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Forbat L, Macgregor A, Spilsbury K, McCormack B, Rutherford A, Hanratty B, Hockley J, Davison L, Ogden M, Soulsby I, McKenzie M. Using Palliative Care Needs Rounds in the UK for care home staff and residents: an implementation science study. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-134. [PMID: 39046763 DOI: 10.3310/krwq5829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
Background Care home residents often lack access to end-of-life care from specialist palliative care providers. Palliative Care Needs Rounds, developed and tested in Australia, is a novel approach to addressing this. Objective To co-design and implement a scalable UK model of Needs Rounds. Design A pragmatic implementation study using the integrated Promoting Action on Research Implementation in Health Services framework. Setting Implementation was conducted in six case study sites (England, n = 4, and Scotland, n = 2) encompassing specialist palliative care service working with three to six care homes each. Participants Phase 1: interviews (n = 28 care home staff, specialist palliative care staff, relatives, primary care, acute care and allied health practitioners) and four workshops (n = 43 care home staff, clinicians and managers from specialist palliative care teams and patient and public involvement and engagement representatives). Phase 2: interviews (n = 58 care home and specialist palliative care staff); family questionnaire (n = 13 relatives); staff questionnaire (n = 171 care home staff); quality of death/dying questionnaire (n = 81); patient and public involvement and engagement evaluation interviews (n = 11); fidelity assessment (n = 14 Needs Rounds recordings). Interventions (1) Monthly hour-long discussions of residents' physical, psychosocial and spiritual needs, alongside case-based learning, (2) clinical work and (3) relative/multidisciplinary team meetings. Main outcome measures A programme theory describing what works for whom under what circumstances with UK Needs Rounds. Secondary outcomes focus on health service use and cost effectiveness, quality of death and dying, care home staff confidence and capability, and the use of patient and public involvement and engagement. Data sources Semistructured interviews and workshops with key stakeholders from the six sites; capability of adopting a palliative approach, quality of death and dying index, and Canadian Health Care Evaluation Project Lite questionnaires; recordings of Needs Rounds; care home data on resident demographics/health service use; assessments and interventions triggered by Needs Rounds; semistructured interviews with academic and patient and public involvement and engagement members. Results The programme theory: while care home staff experience workforce challenges such as high turnover, variable skills and confidence, Needs Rounds can provide care home and specialist palliative care staff the opportunity to collaborate during a protected time, to plan for residents' last months of life. Needs Rounds build care home staff confidence and can strengthen relationships and trust, while harnessing services' complementary expertise. Needs Rounds strengthen understandings of dying, symptom management, advance/anticipatory care planning and communication. This can improve resident care, enabling residents to be cared for and die in their preferred place, and may benefit relatives by increasing their confidence in care quality. Limitations COVID-19 restricted intervention and data collection. Due to an insufficient sample size, it was not possible to conduct a cost-benefit analysis of Needs Rounds or calculate the treatment effect or family perceptions of care. Conclusions Our work suggests that Needs Rounds can improve the quality of life and death for care home residents, by enhancing staff skills and confidence, including symptom management, communications with general practitioners and relatives, and strengthen relationships between care home and specialist palliative care staff. Future work Conduct analysis of costs-benefits and treatment effects. Engagement with commissioners and policy-makers could examine integration of Needs Rounds into care homes and primary care across the UK to ensure equitable access to specialist care. Study registration This study is registered as ISRCTN15863801. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128799) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 19. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Liz Forbat
- Faculty of Social Science, University of Stirling, Stirling, UK
| | - Aisha Macgregor
- Faculty of Social Science, University of Stirling, Stirling, UK
| | | | - Brendan McCormack
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia
- Queen Margaret University Edinburgh, Scotland, UK
- Østfold University College, Norway
| | | | - Barbara Hanratty
- Faculty of Medical Sciences, University of Newcastle, England, UK
| | - Jo Hockley
- College of Medicine and Veterinary Science, University of Edinburgh, UK
| | - Lisa Davison
- Faculty of Social Science, University of Stirling, Stirling, UK
| | - Margaret Ogden
- Patient and Public Involvement and Engagement, Faculty of Social Science, University of Stirling, UK
| | - Irene Soulsby
- Patient and Public Involvement and Engagement, Faculty of Social Science, University of Stirling, UK
| | - Maisie McKenzie
- Patient and Public Involvement and Engagement, Faculty of Social Science, University of Stirling, UK
