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Sorensen J, Kadowaki L, Kervin L, Hamilton C, Berndt A, Dhadda S, Irfan A, Leong E, Mithani A. Quality improvement collaborative approach to COVID-19 pandemic preparedness in long-term care homes: a mixed-methods implementation study. BMJ Open Qual 2024; 13:e002589. [PMID: 38589056 PMCID: PMC11015329 DOI: 10.1136/bmjoq-2023-002589] [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: 09/02/2023] [Accepted: 03/12/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND The devastating impact of the COVID-19 pandemic on long-term care (LTC) homes underscores the importance of effective pandemic preparedness and response. This mixed-methods, implementation science study investigated how a virtual-based quality improvement (QI) collaborative approach can improve uptake of pandemic-related promising practices and shared learning across six LTC homes in British Columbia, Canada in 2021 during the COVID-19 pandemic health emergency. METHODS QI teams consisting of residents, family/informal caregivers, care providers and leadership in LTC homes are supported by QI facilitation and shared learning through virtual communication platforms. QI projects address gaps in outbreak preparation, prevention and response; planning for care; staffing; and family presence. Thematically analysed semi-structured qualitative interviews and a validated questionnaire on organisational readiness investigated participants' perceptions of challenges, success factors and benefits of participating in the virtual QI collaborative approach. RESULTS Nine themes were identified through interview analysis, including two related to challenges (ie, making time for QI and hands tied by external forces), four regarding factors for successes (ie, team buy-in, working together as a team, bringing together diverse perspectives and facilitators keep us on track) and three on the benefits of the QI collaborative approach (ie, seeing improvements, staff empowerment and appetite for change). Continuous QI facilitation and coaching for QI teams was feasible and sustainable virtually via video conferencing (Zoom). The QI team members showed limited engagement on the virtual communication platform (Slack), which was predominantly used by the implementation science team and QI facilitators to coordinate the study and QI projects, respectively. CONCLUSIONS The virtual-based QI collaborative approach to pandemic preparedness supported LTC homes to rapidly and successfully form multidisciplinary QI teams, learn about QI methods and conduct timely QI projects to implement promising practice for improved COVID-19 pandemic response.
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Affiliation(s)
- Janice Sorensen
- Long-Term Care and Assisted Living, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Laura Kadowaki
- Long-Term Care and Assisted Living, Fraser Health Authority, Surrey, British Columbia, Canada
- Simon Fraser University Gerontology Research Centre, Vancouver, British Columbia, Canada
| | - Lucy Kervin
- Long-Term Care and Assisted Living, Fraser Health Authority, Surrey, British Columbia, Canada
- Simon Fraser University Gerontology Research Centre, Vancouver, British Columbia, Canada
| | - Clayon Hamilton
- Long-Term Care and Assisted Living, Fraser Health Authority, Surrey, British Columbia, Canada
- Simon Fraser University, Burnaby, British Columbia, Canada
| | - Annette Berndt
- Long-Term Care and Assisted Living Research Partners Group, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Simran Dhadda
- Long-Term Care and Assisted Living, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Abeera Irfan
- Long-Term Care and Assisted Living, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Emma Leong
- Long-Term Care and Assisted Living, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Akber Mithani
- Long-Term Care and Assisted Living, Fraser Health Authority, Surrey, British Columbia, Canada
- Department of Psychiatry, The University of British Columbia, Vancouver, British Columbia, Canada
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Albasha N, Ahern L, O’Mahony L, McCullagh R, Cornally N, McHugh S, Timmons S. Implementation strategies to support fall prevention interventions in long-term care facilities for older persons: a systematic review. BMC Geriatr 2023; 23:47. [PMID: 36698065 PMCID: PMC9878796 DOI: 10.1186/s12877-023-03738-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Falls are common among older people in long-term care facilities (LTCFs). Falls cause considerable morbidity, mortality and reduced quality of life. Of numerous interventional studies of fall prevention interventions in LTCFs, some reduced falls. However, there are challenges to implementing these interventions in real-world (non-trial) clinical practice, and the implementation techniques may be crucial to successful translation. This systematic review thus aimed to synthesise the evidence on implementation strategies, implementation outcomes and clinical outcomes included in fall prevention intervention studies. METHODS A systematic search of six electronic databases (PubMed, CINAHL, EMBASE, PsycINFO, SCOPUS, Web of Science) and eight grey literature databases was conducted, involving papers published during 2001-2021, in English or Arabic, targeting original empirical studies of fall prevention interventions (experimental and quasi-experimental). Two seminal implementation frameworks guided the categorisation of implementation strategies and outcomes: the Expert Recommendations for Implementing Change (ERIC) Taxonomy and the Implementation Outcomes Framework. Four ERIC sub-categories and three additional implementation strategies were created to clarify overlapping definitions and reflect the implementation approach. Two independent researchers completed title/abstract and full-text screening, quality appraisal assessment, data abstraction and coding of the implementation strategies and outcomes. A narrative synthesis was performed to analyse results. RESULTS Four thousand three hundred ninety-seven potential papers were identified; 31 papers were included, describing 27 different fall prevention studies. These studies used 39 implementation strategies (3-17 per study). Educational and training strategies were used in almost all (n = 26), followed by evaluative strategies (n = 20) and developing stakeholders' interrelationships (n = 20). Within educational and training strategies, education outreach/meetings (n = 17), distributing educational materials (n = 17) and developing educational materials (n = 13) were the most common, with 36 strategies coded to the ERIC taxonomy. Three strategies were added to allow coding of once-off training, dynamic education and ongoing medical consultation. Among the 15 studies reporting implementation outcomes, fidelity was the most common (n = 8). CONCLUSION This is the first study to comprehensively identify the implementation strategies used in falls prevention interventions in LTCFs. Education is the most common implementation strategy used in this setting. This review highlighted that there was poor reporting of the implementation strategies, limited assessment of implementation outcomes, and there was no discernible pattern of implementation strategies used in effective interventions, which should be improved and clearly defined. TRIAL REGISTRATION This systematic review was registered on the PROSPERO database; registration number: CRD42021239604.
