1
|
Jiang C, Zou M, Chen M, Jiang Y, Chang P, Cui Y, Jiang L. Reliability and validity of the Mandarin version of the Continuity Assessment Record and Evaluation for older people who are transferred between hospitals and nursing homes in China. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1180-1189. [PMID: 32048425 DOI: 10.1111/hsc.12951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 01/07/2020] [Accepted: 01/12/2020] [Indexed: 06/10/2023]
Abstract
To date, assessment tools for older people are different between hospitals and nursing homes in China. The difference between assessment tools can lead to poor communication of information between hospitals and nursing homes, which causes discontinuity of care and adverse outcomes when older people are transferred between these different settings. Continuity Assessment Record and Evaluation (CARE) is a comprehensive geriatric assessment tool developed in the United States of America. This study aimed to evaluate the reliability and validity of the Mandarin Version of CARE for older people who are transferred between hospitals and nursing homes. Using a convenience sampling method, 120 older people in hospitals and 120 older people in nursing homes in Shanghai were selected to test the internal consistency, interrater reliability and criterion-related validity of CARE from May to November 2017. When used among hospital, 70.0% (7/10) of the subscales had a Cronbach's alpha coefficients of greater than 0.7, 94.3% (50/53) of the items had an intraclass correlation coefficient (ICC) of greater than 0.75. When used in nursing homes, 90.0% (9/10) of the subscales had a Cronbach's alpha coefficients of greater than 0.7, 94.3% (50/53) of the items had an ICC of greater than 0.75. For both settings, the correlation coefficients of the subscales with their corresponding instruments for criterion-related validity were all greater than 0.8 (p < .01). The Mandarin version of CARE exhibits good reliability and validity. It can be used as an assessment tool for transition between hospitals and nursing homes.
Collapse
Affiliation(s)
- Caixia Jiang
- Shanghai Jiao Tong University School of Nursing, Shanghai, China
| | - Min Zou
- Shanghai Jiao Tong University School of Nursing, Shanghai, China
| | | | - Yijun Jiang
- Shanghai Jiao Tong University School of Nursing, Shanghai, China
| | - Polun Chang
- Institute of bioMedical Informatics, National Yang-Ming University, Taipei City, Taiwan
| | - Yanyan Cui
- Institute of bioMedical Informatics, National Yang-Ming University, Taipei City, Taiwan
| | - Liping Jiang
- Department of Nursing, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
2
|
Detroyer E, Timmermans A, Segers D, Meyfroidt G, Dubois J, Van Assche A, Joosten E, Milisen K. Psychometric properties of the intensive care delirium screening checklist when used by bedside nurses in clinical practice: a prospective descriptive study. BMC Nurs 2020; 19:21. [PMID: 32308558 PMCID: PMC7149913 DOI: 10.1186/s12912-020-00415-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/30/2020] [Indexed: 01/11/2023] Open
Abstract
Background The Intensive Care Delirium Screening Checklist (ICDSC) demonstrates good psychometric characteristics in research settings. However, evidence about these characteristics in pragmatic ICU settings is inconsistent. This study evaluated psychometric properties and user-friendliness of the ICDSC when administered by ICU nurses in daily practice. Methods This prospective study included 77 patients from a surgical intensive care unit. To examine the psychometric characteristics, the scores on the ICDSC (performed by bedside nurses) were compared with the scores on the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) (performed by researchers as gold standard). The user-friendliness was evaluated by 34 ICU nurses with a 20-item questionnaire. Results The ICDSC had an area under the curve of 0.843. It showed a good diagnostic accuracy with a sensitivity of 81.0%, a specificity of 87.7%, and a 53.1% positive and 96.4% negative predictive value. The overall Cronbach’s alpha coefficient for all ICDSC scores was high (0.839). Overall, ICU nurses experienced the ICDSC as easy-to-use. The scale was usable in most surgical ICU patients. Yet, some nurses (11.8%) had problems to score the items ‘inappropriate speech’ and ‘symptom fluctuation’ in intubated patients. Conclusions The ICDSC is a valid and user-friendly tool for delirium screening in daily ICU nursing practice. Yet, some problems were reported in intubated patients. Therefore, validation studies with specific focus on intubated patients are needed.
