerberg
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | - J. P. Mackenbach
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - A. P. Nieboer
- Institute of Health Policy and Management (iBMG), Erasmus University, Burgemeester Oudlaan 50, 3062 PA Rotterdam, The Netherlands
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The Prevention and Reactivation Care Program: intervention fidelity matters. BMC Health Serv Res 2013; 13:29. [PMID: 23351355 PMCID: PMC3566920 DOI: 10.1186/1472-6963-13-29] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 01/18/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Prevention and Reactivation Care Program (PReCaP) entails an innovative multidisciplinary, integrated and goal oriented approach aimed at reducing hospital related functional decline among elderly patients. Despite calls for process evaluation as an essential component of clinical trials in the geriatric care field, studies assessing fidelity lag behind the number of effect studies. The threefold purpose of this study was (1) to systematically assess intervention fidelity of the hospital phase of the PReCaP in the first year of the intervention delivery; (2) to improve our understanding of the moderating factors and modifications affecting intervention fidelity; and (3) to explore the feasibility of the PReCaP fidelity assessment in view of the modifications. METHODS Based on the PReCaP description we developed a fidelity instrument incorporating nineteen (n=19) intervention components. A combination of data collection methods was utilized, i.e. data collection from patient records and individual Goal Attainment Scaling care plans, in-depth interviews with stakeholders, and non-participant observations. Descriptive analysis was performed to obtain levels of fidelity of each of the nineteen PReCaP components. Moderating factors were identified by using the Conceptual Framework for Implementation Fidelity. RESULTS Ten of the nineteen intervention components were always or often delivered to the group of twenty elderly patients. Moderating factors, such as facilitating strategies and context were useful in explaining the non- or low-adherence of particular intervention components. CONCLUSIONS Fidelity assessment was carried out to evaluate the adherence to the PReCaP in the Vlietland Ziekenhuis in the Netherlands. Given that the fidelity was assessed in the first year of PReCaP implementation it was commendable that ten of the nineteen intervention components were performed always or often. The adequate delivery of the intervention components strongly depended on various moderating factors. Since the intervention is still developing and undergoing continuous modifications, it has been concluded that the fidelity criteria should evolve with the modified intervention. Furthermore, repeated intervention fidelity assessments will be necessary to ensure a valid and reliable fidelity assessment of the PReCaP. TRIAL REGISTRATION The Netherlands National Trial Register: NTR2317.
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Cramm JM, Hartgerink JM, de Vreede PL, Bakker TJ, Steyerberg EW, Mackenbach JP, Nieboer AP. The relationship between older adults' self-management abilities, well-being and depression. Eur J Ageing 2012; 9:353-360. [PMID: 23125820 PMCID: PMC3480589 DOI: 10.1007/s10433-012-0237-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This study aimed to identify the relationship between self-management abilities, well-being and depression. Our study was conducted among older adults (>65 years of age) who were vulnerable to loss of function after hospital discharge. Three months after hospital admission, 296/456 patients (65 % response rate) were interviewed in their homes. The 30-item Self-Management Ability Scale was used to measure six self-management abilities: taking initiative, investing in resources for long-term benefits, taking care of a variety of resources, taking care of resource multifunctionality, being self-efficacious and having a positive frame of mind. Well-being was measured with the Social Production Function (SPF) Instrument for the Level of Well-being (SPF-IL) and Cantril's ladder. The Geriatric Depression Scale was used to assess depression. Correlation analyses showed that all self-management abilities were strong indicators for well-being (p < 0.001 for all). Regression analyses revealed that investing in resources for long-term benefits, taking care of a variety of resources, taking care of resource multifunctionality and being self-efficacious were associated with well-being. While no significant relationship was found between well-being and having a positive frame of mind or taking initiative, regression analyses revealed that these self-management abilities were related to depression. Investing in resources for long-term benefits and taking care of a variety of resources were significantly related to depression. This research showed that self-management abilities are related to well-being and depression among older adults. In addition, this study identified key self-management abilities for older adults who had recently been discharged from a hospital.