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Affiliation(s)
- Neah Albasha
- grid.7872.a0000000123318773Center for Gerontology and Rehabilitation, School of Medicine, University College Cork, St Finbarr’s Hospital, The Bungalow, Block 13, Douglas Road, Cork City, Ireland ,grid.449346.80000 0004 0501 7602Rehabilitation Department, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Leanne Ahern
- grid.7872.a0000000123318773School of Clinical Therapies, University College Cork, Cork City, Ireland
| | - Lauren O’Mahony
- grid.7872.a0000000123318773Center for Gerontology and Rehabilitation, School of Medicine, University College Cork, St Finbarr’s Hospital, The Bungalow, Block 13, Douglas Road, Cork City, Ireland
| | - Ruth McCullagh
- grid.7872.a0000000123318773School of Clinical Therapies, University College Cork, Cork City, Ireland
| | - Nicola Cornally
- grid.7872.a0000000123318773School of Nursing and Midwifery, University College Cork, Cork City, Ireland
| | - Sheena McHugh
- grid.7872.a0000000123318773School of Public Health, University College Cork, Cork City, Ireland
| | - Suzanne Timmons
- grid.7872.a0000000123318773Center for Gerontology and Rehabilitation, School of Medicine, University College Cork, St Finbarr’s Hospital, The Bungalow, Block 13, Douglas Road, Cork City, Ireland
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Toles M, Colón-Emeric C, Moreton E, Frey L, Leeman J. Quality improvement studies in nursing homes: a scoping review. BMC Health Serv Res 2021; 21:803. [PMID: 34384404 PMCID: PMC8361800 DOI: 10.1186/s12913-021-06803-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 07/20/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Quality improvement (QI) is used in nursing homes (NH) to implement and sustain improvements in patient outcomes. Little is known about how QI strategies are used in NHs. This lack of information is a barrier to replicating successful strategies. Guided by the Framework for Implementation Research, the purpose of this study was to map-out the use, evaluation, and reporting of QI strategies in NHs. METHODS This scoping review was completed to identify reports published between July 2003 through February 2019. Two reviewers screened articles and included those with (1) the term "quality improvement" to describe their methods, or reported use of a QI model (e.g., Six Sigma) or strategy (e.g., process mapping) (2), findings related to impact on service and/or resident outcomes, and (3) two or more NHs included. Reviewers extracted data on study design, setting, population, problem, solution to address problem, QI strategies, and outcomes (implementation, service, and resident). Vote counting and narrative synthesis were used to describe the use of QI strategies, implementation outcomes, and service and/or resident outcomes. RESULTS Of 2302 articles identified, the full text of 77 articles reporting on 59 studies were included. Studies focused on 23 clinical problems, most commonly pressure ulcers, falls, and pain. Studies used an average of 6 to 7 QI strategies. The rate that strategies were used varied substantially, e.g., the rate of in-person training (55%) was more than twice the rate of plan-do-study-act cycles (20%). On average, studies assessed two implementation outcomes; the rate these outcomes were used varied widely, with 37% reporting on staff perceptions (e.g., feasibility) of solutions or QI strategies vs. 8% reporting on fidelity and sustainment. Most studies (n = 49) reported service outcomes and over half (n = 34) reported resident outcomes. In studies with statistical tests of improvement, service outcomes improved more often than resident outcomes. CONCLUSIONS This study maps-out the scope of published, peer-reviewed studies of QI in NHs. The findings suggest preliminary guidance for future studies designed to promote the replication and synthesis of promising solutions. The findings also suggest strategies to refine procedures for more effective improvement work in NHs.
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Affiliation(s)
- Mark Toles
- University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | | | | | - Lauren Frey
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Jennifer Leeman
- University of North Carolina at Chapel Hill, Chapel Hill, USA
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Devi R, Chadborn NH, Meyer J, Banerjee J, Goodman C, Dening T, Gladman JRF, Hinsliff-Smith K, Long A, Usman A, Housley G, Lewis S, Glover M, Gage H, Logan PA, Martin FC, Gordon AL. How quality improvement collaboratives work to improve healthcare in care homes: a realist evaluation. Age Ageing 2021; 50:1371-1381. [PMID: 33596305 PMCID: PMC8522714 DOI: 10.1093/ageing/afab007] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Quality improvement collaboratives (QICs) bring together multidisciplinary teams in a structured process to improve care quality. How QICs can be used to support healthcare improvement in care homes is not fully understood. METHODS A realist evaluation to develop and test a programme theory of how QICs work to improve healthcare in care homes. A multiple case study design considered implementation across 4 sites and 29 care homes. Observations, interviews and focus groups captured contexts and mechanisms operating within QICs. Data analysis classified emerging themes using context-mechanism-outcome configurations to explain how NHS and care home staff work together to design and implement improvement. RESULTS QICs will be able to implement and iterate improvements in care homes where they have a broad and easily understandable remit; recruit staff with established partnership working between the NHS and care homes; use strategies to build relationships and minimise hierarchy; protect and pay for staff time; enable staff to implement improvements aligned with existing work; help members develop plans in manageable chunks through QI coaching; encourage QIC members to recruit multidisciplinary support through existing networks; facilitate meetings in care homes and use shared learning events to build multidisciplinary interventions stepwise. Teams did not use measurement for change, citing difficulties integrating this into pre-existing and QI-related workload. CONCLUSIONS These findings outline what needs to be in place for health and social care staff to work together to effect change. Further research needs to consider ways to work alongside staff to incorporate measurement for change into QI.
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Affiliation(s)
- Reena Devi
- School of Healthcare, University of Leeds,
Leeds, UK
| | - Neil H Chadborn
- School of Medicine, University of Nottingham,
Nottingham, UK
- NIHR Applied Research Collaboration - East Midlands
(ARC-EM), UK
| | - Julienne Meyer
- School of Health Sciences, City University of
London, London, UK
| | - Jay Banerjee
- University Hospitals of Leicester NHS Trust,
University of Leicester, Leicester, and Loughborough University,
Loughborough, UK
| | - Claire Goodman
- School of Health and Social Work, University of
Hertfordshire, Hatfield, UK
- NIHR Applied Research Collaboration – East of England
(ARC-EoE), UK
| | - Tom Dening
- School of Medicine, University of Nottingham,
Nottingham, UK
| | - John R F Gladman
- School of Medicine, University of Nottingham,
Nottingham, UK
- NIHR Applied Research Collaboration - East Midlands
(ARC-EM), UK
- NIHR Nottingham Biomedical Research Centre,
Nottingham, UK
| | | | - Annabelle Long
- School of Medicine, University of Nottingham,
Nottingham, UK
| | - Adeela Usman
- School of Medicine, University of Nottingham,
Nottingham, UK
| | - Gemma Housley
- Nottingham University Hospitals NHS Trust,
Nottingham, UK
| | - Sarah Lewis
- School of Medicine, University of Nottingham,
Nottingham, UK
| | - Matthew Glover
- Surrey Health Economics Centre, University of
Surrey, Guildford, UK
| | - Heather Gage
- Surrey Health Economics Centre, University of
Surrey, Guildford, UK
| | - Philippa A Logan
- School of Medicine, University of Nottingham,
Nottingham, UK
- NIHR Applied Research Collaboration - East Midlands
(ARC-EM), UK
- NIHR Nottingham Biomedical Research Centre,
Nottingham, UK
- Nottingham CityCare Partnership, NHS Provider
Service, Nottingham, UK
| | | | - Adam L Gordon
- School of Medicine, University of Nottingham,
Nottingham, UK
- NIHR Applied Research Collaboration - East Midlands
(ARC-EM), UK
- School of Health Sciences, City University of
London, London, UK
- NIHR Nottingham Biomedical Research Centre,
Nottingham, UK
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5
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Chadborn NH, Devi R, Hinsliff-Smith K, Banerjee J, Gordon AL. Quality improvement in long-term care settings: a scoping review of effective strategies used in care homes. Eur Geriatr Med 2020; 12:17-26. [PMID: 32888183 PMCID: PMC7472942 DOI: 10.1007/s41999-020-00389-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/26/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE We conducted a scoping review of quality improvement in care homes. We aimed to identify participating occupational groups and methods for evaluation. Secondly, we aimed to describe resident-level interventions and which outcomes were measured. METHODS Following extended PRISMA guideline for scoping reviews, we conducted systematic searches of Medline, CINAHL, Psychinfo, and ASSIA (2000-2019). Furthermore, we searched systematic reviews databases including Cochrane Library and JBI, and the grey literature database, Greylit. Four co-authors contributed to selection and data extraction. RESULTS Sixty five studies were included, 6 of which had multiple publications (75 articles overall). A range of quality improvement strategies were implemented, including audit feedback and quality improvement collaboratives. Methods consisted of controlled trials, quantitative time series and qualitative interview and observational studies. Process evaluations, involving staff of various occupational groups, described experiences and implementation measures. Many studies measured resident-level outputs and health outcomes. 14 studies reported improvements to a clinical measure; however, four of these articles were of low quality. Larger randomised controlled studies did not show statistically significant benefits to resident health outcomes. CONCLUSION In care homes, quality improvement has been applied with several different strategies, being evaluated by a variety of measures. In terms of measuring benefits to residents, process outputs and health outcomes have been reported. There was no pattern of which quality improvement strategy was used for which clinical problem. Further development of reporting of quality improvement projects and outcomes could facilitate implementation.