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Albanesi B, Conti A, Politano G, Dimonte V, Gianino MM, Campagna S. Emergency department visits by nursing home residents. A retrospective Italian study of administrative databases from 2015 to 2019. BMC Geriatr 2024; 24:295. [PMID: 38549053 PMCID: PMC10976813 DOI: 10.1186/s12877-024-04912-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 03/21/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Visits to Emergency Departments (ED) can be traumatic for Nursing Home (NH) residents. In Italy, the rate of ED visits by NH residents was recently calculated as 3.3%. The reduction of inappropriate ED visits represents a priority for National Healthcare Systems worldwide. Nevertheless, research on factors associated with ED visits is still under-studied in the Italian setting. This study has two main aims: (i) to describe the baseline characteristics of NH residents visiting ED at regional level; (ii) to assess the characteristics, trends, and factors associated with these visits. METHODS A retrospective study of administrative data for five years was performed in the Piedmont Region. Data from 24,208 NH residents were analysed. Data were obtained by merging two ministerial databases of residential care and ED use. Sociodemographic and clinical characteristics of the residents, trends, and rates of ED visits were collected. A Generalized Linear Model (GLM) regression was used to evaluate the factors associated with ED visits. RESULTS In 5 years, 12,672 residents made 24,609 ED visits. Aspecific symptoms (45%), dyspnea (17%) and trauma (16%) were the most frequent problems reported at ED. 51% of these visits were coded as non-critical, and 58% were discharged to the NH. The regression analysis showed an increased risk of ED visits for men (OR = 1.61, 95% CI 1.51-1.70) and for residents with a stay in NH longer than 400 days (OR = 2.19, 95% CI 2.08-2.31). CONCLUSIONS Our study indicates that more than half of NH residents' ED visits could potentially be prevented by treating residents in NH. Investments in the creation of a structured and effective network within primary care services, promoting the use of health technology and palliative care approaches, could reduce ED visits and help clinicians manage residents on-site and remotely.
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Affiliation(s)
- Beatrice Albanesi
- Department of Sciences of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, Turin, 10126, Italy
| | - Alessio Conti
- Department of Sciences of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, Turin, 10126, Italy.
| | - Gianfranco Politano
- Department of Control and Computer Engineering, Politecnico di Torino, Turin, Italy
| | - Valerio Dimonte
- Department of Sciences of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, Turin, 10126, Italy
| | - Maria Michela Gianino
- Department of Sciences of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, Turin, 10126, Italy
| | - Sara Campagna
- Department of Sciences of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, Turin, 10126, Italy
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Ciminata G, Burton JK, Quinn TJ, Geue C. Understanding Pathways into Care-homes using Data (UnPiCD study): a two-part model to estimate inpatient and care-home costs using national linked health and social care data. BMC Health Serv Res 2024; 24:281. [PMID: 38443919 PMCID: PMC10916167 DOI: 10.1186/s12913-024-10675-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/01/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Pathways into care-homes have been under-researched. Individuals who move-in to a care-home from hospital are clinically distinct from those moving-in from the community. However, it remains unclear whether the source of care-home admission has any implications in term of costs. Our aim was to quantify hospital and care-home costs for individuals newly moving-in to care homes to compare those moving-in from hospital to those moving-in from the community. METHODS Using routinely-collected national social care and health data we constructed a cohort including people moving into care-homes from hospital and community settings between 01/04/2013-31/03/2015 based on records from the Scottish Care-Home Census (SCHC). Individual-level data were obtained from Scottish Morbidity Records (SMR01/04/50) and death records from National Records of Scotland (NRS). Unit costs were identified from NHS Scotland costs data and care-home costs from the SCHC. We used a two-part model to estimate costs conditional on having incurred positive costs. Additional analyses estimated differences in costs for the one-year period preceding and following care-home admission. RESULTS We included 14,877 individuals moving-in to a care-home, 8,472 (57%) from hospital, and 6,405 (43%) from the community. Individuals moving-in to care-homes from the community incurred higher costs at £27,117 (95% CI £ 26,641 to £ 27,594) than those moving-in from hospital with £24,426 (95% CI £ 24,037 to £ 24,814). Hospital costs incurred during the year preceding care-home admission were substantially higher (£8,323 (95% CI£8,168 to £8,477) compared to those incurred after moving-in to care-home (£1,670 (95% CI£1,591 to £1,750). CONCLUSION Individuals moving-in from hospital and community have different needs, and this is reflected in the difference in costs incurred. The reduction in hospital costs in the year after moving-in to a care-home indicates the positive contribution of care-home residency in supporting those with complex needs. These data provide an important contribution to inform capacity planning on care provision for adults with complex needs and the costs of care provision.
