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Guerbaai RA, Dollinger C, Kressig RW, Zeller A, Wellens NIH, Popejoy LL, Serdaly C, Zúñiga F. Factors associated with avoidable hospital transfers among residents in Swiss nursing homes. Geriatr Nurs 2023; 53:12-18. [PMID: 37399613 DOI: 10.1016/j.gerinurse.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 07/05/2023]
Abstract
Unplanned hospitalizations from nursing homes (NHs) may be considered potentially avoidable and can result in adverse resident outcomes. There is little information about the relationship between a clinical assessment conducted by a physician or geriatric nurse expert before hospitalization and an ensuing rating of avoidability. This study aimed to describe characteristics of unplanned hospitalizations (admitted residents with at least one night stay, emergency department visits were excluded) and to examine this relationship. We conducted a cohort study in 11 Swiss NHs and retrospectively evaluated data from the root cause analysis of 230 unplanned hospitalizations. A telephone assessment by a physician (p=.043) and the need for further medical clarification and treatment (p=<0.001) were the principal factors related to ratings of avoidability. Geriatric nurse experts can support NH teams in acute situations and assess residents while adjudicating unplanned hospitalizations. Constant support for nurses expanding their clinical role is still warranted.
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Affiliation(s)
- Raphaëlle-Ashley Guerbaai
- Department of Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland; Rehabilitation, Ageing and Independent Living (RAIL) research centre, School of Primary and Allied Health Care, Monash University, Frankston, Australia
| | - Claudia Dollinger
- Department of Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland; Lindenhofgruppe AG, Lindenhof Spital, Bern, Switzerland
| | - Reto W Kressig
- University Department of Geriatric Medicine FELIX PLATTER & Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Andreas Zeller
- Centre for Primary Health Care, University of Basel, Basel, Switzerland
| | - Nathalie I H Wellens
- La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Lori L Popejoy
- University of Missouri, Sinclair School of Nursing, Columbia, United States
| | | | - Franziska Zúñiga
- Department of Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland.
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Guerbaai RA, DeGeest S, Popejoy LL, Simon M, Wellens NIH, Denhaerynck K, Zúñiga F. Evaluating the implementation fidelity to a successful nurse-led model (INTERCARE) which reduced nursing home unplanned hospitalisations. BMC Health Serv Res 2023; 23:138. [PMID: 36759902 PMCID: PMC9910256 DOI: 10.1186/s12913-023-09146-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/03/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Implementation fidelity assesses the degree to which an intervention is delivered as it should be. Fidelity helps to determine if the outcome(s) of an intervention are attributed to the intervention itself or to a failure of its implementation. Little is known about how fidelity impacts the intended outcome(s) and what elements or moderators can affect the fidelity trajectory over time. We exemplify the meaning of implementation fidelity with INTERCARE, a nurse-led care model that was implemented in eleven Swiss nursing homes (NHs) and showed effectiveness in reducing unplanned hospital transfers. INTERCARE comprises six core elements, including advance care planning and tools to support inter- and interprofessional communication, which were introduced with carefully developed implementation strategies. METHODS A mixed-methods convergent/triangulation design was used to investigate the influence of implementation fidelity on unplanned transfers. A fidelity questionnaire measuring the degree of fidelity to INTERCARE's core components was fielded at four time points in the participating NHs. Two-monthly meetings were conducted with NHs (September 2018-January 2020) and structured notes were used to determine moderators affecting fidelity (e.g., participant responsiveness). We used the fidelity scores and generalized linear mixed models to analyze the quantitative data. The Framework method was used for the qualitative analysis. The quantitative and qualitative findings were integrated using triangulation. RESULTS A higher overall fidelity score showed a decreasing rate of unplanned hospital transfers post-intervention (OR: 0.65 (CI = 0.43-0.99), p = 0.047). A higher fidelity score to advance care planning was associated with lower unplanned transfers (OR = 0.24 (CI 0.13-0.44), p = < 0.001) and a lower fidelity score for communication tools (e.g., ISBAR) to higher rates in unplanned transfers (OR = 1.69 (CI 1.30-2.19), p = < 0.003). In-house physicians with a collaborative approach and staff's perceived need for nurses working in extended roles, were important moderators to achieve and sustain high fidelity. CONCLUSION Implementation fidelity is challenging to measure and report, especially in complex interventions, yet is crucial to better understand how such interventions may be tailored for scale-up. This study provides both a detailed description of how fidelity can be measured and which ingredients highly contributed to reducing unplanned NH transfers. TRIAL REGISTRATION The INTERCARE study was registered at clinicaltrials.gov Protocol Record NCT03590470.
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Affiliation(s)
- Raphaëlle A. Guerbaai
- grid.6612.30000 0004 1937 0642Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Sabina DeGeest
- grid.6612.30000 0004 1937 0642Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland ,grid.5596.f0000 0001 0668 7884Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Lori L. Popejoy
- grid.134936.a0000 0001 2162 3504Sinclair School of Nursing, University of Missouri, Columbia, United States of America
| | - Michael Simon
- grid.6612.30000 0004 1937 0642Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Nathalie I. H. Wellens
- grid.5681.a0000 0001 0943 1999La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Kris Denhaerynck
- grid.6612.30000 0004 1937 0642Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Franziska Zúñiga
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.
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Bartakova J, Zúñiga F, Guerbaai RA, Basinska K, Brunkert T, Simon M, Denhaerynck K, De Geest S, Wellens NIH, Serdaly C, Kressig RW, Zeller A, Popejoy LL, Nicca D, Desmedt M, De Pietro C. Health economic evaluation of a nurse-led care model from the nursing home perspective focusing on residents' hospitalisations. BMC Geriatr 2022; 22:496. [PMID: 35681157 PMCID: PMC9185955 DOI: 10.1186/s12877-022-03182-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health economic evaluations of the implementation of evidence-based interventions (EBIs) into practice provide vital information but are rarely conducted. We evaluated the health economic impact associated with implementation and intervention of the INTERCARE model-an EBI to reduce hospitalisations of nursing home (NH) residents-compared to usual NH care. METHODS The INTERCARE model was conducted in 11 NHs in Switzerland. It was implemented as a hybrid type 2 effectiveness-implementation study with a multi-centre non-randomised stepped-wedge design. To isolate the implementation strategies' costs, time and other resources from the NHs' perspective, we applied time-driven activity-based costing. To define its intervention costs, time and other resources, we considered intervention-relevant expenditures, particularly the work of the INTERCARE nurse-a core INTERCARE element. Further, the costs and revenues from the hotel and nursing services were analysed to calculate the NHs' losses and savings per resident hospitalisation. Finally, alongside our cost-effectiveness analysis (CEA), a sensitivity analysis focused on the intervention's effectiveness-i.e., regarding reduction of the hospitalisation rate-relative to the INTERCARE costs. All economic variables and CEA were assessed from the NHs' perspective. RESULTS Implementation strategy costs and time consumption per bed averaged 685CHF and 9.35 h respectively, with possibilities to adjust material and human resources to each NH's needs. Average yearly intervention costs for the INTERCARE nurse salary per bed were 939CHF with an average of 1.4 INTERCARE nurses per 100 beds and an average employment rate of 76% of full-time equivalent per nurse. Resident hospitalisation represented a total average loss of 52% of NH revenues, but negligible cost savings. The incremental cost-effectiveness ratio of the INTERCARE model compared to usual care was 22'595CHF per avoided hospitalisation. As expected, the most influential sensitivity analysis variable regarding the CEA was the pre- to post-INTERCARE change in hospitalisation rate. CONCLUSIONS As initial health-economic evidence, these results indicate that the INTERCARE model was more costly but also more effective compared to usual care in participating Swiss German NHs. Further implementation and evaluation of this model in randomised controlled studies are planned to build stronger evidential support for its clinical and economic effectiveness. TRIAL REGISTRATION clinicaltrials.gov ( NCT03590470 ).