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Affiliation(s)
- Neil H Chadborn
- Division of Medical Science and Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham, UK. .,NIHR Applied Research Collaboration East Midlands, Nottingham, UK.
| | - Reena Devi
- School of Healthcare, University of Leeds, Leeds, UK
| | | | - Jay Banerjee
- School of Life Sciences, University of Leicester, Leicester, UK
| | - Adam L Gordon
- Division of Medical Science and Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham, UK.,NIHR Applied Research Collaboration East Midlands, Nottingham, UK
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Rohweder C, Wangen M, Black M, Dolinger H, Wolf M, O'Reilly C, Brandt H, Leeman J. Understanding quality improvement collaboratives through an implementation science lens. Prev Med 2019; 129S:105859. [PMID: 31655174 PMCID: PMC7138534 DOI: 10.1016/j.ypmed.2019.105859] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/03/2019] [Accepted: 10/08/2019] [Indexed: 12/18/2022]
Abstract
Quality improvement collaboratives (QICs) have long been used to facilitate group learning and implementation of evidence-based interventions (EBIs) in healthcare. However, few studies systematically describe implementation strategies linked to QIC success. To address this gap, we evaluated a QIC on colorectal cancer (CRC) screening in Federally Qualified Health Centers (FQHCs) by aligning standardized implementation strategies with collaborative activities and measuring implementation and effectiveness outcomes. In 2018, the American Cancer Society and North Carolina Community Health Center Association provided funding, in-person/virtual training, facilitation, and audit and feedback with the goal of building FQHC capacity to enact selected implementation strategies. The QIC evaluation plan included a pre-test/post-test single group design and mixed methods data collection. We assessed: 1) adoption, 2) engagement, 3) implementation of QI tools and CRC screening EBIs, and 4) changes in CRC screening rates. A post-collaborative focus group captured participants' perceptions of implementation strategies. Twenty-three percent of North Carolina FQHCs (9/40) participated in the collaborative. Health Center engagement was high although individual participation decreased over time. Teams completed all four QIC tools: aim statements, process maps, gap and root cause analysis, and Plan-Do-Study-Act cycles. FQHCs increased their uptake of evidence-based CRC screening interventions and rates increased 8.0% between 2017 and 2018. Focus group findings provided insights into participants' opinions regarding the feasibility and appropriateness of the implementation strategies and how they influenced outcomes. Results support the collaborative's positive impact on FQHC capacity to implement QI tools and EBIs to improve CRC screening rates.
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Affiliation(s)
- Catherine Rohweder
- University of North Carolina at Chapel Hill, 200 N. Greensboro St., Suite D-15, Room 212, Carrboro, NC 27510, United States of America.
| | - Mary Wangen
- University of North Carolina at Chapel Hill, 3005 Carrington Hall, CB #7460, Chapel Hill, NC 27599-7460, United States of America.
| | - Molly Black
- American Cancer Society, Inc., 250 Williams St., Atlanta, GA 30303, United States of America.
| | - Heather Dolinger
- American Cancer Society, Inc., 8300 Health Park Suite 10, Raleigh, NC 27615, United States of America.
| | - Marti Wolf
- North Carolina Community Health Center Association, 4917 Waters Edge Drive, Suite 165, Raleigh, NC 27606, United States of America.
| | - Carey O'Reilly
- North Carolina Community Health Center Association, 4917 Waters Edge Drive, Suite 165, Raleigh, NC 27606, United States of America.
| | - Heather Brandt
- University of South Carolina, 915 Greene Street, Discovery Building, Columbia, SC 29208, United States of America.
| | - Jennifer Leeman
- University of North Carolina at Chapel Hill, 4005 Carrington Hall, CB #7460, Chapel Hill, NC 27599-7460, United States of America.
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Francis-Coad J, Etherton-Beer C, Burton E, Naseri C, Hill AM. Effectiveness of complex falls prevention interventions in residential aged care settings: a systematic review. ACTA ACUST UNITED AC 2019; 16:973-1002. [PMID: 29634516 DOI: 10.11124/jbisrir-2017-003485] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review was to synthesize the best available evidence for the effectiveness of complex falls prevention interventions delivered at two or more of the following levels: resident, facility or organization, on fall rates in the residential aged care (RAC) population. INTRODUCTION Preventing falls in the high risk RAC population is a common global goal with acknowledged complexity. Previous meta-analyses have not specifically addressed complexity, described as falls prevention intervention delivery at multiple levels of a RAC organization, to determine its effect on fall outcomes. INCLUSION CRITERIA The current review considered studies that included participants who were aged 65 years and over residing in long-term care settings providing 24-hour supervision and/or care assistance.Studies that evaluated complex falls prevention interventions delivered by single discipline or multidisciplinary teams across at least two or all of the following levels: residents, RAC facility and RAC organization were eligible. Experimental study designs including randomized controlled trials, controlled clinical trials and quasi-experimental trials that reported on measures related to fall incidence were considered, namely, rate of falls (expressed as the number of falls per 1000 occupied bed days), the number of participants who became fallers (expressed as the number of participants who fell once or more) and the rate of injurious falls (expressed as the number of falls with injury per 1000 occupied bed days). METHODS A three-step search strategy was undertaken, commencing with an initial scoping search of MEDLINE and CINAHL databases prior to an extensive search of all relevant published literature, clinical trial registries and gray literature. Two independent reviewers assessed selected studies for methodological validity using the standardized critical appraisal instrument from the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI). Data were extracted from the selected studies using the standardized data extraction tool from JBI SUMARI. Quantitative data were pooled in statistical meta-analysis for rate of falls, the number of participants who became fallers and the rate of injurious falls. Meta-analysis was conducted using a random-effect model with heterogeneity assessed using the standard Chi-squared and I index. Where statistical pooling was not possible, study findings were presented in narrative form. RESULTS Twelve studies were included in this review with seven being eligible for meta-analysis. Complex falls prevention interventions delivered at multiple levels in RAC populations did not show a significant effect in reducing fall rates (MD = -1.29; 95% CI [-3.01, 0.43]), or the proportion of residents who fell (OR = 0.76; 95% CI [0.42, 1.38]). However, a sensitivity analysis suggested complex falls prevention interventions delivered with additional resources at multiple levels had a significant positive effect in reducing fall rates (MD = -2.26; 95% CI [-3.72, -0.80]). CONCLUSIONS Complex falls prevention interventions delivered at multiple levels in the RAC population may reduce fall rates when additional staffing, expertise or resources are provided. Organizations may need to determine how resources can be allocated to best address falls prevention management. Future research should continue to investigate which combinations of multifactorial interventions are effective.
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Affiliation(s)
| | | | - Elissa Burton
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia
| | - Chiara Naseri
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia.,The Western Australian Group for Evidence Informed Healthcare Practice: a Joanna Briggs Institute Centre of Excellence
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia.,The Western Australian Group for Evidence Informed Healthcare Practice: a Joanna Briggs Institute Centre of Excellence
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Albornos-Muñoz L, Melián-Correa E, Acosta-Arrocha A, Gallo-Blanco C, Béjar-Bacas F, Alonso-Poncelas E, Serra-Estrada M, González-María E, Moreno-Casbas MT. Falls assessment and interventions among older patients in two medical and one surgical hospital wards in Spain: a best practice implementation project. ACTA ACUST UNITED AC 2019; 16:247-257. [PMID: 29324564 DOI: 10.11124/jbisrir-2017-003349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The current project aimed to improve fall prevention and management through clinical audits and the implementation of a quality-improvement cycle at the local level. INTRODUCTION Falls are one of the most common adverse events reported in hospitals; evidence-based fall prevention interventions aim to reduce the number of people who fall. METHODS A one-year clinical audit was conducted using a pre-post implementation audit method, namely the Joanna Briggs Institute's (JBI) Practical Application of Clinical Evidence System and the getting research into practice audit and feedback tool. Two medical wards and a surgical ward in a Spanish hospital participated. The subjects were evaluated at baseline and at a follow-up at six months after key strategies had been implemented. RESULTS Compliance rates for the evidence-based criteria were low in the baseline audit. Five barriers were identified in relation to fall assessment and management and, based on getting research into practice, strategies were designed, developed and implemented to overcome these barriers. After implementation, most of the fall-risk-assessment criteria showed an overall improvement, but there was no effect on care plan recording. Awareness of the assessment and management of fall risks were increased among professionals and patients on all three study wards. CONCLUSIONS The current project may improve compliance with regard to promoting evidence-based fall prevention and management interventions. Further audits are necessary to evaluate any improvements achieved, in particular, care plans.