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Affiliation(s)
- G Ciminata
- Health Economics and Health Technology Assessment, School of Health & Wellbeing, University of Glasgow, Glasgow, Scotland, U.K..
| | - J K Burton
- Academic Geriatric Medicine, School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, Scotland, U.K
| | - T J Quinn
- Academic Geriatric Medicine, School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, Scotland, U.K
| | - C Geue
- Health Economics and Health Technology Assessment, School of Health & Wellbeing, University of Glasgow, Glasgow, Scotland, U.K
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Harrison SL, Lang C, Eshetie TC, Crotty M, Whitehead C, Evans K, Corlis M, Wesselingh S, Caughey GE, Inacio MC. Hospitalisations and emergency department presentations by older individuals accessing long-term aged care in Australia. AUST HEALTH REV 2024; 48:182-190. [PMID: 38537302 DOI: 10.1071/ah24019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/06/2024] [Indexed: 04/05/2024]
Abstract
Objective The study examined emergency department (ED) presentations, unplanned hospitalisations and potentially preventable hospitalisations in older people receiving long-term care by type of care received (i.e. permanent residential aged care or home care packages in the community), in Australia in 2019. Methods A retrospective cohort study was conducted using the Registry of Senior Australians National Historical Cohort. Individuals were included if they resided in South Australia, Queensland, Victoria or New South Wales, received a home care package or permanent residential aged care in 2019 and were aged ≥65 years. The cumulative incidence of ED presentations, unplanned hospitalisations and potentially preventable hospitalisations in each of the long-term care service types were estimated during the year. Days in hospital per 1000 individuals were also calculated. Results The study included 203,278 individuals accessing permanent residential aged care (209,639 episodes) and 118,999 accessing home care packages in the community (127,893 episodes). A higher proportion of people accessing home care packages had an ED presentation (43.1% [95% confidence interval, 42.8-43.3], vs 37.8% [37.6-38.0]), unplanned hospitalisation (39.8% [39.6-40.1] vs 33.4% [33.2-33.6]) and potentially preventable hospitalisation (11.8% [11.6-12.0] vs 8.2% [8.1-8.4]) than people accessing permanent residential aged care. Individuals with home care packages had more days in hospital due to unplanned hospitalisations than those in residential care (7745 vs 3049 days/1000 individuals). Conclusions While a high proportion of older people in long-term care have ED presentations, unplanned hospitalisations and potentially preventable hospitalisations, people in the community with home care packages experience these events at a higher frequency.