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Affiliation(s)
- Jana Bartakova
- Department Public Health, Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland.,Institute of Biophysics and Informatics, 1St Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Franziska Zúñiga
- Department Public Health, Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland.
| | - Raphaëlle-Ashley Guerbaai
- Department Public Health, Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Kornelia Basinska
- Department Public Health, Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Thekla Brunkert
- Department Public Health, Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland.,University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland
| | - Michael Simon
- Department Public Health, Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Kris Denhaerynck
- Department Public Health, Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Sabina De Geest
- Department Public Health, Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland.,Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Louvain, Belgium
| | - Nathalie I H Wellens
- Department of Public Health and Social Affairs, Directorate General of Health, Canton of Vaud, Lausanne, Switzerland.,La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | | | - Reto W Kressig
- University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Andreas Zeller
- Centre for Primary Health Care, University of Basel, Basel, Switzerland
| | - Lori L Popejoy
- The University of Missouri, Sinclair School of Nursing, Columbia, US
| | - Dunja Nicca
- Institute of Epidemiology, Biostatistics and Prevention, University of Zürich, Conches, Switzerland
| | - Mario Desmedt
- Foundation Asile Des Aveugles, Lausanne, Switzerland
| | - Carlo De Pietro
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Lugano, Switzerland
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Basinska K, Zúñiga F, Simon M, De Geest S, Guerbaai RA, Wellens NIH, Nicca D, Brunkert T. Implementation of a complex intervention to reduce hospitalizations from nursing homes: a mixed-method evaluation of implementation processes and outcomes. BMC Geriatr 2022; 22:196. [PMID: 35279088 PMCID: PMC8918313 DOI: 10.1186/s12877-022-02878-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 02/28/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background | objective
To evaluate the implementation of three intervention elements to reduce hospitalizations in nursing home residents.
Design
Convergent mixed-method design within a hybrid type-2 effectiveness-implementation study.
Setting
Eleven nursing homes in the German-speaking region of Switzerland.
Participants
Quantitative data were collected from 573 care workers; qualitative data were collected from 108 care workers and the leadership from 11 nursing homes.
Intervention
Three intervention elements targeting care workers were implemented to reduce unplanned hospitalizations: (1) the STOP&WATCH instrument for early recognition of changes in resident condition; (2) the ISBAR instrument for structured communication; and (3) specially-trained INTERCARE nurses providing on-site geriatric support. Multifaceted implementation strategies focusing both on the overall nursing home organization and on the care workers were used.
Methods
The quantitative part comprised surveys of care workers six- and twelve-months post-intervention. The intervention’s acceptability, feasibility and uptake were assessed using validated and self-developed scales.
Qualitative data were collected in 22 focus groups with care workers, then analyzed using thematic analysis methodology. Data on implementation processes were collected during implementation meetings with nursing home leadership and were analyzed via content analysis. Findings were integrated using a complementary approach.
Results
The ISBAR instrument and the INTERCARE nurse role were considered acceptable, feasible, and taken up by > 70% of care workers. The STOP&WATCH instrument showed the lowest acceptance (mean: 68%), ranging from 24 to 100% across eleven nursing homes. A combination of factors, including the amount of information received, the amount of support provided in daily practice, the users’ perceived ease of using the intervention and its adaptations, and the intervention’s usefulness, appeared to influence the implementation’s success. Two exemplary nursing homes illustrated context-specific implementation processes that serve as either barriers or facilitators to implementation.
Conclusions
Our findings suggest that, alongside the provision of information shortly before intervention start, constant daily support is crucial for implementation success. Ideally, this support is provided by designated and trained individuals who oversee implementation at the organizational and unit levels. Leaders who seek to implement interventions in nursing homes should consider their complexity and their consequences for workflow to optimize implementation processes accordingly.
Trial registration
This study was registered at clinicaltrials.gov (NCT03590470) on the 18/06/2018.
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Zúñiga F, Guerbaai RA, de Geest S, Popejoy LL, Bartakova J, Denhaerynck K, Trutschel D, Basinska K, Nicca D, Kressig RW, Zeller A, Wellens NIH, de Pietro C, Desmedt M, Serdaly C, Simon M. Positive effect of the INTERCARE nurse-led model on reducing nursing home transfers: A nonrandomized stepped-wedge design. J Am Geriatr Soc 2022; 70:1546-1557. [PMID: 35122238 PMCID: PMC9305956 DOI: 10.1111/jgs.17677] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/04/2021] [Accepted: 12/01/2021] [Indexed: 11/29/2022]
Abstract
Background Unplanned nursing home (NH) transfers are burdensome for residents and costly for health systems. Innovative nurse‐led models of care focusing on improving in‐house geriatric expertise are needed to decrease unplanned transfers. The aim was to test the clinical effectiveness of a comprehensive, contextually adapted geriatric nurse‐led model of care (INTERCARE) in reducing unplanned transfers from NHs to hospitals. Methods A multicenter nonrandomized stepped‐wedge design within a hybrid type‐2 effectiveness‐implementation study was implemented in 11 NHs in German‐speaking Switzerland. The first NH enrolled in June 2018 and the last in November 2019. The study lasted 18 months, with a baseline period of 3 months for each NH. Inclusion criteria were 60 or more long‐term care beds and 0.8 or more hospitalizations per 1′000 resident care days. Nine hundred and forty two long‐term NH residents were included between June 2018 and January 2020 with informed consent. Short‐term residents were excluded. The primary outcome was unplanned hospitalizations. A fully anonymized dataset of overall transfers of all NH residents served as validation. Analysis was performed with segmented mixed regression modeling. Results Three hundred and three unplanned and 64 planned hospitalizations occurred. During the baseline period, unplanned transfers increased over time (β1 = 0.52), after which the trend significantly changed by a similar but opposite amount (β2 = −0.52; p = 0.0001), resulting in a flattening of the average transfer rate throughout the postimplementation period (β1 + β2 ≈ 0). Controlling for age, gender, and cognitive performance did not affect these trends. The validation set showed a similar flattening trend. Conclusion A complex intervention with six evidence‐based components demonstrated effectiveness in significantly reducing unplanned transfers of NH residents to hospitals. INTERCARE's success was driven by registered nurses in expanded roles and the use of tools for clinical decision‐making. See related Editorial by Kaehr et al. in this issue.