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Affiliation(s)
- Laura Albornos-Muñoz
- The Spanish Centre for Evidence Based Nursing and Healthcare: a Joanna Briggs Institute Centre of Excellence
| | - Esther Melián-Correa
- Hospital Doctor José Molina Orosa, Servicio Canario de Salud, Islas Canarias, Spain
| | | | - Carmen Gallo-Blanco
- Hospital Doctor José Molina Orosa, Servicio Canario de Salud, Islas Canarias, Spain
| | | | - Emma Alonso-Poncelas
- Hospital Doctor José Molina Orosa, Servicio Canario de Salud, Islas Canarias, Spain
| | | | - Esther González-María
- The Spanish Centre for Evidence Based Nursing and Healthcare: a Joanna Briggs Institute Centre of Excellence
| | - María Teresa Moreno-Casbas
- The Spanish Centre for Evidence Based Nursing and Healthcare: a Joanna Briggs Institute Centre of Excellence
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Devi R, Meyer J, Banerjee J, Goodman C, Gladman JRF, Dening T, Chadborn N, Hinsliff-Smith K, Long A, Usman A, Housley G, Bowman C, Martin F, Logan P, Lewis S, Gordon AL. Quality improvement collaborative aiming for Proactive HEAlthcare of Older People in Care Homes (PEACH): a realist evaluation protocol. BMJ Open 2018; 8:e023287. [PMID: 30420349 PMCID: PMC6252778 DOI: 10.1136/bmjopen-2018-023287] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION This protocol describes a study of a quality improvement collaborative (QIC) to support implementation and delivery of comprehensive geriatric assessment (CGA) in UK care homes. The QIC will be formed of health and social care professionals working in and with care homes and will be supported by clinical, quality improvement and research specialists. QIC participants will receive quality improvement training using the Model for Improvement. An appreciative approach to working with care homes will be encouraged through facilitated shared learning events, quality improvement coaching and assistance with project evaluation. METHODS AND ANALYSIS The QIC will be delivered across a range of partnering organisations which plan, deliver and evaluate health services for care home residents in four local areas of one geographical region. A realist evaluation framework will be used to develop a programme theory informing how QICs are thought to work, for whom and in what ways when used to implement and deliver CGA in care homes. Data collection will involve participant observations of the QIC over 18 months, and interviews/focus groups with QIC participants to iteratively define, refine, test or refute the programme theory. Two researchers will analyse field notes, and interview/focus group transcripts, coding data using inductive and deductive analysis. The key findings and linked programme theory will be summarised as context-mechanism-outcome configurations describing what needs to be in place to use QICs to implement service improvements in care homes. ETHICS AND DISSEMINATION The study protocol was reviewed by the National Health Service Health Research Authority (London Bromley research ethics committee reference: 205840) and the University of Nottingham (reference: LT07092016) ethics committees. Both determined that the Proactive HEAlthcare of Older People in Care Homes study was a service and quality improvement initiative. Findings will be shared nationally and internationally through conference presentations, publication in peer-reviewed journals, a graphical illustration and a dissemination video.
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Affiliation(s)
- Reena Devi
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham, UK
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Julienne Meyer
- School of Health Sciences, City University London, London, UK
| | - Jay Banerjee
- University Hospitals of Leicester NHS Trust, University of Leicester, Leicester, UK
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | | | - Tom Dening
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Neil Chadborn
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kathryn Hinsliff-Smith
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham, UK
| | - Annabelle Long
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham, UK
| | - Adeela Usman
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham, UK
| | - Gemma Housley
- Health Analytics and Informatics, East Midlands Academic Health Science Network, Nottingham, Nottingham, UK
| | - Clive Bowman
- School of Health Sciences, City University London, London, UK
| | - Finbarr Martin
- Ageing and Health, Guy’s and St Thomas' NHS Foundation Trust, London, UK
- Population Health Sciences, King’s College London, London, UK
| | - Phillipa Logan
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Sarah Lewis
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Adam Lee Gordon
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham, UK
- School of Health Sciences, City University London, London, UK
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10
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Sterke CS, Panneman MJ, Erasmus V, Polinder S, Beeck EF. Increased care demand and medical costs after falls in nursing homes: A Delphi study. J Clin Nurs 2018; 27:2896-2903. [DOI: 10.1111/jocn.14488] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Carolyn Shanty Sterke
- Department of Physiotherapy Aafje Nursing Homes Rotterdam The Netherlands
- Department of Public Health Erasmus University Medical Center Rotterdam The Netherlands
| | | | - Vicki Erasmus
- Department of Public Health Erasmus University Medical Center Rotterdam The Netherlands
| | - Suzanne Polinder
- Department of Public Health Erasmus University Medical Center Rotterdam The Netherlands
| | - Ed F Beeck
- Department of Public Health Erasmus University Medical Center Rotterdam The Netherlands
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11
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Wells S, Tamir O, Gray J, Naidoo D, Bekhit M, Goldmann D. Are quality improvement collaboratives effective? A systematic review. BMJ Qual Saf 2017; 27:226-240. [DOI: 10.1136/bmjqs-2017-006926] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 09/09/2017] [Accepted: 10/07/2017] [Indexed: 12/16/2022]
Abstract
BackgroundQuality improvement collaboratives (QIC) have proliferated internationally, but there is little empirical evidence for their effectiveness.MethodWe searched Medline, Embase, CINAHL, PsycINFO and the Cochrane Library databases from January 1995 to December 2014. Studies were included if they met the criteria for a QIC intervention and the Cochrane Effective Practice and Organisation of Care (EPOC) minimum study design characteristics for inclusion in a review. We assessed study bias using the EPOC checklist and the quality of the reported intervention using a subset of SQUIRE 1.0 standards.ResultsOf the 220 studies meeting QIC criteria, 64 met EPOC study design standards for inclusion. There were 10 cluster randomised controlled trials, 24 controlled before-after studies and 30 interrupted time series studies. QICs encompassed a broad range of clinical settings, topics and populations ranging from neonates to the elderly. Few reports fully described QIC implementation and methods, intensity of activities, degree of site engagement and important contextual factors. By care setting, an improvement was reported for one or more of the study’s primary effect measures in 83% of the studies (32/39 (82%) hospital based, 17/20 (85%) ambulatory care, 3/4 nursing home and a sole ambulance QIC). Eight studies described persistence of the intervention effect 6 months to 2 years after the end of the collaborative. Collaboratives reporting success generally addressed relatively straightforward aspects of care, had a strong evidence base and noted a clear evidence-practice gap in an accepted clinical pathway or guideline.ConclusionsQICs have been adopted widely as an approach to shared learning and improvement in healthcare. Overall, the QICs included in this review reported significant improvements in targeted clinical processes and patient outcomes. These reports are encouraging, but most be interpreted cautiously since fewer than a third met established quality and reporting criteria, and publication bias is likely.
