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Chambers D, Cantrell A, Preston L, Marincowitz C, Wright L, Conroy S, Lee Gordon A. Reducing unplanned hospital admissions from care homes: a systematic review. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-130. [PMID: 37916580 DOI: 10.3310/klpw6338] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Background Care homes predominantly care for older people with complex health and care needs, who are at high risk of unplanned hospital admissions. While often necessary, such admissions can be distressing and provide an opportunity cost as well as a financial cost. Objectives Our objective was to update a 2014 evidence review of interventions to reduce unplanned admissions of care home residents. We carried out a systematic review of interventions used in the UK and other high-income countries by synthesising evidence of effects of these interventions on hospital admissions; feasibility and acceptability; costs and value for money; and factors affecting applicability of international evidence to UK settings. Data sources We searched the following databases in December 2021 for studies published since 2014: Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews; Cumulative Index to Nursing and Allied Health Literature; Health Management Information Consortium; Medline; PsycINFO; Science and Social Sciences Citation Indexes; Social Care Online; and Social Service Abstracts. 'Grey' literature (January 2022) and citations were searched and reference lists were checked. Methods We included studies of any design reporting interventions delivered in care homes (with or without nursing) or hospitals to reduce unplanned hospital admissions. A taxonomy of interventions was developed from an initial scoping search. Outcomes of interest included measures of effect on unplanned admissions among care home residents; barriers/facilitators to implementation in a UK setting and acceptability to care home residents, their families and staff. Study selection, data extraction and risk of bias assessment were performed by two independent reviewers. We used published frameworks to extract data on intervention characteristics, implementation barriers/facilitators and applicability of international evidence. We performed a narrative synthesis grouped by intervention type and setting. Overall strength of evidence for admission reduction was assessed using a framework based on study design, study numbers and direction of effect. Results We included 124 publications/reports (30 from the UK). Integrated care and quality improvement programmes providing additional support to care homes (e.g. the English Care Homes Vanguard initiatives and hospital-based services in Australia) appeared to reduce unplanned admissions relative to usual care. Simpler training and staff development initiatives showed mixed results, as did interventions aimed at tackling specific problems (e.g. medication review). Advance care planning was key to the success of most quality improvement programmes but do-not-hospitalise orders were problematic. Qualitative research identified tensions affecting decision-making involving paramedics, care home staff and residents/family carers. The best way to reduce end-of-life admissions through access to palliative care was unclear in the face of inconsistent and generally low-quality evidence. Conclusions Effective implementation of interventions at various stages of residents' care pathways may reduce unplanned admissions. Most interventions are complex and require adaptation to local contexts. Work at the interface between health and social care is key to successful implementation. Limitations Much of the evidence identified was of low quality because of factors such as uncontrolled study designs and small sample size. Meta-analysis was not possible. Future work We identified a need for improved economic evidence and the evaluation of integrated care models of the type delivered by hospital-based teams. Researchers should carefully consider what is realistic in terms of study design and data collection given the current context of extreme pressure on care homes. Study registration This study is registered as PROSPERO database CRD42021289418. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (award number NIHR133884) and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 18. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Duncan Chambers
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Louise Preston
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Carl Marincowitz
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Simon Conroy
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Adam Lee Gordon
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Nottingham, UK
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Burgess AJ, Clee D, Prichburg A, Burberry DJ, Keen L, Davies EA. CWTCH in the community: improving education to reduce adverse outcomes for patients who fall in nursing homes. GERONTOLOGY & GERIATRICS EDUCATION 2023:1-9. [PMID: 37667556 DOI: 10.1080/02701960.2023.2255536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
Falls in nursing homes (NH) are common and cause significant morbidity and mortality. We proposed that by improving staff education, the volume of emergency calls, hospital conveyance and adverse patient outcomes could be reduced. An analysis of the volume of emergency calls coded as Falls from January 2020 to February 2022, with 4907 calls in total, 866 were falls (17.65%), further 1032 potential falls (21.07%). A survey was sent to NH to evaluate how staff treated residents who fell and showed that 47% of NH do not have any guidelines for falls and emergency services, are contacted 88.24% of the time. Education was delivered focusing on the negative consequences of falls. The package used the acronym "CWTCH" translated from the Welsh language as a hug. Education was offered to all NH (177 staff) and Feedback showed 100% felt more confident and found the session helpful with 90.96% less likely to contact emergency services. Falls remain a significant burden on emergency services, with clear opportunity to improve patient outcomes and experience. A referral pathway was developed diverting calls, showing a significant change in conveyance to hospital (p < 0.05).