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Affiliation(s)
- Stephanie L Harrison
- Registry of Senior Australians, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia; and Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Catherine Lang
- Registry of Senior Australians, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Tesfahun C Eshetie
- Registry of Senior Australians, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia; and Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia; and UniSA Clinical & Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Maria Crotty
- Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia; and College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Craig Whitehead
- Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia; and College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Keith Evans
- Registry of Senior Australians, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Megan Corlis
- Australian Nursing and Midwifery Federation SA Branch, Adelaide, SA, Australia
| | - Steve Wesselingh
- Registry of Senior Australians, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia; and National Health and Medical Research Council, ACT, Australia
| | - Gillian E Caughey
- Registry of Senior Australians, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia; and Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia; and Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
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Chambers D, Cantrell A, Preston L, Marincowitz C, Wright L, Conroy S, Lee Gordon A. Reducing unplanned hospital admissions from care homes: a systematic review. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-130. [PMID: 37916580 DOI: 10.3310/klpw6338] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Background Care homes predominantly care for older people with complex health and care needs, who are at high risk of unplanned hospital admissions. While often necessary, such admissions can be distressing and provide an opportunity cost as well as a financial cost. Objectives Our objective was to update a 2014 evidence review of interventions to reduce unplanned admissions of care home residents. We carried out a systematic review of interventions used in the UK and other high-income countries by synthesising evidence of effects of these interventions on hospital admissions; feasibility and acceptability; costs and value for money; and factors affecting applicability of international evidence to UK settings. Data sources We searched the following databases in December 2021 for studies published since 2014: Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews; Cumulative Index to Nursing and Allied Health Literature; Health Management Information Consortium; Medline; PsycINFO; Science and Social Sciences Citation Indexes; Social Care Online; and Social Service Abstracts. 'Grey' literature (January 2022) and citations were searched and reference lists were checked. Methods We included studies of any design reporting interventions delivered in care homes (with or without nursing) or hospitals to reduce unplanned hospital admissions. A taxonomy of interventions was developed from an initial scoping search. Outcomes of interest included measures of effect on unplanned admissions among care home residents; barriers/facilitators to implementation in a UK setting and acceptability to care home residents, their families and staff. Study selection, data extraction and risk of bias assessment were performed by two independent reviewers. We used published frameworks to extract data on intervention characteristics, implementation barriers/facilitators and applicability of international evidence. We performed a narrative synthesis grouped by intervention type and setting. Overall strength of evidence for admission reduction was assessed using a framework based on study design, study numbers and direction of effect. Results We included 124 publications/reports (30 from the UK). Integrated care and quality improvement programmes providing additional support to care homes (e.g. the English Care Homes Vanguard initiatives and hospital-based services in Australia) appeared to reduce unplanned admissions relative to usual care. Simpler training and staff development initiatives showed mixed results, as did interventions aimed at tackling specific problems (e.g. medication review). Advance care planning was key to the success of most quality improvement programmes but do-not-hospitalise orders were problematic. Qualitative research identified tensions affecting decision-making involving paramedics, care home staff and residents/family carers. The best way to reduce end-of-life admissions through access to palliative care was unclear in the face of inconsistent and generally low-quality evidence. Conclusions Effective implementation of interventions at various stages of residents' care pathways may reduce unplanned admissions. Most interventions are complex and require adaptation to local contexts. Work at the interface between health and social care is key to successful implementation. Limitations Much of the evidence identified was of low quality because of factors such as uncontrolled study designs and small sample size. Meta-analysis was not possible. Future work We identified a need for improved economic evidence and the evaluation of integrated care models of the type delivered by hospital-based teams. Researchers should carefully consider what is realistic in terms of study design and data collection given the current context of extreme pressure on care homes. Study registration This study is registered as PROSPERO database CRD42021289418. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (award number NIHR133884) and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 18. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Duncan Chambers
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Louise Preston
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Carl Marincowitz
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Simon Conroy
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Adam Lee Gordon
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Nottingham, UK
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Cetin-Sahin D, Karanofsky M, Cummings GG, Vedel I, Wilchesky M. Measuring Potentially Avoidable Acute Care Transfers From Long-Term Care Homes in Quebec: a Cross Sectional Study. Can Geriatr J 2023; 26:339-349. [PMID: 37662066 PMCID: PMC10444526 DOI: 10.5770/cgj.26.620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
Background Potentially avoidable emergency department transfers (PAEDTs) and hospitalizations (PAHs) from long-term care (LTC) homes are two key quality improvement metrics. We aimed to: 1) Measure proportions of PAEDTs and PAHs in a Quebec sample; and 2) Compare them with those reported for the rest of Canada. Methods We conducted a repeated cross-sectional study of residents who were received at one tertiary hospital between April 2017 and March 2019 from seven LTC homes in Quebec, Canada. The MedUrge emergency department database was used to extract transfers and resident characteristics. Using published definitions, PAEDTs and PAHs were identified from principal emergency department and hospitalization diagnoses, respectively. PAEDT and PAH proportions were compared to those reported by the Canadian Institute for Health Information. Results A total of 1,233 transfers by 692 residents were recorded, among which 36.3% were classified as being potentially avoidable: 22.8% 'PAEDT only', 11.6% 'both PAEDT & PAH', and 1.9% 'PAH only'. Shortness of breath was the most common reason for transfer. Pneumonia was the most common diagnosis from the 'both PAEDT & PAH' category. PAEDTs and PAHs accounted for 95% and 37% of potentially avoidable transfers, respectively. Among 533 hospitalizations, 31.3% were PAHs. These proportions were comparable to the rest of Canada, with some differences in proportions of transfers due to congestive heart failure, urinary tract infection, and implanted device management. Conclusions PAEDTs far outweigh PAHs in terms of frequency, and their monitoring is important for quality assurance as they may inform LTC-level interventions aimed at their reduction.