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12
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Jacobs ML, Snow AL, Parmelee PA, Davis JA. Person-Centered Care Practices in Long-Term Care in the Deep South: Consideration of Structural, Market, and Administrator Characteristics. J Appl Gerontol 2016; 37:349-370. [PMID: 27091880 DOI: 10.1177/0733464816642583] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to identify structural, market, and administrator factors of nursing homes that are related to the implementation of person-centered care. Administrators of Medicare/Medicaid-certified nursing homes in the Deep South were invited to complete a standardized survey about their facility and their perceptions and attitudes regarding person-centered care practices (PCCPs). Nursing home structural and market factors were obtained from public websites, and these data were matched with administrator data. Consistent with the resource-based theory of competitive advantage, nursing homes with greater resources and more competition were more likely to implement PCCPs. Implementation of person-centered care was also higher in nursing homes with administrators who perceived culture change implementation to be feasible in their facilities. Given that there is a link between resource availability and adoption of person-centered care, future research should investigate the cost of such innovations.
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Affiliation(s)
| | - A Lynn Snow
- 1 The University of Alabama, Tuscaloosa, USA
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13
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Factors associated with falls in hospitalized adult patients. Appl Nurs Res 2015; 28:78-82. [DOI: 10.1016/j.apnr.2014.12.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 12/05/2014] [Accepted: 12/13/2014] [Indexed: 11/21/2022]
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14
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Colon-Emeric CS, McConnell E, Pinheiro SO, Corazzini K, Porter K, Earp KM, Landerman L, Beales J, Lipscomb J, Hancock K, Anderson RA. CONNECT for better fall prevention in nursing homes: results from a pilot intervention study. J Am Geriatr Soc 2013; 61:2150-2159. [PMID: 24279686 DOI: 10.1111/jgs.12550] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine whether an intervention that improves nursing home (NH) staff connections, communication, and problem solving (CONNECT) would improve implementation of a falls reduction education program (FALLS). DESIGN Cluster randomized trial. SETTING Community (n=4) and Veterans Affairs (VA) NHs (n=4). PARTICIPANTS Staff in any role with resident contact (n=497). INTERVENTION NHs received FALLS alone (control) or CONNECT followed by FALLS (intervention), each delivered over 3 months. CONNECT used storytelling, relationship mapping, mentoring, self-monitoring, and feedback to help staff identify communication gaps and practice interaction strategies. FALLS included group training, modules, teleconferences, academic detailing, and audit and feedback. MEASUREMENTS NH staff completed surveys about interactions at baseline, 3 months (immediately after CONNECT or control period), and 6 months (immediately after FALLS). A random sample of resident charts was abstracted for fall risk reduction documentation (n=651). Change in facility fall rates was an exploratory outcome. Focus groups were conducted to explore changes in organizational learning. RESULTS Significant improvements in staff perceptions of communication quality, participation in decision-making, safety climate, caregiving quality, and use of local interaction strategies were observed in intervention community NHs (treatment-by-time effect P=.01) but not in VA NHs, where a ceiling effect was observed. Fall risk reduction documentation did not change significantly, and the direction of change in individual facilities did not relate to observed direction of change in fall rates. Fall rates did not change in control facilities (falls/bed per year: baseline, 2.61; after intervention, 2.64) but decreased by 12% in intervention facilities (falls/bed per year: baseline, 2.34; after intervention, 2.06); the effect of treatment on rate of change was 0.81 (95% confidence interval=0.55-1.20). CONCLUSION CONNECT has the potential to improve care delivery in NHs, but the trend toward improving fall rates requires confirmation in a larger ongoing study.
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Affiliation(s)
- Cathleen S Colon-Emeric
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina.,Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham, North Carolina
| | - Eleanor McConnell
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina.,Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham, North Carolina.,School of Nursing, Duke University, Durham, North Carolina
| | - Sandro O Pinheiro
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
| | - Kirsten Corazzini
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
| | - Kristie Porter
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
| | | | - Lawrence Landerman
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina.,School of Nursing, Duke University, Durham, North Carolina
| | - Julie Beales
- Richmond Veterans Affairs Medical Center, Richmond, Virginia
| | - Jeffrey Lipscomb
- KayeM, Inc., Durham, North Carolina.,Salem Veterans Affairs Medical Center, Salem, Virginia
| | - Kathryn Hancock
- Asheville Veterans Affairs Medical Center, Asheville, North Carolina
| | - Ruth A Anderson
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina.,School of Nursing, Duke University, Durham, North Carolina
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Hoben M, Mahler C, Bär M, Berger S, Squires JE, Estabrooks CA, Behrens J. German translation of the Alberta Context Tool and two measures of research use: methods, challenges and lessons learned. BMC Health Serv Res 2013; 13:478. [PMID: 24238613 PMCID: PMC3893410 DOI: 10.1186/1472-6963-13-478] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 11/14/2013] [Indexed: 11/30/2022] Open
Abstract
Background Understanding the relationship between organizational context and research utilization is key to reducing the research-practice gap in health care. This is particularly true in the residential long term care (LTC) setting where relatively little work has examined the influence of context on research implementation. Reliable, valid measures and tools are a prerequisite for studying organizational context and research utilization. Few such tools exist in German. We thus translated three such tools (the Alberta Context Tool and two measures of research use) into German for use in German residential LTC. We point out challenges and strategies for their solution unique to German residential LTC, and demonstrate how resolving specific challenges in the translation of the health care aide instrument version streamlined the translation process of versions for registered nurses, allied health providers, practice specialists, and managers. Methods Our translation methods were based on best practices and included two independent forward translations, reconciliation of the forward translations, expert panel discussions, two independent back translations, reconciliation of the back translations, back translation review, and cognitive debriefing. Results We categorized the challenges in this translation process into seven categories: (1) differing professional education of Canadian and German care providers, (2) risk that German translations would become grammatically complex, (3) wordings at risk of being misunderstood, (4) phrases/idioms non-existent in German, (5) lack of corresponding German words, (6) limited comprehensibility of corresponding German words, and (7) target persons’ unfamiliarity with activities detailed in survey items. Examples of each challenge are described with strategies that we used to manage the challenge. Conclusion Translating an existing instrument is complex and time-consuming, but a rigorous approach is necessary to obtain instrument equivalence. Essential components were (1) involvement of and co-operation with the instrument developers and (2) expert panel discussions, including both target group and content experts. Equivalent translated instruments help researchers from different cultures to find a common language and undertake comparative research. As acceptable psychometric properties are a prerequisite for that, we are currently carrying out a study with that focus.
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Affiliation(s)
- Matthias Hoben
- Network Aging Research (NAR), Ruprecht-Karls-University Heidelberg, Bergheimer Str, 20, Heidelberg 69115, Germany.
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Nadeem E, Olin SS, Hill LC, Hoagwood KE, Horwitz SM. Understanding the components of quality improvement collaboratives: a systematic literature review. Milbank Q 2013; 91:354-94. [PMID: 23758514 DOI: 10.1111/milq.12016] [Citation(s) in RCA: 213] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
CONTEXT In response to national efforts to improve quality of care, policymakers and health care leaders have increasingly turned to quality improvement collaboratives (QICs) as an efficient approach to improving provider practices and patient outcomes through the dissemination of evidence-based practices. This article presents findings from a systematic review of the literature on QICs, focusing on the identification of common components of QICs in health care and exploring, when possible, relations between QIC components and outcomes at the patient or provider level. METHODS A systematic search of five major health care databases generated 294 unique articles, twenty-four of which met our criteria for inclusion in our final analysis. These articles pertained to either randomized controlled trials or quasi-experimental studies with comparison groups, and they reported the findings from twenty different studies of QICs in health care. We coded the articles to identify the components reported for each collaborative. FINDINGS We found fourteen crosscutting components as common ingredients in health care QICs (e.g., in-person learning sessions, phone meetings, data reporting, leadership involvement, and training in QI methods). The collaboratives reported included, on average, six to seven of these components. The most common were in-person learning sessions, plan-do-study-act (PDSA) cycles, multidisciplinary QI teams, and data collection for QI. The outcomes data from these studies indicate the greatest impact of QICs at the provider level; patient-level findings were less robust. CONCLUSIONS Reporting on specific components of the collaborative was imprecise across articles, rendering it impossible to identify active QIC ingredients linked to improved care. Although QICs appear to have some promise in improving the process of care, there is great need for further controlled research examining the core components of these collaboratives related to patient- and provider-level outcomes.