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Affiliation(s)
- Franziska Zúñiga
- Department of Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Raphaëlle-Ashley Guerbaai
- Department of Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Sabina de Geest
- Department of Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland.,Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium
| | - Lori L Popejoy
- University of Missouri, Sinclair School of Nursing, Columbia, USA
| | - Jana Bartakova
- Department of Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Kris Denhaerynck
- Department of Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland.,Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium
| | - Diana Trutschel
- Department of Computational Biology, Institut Pasteur, Paris, France
| | - Kornelia Basinska
- Department of Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Dunja Nicca
- Institut of Epidemiology, Biostatistics and Prevention, University of Zürich, Zürich, Switzerland
| | - Reto W Kressig
- University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Andreas Zeller
- Centre for Primary Health Care, University of Basel, Basel, Switzerland
| | - Nathalie I H Wellens
- Directorate General of Health, Department of Public Health and Social Affairs of the Canton of Vaud, Lausanne, Switzerland.,La Source School of Nursing, HES-SO University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland
| | - Carlo de Pietro
- The department of Business economics, Health and Social Care at the University of Applied Sciences and Arts of Southern Switzerland, Lugano, Switzerland
| | - Mario Desmedt
- Foundation Asile des Aveugles, Lausanne, Switzerland
| | | | - Michael Simon
- Department of Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland.,Inselspital Bern University Hospital, Department of Nursing, Nursing & Midwifery Research Unit, Bern, Switzerland
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Basinska K, Künzler-Heule P, Guerbaai RA, Zúñiga F, Simon M, Wellens NIH, Serdaly C, Nicca D. Residents' and Relatives' Experiences of Acute Situations: A Qualitative Study to Inform a Care Model. Gerontologist 2021; 61:1041-1052. [PMID: 33624766 PMCID: PMC8437505 DOI: 10.1093/geront/gnab027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Indexed: 11/24/2022] Open
Abstract
Background and Objectives As new models of care aiming to reduce hospitalizations from nursing homes emerge, their implementers must consider residents’ and relatives’ needs and experiences with acute changes in the residents’ health situations. As part of the larger INTERCARE implementation study, we explored these persons’ experiences of acute situations in Swiss nursing homes. Research Design and Methods 3 focus groups were conducted with residents and their relatives and analyzed via reflexive thematic analysis. Results The first theme, the orchestra plays its standards, describes experiences of structured everyday care in nursing homes, which functions well despite limited professional and competency resources. The second theme, the orchestra reaches its limits, illustrates accounts of acute situations in which resources were insufficient to meet residents’ needs. Interestingly, participants’ perceptions of acute situations went well beyond our own professional view, that is, changes in health situations, and included situations best summarized as “changes that might have negative consequences for residents if not handled adequately by care workers.” Within the third theme, the audience compensates for the orchestra’s limitations, participants’ strategies to cope with resource limitations in acute situations are summarized. Discussion and Implications Our findings suggest differences between care providers’ and participants’ perspectives regarding acute situations and care priority setting. Alongside efforts to promote staff awareness of and responsiveness to acute situations, care staff must commit to learning and meeting individual residents’ and relatives’ needs. Implications for the development and implementation of a new nurse-led model of care are discussed.
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Affiliation(s)
- Kornelia Basinska
- Nursing Science (INS), Department of Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Patrizia Künzler-Heule
- Nursing Science (INS), Department of Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland.,Department of Gastroenterology/Hepatology, Cantonal Hospital St. Gallen, Switzerland.,Department of Nursing Development, Cantonal Hospital St. Gallen, Switzerland
| | - Raphaëlle Ashley Guerbaai
- Nursing Science (INS), Department of Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Franziska Zúñiga
- Nursing Science (INS), Department of Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Michael Simon
- Nursing Science (INS), Department of Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland.,Inselspital Bern University Hospital, Nursing Research Unit, Switzerland
| | - Nathalie I H Wellens
- Department of Public Health and Social Affairs of the Canton of Vaud, Lausanne, Switzerland
| | | | - Dunja Nicca
- Nursing Science (INS), Department of Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland.,Department of Public & Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Switzerland
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Matos Queirós A, von Gunten A, Martins M, Wellens NIH, Verloo H. The Forgotten Psychopathology of Depressed Long-Term Care Facility Residents: A Call for Evidence-Based Practice. Dement Geriatr Cogn Dis Extra 2021; 11:38-44. [PMID: 33790939 PMCID: PMC7989823 DOI: 10.1159/000514118] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 12/29/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction As Earth's population is rapidly aging, the question of how best to care for its older adults suffering from psychiatric disorders is becoming a constant and growing preoccupation. Depression is one of the most common psychiatric disorders among older adults, and depressed nursing home residents are at a particularly high risk of a decreased quality of life. The complex requirements of supporting and caring for depressed older adults in nursing homes demand the development and implementation of innovative clinical and organizational models that can ensure early identification of the disorder and high-quality multidisciplinary services for dealing with it. This perspective article aims to provide an overview of the literature and the state of the art of and the urgent need for research on the epidemiology and clinical treatment of depression among older adults. Method In collaboration with a medical librarian, we conducted literature and bibliometric reviews of published articles in Medline Ovid SP from inception until September 30, 2020, to identify studies related to depression, depressive symptoms, mood disorders, dementia, cognitive disorders, and health complications in long-term care facilities and nursing homes. Results We had 38,777 and 40,277 hits for depression and dementia, respectively, in long-term care facilities or nursing homes. The search equation found 536 and 1,447 studies exploring depression and dementia, respectively, and their related health complications in long-term care facilities or nursing homes. Conclusion Depression's relationships with other health complications have been poorly studied in long-term care facilities and nursing homes. More research is needed to understand them better.