Collapse
Affiliation(s)
- Elke Detroyer
- 1Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 - PB 7001/4, B-3000 Leuven, Belgium.,2Department of Geriatrics, University Hospitals Leuven, Leuven, Belgium
| | - Annick Timmermans
- 1Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 - PB 7001/4, B-3000 Leuven, Belgium.,3Department of Anesthesiology, Jessa Ziekenhuis, Hasselt, Belgium
| | - Dana Segers
- 1Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 - PB 7001/4, B-3000 Leuven, Belgium.,4Department of Intensive Care, Ziekenhuis Oost Limburg, Genk, Belgium
| | - Geert Meyfroidt
- 5Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Jasperina Dubois
- 3Department of Anesthesiology, Jessa Ziekenhuis, Hasselt, Belgium
| | - Aimé Van Assche
- 3Department of Anesthesiology, Jessa Ziekenhuis, Hasselt, Belgium
| | - Etienne Joosten
- 2Department of Geriatrics, University Hospitals Leuven, Leuven, Belgium
| | - Koen Milisen
- 1Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 - PB 7001/4, B-3000 Leuven, Belgium.,2Department of Geriatrics, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
3
|
Brousseau AA, Dent E, Hubbard R, Melady D, Émond M, Mercier É, Costa AP, Gray LC, Hirdes JP, Dey AB, Jonsson PV, Lakhan P, Ljunggren G, Singler K, Sjostrand F, Swoboda W, Wellens NIH. Identification of older adults with frailty in the Emergency Department using a frailty index: results from a multinational study. Age Ageing 2018; 47:242-248. [PMID: 29165543 DOI: 10.1093/ageing/afx168] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 10/16/2017] [Indexed: 01/08/2023] Open
Abstract
Objective frailty is a central concept in geriatric medicine, yet its utility in the Emergency Department (ED) is not well understood nor well utilised. Our objectives were to develop an ED frailty index (FI-ED), using the Rockwood cumulative deficits model and to evaluate its association with adverse outcomes. Method this was a large multinational prospective cohort study using data from the interRAI Multinational Emergency Department Study. The FI-ED was developed from the Canadian cohort and validated in the multinational cohort. All patients aged ≥75 years presenting to an ED were included. The FI-ED was created using 24 variables included in the interRAI ED-Contact Assessment tool. Results there were 2,153 participants in the Canadian cohort and 1,750 in the multinational cohort. The distribution of the FI-ED was similar to previous frailty indices. The mean FI-ED was 0.26 (Canadian cohort) and 0.32 (multinational cohort) and the 99th percentile was 0.71 and 0.81, respectively. In the Canadian cohort, a 0.1 unit increase in the FI-ED was significantly associated with admission (odds ratio (OR) = 1.43 [95% CI: 1.34-1.52]); death at 28 days (OR = 1.55 [1.38-1.73]); prolonged hospital stay (OR = 1.37 [1.22-1.54]); discharge to long-term care (OR = 1.30 [1.16-1.47]); and need for Comprehensive geriatric Assessment (OR = 1.51 [1.41-1.60]). The multinational cohort showed similar associations. Conclusion the FI-ED conformed to characteristics previously reported. A FI, developed and validated from a brief geriatric assessment tool could be used to identify ED patients at higher risk of adverse events.
Collapse
Affiliation(s)
- Audrey-Anne Brousseau
- Department of Family and Community Medicine, University of Toronto, Canada
- Schwartz-Reisman Emergency Medicine Institute, Mount Sinai Hospital, Toronto, Canada
| | - Elsa Dent
- Centre for Research in Geriatric Medicine, The School of Medicine, The University of Queensland, Brisbane, Australia
| | - Ruth Hubbard
- Centre for Research in Geriatric Medicine, The School of Medicine, The University of Queensland, Brisbane, Australia
| | - Don Melady
- Department of Family and Community Medicine, University of Toronto, Canada
- Schwartz-Reisman Emergency Medicine Institute, Mount Sinai Hospital, Toronto, Canada
| | - Marcel Émond
- Axe Sante des Populations et Pratiques Optimales en Sante, Centre de recherche du CHU de Quebec, Canada
- Universite Laval, Quebec, Canada
- Centre d'excellence sur le Vieillissement de Quebec, Canada
| | - Éric Mercier
- Axe Sante des Populations et Pratiques Optimales en Sante, Centre de recherche du CHU de Quebec, Canada
- Universite Laval, Quebec, Canada
- Department of Epidemiology and Preventive Medicine, Monash University, Australia
| | - Andrew P Costa
- Department of Clinical Epidemiology and Biostatistics and Department of Medicine, McMaster University, Hamilton, Canada
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
The Rest of the Story: A Qualitative Study of Complementing Standardized Assessment Data with Informal Interviews with Older Patients and Families. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2017; 10:215-224. [PMID: 27596366 DOI: 10.1007/s40271-016-0193-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND While standardized health assessments capture valuable information on patients' demographic and diagnostic characteristics, health conditions, and physical and mental functioning, they may not capture information of most relevance to individual patients and their families. Given that patients and their informal caregivers are the experts on that patient's unique context, it is important to ensure they are able to convey all relevant personal information to formal healthcare providers so that high-quality, patient-centered care may be delivered. This study aims to identify information that older patients and families consider important but that might not be included in standardized assessments. METHODS Transcripts were analyzed from 29 interviews relating to eight patients with hip fractures from three sites (large urban, smaller urban, rural) in two provinces in Canada. These interviews were conducted as part of a larger ethnographic study. Each transcript was analyzed by two researchers using content