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Affiliation(s)
- Alexandra Jayne Burgess
- Older Person's Assessment Service (OPAS), Morriston Hospital, Swansea Bay University Health Board (SBUHB), Swansea, UK
- Swansea University, Swansea, Wales, UK
| | - Debra Clee
- Older Person's Assessment Service (OPAS), Morriston Hospital, Swansea Bay University Health Board (SBUHB), Swansea, UK
| | - Alice Prichburg
- Older Person's Assessment Service (OPAS), Morriston Hospital, Swansea Bay University Health Board (SBUHB), Swansea, UK
| | - David James Burberry
- Older Person's Assessment Service (OPAS), Morriston Hospital, Swansea Bay University Health Board (SBUHB), Swansea, UK
| | - Leigh Keen
- Older Person's Assessment Service (OPAS), Morriston Hospital, Swansea Bay University Health Board (SBUHB), Swansea, UK
| | - Elizabeth Alexandra Davies
- Older Person's Assessment Service (OPAS), Morriston Hospital, Swansea Bay University Health Board (SBUHB), Swansea, UK
- Swansea University, Swansea, Wales, UK
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Marshall F, Gordon AL, Gladman JRF, Bishop S. "Crack on": a qualitative study of care home managers experiences and responses to system-led setbacks during the crisis of the COVID-19 Pandemic in England. Eur Geriatr Med 2023; 14:811-821. [PMID: 37278920 PMCID: PMC10241602 DOI: 10.1007/s41999-023-00804-y] [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: 12/30/2022] [Accepted: 05/22/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To explore care home managers' experiences of systems working with various organisations, including statutory, third sector and private, during the second wave of the COVID-19 pandemic from Sept 2020 to April 2021 DESIGN: An exploratory qualitative interview study using a systems theory approach focussing on the intersections of relationship interdependencies with other organisations. SETTING Conducted remotely with care home managers and key advisors who had worked since the start of the pandemic in/with care homes for older people across the East Midlands, UK. PARTICIPANTS 8 care home managers and 2 end-of-life advisors who participated during the second wave of the pandemic from Sept 2020. A total of 18 care home managers participated in the wider study from April 2020 to April 2021 RESULTS: Four organisational relationship interdependencies were identified: care practices, resources governance and wise working. Managers identified changes in their care practices as a shift towards the normalisation of care, with an emphasis on navigating pandemic restrictions to fit the context. Resources such as staffing, clinical reviews, pharmaceutical and equipment supplies were challenged, leading to a sense of precarity and tension. National polices and local guidance were fragmented, complex and disconnected from the reality of managing a care home. As a response a highly pragmatic reflexive style of management was identified which encompassed the use of mastery to navigate and in some cases circumvent official systems and mandates. Managers' experience of persistent and multiple setbacks were viewed as negative and confirmed their views that care homes as a sector ere marginalised by policy makers and statutory bodies. CONCLUSIONS Interactions with various organisations shaped the ways in which care home managers responded to and sought to maximise residents and staff well-being. Some relationships dissolved over time, such as when local business and schools returned to normal obligations. Other newly formed relationships became more robust including those with other care home managers, families, and hospices. Significantly, most managers viewed their relationship with local authority and national statutory bodies as detrimental to effective working, leading to a sense of increased mistrust and ambiguity. Respect, recognition and meaningful collaboration with the care home sector should underpin any future attempts to introduce practice change in the sector.
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Affiliation(s)
- Fiona Marshall
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Nottingham, UK
- Knowledge and Intelligence Team, Derbyshire County Council, Matlock, UK
| | - Adam L Gordon
- NIHR Applied Research Collaboration-East Midlands (ARC-EM), Nottingham, UK.
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Nottingham, UK.