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Affiliation(s)
- Alcina Matos Queirós
- Department of Health and Social Welfare, Lausanne, Switzerland.,Escola Superior de Enfermagem do Porto/Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Armin von Gunten
- Service of Old Age Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Manuela Martins
- Escola Superior de Enfermagem do Porto/Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal.,Higher School of Nursing of Porto, Porto, Portugal
| | - Nathalie I H Wellens
- Department of Health and Social Welfare, Lausanne, Switzerland.,Department of Public Health and Primary Care, Lausanne, Switzerland
| | - Henk Verloo
- Service of Old Age Psychiatry, Lausanne University Hospital, Prilly, Switzerland.,Nursing Sciences, University of Applied Sciences and Arts Western Switzerland, HES-SO Valais/Wallis, Sion, Switzerland
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8
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Basinska K, Wellens NIH, Simon M, Zeller A, Kressig RW, Zúñiga F. Registered nurses in expanded roles improve care in nursing homes: Swiss perspective based on the modified Delphi method. J Adv Nurs 2020; 77:742-754. [PMID: 33222269 PMCID: PMC7894469 DOI: 10.1111/jan.14644] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/19/2020] [Accepted: 10/27/2020] [Indexed: 01/17/2023]
Abstract
AIM To define both competencies and envisaged outcomes for registered nurses in expanded roles in Swiss nursing homes to be implemented and evaluated within a new model of care. BACKGROUND In regions where Advanced Practice Nurses are rare or absent, registered nurses take up clinical leadership and expanded roles. To allow effective implementation, monitoring and evaluation of these nurses, stakeholders need a shared understanding of the competencies they require and what outcomes they should achieve. DESIGN RAND/UCLA Appropriateness Method - a modified Delphi method. METHODS A critical literature review and case studies were conducted to identify possible competencies and outcomes for registered nurses in expanded roles. In 2017, a two-round rating process and an in-person panel discussion was completed by a group of multi-professional stakeholders. FINDINGS Two rounds generated 190 competencies and 72 outcomes relevant to registered nurses in expanded roles. CONCLUSION The relevant competencies and outcomes of registered nurses in expanded roles indicate their support for care teams and development of nursing care in nursing homes. Their geriatric expertise allows them to function as role models and innovators, reinforcing overall perceptions of nursing as a profession. These nurses are especially important in countries and settings where Advanced Practice Nurses are scarce or unavailable. IMPACT The identified competencies clarify the duties of expanded-role registered nurses, thereby differentiating them from other care providers. Although conducted in the Swiss healthcare system, our methods and findings can be adapted to other healthcare settings. The results of this study will guide the development of an educational programme in a multi-centre study to reduce avoidable hospitalizations, while the defined outcomes guide the evaluation of their impact.
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Affiliation(s)
- Kornelia Basinska
- Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Nathalie I H Wellens
- Department of Public Health and Social Affairs of the Canton of Vaud, Lausanne, Switzerland
| | - Michael Simon
- Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland.,Nursing Research Unit, Inselspital Bern University Hospital, Bern, Switzerland
| | - Andreas Zeller
- Faculty of Medicine, University of Basel, Basel, Switzerland.,Center for Primary Health Care, University of Basel, Basel, Switzerland
| | - Reto W Kressig
- Faculty of Medicine, University of Basel, Basel, Switzerland.,University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland
| | - Franziska Zúñiga
- Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
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Heeren P, Devriendt E, Wellens NIH, Deschodt M, Flamaing J, Sabbe M, Milisen K. Comment on: Geriatric Screeners 2.0: Time for a Paradigm Shift in Emergency Department Vulnerability Research. J Am Geriatr Soc 2020; 68:2414-2415. [PMID: 32621613 DOI: 10.1111/jgs.16691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/06/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Pieter Heeren
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium.,Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium.,Research Foundation Flanders, Brussels, Belgium
| | - Els Devriendt
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium.,Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Nathalie I H Wellens
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium.,Department of Public Health and Social Affairs DSAS, Direction Générale de la Santé Canton Vaud, Etat de Vaud, Lausanne, Switzerland
| | - Mieke Deschodt
- Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven, Leuven, Belgium.,Department of Public Health, Nursing Science, University of Basel, Basel, Switzerland
| | - Johan Flamaing
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven, Leuven, Belgium
| | - Marc Sabbe
- Department of Emergency Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Public Health and Primary Care, Emergency Medicine, KU Leuven, Leuven, Belgium
| | - Koen Milisen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium.,Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
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10
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Heckman GA, Saari M, McArthur C, Wellens NIH, Hirdes JP. COVID-19 outbreak measures may indirectly lead to greater burden on hospitals. CMAJ 2020; 192:E384. [PMID: 32392532 DOI: 10.1503/cmaj.75230] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- George A Heckman
- Geriatrician, Schlegel-University of Waterloo Research Institute for Aging, Waterloo, Ont
| | | | - Caitlin McArthur
- Postdoctoral fellow, GERAS Centre for Aging Research, St. Peter's Hospital, Hamilton, Ont
| | - Nathalie I H Wellens
- Program manager, coRAI; research fellow, Centre Qualité et Systèmes, Department of Public Health Services and Social Affairs, Canton Vaud, Switzerland
| | - John P Hirdes
- Health services researcher, University of Waterloo, Waterloo, Ont
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11
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Heeren P, Devriendt E, Fieuws S, Wellens NIH, Deschodt M, Flamaing J, Sabbe M, Milisen K. Unplanned readmission prevention by a geriatric emergency network for transitional care (URGENT): a prospective before-after study. BMC Geriatr 2019; 19:215. [PMID: 31390994 PMCID: PMC6686568 DOI: 10.1186/s12877-019-1233-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/30/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND URGENT is a comprehensive geriatric assessment (CGA) based nurse-led care model in the emergency department (ED) with geriatric follow-up after ED discharge aiming to prevent unplanned ED readmissions. METHODS A quasi-experimental study (sequential design with two cohorts) was conducted in the ED of University Hospitals Leuven (Belgium). Dutch-speaking, community-dwelling ED patients aged 70 years or older were eligible for enrolment. Patients in the control cohort received usual care. Patient in the intervention cohort received the URGENT care model. A geriatric emergency nurse conducted CGA and interdisciplinary care planning among older patients identified as at risk for adverse events (e.g. unplanned ED readmission, functional decline) with the interRAI ED Screener© and clinical judgement of ED staff. Case manager follow-up was offered to at risk patients without hospitalization after index ED visit. For inpatients, geriatric follow-up was guaranteed on an acute geriatric ward or by the inpatient geriatric consultation team on a non-geriatric ward if considered necessary. Primary outcome was unplanned 90-day ED readmission. Secondary outcomes were ED length of stay (LOS), hospitalization rate, in-hospital LOS, 90-day higher level of care, 90-day functional decline and 90-day post-hospitalization mortality. RESULTS Almost half of intervention patients (404/886 = 45.6%) were categorized at risk. These received on average seven advices. Adherence rate to advices on the ED, during hospitalization and in community care was 86.1, 74.6 and 34.1%, respectively. One out of four at risk patients without hospitalization after index ED visit accepted case manager follow-up. Unplanned ED readmission occurred in 170 of 768 (22.1%) control patients and in 205 of 857 (23.9%) intervention patients (p = .11). The intervention group had shorter ED LOS (12.7 h versus 19.1 h in the control group; p < .001), but higher rate of hospitalization (70.0% versus 67.0% in the control group; p = .003). CONCLUSIONS The URGENT care model shortened ED LOS and increased the hospitalization rate, but did not prevent unplanned ED readmissions. A geriatric emergency nurse could improve in-hospital patient management, but failed to introduce substantial out-hospital case-management. TRIAL REGISTRATION The protocol of this study was registered retrospectively with ISRCTN ( ISRCTN91449949 ; registered 20 June 2017).