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Affiliation(s)
- Deniz Cetin-Sahin
- Department of Family Medicine, McGill University, Montreal, QC
- Donald Berman Maimonides Geriatric Centre for Research in Aging, Montreal, QC
| | - Mark Karanofsky
- Department of Family Medicine, McGill University, Montreal, QC
- Herzl Family Practice Centre, Jewish General Hospital CIUSSS Centre-Ouest-de-l’Île-de-Montréal, Montreal, QC
| | | | - Isabelle Vedel
- Department of Family Medicine, McGill University, Montreal, QC
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC
| | - Machelle Wilchesky
- Department of Family Medicine, McGill University, Montreal, QC
- Donald Berman Maimonides Geriatric Centre for Research in Aging, Montreal, QC
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC
- Division of Geriatric Medicine, McGill University, Montreal, QC, Canada
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Tyler N, Planner C, Shears B, Hernan A, Panagioti M, Giles S. Developing the Resident Measure of Safety in Care Homes (RMOS): A Delphi and Think Aloud Study. Health Expect 2023; 26:1149-1158. [PMID: 36797827 PMCID: PMC10154851 DOI: 10.1111/hex.13730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 01/26/2023] [Accepted: 02/05/2023] [Indexed: 02/18/2023] Open
Abstract
OBJECTIVE This study aimed to develop a measure of contributory factors to safety incidents in care homes to be completed by residents and/or their unpaid carers. INTRODUCTION Care home residents are particularly vulnerable to patient safety incidents, due to higher likelihood of frailty, multimorbidity and cognitive decline. However, despite residents and their carers wanting to be involved in safety initiatives, there are few mechanisms for them to contribute and make meaningful safety improvements to practice. METHODS We developed 73 evidence-based items from synthesis and existing measures, which we presented to a panel of stakeholders (residents/carers, health/social care professionals and researchers). We used two online rounds of Delphi to generate consensus (80%) on items important to include in the Resident Measure of Safety in Care Homes (RMOS); a consensus meeting was later held. The draft RMOS developed through the Delphi was presented to participants during 'Think Aloud' interviews using cognitive testing techniques. RESULTS The 29-item RMOS was developed. Forty-three participants completed Delphi round 1, and 27 participants completed round 2, 11 participants attended the consensus meeting and 12 'Think Aloud' interviews were conducted. Of the 73 original items, 42 items that did not meet consensus in Delphi round 1 were presented in round 2. After the consensus meeting, it was agreed that 35 items would comprise the RMOS questionnaire and were presented in the 'Think Aloud' interviews. Participants suggested numerous changes to items mostly to improve comprehension and ability to answer. CONCLUSION We have a developed an evidence-based RMOS, with good face validity, to assess contributory factors to safety in care homes from a resident/carer perspective. Future work will involve psychometrically testing the items in a pilot and developing a complementary simplified, dementia-friendly version to promote inclusivity. PATIENT OR PUBLIC INVOLVEMENT Four patient and public contributors worked with researchers to develop the online questionnaires. Patients (residents) and carers participated on the consensus panel. One member of the research team is an expert by lived experience and was involved in design and analysis decisions. The item list and instructions for the questionnaires were reviewed for face validity, understanding and acceptability by a patient and public involvement group and modified.