| | - John R F Gladman
- NIHR Applied Research Collaboration-East Midlands (ARC-EM), Nottingham, UK
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Nottingham, UK
| | - Simon Bishop
- Nottingham University Business School, Nottingham, UK
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Hodge SY, Ali MR, Hui A, Logan P, Gordon AL. Recognising and responding to acute deterioration in care home residents: a scoping review. BMC Geriatr 2023; 23:399. [PMID: 37386360 PMCID: PMC10308707 DOI: 10.1186/s12877-023-04082-y] [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: 10/10/2022] [Accepted: 05/31/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Acute deterioration describes a rapid change in physical and/or mental health resulting from an acute illness - e.g., heart attack or infection. Older people in care homes are some of the frailest and vulnerable in society. They have complex health needs, experience multiple long-term conditions (MLTC) and have weakened immune systems due to the ageing process. They are more susceptible to acute deterioration and delayed recognition and response, is linked to poorer health outcomes, adverse events and death. Over the past five years, the need to manage acute deterioration in care homes and prevent hospital admissions has led to development and implementation of improvement projects, including the use of hospital derived practices and tools to identify and manage this condition. This is potentially problematic as care homes are different from hospitals-options to escalate care vary throughout the UK. Further, hospital tools have not been validated for use in care homes and have shown to be less sensitive in older adults living with frailty. OBJECTIVES To collate the available evidence on how care home workers recognise and respond to acute deterioration in residents using published primary research, non-indexed and grey literature, policies, guidelines and protocols. METHODS A systematic scoping review was conducted following Joanna Briggs Institute (JBI) scoping review methodology. Searches were conducted using: CINAHL (EBSCOhost), EMCARE (OVID), MEDLINE (OVID) and HMIC (OVID). Snowball searches of included studies' reference lists were conducted. Studies that featured care homes with or without nursing and provided 24/7 care to residents were included. RESULTS Three hundred and ninety-nine studies were identified. After reviewing all studies against inclusion criteria, n = 11 were included in the review. All studies used qualitative methods and were conducted in Australia, UK, South Korea, USA and Singapore. Four themes were generated from the review: identifying residents with acute deterioration; managing acute deterioration, care home policies and procedures, and factors affecting recognition and response to acute deterioration. FINDINGS Recognition and response to acute deterioration in residents is determined by multiple factors and is context sensitive. There are several interrelated factors within and external to the care home that contribute to how acute deterioration is recognised and managed. CONCLUSIONS AND IMPLICATIONS The available literature on how care home workers recognise and respond to acute deterioration is limited and often subtends other areas of interest. Recognising and responding to acute deterioration in care home residents is reliant on a complex and open system encompassing multiple interrelated components. The phenomenon of acute deterioration remains underexplored and further research is required to examine contextual factors that accompany identification and management of this condition in care home residents.
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Affiliation(s)
- Sevim Y Hodge
- School of Medicine, Centre for Rehabilitation and Ageing Research, University of Nottingham, Nottingham, UK.
| | - Mohammad R Ali
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Ada Hui
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Pip Logan
- School of Medicine, Centre for Rehabilitation and Ageing Research, University of Nottingham, Nottingham, UK
| | - Adam L Gordon
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK
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Connelly D, Hay M, Garnett A, Hung L, Yous ML, Furlan-Craievich C, Snelgrove S, Babcock M, Ripley J, Snobelen N, Gao H, Zhuang R, Hamilton P, Sturdy-Smith C, O’Connell M. Video Conferencing With Residents and Families for Care Planning During COVID-19: Experiences in Canadian Long-Term Care. THE GERONTOLOGIST 2023; 63:478-489. [PMID: 36201219 PMCID: PMC9619647 DOI: 10.1093/geront/gnac154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Government-mandated health and safety restrictions to mitigate the effects of coronavirus disease 2019 (COVID-19) intensified challenges in caring for older adults in long-term care (LTC) without family/care partners. This article describes the experiences of a multidisciplinary research team in implementing an evidence-based intervention for family-centered, team-based, virtual care planning-PIECESTM approach-into clinical practice. We highlight challenges and considerations for implementation science to support care practices for older adults in LTC, their families, and the workforce. RESEARCH DESIGN AND METHODS A qualitative descriptive design was used. Data included meetings with LTC directors and Registered Practical Nurses (i.e., licensed nurse who graduated with a 2-year diploma program that allows them to provide basic nursing care); one-on-one interviews with family/care partners, residents, Registered Practical Nurses, and PIECES mentors; and reflections of the academic team. The Consolidated Framework for Implementation Research provided sensitizing constructs for deductive coding, while an inductive approach also allowed themes to emerge. RESULTS Findings highlighted how aspects related to planning, engagement, execution, reflection, and evaluation influenced the implementation process from the perspectives of stakeholders. Involving expert partners on the research team to bridge research and practice, developing relationships from a distance, empowering frontline champions, and adapting to challenging circumstances led to shared commitments for intervention success. DISCUSSION AND IMPLICATIONS Lessons learned include the significance of stakeholder involvement throughout all research activities, the importance of clarity around expectations of all team members, and the consequence of readiness for implementation with respect to circumstances (e.g., COVID-19) and capacity for change.