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Affiliation(s)
- Pieter Heeren
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35/4, 3000, Leuven, Belgium.,Department of Geriatric Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.,Research Foundation Flanders, Egmontstraat 5, 1000, Brussels, Belgium
| | - Els Devriendt
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35/4, 3000, Leuven, Belgium.,Department of Geriatric Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Steffen Fieuws
- I-Biostat, Interuniversity Institute for Biostatistics and statistical Bioinformatics KU Leuven, Kapucijnenvoer 35/3, 3000, Leuven, Belgium
| | - Nathalie I H Wellens
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35/4, 3000, Leuven, Belgium.,Public Health and Social Affairs Department, Government Canton Vaud, Avenue des Casernes 2, 1014, Lausanne, Switzerland
| | - Mieke Deschodt
- Department of Chronic Diseases, Metabolism and Ageing, Gerontology and Geriatrics, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Public Health, Nursing Science, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Johan Flamaing
- Department of Geriatric Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Chronic Diseases, Metabolism and Ageing, Gerontology and Geriatrics, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Marc Sabbe
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Public Health and Primary Care, Emergency Medicine, KU Leuven, Kapucijnenvoer 35/4, 3000, Leuven, Belgium
| | - Koen Milisen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35/4, 3000, Leuven, Belgium. .,Department of Geriatric Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
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12
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Zúñiga F, De Geest S, Guerbaai RA, Basinska K, Nicca D, Kressig RW, Zeller A, Wellens NIH, De Pietro C, Vlaeyen E, Desmedt M, Serdaly C, Simon M. Strengthening Geriatric Expertise in Swiss Nursing Homes: INTERCARE Implementation Study Protocol. J Am Geriatr Soc 2019; 67:2145-2150. [PMID: 31317544 DOI: 10.1111/jgs.16074] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 06/15/2019] [Accepted: 06/22/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Nursing home (NH) residents with complex care needs ask for attentive monitoring of changes and appropriate in-house decision making. However, access to geriatric expertise is often limited with a lack of geriatricians, general practitioners, and/or nurses with advanced clinical skills, leading to potentially avoidable hospitalizations. This situation calls for the development, implementation, and evaluation of innovative, contextually adapted nurse-led care models that support NHs in improving their quality of care and reducing hospitalizations by investing in effective clinical leadership, geriatric expertise, and care coordination. DESIGN An effectiveness-implementation hybrid type 2 design to assess clinical outcomes of a nurse-led care model and a mixed-method approach to evaluate implementation outcomes will be applied. The model development, tailoring, and implementation are based on the Consolidated Framework for Implementation Research (CFIR). SETTING NHs in the German-speaking region of Switzerland. PARTICIPANTS Eleven NHs were recruited. The sample size was estimated assuming an average of .8 unplanned hospitalizations/1000 resident days and a reduction of 25% in NHs with the nurse-led care model. INTERVENTION The multilevel complex context-adapted intervention consists of six core elements (eg, specifically trained INTERCARE nurses or evidence-based tools like Identify, Situation, Background, Assessment and Recommendation [ISBAR]). Multilevel implementation strategies include leadership and INTERCARE nurse training and support. MEASUREMENTS The primary outcomes are unplanned hospitalizations/1000 care days. Secondary outcomes include unplanned emergency department visits, quality indicators (eg, physical restraint use), and costs. Implementation outcomes included, for example, fidelity to the model's core elements. CONCLUSION The INTERCARE study will provide evidence about the effectiveness of a nurse-led care model in the real-world setting and accompanying implementation strategies. J Am Geriatr Soc 67:2145-2150, 2019.
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Affiliation(s)
- Franziska Zúñiga
- Department Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Sabina De Geest
- Department Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland.,Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Raphaëlle Ashley Guerbaai
- Department Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Kornelia Basinska
- Department Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Dunja Nicca
- Department Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland.,Department of Nursing and Allied Health Professions, University Hospital Basel, Basel, Switzerland
| | - Reto W Kressig
- University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Andreas Zeller
- Faculty of Medicine, University of Basel, Basel, Switzerland.,Center for Primary Health Care, University of Basel, Basel, Switzerland
| | - Nathalie I H Wellens
- Department of Public Health and Social Affairs of the Canton of Vaud, Lausanne, Switzerland
| | - Carlo De Pietro
- Department of Business Economics, Health and Social Care at the University of Applied Sciences and Arts of Southern Switzerland, Lugano, Switzerland
| | - Ellen Vlaeyen
- Department Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland.,Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Mario Desmedt
- Foundation Asile des Aveugles, Lausanne, Switzerland
| | | | - Michael Simon
- Department Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Basel, Switzerland.,Inselspital Bern University Hospital, Nursing & Midwifery Research Unit, Bern, Switzerland
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13
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Devriendt E, Heeren P, Fieuws S, Wellens NIH, Deschodt M, Flamaing J, Sabbe M, Milisen K. Unplanned Readmission prevention by Geriatric Emergency Network for Transitional care (URGENT): protocol of a prospective single centre quasi-experimental study. BMC Geriatr 2018; 18:244. [PMID: 30326860 PMCID: PMC6191899 DOI: 10.1186/s12877-018-0933-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 10/01/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND International guidelines recommend adapting the classic emergency department (ED) management model to the needs of older adults in order to ameliorate post-ED outcomes among this vulnerable group. To improve the care for older ED patients and especially prevent unplanned ED readmissions, the URGENT care model was developed. METHODS The URGENT care model is a nurse-led, comprehensive geriatric assessment based care model in the ED with geriatric follow-up after ED discharge. A prospective single centre quasi-experimental study (sequential design with two cohorts) is used to evaluate its effectiveness on unplanned ED readmission compared to usual ED care. Secondary outcome measures are hospitalization rate, ED length of stay, in-hospital length of stay, higher level of care, functional decline and mortality. DISCUSSION URGENT builds on previous research with adaptations tailored to the local context and addresses the needs of older patients in the ED with a special focus on transition of care. Although the selected approaches have been tested in other settings, evidence on this type of innovative care models in the ED setting is inconclusive. TRIAL REGISTRATION The study protocol is registered retrospectively with ISRCTN ( ISRCTN91449949 ).