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Affiliation(s)
- J. M. Cramm
- Institute of Health Policy & Management (iBMG), Erasmus University, Burgemeester Oudlaan 50, 3000 DR Rotterdam, The Netherlands
| | - J. M. Hartgerink
- Institute of Health Policy & Management (iBMG), Erasmus University, Burgemeester Oudlaan 50, 3000 DR Rotterdam, The Netherlands
| | - P. L. de Vreede
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | - E. W. Steyerberg
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - J. P. Mackenbach
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - A. P. Nieboer
- Institute of Health Policy & Management (iBMG), Erasmus University, Burgemeester Oudlaan 50, 3000 DR Rotterdam, The Netherlands
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Hartgerink JM, Cramm JM, Bakker TJEM, van Eijsden RAM, Mackenbach JP, Nieboer AP. The importance of relational coordination for integrated care delivery to older patients in the hospital. J Nurs Manag 2012; 22:248-56. [PMID: 24576117 DOI: 10.1111/j.1365-2834.2012.01481.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2012] [Indexed: 12/29/2022]
Abstract
AIM This study investigated relational coordination among professionals providing healthcare to hospitalized older patients and assessed its impact on integrated care delivery. BACKGROUND Previous studies have shown that relational coordination is positively associated with the delivery of acute, emergency and trauma care. The effect of relational coordination in integrated care delivery to hospitalized older patients remains unknown. METHODS This cross-sectional study was part of an examination of integrated care delivery to hospitalized older patients. Data were collected using questionnaires distributed to hospital professionals (192 respondents; 44% response rate). RESULTS After controlling for demographic variables, regression analyses showed that relational coordination was positively related to integrated care delivery (β = 0.20; P ≤ 0.05). Relational coordination was lower among professionals in the same discipline, and higher between nurses and others than between medical specialists and others. Relational coordination and integrated care delivery were significantly higher in geriatrics than in other units (both P ≤ 0.001). CONCLUSIONS The enhancement of relational coordination among healthcare professionals is positively associated with integrated care delivery to older patients. IMPLICATIONS FOR NURSING MANAGEMENT Relational coordination should be improved between medical specialists and others and higher levels of relational coordination and integrated care delivery should be achieved in all hospital units.
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de Vos AJBM, Asmus-Szepesi KJE, Bakker TJEM, de Vreede PL, van Wijngaarden JDH, Steyerberg EW, Mackenbach JP, Nieboer AP. Integrated approach to prevent functional decline in hospitalized elderly: the Prevention and Reactivation Care Program (PReCaP). BMC Geriatr 2012; 12:7. [PMID: 22423638 PMCID: PMC3368750 DOI: 10.1186/1471-2318-12-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 03/16/2012] [Indexed: 11/26/2022] Open
Abstract
Background Hospital related functional decline in older patients is an underestimated problem. Thirty-five procent of 70-year old patients experience functional decline during hospital admission in comparison with pre-illness baseline. This percentage increases considerably with age. Methods/design To address this issue, the Vlietland Ziekenhuis in The Netherlands has implemented an innovative program (PReCaP), aimed at reducing hospital related functional decline among elderly patients by offering interventions that are multidisciplinary, integrated and goal-oriented at the physical, social, and psychological domains of functional decline. Discussion This paper presents a detailed description of the intervention, which incorporates five distinctive elements: (1) Early identification of elderly patients with a high risk of functional decline, and if necessary followed by the start of the reactivation treatment within 48 h after hospital admission; (2) Intensive follow-up treatment for a selected patient group at the Prevention and Reactivation Centre (PRC); (3) Availability of multidisciplinary geriatric expertise; (4) Provision of support and consultation of relevant professionals to informal caregivers; (5) Intensive follow-up throughout the entire chain of care by a casemanager with geriatric expertise. Outcome and process evaluations are ongoing and results will be published in a series of future papers. Trial registration The Netherlands National Trial Register: NTR2317
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Affiliation(s)
- Annemarie J B M de Vos
- Institute of Health Policy and Management, Erasmus University Rotterdam, P,O, Box 1738, 3000 DR Rotterdam, The Netherlands.
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