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Affiliation(s)
- Natasha Tyler
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,National Institute for Health and Care Research School for Primary Care Research, University of Manchester, Manchester, UK
| | - Claire Planner
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Bethany Shears
- Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
| | - Andrea Hernan
- Faculty of Health, Deakin University, Warrnambool, Australia
| | - Maria Panagioti
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,National Institute for Health and Care Research School for Primary Care Research, University of Manchester, Manchester, UK
| | - Sally Giles
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Nguyen PT, Liaw SY, Tan AJQ, Rusli KDB, Tan LLC, Goh HS, Chua WL. “Nurses caught in the middle”: A qualitative study of nurses’ perspectives on the decision to transfer deteriorating nursing home residents to emergency departments in Singapore. Collegian 2022. [DOI: 10.1016/j.colegn.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Schmüdderich K, Kiwitt J, Palm R, Roes M, Holle B. Core elements and potential of nurse-led care models in residential long-term care: A scoping review. J Clin Nurs 2022; 32:1858-1884. [PMID: 35122351 DOI: 10.1111/jocn.16231] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/26/2021] [Accepted: 01/12/2022] [Indexed: 01/12/2023]
Abstract
AIMS AND OBJECTIVE To identify and summarise core elements, resident-, staff- and process-related outcomes and challenges of nurse-led care models in residential long-term care. BACKGROUND Due to demographic trends, the complexity of residential long-term care has increased. To address this complexity, the implementation of nurse-led care models has been recommended. DESIGN Scoping review. METHODS A systematic search was conducted of English and German articles in CINAHL via EBSCO, MEDLINE via PubMed, Cochrane Library and Scopus. Forward and backward citation tracking via reference lists and Google Scholar supplemented the search. The final update was made on 19 January 2021. To draw conclusions about the potential of nurse-led care models, evaluation studies of the described models for residents in nursing homes were included. Full texts were independently screened and assessed for methodological quality. Data were extracted and summarised in tables and synthesised for analysis. The core elements of the models were described using the Sustainable intEgrated chronic care modeLs for multimorbidity: delivery, FInancing and performancE (SELFIE) framework. The review followed the PRISMA-ScR guideline. RESULTS We included 13 studies of 12 nurse-led care models. The different models comprised many of the core elements suggested in the SELFIE framework, particularly in the components service delivery, workforce, and leadership and governance. The studies reported a broad range of resident-, staff- and process-related outcomes and challenges considered relevant to the success of the models. CONCLUSIONS Studies evaluating nurse-led care models in nursing homes are limited and of moderate quality. This review demonstrates that nurse-led care models include many elements for care coordination and could improve resident-, staff- and process-related outcomes. RELEVANCE TO CLINICAL PRACTICE This review highlights that nurse-led care models share common core elements despite their heterogeneity. It also shows that highly qualified nurses in nurse-led care models can advance nursing practice in nursing homes.
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Affiliation(s)
- Kathrin Schmüdderich
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Witten, Germany.,Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Jörn Kiwitt
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Rebecca Palm
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Martina Roes
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Witten, Germany.,Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Bernhard Holle
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Witten, Germany.,Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
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Lütz KCC, Bierhals CCBK, Rosset I, Paskulin LMG. Use of specialized public health services by older people in southern Brazil. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2022. [DOI: 10.1590/1981-22562022025.220183.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
Abstract Objective To analyze the use of specialized public health services by older adults, by sex and age group, in the city of Porto Alegre. Methods A cross-sectional study with secondary data from the city's outpatient and inpatient consultation systems. All records from 2019 were used, and Pearson's chi-square test was applied. Results In total, 64,888 older people sought specialized services, generating 113.694 visits (82,8% outpatient visits and 17.2% hospitalizations). It was found that 74.7% of the older adults were referred by primary care for specialized care, with higher percentages of young older people and women (p<0.001). On the other hand, men and older adults aged 80 years or older were referred more frequently for care from hospitals and emergency rooms (p<0.001). Women and older adults between 60 and 79 years old used outpatient centers, physical therapy, rehabilitation centers, dentistry and mental health in greater proportion (p<0.001). The main reasons for using specialized services were diseases of the circulatory system, being more expressive among older adults aged 80 years or older and men (p<0.001). Musculoskeletal diseases (22.5%) were the main reasons for outpatient consultations and, in emergency hospitalizations, diseases of the circulatory system (37.9%). Older adults with a history of outpatient consultations had fewer hospital admissions (p<0.001). Conclusion The need for articulated actions by health services is highlighted, prioritizing the male and long-lived population, focusing on the prevention/control of non-communicable chronic diseases and the vulnerabilities of this stage of life.