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Affiliation(s)
- Denise Connelly
- Address correspondence to: Denise Connelly, BScPT, MSc, PhD, School of Physical Therapy, The University of Western Ontario, Room 1000, Elborn College, London ON, N6A 3K7, Canada. E-mail:
| | - Melissa Hay
- School of Physical Therapy, The University of Western Ontario, London, Ontario, Canada
| | - Anna Garnett
- Arthur Labatt Family School of Nursing, The University of Western Ontario, London, Ontario, Canada
| | - Lillian Hung
- School of Nursing, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Marie-Lee Yous
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | | | - Shannon Snelgrove
- APANS Health Service―Copper Terrace Long Term Care Home, Chatham, Ontario, Canada
| | | | - Jacqueline Ripley
- APANS Health Service―Copper Terrace Long Term Care Home, Chatham, Ontario, Canada
| | - Nancy Snobelen
- Registered Practical Nurses Association of Ontario (WeRPN), Toronto, Ontario, Canada
| | - Harrison Gao
- Department of Physiology and Pharmacology, The University of Western Ontario, London, Ontario, Canada
| | - Ruthie Zhuang
- Department of Physiology and Pharmacology, The University of Western Ontario, London, Ontario, Canada
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Hakimjavadi R, Karunananthan S, Alexander G, Fung C, Gazarin M, Houghton D, Hsu AT, LaPlante J, Levi C, Tanuseputro P, Liddy C. What is the level of information technology maturity in Ontario's long-term care homes? A cross-sectional survey study protocol. BMJ Open 2023; 13:e064745. [PMID: 36764709 PMCID: PMC9923326 DOI: 10.1136/bmjopen-2022-064745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
INTRODUCTION The number of Canadians 75 years and older is expected to double over the next 20 years, putting continuing care systems such as long-term care (LTC) homes under increasing pressure. Health information technology (IT) has been found to improve the quality, safety and efficiency of care in numerous clinical settings and could help optimise LTC for residents. However, the level of health IT adoption in Ontario's LTC homes is unknown and, as a result, requires an accurate assessment to provide a baseline understanding for future planning. METHODS AND ANALYSIS We will use a cross-sectional design to investigate the level of IT maturity in Ontario's LTC homes. IT maturity will be assessed with the LTC IT Maturity Instrument, a validated survey examining IT capabilities, the extent of IT use and degree of internal/external IT integration across the domains of resident care, clinical support and administrative activities. All LTC homes in Ontario will be invited to participate. The Director of Care for each home will be directly contacted for recruitment. The survey will be distributed online (or by paper, if preferred) to LTC homes and completed by a staff member designated by the LTC to be knowledgeable about its IT systems. Analyses will consist of descriptive statistics characterising IT maturity across LTC homes and inferential statistics to examine the association between key facility-level characteristics (size, ownership, rurality) and IT maturity. ETHICS AND DISSEMINATION This study was reviewed by the Ottawa Health Science Network Research Ethics Board and was exempt from full ethics review. Findings will be disseminated through peer-reviewed publication and presentations to the scientific community and stakeholders. Dissemination of our findings will not only inform provincial planning for harnessing the potential of technology in LTC but may also enable quality improvement initiatives in individual LTC homes.
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Affiliation(s)
- Ramtin Hakimjavadi
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Sathya Karunananthan
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Celeste Fung
- St. Patrick's Home of Ottawa, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Mohamed Gazarin
- Centre of Excellence for Rural Health and Education, Winchester District Memorial Hospital, Winchester, Ontario, Canada
| | - Deanne Houghton
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Amy T Hsu
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - James LaPlante
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Cheryl Levi
- Emergency Department Outreach Program, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
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Chadborn NH, Devi R, Goodman C, Williams CD, Sartain K, Gordon AL. General practitioners' role in improving health care in care homes: a realist review. Fam Pract 2023; 40:119-127. [PMID: 35781333 PMCID: PMC9909664 DOI: 10.1093/fampra/cmac071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Despite recent focus on improving health care in care homes, it is unclear what role general practitioners (GPs) should play. To provide evidence for future practice we set out to explore how GPs have been involved in such improvements. METHODS Realist review incorporated theory-driven literature searches and stakeholder interviews, supplemented by focussed searches on GP-led medication reviews and end-of-life care. Medline, Embase, CINAHL, PsycInfo, Web of Science, and the Cochrane library were searched. Grey literature was identified through internet searches and professional networks. Studies were included based upon relevance. Data were coded to develop and test contexts, mechanisms, and outcomes for improvements involving GPs. RESULTS Evidence was synthesized from 30 articles. Programme theories described: (i) "negotiated working with GPs," where other professionals led improvement and GPs provided expertise; and (ii) "GP involvement in national/regional improvement programmes." The expertise of GPs was vital to many improvement programmes, with their medical expertise or role as coordinators of primary care proving pivotal. GPs had limited training in quality improvement (QI) and care home improvement work had to be negotiated in the context of wider primary care commitments. CONCLUSIONS GPs are central to QI in health care in care homes. Their contributions relate to their specialist expertise and recognition as leaders of primary care but are challenged by available time and resources to develop this role.