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17
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Role of method of implementing multi-factorial falls prevention in nursing homes for elderly persons. The EUNESE project. Aging Clin Exp Res 2013. [DOI: 10.1007/bf03324806] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nadeem E, Olin SS, Hill LC, Hoagwood KE, Horwitz SM. Understanding the components of quality improvement collaboratives: a systematic literature review. Milbank Q 2013. [PMID: 23758514 DOI: 10.1111/milq.12016.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
CONTEXT In response to national efforts to improve quality of care, policymakers and health care leaders have increasingly turned to quality improvement collaboratives (QICs) as an efficient approach to improving provider practices and patient outcomes through the dissemination of evidence-based practices. This article presents findings from a systematic review of the literature on QICs, focusing on the identification of common components of QICs in health care and exploring, when possible, relations between QIC components and outcomes at the patient or provider level. METHODS A systematic search of five major health care databases generated 294 unique articles, twenty-four of which met our criteria for inclusion in our final analysis. These articles pertained to either randomized controlled trials or quasi-experimental studies with comparison groups, and they reported the findings from twenty different studies of QICs in health care. We coded the articles to identify the components reported for each collaborative. FINDINGS We found fourteen crosscutting components as common ingredients in health care QICs (e.g., in-person learning sessions, phone meetings, data reporting, leadership involvement, and training in QI methods). The collaboratives reported included, on average, six to seven of these components. The most common were in-person learning sessions, plan-do-study-act (PDSA) cycles, multidisciplinary QI teams, and data collection for QI. The outcomes data from these studies indicate the greatest impact of QICs at the provider level; patient-level findings were less robust. CONCLUSIONS Reporting on specific components of the collaborative was imprecise across articles, rendering it impossible to identify active QIC ingredients linked to improved care. Although QICs appear to have some promise in improving the process of care, there is great need for further controlled research examining the core components of these collaboratives related to patient- and provider-level outcomes.
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Colón-Emeric CS, Pinheiro SO, Anderson RA, Porter K, McConnell E, Corazzini K, Hancock K, Lipscomb J, Beales J, Simpson KM. Connecting the learners: improving uptake of a nursing home educational program by focusing on staff interactions. THE GERONTOLOGIST 2013; 54:446-59. [PMID: 23704219 DOI: 10.1093/geront/gnt043] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE OF THE STUDY The CONNECT intervention is designed to improve staff connections, communication, and use of multiple perspectives for problem solving. This analysis compared staff descriptions of the learning climate, use of social constructivist learning processes, and outcomes in nursing facilities receiving CONNECT with facilities receiving a falls education program alone. DESIGN AND METHODS Qualitative evaluation of a randomized controlled trial was done using a focus group design. Facilities (n = 8) were randomized to a falls education program alone (control) or CONNECT followed by FALLS (intervention). A total of 77 staff participated in 16 focus groups using a structured interview protocol. Transcripts were analyzed using framework analysis, and summaries for each domain were compared between intervention and control facilities. RESULTS Notable differences in descriptions of the learning climate included greater learner empowerment, appreciation of the role of all disciplines, and seeking diverse viewpoints in the intervention group. Greater use of social constructivist learning processes was evidenced by the intervention group as they described greater identification of communication weaknesses, improvement in communication frequency and quality, and use of sense-making by seeking out multiple perspectives to better understand and act on information. Intervention group participants reported outcomes including more creative fall prevention plans, a more respectful work environment, and improved relationships with coworkers. No substantial difference between groups was identified in safety culture, shared responsibility, and self-reported knowledge about falls. IMPLICATIONS CONNECT appears to enhance the use of social constructivist learning processes among nursing home staff. The impact of CONNECT on clinical outcomes requires further study.
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Affiliation(s)
- Cathleen S Colón-Emeric
- *Address correspondence to Cathleen Colón-Emeric, MHS, Durham VA Geriatric Research Education and Clinical Center, MD 508 Fulton St., GRECC 182, Durham, NC 27705. E-mail:
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20
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Gregory KE, Radovinsky L. Research strategies that result in optimal data collection from the patient medical record. Appl Nurs Res 2012; 25:108-16. [PMID: 20974093 PMCID: PMC3030926 DOI: 10.1016/j.apnr.2010.02.004] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Revised: 02/01/2010] [Accepted: 02/03/2010] [Indexed: 11/17/2022]
Abstract
Data obtained from the patient medical record are often a component of clinical research led by nurse investigators. The rigor of the data collection methods correlates to the reliability of the data and, ultimately, the analytical outcome of the study. Research strategies for reliable data collection from the patient medical record include the development of a precise data collection tool, the use of a coding manual, and ongoing communication with research staff.
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Affiliation(s)
- Katherine E Gregory
- W.F. Connell School of Nursing, Boston College, Chestnut Hill, MA 02467, USA.
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21
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Anderson RA, Corazzini K, Porter K, Daily K, McDaniel RR, Colón-Emeric C. CONNECT for quality: protocol of a cluster randomized controlled trial to improve fall prevention in nursing homes. Implement Sci 2012; 7:11. [PMID: 22376375 PMCID: PMC3310735 DOI: 10.1186/1748-5908-7-11] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 02/29/2012] [Indexed: 12/02/2022] Open
Abstract
Background Quality improvement (QI) programs focused on mastery of content by individual staff members are the current standard to improve resident outcomes in nursing homes. However, complexity science suggests that learning is a social process that occurs within the context of relationships and interactions among individuals. Thus, QI programs will not result in optimal changes in staff behavior unless the context for social learning is present. Accordingly, we developed CONNECT, an intervention to foster systematic use of management practices, which we propose will enhance effectiveness of a nursing home Falls QI program by strengthening the staff-to-staff interactions necessary for clinical problem-solving about complex problems such as falls. The study aims are to compare the impact of the CONNECT intervention, plus a falls reduction QI intervention (CONNECT + FALLS), to the falls reduction QI intervention alone (FALLS), on fall-related process measures, fall rates, and staff interaction measures. Methods/design Sixteen nursing homes will be randomized to one of two study arms, CONNECT + FALLS or FALLS alone. Subjects (staff and residents) are clustered within nursing homes because the intervention addresses social processes and thus must be delivered within the social context, rather than to individuals. Nursing homes randomized to CONNECT + FALLS will receive three months of CONNECT first, followed by three months of FALLS. Nursing homes randomized to FALLS alone receive three months of FALLs QI and are offered CONNECT after data collection is completed. Complexity science measures, which reflect staff perceptions of communication, safety climate, and care quality, will be collected from staff at baseline, three months after, and six months after baseline to evaluate immediate and sustained impacts. FALLS measures including quality indicators (process measures) and fall rates will be collected for the six months prior to baseline and the six months after the end of the intervention. Analysis will use a three-level mixed model. Discussion By focusing on improving local interactions, CONNECT is expected to maximize staff's ability to implement content learned in a falls QI program and integrate it into knowledge and action. Our previous pilot work shows that CONNECT is feasible, acceptable and appropriate. Trial Registration ClinicalTrials.gov: NCT00636675
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Creation of a multi-interventional fall-prevention program: using evidence-based practice to identify high-risk units and tailor interventions. Orthop Nurs 2011; 30:249-57; quiz 258-9. [PMID: 21799380 DOI: 10.1097/nor.0b013e3182247c61] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Prevention of falls is an issue of concern for all hospitalized patients. Certain units, however, may be at higher risk for falls due to patient diagnosis, comorbidities, and other intrinsic factors. Creation of a unit-specific fall-prevention program may be more effective at reducing incidence of falls in the adult orthopaedic inpatient setting. It may also be better valued by staff according to a critical analysis of the literature and staff survey of perceptions. This information was used as a starting point to create a template for a unit-based fall program specifically for high-risk units. The evidence from this analysis could be used to identify high-risk units and adapt existing generic fall-prevention programs to this higher risk population.