analysis. Results were reviewed in two focus group interviews with older adults and family caregivers. Identified themes were compared with items from two standardized assessments used in healthcare settings. RESULTS Three broad themes emerged from the qualitative analysis that were not covered in the standardized assessments: informal caregiver and family considerations, insider healthcare knowledge, and patients' healthcare attitudes and experiences. The importance of these themes was confirmed through focus group interviews. Focus group participants also emphasized the importance of conducting assessments in a patient-centered way and the importance of open-ended questions. CONCLUSIONS A less structured interview approach may yield information that would otherwise be missed in standardized assessments. Combining both sources could yield better-informed healthcare planning and quality-improvement efforts.
Collapse
|
5
|
Lee T. Community-based home healthcare project for korean older adults. Osong Public Health Res Perspect 2013; 4:233-9. [PMID: 24298438 PMCID: PMC3845225 DOI: 10.1016/j.phrp.2013.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 08/30/2013] [Accepted: 09/02/2013] [Indexed: 11/27/2022] Open
Abstract
Objectives The aim of this study was to identify the effects of community-based home healthcare projects that influence service performances with regard to Korean national long-term care insurance services in older adults. Methods The project's applicants were 18 operational agencies in national long-term care institutions in Korea, and participants were care recipients (n = 2263) registered in long-term care institutions. We applied our healthcare system to the recruited participants for a 3-month period from October 2012 to December 2012. We measured the community-based home healthcare services such as long-term care, health and medical service, and welfare and leisure service prior to and after applying the community-based home healthcare system. Results After the implementation of community-based home healthcare project, all community-based home healthcare services showed an increase than prior to the project implementation. The nutrition management service was the most increased and its increase rate was 628.6%. A comparison between the long-term care insurance beneficiaries and nonbeneficiaries showed that health and medical services’ increase rate of nonbeneficiaries was significantly higher than beneficiaries (p < 0.001). Conclusion Our community-based home healthcare project might improve the service implementation for older adults and there was a difference in the increase rate of health and medical services between Korean national long-term care insurance beneficiaries and nonbeneficiaries.
Collapse
Affiliation(s)
- Taebum Lee
- Advanced Medical Device Research Center, Korea Electrotechnology Research Institute, Ansan, Korea
| |
Collapse
|
6
|
Devriendt E, Wellens NIH, Flamaing J, Declercq A, Moons P, Boonen S, Milisen K. The interRAI Acute Care instrument incorporated in an eHealth system for standardized and web-based geriatric assessment: strengths, weaknesses, opportunities and threats in the acute hospital setting. BMC Geriatr 2013; 13:90. [PMID: 24007312 PMCID: PMC3766642 DOI: 10.1186/1471-2318-13-90] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 08/29/2013] [Indexed: 01/04/2023] Open
Abstract
Background The interRAI Acute Care instrument is a multidimensional geriatric assessment system intended to determine a hospitalized older persons’ medical, psychosocial and functional capacity and needs. Its objective is to develop an overall plan for treatment and long-term follow-up based on a common set of standardized items that can be used in various care settings. A Belgian web-based software system (BelRAI-software) was developed to enable clinicians to interpret the output and to communicate the patients’ data across wards and care organizations. The purpose of the study is to evaluate the (dis)advantages of the implementation of the interRAI Acute Care instrument as a comprehensive geriatric assessment instrument in an acute hospital context. Methods In a cross-sectional multicenter study on four geriatric wards in three acute hospitals, trained clinical staff (nurses, occupational therapists, social workers, and geriatricians) assessed 410 inpatients in routine clinical practice. The BelRAI-system was evaluated by focus groups, observations, and questionnaires. The Strengths, Weaknesses, Opportunities and Threats were mapped (SWOT-analysis) and validated by the participants. Results The primary strengths of the BelRAI-system were a structured overview of the patients’ condition early after admission and the promotion of multidisciplinary assessment. Our study was a first attempt to transfer standardized data between home care organizations, nursing homes and hospitals and a way to centralize medical, allied health professionals and nursing data. With the BelRAI-software, privacy of data is guaranteed. Weaknesses are the time-consuming character of the process and the overlap with other assessment instruments or (electronic) registration forms. There is room for improving the user-friendliness and the efficiency of the software, which needs hospital-specific adaptations. Opportunities are a timely and systematic problem detection and continuity of care. An actual shortage of funding of personnel to coordinate the assessment process is the most important threat. Conclusion The BelRAI-software allows standardized transmural information transfer and the centralization of medical, allied health professionals and nursing data. It is strictly secured and follows strict privacy regulations, allowing hospitals to optimize (transmural) communication and interaction. However, weaknesses and threats exist and must be tackled in order to promote large scale implementation.