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Affiliation(s)
- Els Devriendt
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35/4, B-3000 Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Pieter Heeren
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35/4, B-3000 Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
- Research Foundation Flanders, Egmontstraat 5, 1000 Brussels, Belgium
| | - Steffen Fieuws
- I-Biostat Interuniversity Institute for Biostatistics and statistical Bioinformatics KU Leuven, Kapucijnenvoer 35/3, 3000 Leuven, Belgium
| | - Nathalie I. H. Wellens
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35/4, B-3000 Leuven, Belgium
- Public Health and Social Affairs Department, Government Canton Vaud, Avenue des Casernes 2, 1014 Lausanne, Switzerland
| | - Mieke Deschodt
- Department of Chronic Diseases, Metabolism and Ageing, Gerontology and Geriatrics, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Public Health, Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Johan Flamaing
- Department of Geriatric Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Chronic Diseases, Metabolism and Ageing, Gerontology and Geriatrics, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Marc Sabbe
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Public Health and Primary Care, Emergency Medicine, KU Leuven, Kapucijnenvoer 35/4, 3000 Leuven, Belgium
| | - Koen Milisen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35/4, B-3000 Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
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14
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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15
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Foebel A, Ballokova A, Wellens NIH, Fialova D, Milisen K, Liperoti R, Hirdes JP. A retrospective, longitudinal study of factors associated with new antipsychotic medication use among recently admitted long-term care residents. BMC Geriatr 2015; 15:128. [PMID: 26482028 PMCID: PMC4615888 DOI: 10.1186/s12877-015-0127-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 10/12/2015] [Indexed: 12/01/2022] Open
Abstract
Background Use of antipsychotic (AP) medications is high and often inappropriate among institutionalized populations. Little is known about the correlates of new AP drug use following admission to long-term care (LTC) settings. This study investigated the frequency and correlates of new AP drug use among newly admitted LTC residents. Methods This longitudinal, retrospective study used data from the interRAI - Nursing Home Minimum Data Set version 2.0 (MDS 2.0) instrument. Data about demographic, clinical and social characteristics, and medication use, were collected in Ontario, Canada, from 2003–2011 by trained nurses. Residents with complete admission and 3–6 month follow-up data were included (N = 47,768). Multivariate logistic regression analyses, stratified by gender, explored correlates of new AP drug use upon admission to LTC. Results New AP drug users comprised 7 % of the final cohort. Severe cognitive impairment, dementia, and motor agitation were significantly associated with new AP drug use among both sexes. Additionally, behavioural problems, conflicts with staff and reduced social engagement were strong correlates of new AP drug use. Conclusions Social factors were as strongly associated with new AP drug use after LTC admission as clinical factors. Strategies to prevent the potential misuse of AP drugs upon LTC admission should consider the social determinants of such prescribing.
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Affiliation(s)
- Andrea Foebel
- Department of Medical Epidemiology and Biostatistics Karolinska Institutet, Nobels väg 12A, Stockholm, Sweden. .,School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada.
| | - Anna Ballokova
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Nathalie I H Wellens
- Department of Public Health and Primary Care, Center for Health Services and Nursing Research, KULeuven, Leuven, Belgium. .,Geriatrics Center and Institute of Gerontology, University of Michigan, Ann Arbor, MI, USA.
| | - Daniela Fialova
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic. .,Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Prague, Czech Republic.
| | - Koen Milisen
- Department of Public Health and Primary Care, Center for Health Services and Nursing Research, KULeuven, Leuven, Belgium. .,Division of Geriatric Medicine, Leuven University Hospital, Herestraat 49, Leuven, 3000, Belgium.
| | - Rosa Liperoti
- Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - John P Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada.
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16
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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.
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17
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Wellens NIH, Flamaing J, Tournoy J, Hanon T, Moons P, Verbeke G, Boonen S, Milisen K. Convergent validity of the Cognitive Performance Scale of the interRAI acute care and the mini-mental state examination. Am J Geriatr Psychiatry 2013; 21:636-45. [PMID: 23567408 DOI: 10.1016/j.jagp.2012.12.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 10/14/2011] [Accepted: 11/30/2011] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The Cognitive Performance Scale (CPS) is generated from five items of the interRAI/ Minimum Data Set instruments, a comprehensive geriatric assessment method. CPS was initially designed to assess cognition in residential care, where it has shown good psychometric performance. We evaluated the performance of the interRAI Acute Care in identifying cognitive impairment among patients hospitalized on acute geriatric wards. METHODS An observational study was conducted on two geriatric wards. Trained raters independently completed the interRAI Acute Care and the Mini-Mental State Examination (MMSE) in 97 inpatients (85 ± 5 years; 67% female). The level of agreement between CPS and MMSE was explored using comparisons of means, agreement coefficients, and diagnostic accuracy. RESULTS Cognitive impairment was present in 61% of the participants. Average MMSE scores were significantly different between groups with low CPS scores compared with those with high CPS scores (p <0.05). CPS explained only 48.8% of the variability in MMSE. Agreement in defining cognitively impaired subjects was moderate (percentage observed agreement, 68%; κ = 0.41). With MMSE score less than 24 as a gold standard, diagnostic accuracy of CPS was moderate (area under curve = 0.73), with low sensitivity, but excellent specificity. When lowering the MMSE cutoff to less than 18 and focusing on patients with severe cognitive impairment, CPS agreement coefficients and sensitivity increased but specificity decreased. Using education-adjusted MMSE cutoffs did not substantially affect the results. CONCLUSION CPS can be used for coarse triage between intact and severe cognitive impairment. Although promising results have been obtained in residential and community settings, our results suggest that CPS fails to differentiate across different levels of cognitive impairment in hospitalized geriatric patients.
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Affiliation(s)
- Nathalie I H Wellens
- Department of Public Health, Center for Health Services and Nursing Research, KU Leuven, Leuven, Belgium.