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Abstract
Depression is significant among older Americans in the United States. A literature review found only five studies on the interrelationship between individual and neighborhood effects in predicting depression among older Americans. This article presents the results of exploring this interrelationship using data from the Brookdale Demonstration Project Initiative on Healthy Urban Aging (BDI). The BDI database is from a sample of 1,870 enrollees in New York City senior centers in 2008. The BDI analysis finds the association with depression is highest with visual impairment ( p = .000); frequent falling ( p = .000); lower income ( p = .000); little leisure-time physical activity ( p = .000); low neighborhood satisfaction ( p = .000); trouble hearing ( p = .000); arthritis/rheumatoid arthritis ( p = .001); and being disabled ( p = .005). Implications for senior center and home care provider collaboration on early preventive interventions relating to sensory impairment, depression, and conditions related to falls and the built environment are discussed.
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Affiliation(s)
- William D. Cabin
- The Richard Stockton College, Pomona, NJ
- Hunter College, City University of New York, NY
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Teresi JA, Ramirez M, Remler D, Ellis J, Boratgis G, Silver S, Lindsey M, Kong J, Eimicke JP, Dichter E. Comparative effectiveness of implementing evidence-based education and best practices in nursing homes: effects on falls, quality-of-life and societal costs. Int J Nurs Stud 2011; 50:448-63. [PMID: 21807366 DOI: 10.1016/j.ijnurstu.2011.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 06/24/2011] [Accepted: 07/03/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The aim was to conduct a comparative effectiveness research study to estimate the effects on falls, negative affect and behavior, and the associated societal costs of implementing evidence-based education and best practice programs in nursing homes (NHs). DESIGN A quasi-experimental design, a variant of a cluster randomized trial of implementation research examining transfer of research findings into practice, was used to compare outcomes among three groups of residents in 15 nursing homes per group. METHODS Forty-five NHs participated in one of three conditions: (1) standard training, (2) training and implementation modules provided to facility staff, or (3) staff training and implementation modules augmented by surveyor training. After application of exclusion and matching criteria, nursing homes were selected at random within three regions of New York State. Outcomes were assessed using medical records and the Minimum Data Set (MDS). RESULTS The main finding was of a significant reduction of between 5 and 12 annual falls in a typical nursing home. While both intervention groups resulted in fall reduction, the larger and significant reduction occurred in the group without surveyor training. A significant reduction in negative affect associated with training staff and surveyors was observed. Net cost savings from fall prevention was estimated. CONCLUSIONS A low cost intervention targeting dissemination of evidence-based best practices in nursing homes can result in the potential for fall reduction, and cost savings.
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Affiliation(s)
- Jeanne A Teresi
- Research Division, Hebrew Home at Riverdale, 5901 Palisade Avenue, Riverdale, NY 10471, USA.
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Gama ZA, Medina-Mirapeix F, Saturno PJ. Ensuring Evidence-Based Practices for Falls Prevention in a Nursing Home Setting. J Am Med Dir Assoc 2011; 12:398-402. [DOI: 10.1016/j.jamda.2011.01.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Revised: 01/13/2011] [Accepted: 01/14/2011] [Indexed: 10/18/2022]
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The use of data for process and quality improvement in long term care and home care: a systematic review of the literature. J Am Med Dir Assoc 2011; 13:103-13. [PMID: 21450243 DOI: 10.1016/j.jamda.2011.01.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Standardized resident or client assessments, including the Resident Assessment Instrument (RAI), have been available in long term care and home care settings (continuing care sector) in many jurisdictions for a number of years. Although using these data can make quality improvement activities more efficient and less costly, there has not been a review of the literature reporting quality improvement interventions using standardized data. OBJECTIVES To address 2 questions: (1) How have RAI and other standardized data been used in process or quality improvement activities in the continuing care sector? and (2) Has the use of RAI and similar data resulted in improvements to resident or other outcomes? DATA SOURCES Searches using a combination of keyword and controlled vocabulary term searches were conducted in MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, the Cochrane Library, and PsychINFO. ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: English language publications from database inception to October 2008 were included. Eligibility criteria included the following: (1) set in continuing care (long-term care facility or home care), (2) involved some form of intervention designed to improve quality or process of care, and (3) used standardized data in the quality or process improvement intervention. STUDY APPRAISAL AND SYNTHESIS METHODS After reviewing the articles, we grouped the studies according to the type of intervention used to initiate process improvement. Four different intervention types were identified. We organized the results and discussion by these 4 intervention types. RESULTS Key word searches identified 713 articles, of which we excluded 639 on abstract review because they did not meet inclusion criteria. A further 50 articles were excluded on full-text review, leaving a total of 24 articles. Of the 24 studies, 10 used a defined process improvement model, 8 used a combination of interventions (multimodal), 5 implemented new guidelines or protocols, and 1 used an education intervention. CONCLUSIONS/IMPLICATIONS The most frequently cited issues contributing to unsuccessful quality improvement interventions were lack of staff, high staff turnover, and limited time available to train staff in ways that would improve client care. Innovative strategies and supporting research are required to determine how to intervene successfully to improve quality in these settings characterized by low staffing levels and predominantly nonprofessional staff. Research on how to effectively enable practitioners to use data to improve quality of care, and ultimately quality of life, needs to be a priority.
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Abstract
The association between drugs and falls has been widely studied in the past 3 decades, with increasingly robust evidence of a causal link. Both specific classes of drugs and the total number of drugs taken are associated with falls. This review examines some of the reasons why older people are at greater risk of drug-related adverse events such as falls. We discuss the role of drugs in general and polypharmacy (the concurrent use of multiple drugs) on the risk of falling, with a focus on community-dwelling older people. We critically appraise the evidence that specific classes of drugs, such as benzodiazepines and antidepressants, increase the risk of falling and that falls can be prevented through interventions that target medications.
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Affiliation(s)
- Nichola Boyle
- Centre for Education and Research on Ageing, Building 18, Concord Repatriation General Hospital, Concord, New South Wales 2139, Australia.
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Hedley L, Suckley N, Robinson L, Dawson P. Staying Steady: A community-based exercise initiative for falls prevention. Physiother Theory Pract 2010; 26:425-38. [DOI: 10.3109/09593980903585059] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Stenberg M, Wann-Hansson C. Health Care Professionals’ Attitudes and Compliance to Clinical Practice Guidelines to Prevent Falls and Fall Injuries. Worldviews Evid Based Nurs 2010; 8:87-95. [DOI: 10.1111/j.1741-6787.2010.00196.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wagner LM, Damianakis T, Mafrici N, Robinson-Holt K. Falls Communication Patterns Among Nursing Staff Working in Long-Term Care Settings. Clin Nurs Res 2010; 19:311-26. [DOI: 10.1177/1054773810370995] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Effective fall-risk communication both among staff and between staff and family members is vital for ensuring the safety of residents in long-term care (LTC) settings. This study uses focus group methodology to investigate how information about falls is identified, communicated, and responded to by licensed staff (registered nurses/registered practical nurses) and unlicensed staff (personal support workers) in four LTC facilities. The authors report on the major themes that emerged throughout the focus groups relating to falls management and report on similarities and differences in the communication processes between the two sampled groups. Results highlight communication of the resident’s fall risk, reporting procedures to staff and family members, care plan communication and adherence information, a falls quality improvement knowledge deficit, and barriers to falls quality improvement. Recommendations toward improved communication networks among diverse LTC staff to enhance fall-reduction efforts in LTC settings are provided.