Collapse
Affiliation(s)
- Els Devriendt
- Department of Public Health and Primary Care, Health Services and Nursing Research, KU Leuven, Kapucijnenvoer 35, 4th floor, Leuven, 3000, Belgium.
| | | | | | | | | | | | | |
Collapse
|
7
|
Gray LC, Peel NM, Costa AP, Burkett E, Dey AB, Jonsson PV, Lakhan P, Ljunggren G, Sjostrand F, Swoboda W, Wellens NIH, Hirdes J. Profiles of older patients in the emergency department: findings from the interRAI Multinational Emergency Department Study. Ann Emerg Med 2013; 62:467-474. [PMID: 23809229 DOI: 10.1016/j.annemergmed.2013.05.008] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 05/07/2013] [Accepted: 05/14/2013] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE We examine functional profiles and presence of geriatric syndromes among older patients attending 13 emergency departments (EDs) in 7 nations. METHODS This was a prospective observational study of a convenience sample of patients, aged 75 years and older, recruited sequentially and mainly during normal working hours. Clinical observations were drawn from the interRAI Emergency Department Screener, with assessments performed by trained nurses. RESULTS A sample of 2,282 patients (range 98 to 549 patients across nations) was recruited. Before becoming unwell, 46% were dependent on others in one or more aspects of personal activities of daily living. This proportion increased to 67% at presentation to the ED. In the ED, 26% exhibited evidence of cognitive impairment, and 49% could not walk without supervision. Recent falls were common (37%). Overall, at least 48% had a geriatric syndrome before becoming unwell, increasing to 78% at presentation to the ED. This pattern was consistent across nations. CONCLUSION Functional problems and geriatric syndromes affect the majority of older patients attending the ED, which may have important implications for clinical protocols and design of EDs.
Collapse
Affiliation(s)
- Leonard C Gray
- Centre for Research in Geriatric Medicine, the University of Queensland, Brisbane, Queensland, Australia
| | - Nancye M Peel
- Centre for Research in Geriatric Medicine, the University of Queensland, Brisbane, Queensland, Australia.
| | - Andrew P Costa
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ellen Burkett
- Princess Alexandra Hospital Emergency Department, Brisbane, Queensland, Australia
| | - Aparajit B Dey
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Palmi V Jonsson
- Department of Geriatrics, Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavic, Iceland
| | - Prabha Lakhan
- Centre for Research in Geriatric Medicine, the University of Queensland, Brisbane, Queensland, Australia
| | - Gunnar Ljunggren
- Public Healthcare Services Committee Administration, Stockholm County Council, Stockholm, Sweden; Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Stockholm, Sweden; Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Sjostrand
- Karolinska Institutet, Stockholm, Sweden; Department of Clinical Science and Education, Södersjukhuset and Section of Emergency Medicine, Södersjukhuset AB, Stockholm, Sweden
| | - Walter Swoboda
- Institute for Biomedicine of Aging, University of Erlangen Nuremberg, Klinikum Nuremberg, Germany
| | - Nathalie I H Wellens
- Department of Public Health, Centre for Health Services and Nursing Research, KU Leuven, Belgium
| | - John Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| |
Collapse
|