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Lütz KCC, Bierhals CCBK, Rosset I, Paskulin LMG. Utilização dos serviços públicos de saúde especializados por pessoas idosas no sul do Brasil. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2022. [DOI: 10.1590/1981-22562022025.220183.pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Resumo Objetivo Analisar a utilização dos serviços públicos de saúde especializados por idosos de acordo com o sexo e grupo etário no município de Porto Alegre. Métodos Estudo transversal com dados secundários dos sistemas de consulta ambulatorial e de internação do município. Utilizaram-se todos os registros de 2019, sendo aplicado o teste qui-quadrado de Pearson. Resultados No total, 64.888 idosos buscaram serviços especializados, gerando 113.694 atendimentos (82,8% atendimentos ambulatoriais e 17,2% internações). Verificou-se que 74,7% dos idosos foram referenciados pela atenção primária para atendimento especializado, com maiores percentuais de idosos jovens e mulheres (p<0,001). Já homens e idosos com 80 anos ou mais foram encaminhados com maior frequência para atendimento a partir de hospitais e pronto atendimentos (p<0,001). Mulheres e idosos entre 60 e 79 anos utilizaram em maior proporção os centros ambulatoriais, fisioterapia, centros de reabilitação, odontologia e saúde mental (p<0,001). Os principais motivos de utilização dos serviços especializados foram doenças do aparelho circulatório, sendo mais expressivo entre idosos com 80 anos ou mais e homens (p<0,001). As doenças osteomusculares (22,5%) foram os principais motivos de consultas ambulatoriais e, nas internações de urgência, as doenças do aparelho circulatório (37,9%). Idosos com histórico de consultas ambulatoriais tiveram menos internações hospitalares (p<0,001). Conclusão Destaca-se a necessidade de ações articuladas dos serviços de saúde priorizando a população masculina e longeva, enfocando a prevenção/controle de doenças crônicas não transmissíveis e as vulnerabilidades dessa etapa de vida.
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Damery S, Flanagan S, Jones J, Jolly K. The Effect of Providing Staff Training and Enhanced Support to Care Homes on Care Processes, Safety Climate and Avoidable Harms: Evaluation of a Care Home Quality Improvement Programme in England. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147581. [PMID: 34300034 PMCID: PMC8307011 DOI: 10.3390/ijerph18147581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 11/22/2022]
Abstract
Older people living in care homes are at risk from avoidable harms, which may require hospital attendance or admission. This paper describes a mixed methods evaluation of a large quality improvement (QI) programme that provides skills training and facilitated support to staff in 29 care homes across two localities in the West Midlands, UK. The Safety Attitudes Questionnaire (SAQ) is used to assess changes to care home safety climate between baseline and programme end at 24 months. We use routinely collected data to assess pre- and post-programme avoidable harms and hospital attendance/admission rates. Semi-structured interviews with programme managers (n = 18), and staff (n = 49) in four case study homes are also used to assess perspectives on programme implementation. Our results show that safety climate scores increase by 1.4 points. There are significant reductions in falls (p = 0.0006), severe pressure ulcers (p = 0.014), UTIs (p = 0.001) and ‘any’ events (p = 0.0003). Emergency hospital attendances reduced, but admissions increased. Interview participants report improvements to teamwork, working practices, information sharing, knowledge and skills. Upskilling care home staff can improve working practices and attitudes towards resident safety and care quality, which may be associated with significant reductions in avoidable harms rates. Care staff turnover rates are high, which may impact the potential for longer-term sustainability of the changes observed.