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18
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Wellens NIH, Verbeke G, Flamaing J, Moons P, Boonen S, Tournoy J, Milisen K. Clinical changes in older adults during hospitalization: responsiveness of the interRAI acute care instrument. J Am Geriatr Soc 2013; 61:799-804. [PMID: 23590203 DOI: 10.1111/jgs.12208] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the responsiveness of the Minimum Data Set interRAI Acute Care (AC), a comprehensive geriatric assessment system, to detect clinical changes in patient status during hospital stays. DESIGN An explorative secondary data-analysis comparing prospectively collected data with the interRAI AC before hospitalization, upon admission, and at discharge. SETTING Clinicians from multiple disciplines in nine geriatric and eight nongeriatric wards of nine acute hospitals performed the assessment. PARTICIPANTS The interRAI AC was administered serially to 256 geriatric inpatients (aged 83.2 ± 5.2; 60% female). MEASUREMENTS Responsiveness (capacity to detect changes in patients) was calculated for the output scales on five domains: activities of daily living (ADLs), cognition, communication, depressive symptoms, and pain. Internal responsiveness was evaluated using the Friedman test and Guyatt technique. RESULTS Significant differences in clinical status were found for all five domains, based on the Friedman test. Post hoc tests revealed differences between each assessment period, except for cognition and communication from admission to discharge and for depressive symptoms from before admission to discharge. The Guyatt Responsiveness Index showed good to excellent capacity to detect longitudinal changes during hospitalization for cognition, communication, and pain and substantial performance for ADLs and depressive symptoms. CONCLUSION In older inpatients, fluctuations in ADLs, cognition, communication, depressive symptoms, and pain can be captured using the interRAI AC output scales, enabling clinicians to evaluate longitudinal changes from admission to discharge and to provide a comparison with patient status before the acute onset of the illness. These results support the use of these scales in geriatric and nongeriatric wards.
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Affiliation(s)
- Nathalie I H Wellens
- Department of Public Health and Primary Care, Center for Health Services and Nursing Research, KU Leuven, Leuven, Belgium
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Wellens NIH, Flamaing J, Moons P, Deschodt M, Boonen S, Milisen K. Translation and adaption of the interRAI Suite to local requirements in Belgian hospitals. BMC Geriatr 2012; 12:53. [PMID: 22958520 PMCID: PMC3492186 DOI: 10.1186/1471-2318-12-53] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 08/31/2012] [Indexed: 12/02/2022] Open
Abstract
Background The interRAI Suite contains comprehensive geriatric assessment tools designed for various healthcare settings. Although each instrument is developed for a particular population, together they form an integrated health evaluation system. The interRAI Acute Care Minimum Data Set (interRAI AC) is tailored for hospitalized older persons. Our aim in this study was to translate and adapt the interRAI AC to the Belgian hospital context, where it can be used together with the interRAI Home Care (HC) and the interRAI Long Term Care Facility (LTCF). Methods A systematic, comprehensive, and rigorous 10-step approach was used to adapt the interRAI AC to local requirements. After linguistic translation by an official translator, five researchers assessed the translation for appropriate hospital jargon. Three researchers double-checked for translation accuracy and proposed additional items. A provisional version was converted into the three official languages of Belgium—Flemish, French, and German. Next, a multidisciplinary panel of nine experts judged item relevance to the Belgian care context and advised which country-specific items should be added. After these suggestions were incorporated into the interRAI AC, hospital staff from nine Flemish hospitals field-tested the tool in their practice. After evaluating field-test results, we compared the interRAI AC with Belgian versions of the interRAI HC and interRAI LTCF. Next, the Flemish, French, and German versions of the Belgian interRAI portfolio were harmonized. Finally, we submitted the Belgian interRAI AC to the interRAI organization for ratification. Results Eighteen administrative items of the interRAI AC were adapted to the Belgian healthcare context (e.g., usual residence, formal community services prior to admission). Fourteen items assessing the ‘informal caregiver’, and 17 items, including country-specific items, were added (e.g., advanced directive for euthanasia). Conclusions The interRAI AC was adapted to local requirements using a meticulous and recursive 10-step approach. As use of the interRAI Suite continues to grow worldwide and as it continues to expand to other care settings and populations, this procedure can guide future translations. This procedure might also be used by others facing similar challenges of complex translation and adaptation situations, where multidimensional instruments are used across multiple care settings in multiple languages.
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Affiliation(s)
- Nathalie I H Wellens
- Center for Health Services and Nursing Research, Kapucijnenvoer 35 - PB 7001/4, B-3000, Leuven, Belgium
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Wellens NIH, Milisen K, Flamaing J, Moons P. Methods to assess the reliability of the interRAI Acute Care: a framework to guide clinimetric testing. Part II. J Eval Clin Pract 2012; 18:822-7. [PMID: 21518399 DOI: 10.1111/j.1365-2753.2011.01685.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The interRAI Acute Care is a comprehensive geriatric assessment tool that provides a holistic picture of complex and frail hospitalized older persons. It is designed to support holistic care planning and to transfer patient data across settings. Its usefulness in clinical decision making depends on the extent to which clinicians can rely on the patient data as accurate and meaningful indicators of patients functioning. But its multidimensional character implies challenges for clinimetric testing as some of the traditional analyses techniques cannot be unconditionally applied. The objective was to present an overview of methods to examine the reliability of the interRAI Acute Care. For each line of evidence, examples of hypotheses and research questions are listed.
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Affiliation(s)
- Nathalie I H Wellens
- Centre for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium.
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Abstract
The objective was to present an overview of methods to examine the validity of the minimum data set of the interRAI Acute Care (interRAI AC). Because of the multidimensional character of this comprehensive geriatric assessment tool, clinimetric testing of the interRAI AC can be more complex than that of one-dimensional instruments. Thus to facilitate testing of the interRAI AC, we translated this complexity into a structured methodological framework that outlines procedures to assess various lines of evidence. Our framework combined traditional clinimetric techniques and the standards of psychological testing. For each line of evidence, examples of hypotheses and research questions were summarized. Future clinimetric testing can use these guidelines as a basis to obtain and provide a wide and diverse body of evidence.
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Affiliation(s)
- Nathalie I H Wellens
- Centre for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium.
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Devriendt E, Van den Heede K, Coussement J, Dejaeger E, Surmont K, Heylen D, Schwendimann R, Sexton B, Wellens NIH, Boonen S, Milisen K. Content validity and internal consistency of the Dutch translation of the Safety Attitudes Questionnaire: an observational study. Int J Nurs Stud 2011; 49:327-37. [PMID: 22035966 DOI: 10.1016/j.ijnurstu.2011.10.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 08/29/2011] [Accepted: 10/02/2011] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patient safety is fundamental to healthcare quality. Attention has recently focused on the patient safety culture of an organisation and its impact on patient outcomes. A strong safety climate appears to be an essential condition for safe patient care in the hospital. A number of instruments are used to measure this patient safety climate or culture. The Safety Attitudes Questionnaire is a validated, widely used instrument to investigate multiple dimensions of safety climate at the clinical level in a variety of inpatient and outpatient settings. OBJECTIVES The purpose of this study is to explore the face- and content validity and the internal consistency of the Safety Attitudes Questionnaire in a large Belgian academic medical center. METHOD The translation into Dutch was done by three researchers. A panel of fifteen Dutch speaking experts evaluated the translation and its content validity. Content validity was quantified by the content validity index (CVI) and a modified kappa index. Face validity was evaluated by two nurses and two physicians who assessed the Dutch version of the SAQ. A cross-sectional design was used to test internal consistency of the SAQ items by calculating Cronbach's alpha and corrected item-total correlations. RESULTS Twenty-three of the 33 SAQ items showed excellent and seven items showed good content validity. One item had a fair kappa value (item 20) and two items had a low content validity index (items 15 and 16). The average CVI of the total scale was 0.83 and ranged from 0.55 to 0.97 for the six subscales. The face-validity was good with no fundamental remarks given. The SAQ's overall Cronbach's alpha was 0.9 and changed minimally when removing items. The item-total correlations ranged from 0.10 to 0.63, no single items were strongly correlated with the sum of the other items. CONCLUSION We conclude that in this study the Dutch version of the Safety Attitudes Questionnaire showed acceptable to good psychometric properties. In line with previous evidence, this instrument seems to be an acceptable to adequate tool to evaluate the safety climate.