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Affiliation(s)
- Laura M. Wagner
- Baycrest Geriatric Health Care System, Toronto, Ontario, Canada, , University of Toronto, Toronto, Ontario, Canada
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Colón-Emeric CS, Schmader KE, Twersky J, Kuchibhatla M, Kellum S, Weinberger M. Development and pilot testing of computerized order entry algorithms for geriatric problems in nursing homes. J Am Geriatr Soc 2009; 57:1644-53. [PMID: 19682123 DOI: 10.1111/j.1532-5415.2009.02387.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To develop order entry algorithms for five common nursing home problems and to test their acceptance, use, and preliminary effect on nine quality indicators and resource utilization. DESIGN Pre-post, quasi-experimental study. SETTING Two Department of Veterans Affairs nursing homes. PARTICIPANTS Randomly selected residents (N=265) with one or more target conditions and 42 nursing home providers. INTERVENTION Expert panels developed computerized order entry algorithms based on clinical practice guidelines. Each was displayed on a single screen and included an array of diagnostic and treatment options and means to communicate with the interdisciplinary team. MEASUREMENTS Medical records were abstracted for the 6 months before and after deployment for quality indicators and resource utilization. RESULTS Despite positive provider attitudes toward the computerized order entry algorithms, their use was infrequent and varied according to condition: falls (73.0%), fever (9.0%), pneumonia (8.0%), urinary tract infection (7.0%), and osteoporosis (3.0%). In subjects with falls, trends for improvements in quality measures were observed for six of the nine measures: measuring orthostatic blood pressure (17.5-30.0%, P=.29), reducing neuroleptics (53.8-75.0%, P=.27), reducing sedative-hypnotics (16.7-50.0%, P=.50), prescription of calcium (22.5-32.5%, P=.45), vitamin D (20.0-35.0%, P=.21), and external hip protectors (25.0-47.5%, P=.06). Little improvement was observed in the other conditions (documentation of vital signs, physical therapy referrals, or reduction of benzodiazepines or antidepressants). There was no change in resource utilization. CONCLUSION Computerized order entry algorithms were used infrequently, except for falls. Further study may determine whether their use leads to improved care.
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Verghese J, Holtzer R, Lipton RB, Wang C. Quantitative gait markers and incident fall risk in older adults. J Gerontol A Biol Sci Med Sci 2009; 64:896-901. [PMID: 19349593 DOI: 10.1093/gerona/glp033] [Citation(s) in RCA: 587] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Identifying quantitative gait markers of falls in older adults may improve diagnostic assessments and suggest novel intervention targets. METHODS We studied 597 adults aged 70 and older (mean age 80.5 years, 62% women) enrolled in an aging study who received quantitative gait assessments at baseline. Association of speed and six other gait markers (cadence, stride length, swing, double support, stride length variability, and swing time variability) with incident fall rate was studied using generalized estimation equation procedures adjusted for age, sex, education, falls, chronic illnesses, medications, cognition, disability as well as traditional clinical tests of gait and balance. RESULTS Over a mean follow-up period of 20 months, 226 (38%) of the 597 participants fell. Mean fall rate was 0.44 per person-year. Slower gait speed (risk ratio [RR] per 10 cm/s decrease 1.069, 95% confidence interval [CI] 1.001-1.142) was associated with higher risk of falls in the fully adjusted models. Among six other markers, worse performance on swing (RR 1.406, 95% CI 1.027-1.926), double-support phase (RR 1.165, 95% CI 1.026-1.321), swing time variability (RR 1.007, 95% CI 1.004-1.010), and stride length variability (RR 1.076, 95% CI 1.030-1.111) predicted fall risk. The associations remained significant even after accounting for cognitive impairment and disability. CONCLUSIONS Quantitative gait markers are independent predictors of falls in older adults. Gait speed and other markers, especially variability, should be further studied to improve current fall risk assessments and to develop new interventions.
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Affiliation(s)
- Joe Verghese
- MBBS, Einstein Aging Study, Albert Einstein College of Medicine, Yeshiva University, 1165 Morris Park Avenue, Room 338, Bronx, NY 10461, USA.
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Smith BA, Lee HJ, Lee JH, Choi M, Jones DE, Bausell RB, Broome ME. Quality of reporting randomized controlled trials (RCTs) in the nursing literature: application of the consolidated standards of reporting trials (CONSORT). Nurs Outlook 2008; 56:31-37. [PMID: 18237622 DOI: 10.1016/j.outlook.2007.09.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Indexed: 11/18/2022]
Abstract
In the era of evidence-based practice (EBP), Randomized Controlled Trials (RCTs) may provide the best evidence of the efficacy of nursing interventions and yet the quality of RCT reporting in nursing literature has not been evaluated. The purposes of this study were to apply the Consolidated Standards of Reporting Trials (CONSORT) statement to published reports of nursing science, examine how adequately the published reports adhere to the statement, and examine the effect of the adoption of CONSORT on the quality of the RCT published reports. One hundred RCTs from 2002-2005 were identified from 4 nursing journals. Articles were randomly assigned to 4 reviewers and the quality of the published reports was evaluated using a modified CONSORT checklist. There was no difference between the 4 journals in the quality of the published reports of RCTs based on the modified CONSORT checklist employed (F = 1.27, P =.29). The quality of reporting of RCTs improved significantly in the only journal, Nursing Research, to adopt the CONSORT statement during the study period (t =-2.70, P =.01). Adoption of CONSORT is recommended as it may lead to an overall improvement in quality of reporting of RCTs in nursing journals. The profession may also wish to explore the use or development of standards similar to CONSORT but ones more appropriate for the types of research typical of that published by nurse scientists.
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Affiliation(s)
- Barbara A Smith
- University of Maryland School of Nursing, Baltimore, MD 21201-1579, USA.
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Colón-Emeric CS, Lyles KW, House P, Levine DA, Schenck AP, Allison J, Gorospe J, Fermazin M, Oliver K, Curtis JR, Weissman N, Xie A, Saag KG. Randomized trial to improve fracture prevention in nursing home residents. Am J Med 2007; 120:886-92. [PMID: 17904460 PMCID: PMC2288656 DOI: 10.1016/j.amjmed.2007.04.020] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2006] [Revised: 04/20/2007] [Accepted: 04/27/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND Interventions to improve the fracture prevention in nursing homes are needed. METHODS Cluster-randomized, single-blind, controlled trial of a multi-modal quality improvement intervention. Nursing homes (n=67) with > or =10 residents with a diagnosis of osteoporosis or recent hip fracture (n=606) were randomized to receive an early or delayed intervention consisting of audit and feedback, educational modules, teleconferences, and academic detailing. Medical record abstraction and the Minimum Data Set were used to measure the prescription of osteoporosis therapies before and after the intervention period. Analysis was at the facility-level and Generalized Estimating Equation modeling was used to account for clustering. RESULTS No significant improvements were observed in any of the quality indicators. The use of osteoporosis pharmacotherapy or hip protectors improved by 8.0% in the intervention group and 0.6% in the control group, but the difference was not statistically significant (P=.72). Participation in the intervention activities was low, but completion of the educational module (odds ratio [OR] 4.8, 95% confidence interval [CI], 1.9-12.0) and direct physician contact by an academic detailer (OR 4.5, 95% CI, 1.1-18.2) were significantly associated with prescription of osteoporosis pharmacotherapy or hip protectors in multivariable models. CONCLUSIONS Audit-feedback and education interventions were ineffective in improving fracture prevention in the nursing home setting, although results may have been tempered by low participation in the intervention activities.
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