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van Vuuren J, Thomas B, Agarwal G, MacDermott S, Kinsman L, O'Meara P, Spelten E. Reshaping healthcare delivery for elderly patients: the role of community paramedicine; a systematic review. BMC Health Serv Res 2021; 21:29. [PMID: 33407406 PMCID: PMC7789625 DOI: 10.1186/s12913-020-06037-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 12/21/2020] [Indexed: 12/19/2022] Open
Abstract
Background Healthcare systems are overloaded and changing. In response to growing demands on the healthcare systems, new models of healthcare delivery are emerging. Community paramedicine is a novel approach in which paramedics use their knowledge and skills beyond emergency health response to contribute to preventative and rehabilitative health. In our systematic review, we aimed to identify evidence of the community paramedicine role in care delivery for elderly patients, with an additional focus on palliative care, and the possible impact of this role on the wider healthcare system. Methods A systematic review of peer-reviewed literature from MEDLINE, Embase, CINAHL, and Web of Sciences was undertaken to identify relevant full-text articles in English published until October 3, 2019. Additional inclusion criteria were studies focussing on extended care paramedics or community paramedics caring for elderly patients. Case studies were excluded. All papers were screened by at least two authors and underwent a quality assessment, using the Joanna Briggs Institute appraisal checklists for cross sectional, qualitative, cohort, and randomised controlled trial studies to assess the methodological quality of the articles. A process of narrative synthesis was used to summarise the data. Results Ten studies, across 13 articles, provided clear evidence that Community Paramedic programs had a positive impact on the health of patients and on the wider healthcare system. The role of a Community Paramedic was often a combination of four aspects: assessment, referral, education and communication. Limited evidence was available on the involvement of Community Paramedics in palliative and end-of-life care and in care delivery in residential aged care facilities. Observed challenges were a lack of additional training, and the need for proper integration and understanding of their role in the healthcare system. Conclusions The use of community paramedics in care delivery could be beneficial to both patients’ health and the wider healthcare system. They already play a promising role in improving the care of our elderly population. With consistent adherence to the training curriculum and effective integration within the wider healthcare system, community paramedics have the potential to take on specialised roles in residential aged care facilities and palliative and end-of-life care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-06037-0.
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Affiliation(s)
- Julia van Vuuren
- Department of Community Health, Rural Health School, La Trobe University, Melbourne, Australia.
| | - Brodie Thomas
- Department of Community Health, Rural Health School, La Trobe University, Melbourne, Australia
| | - Gina Agarwal
- Department of Family Medicine, McMaster University, Hamilton, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Sean MacDermott
- Department of Community Health, Rural Health School, La Trobe University, Melbourne, Australia
| | - Leigh Kinsman
- University of Newcastle and Mid-North Coast Local Health District, Port Macquarie Base Hospital, Port Macquarie, Australia
| | - Peter O'Meara
- Department of Paramedicine, Monash University, Peninsula Campus, Melbourne, Australia
| | - Evelien Spelten
- Department of Community Health, Rural Health School, La Trobe University, Melbourne, Australia
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Improving the Quality of Care in Care Homes Using the Quality Improvement Collaborative Approach: Lessons Learnt from Six Projects Conducted in the UK and The Netherlands. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207601. [PMID: 33086576 PMCID: PMC7589164 DOI: 10.3390/ijerph17207601] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/05/2020] [Accepted: 10/13/2020] [Indexed: 01/08/2023]
Abstract
The Breakthrough Series Quality Improvement Collaborative (QIC) initiative is a well-developed and widely used approach, but most of what we know about it has come from healthcare settings. In this article, those leading QICs to improve care in care homes provide detailed accounts of six QICs and share their learning of applying the QIC approach in the care home sector. Overall, five care home-specific lessons were learnt: (i) plan for the resources needed to support collaborative teams with collecting, processing, and interpreting data; (ii) create encouraging and safe working environments to help collaborative team members feel valued; (iii) recruit collaborative teams, QIC leads, and facilitators who have established relationships with care homes; (iv) regularly check project ideas are aligned with team members’ job roles, responsibilities, and priorities; and (v) work flexibly and accept that planned activities may need adapting as the project progresses. These insights are targeted at teams delivering QICs in care homes. These insights demonstrate the need to consider the care home context when applying improvement tools and techniques in this setting.
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