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Affiliation(s)
- Els Devriendt
- Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium.
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Wellens NIH, Deschodt M, Boonen S, Flamaing J, Gray L, Moons P, Milisen K. Validity of the interRAI Acute Care based on test content: a multi-center study. Aging Clin Exp Res 2011; 23:476-86. [PMID: 22526080 DOI: 10.1007/bf03325244] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND AIMS The MDS inter- RAI Acute Care is a comprehensive geriatric assessment tool for hospitalized older persons. The aim was to examine its validity based on test content by use in daily clinical practice. METHODS Clinical staff of multiple disciplines assessed 256 older persons (83.2±5.2 years; 60% female) in a cross-sectional multicenter study in nine acute hospitals. Test content was empirically tested by frequency distribution of clinical deficits, missing, and invalid data. Item relevance was quantified by the content validity index (CVI) and modified kappa statistics (κ*) based on assessors' judgment. RESULTS Clinical deficits exceeded 30% in the majority of items (67%) across all assessment periods. Mean missing data for premorbid, admission, day-14 and discharge assessments were 9.7%, 5.3%, 29.3% and 13.7%, respectively. Invalid scores ranged from 3.9% to 26.7%. Of the 98 items, 82 had excellent CVI (≥0.78). Item relevance was excellent for 82 (κ*≥0.75), good for 9 (0.60≤κ*≤0.74) and fair for 3 items (0.40≤κ*<0.60). Item revision may optimize clinical relevance: removing 4 items with poor relevance would increase the overall CVI from 0.89 to 0.91, meeting the standard of excellent content validity (CVIaverage≥0.90). CONCLUSIONS Although the frequency distribution provides evidence that item selection of the interRAI Acute Care is appropriate for the targeted population, its use in a clinical context reveals a substantial number of missing and invalid data. To improve validity, training should pay specific attention to items with low compliance and invalid records. Software applications should also be designed to improve data quality.
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Deschodt M, Wellens NIH, Braes T, De Vuyst A, Boonen S, Flamaing J, Moons P, Milisen K. Prediction of functional decline in older hospitalized patients: a comparative multicenter study of three screening tools. Aging Clin Exp Res 2011; 23:421-6. [PMID: 22526073 DOI: 10.1007/bf03325237] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS Older hospitalized patients are at risk of functional decline, which is associated with several negative outcomes. The aim of this study was to compare the predictive accuracy of the Identification of Seniors At Risk (ISAR), Variable Indicative for Placement risk (VIP) and the Flemish version of the Triage Risk Screening Tool (TRST) in predicting functional decline. METHODS A prospective cohort study with 30 days follow-up in geriatric, medical and surgical wards in 25 hospitals was conducted. 752 participants aged 75 years or older were eligible for inclusion. Baseline data were gathered within 72 hours of admission. Functional decline was defined as an increase of one point or more from the premorbid Katz score to the score 30 days post-discharge. Positive predictive value (PPV) and negative predictive value (NPV) were calculated on 2 x 2 tables as well as by Bayes' theorem. RESULTS Functional decline at 30 days postdischarge was observed in 279 participants (39%). ISAR and Flemish TRST showed high sensitivity (88% - 78%) and fair NPV (62% - 67%), but low specificity (19% - 30%) and low PPV (47% - 48%) using the original cut-off of ≥ 2. The sensitivity of VIP with cut-off ≥ 2 was too low (62%), but could be optimized with cut-off ≥ 1, showing sensitivity, specificity, PPV and NPV of 88%, 21%, 48% and 68%, respectively. Accuracy varied between 40% and 61% for all instruments on all calculated cut-offs. CONCLUSIONS All three instruments performed similarly well, showing good sensitivity and fair NPV, the two major characteristics for good screening tools. False positives could be filtered out according to the clinical expert opinion of a care team.
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Affiliation(s)
- Mieke Deschodt
- Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Kapucijnenvoer 35/4, B-3000 Leuven, Belgium
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Wellens NIH, Deschodt M, Flamaing J, Moons P, Boonen S, Boman X, Gosset C, Petermans J, Milisen K. First-generation versus third-generation comprehensive geriatric assessment instruments in the acute hospital setting: a comparison of the Minimum Geriatric Screening Tools (MGST) and the interRAI Acute Care (interRAI AC). J Nutr Health Aging 2011; 15:638-44. [PMID: 21968858 DOI: 10.1007/s12603-011-0109-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Comparison of the first-generation Minimum Geriatric Screening Tools (MGST) and the third-generation interRAI Acute Care (interRAI AC). DESIGN Based on a qualitative multiphase exchange of expert opinion, published evidence was critically analyzed and translated into a consensus. RESULTS Both methods are intended for a multi-domain geriatric assessment in acute hospital settings, but each with a different scope and goal. MGST contains a collection of single-domain, internationally validated instruments. Assessment is usually triggered by care givers' clinical impression based on geriatric expertise. A limited selection of domains is usually assessed only once, by disciplines with domain-specific expertise. Clinical use results in improvement to screen geriatric problems. InterRAI AC, tailored for acute settings, intends to screen a large number of geriatric domains. Based on systematic observational data, risk domains are triggered and clinical guidelines are suggested. Multiple observation periods outline the evolution of patients' functioning over stay in comparison to the premorbid situation. The method is appropriate for application on geriatric and non-geriatric wards, filling geriatric knowledge gaps. The interRAI Suite contains a common set of standardized items across settings, facilitating data transfer in transitional care. CONCLUSION The third-generation interRAI AC has advantages compared to the first-generation MGST. A cascade system is proposed to integrate both, complementary methods in practice. The systematic interRAI AC assessment detects risk domains. Subsequently, clinical protocols suggest components of the MGST as additional assessment. This cascade approach unites the strength of exhaustive assessment of the interRAI AC with domain-specific tools of the MGST.
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Affiliation(s)
- N I H Wellens
- Centre for Health Services and Nursing Research, Katholieke Universiteit Leuven, Belgium
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