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Affiliation(s)
- Neil H Chadborn
- Unit of Injury, Inflammation and Recovery Sciences, University of Nottingham, Derby, United Kingdom.,NIHR Applied Research Collaboration-East Midlands (ARC-EM), Nottingham, United Kingdom
| | - Reena Devi
- School of Healthcare, University of Leeds, Leeds, United Kingdom
| | - Claire Goodman
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, United Kingdom.,NIHR Applied Research Collaboration-East of England (ARC-EoE), Cambridge, United Kingdom
| | | | - Kate Sartain
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Adam L Gordon
- Unit of Injury, Inflammation and Recovery Sciences, University of Nottingham, Derby, United Kingdom.,NIHR Applied Research Collaboration-East Midlands (ARC-EM), Nottingham, United Kingdom.,University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
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Sattar Z, Young-Murphy L, Craig L, Steven A, Wilson-Menzfeld G. Frailty nurse and GP-led models of care in care homes: the role of contextual factors impacting Enhanced health in care homes framework implementation. BMC Geriatr 2023; 23:69. [PMID: 36737688 PMCID: PMC9898931 DOI: 10.1186/s12877-023-03742-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/09/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The Enhanced Health for Care homes (EHCH) framework is an innovative response to provide more proactive, preventative approaches to care for residents living in care homes. It involves co-producing a shared vision with primary care. As part of EHCH a UK clinical commissioning group supported GP's in two localities to implement their preferred delivery approach involving a new Frailty Nurse-led (FN-led) model in care homes alongside an existing General Practitioner-led (GP-led) model. This paper focuses on implementation of the new FN-led model. METHODS A qualitative study design was adopted. Forty-eight qualitative semi-structured interviews were undertaken across six care home sites in a Northern locality: three implementing the FN-led and three engaged in an existing GP-led model. Participants included residents, family members, care home managers, care staff, and health professionals working within the EHCH framework. RESULTS Two overarching themes were generated from data analysis: Unanticipated implementation issues and Unintended consequences. Unsuccessful attempts to recruit Frailty Nurses (FN) with enhanced clinical skills working at the desired level (UK NHS Band 7) led to an unanticipated evolution in the implementation process of the FN-led model towards 'training posts'. This prompted misaligned role expectations subsequently provoking unexpected temporary outcomes regarding role-based trust. The existing, well understood nature of the GP-led model may have further exacerbated these unintended consequences. CONCLUSION Within the broader remit of embedding EHCH frameworks, the implementation of new FN roles needed to evolve due to unforeseen recruitment issues. Wider contextual factors are not in the control of those developing new initiatives and cannot always be foreseen, highlighting how wider factors can force evolution of planned implementation processes with unintended consequences. However, the unintended consequences in this study highlight the need for careful consideration of information dissemination (content and timing) to key stakeholders, and the influence of existing ways of working.
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Affiliation(s)
- Zeibeda Sattar
- Department of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK.
| | - Lesley Young-Murphy
- Chief Operating Officer, North Tyneside Clinical Commissioning Group, Newcastle upon Tyne, UK
| | - Lynn Craig
- Head of Quality, Safety and Development, North Tyneside Clinical Commissioning Group, Newcastle upon Tyne, UK
| | - Alison Steven
- grid.42629.3b0000000121965555Department of Nursing, Midwifery & Health, Northumbria University, Newcastle upon Tyne, UK
| | - Gemma Wilson-Menzfeld
- grid.42629.3b0000000121965555Department, Nursing, Midwifery & Health, Northumbria University, Newcastle upon Tyne, UK
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Ridder HM, Krøier JK, Anderson-Ingstrup J, McDermott O. Person-attuned musical interactions (PAMI) in dementia care. Complex intervention research for constructing a training manual. Front Med (Lausanne) 2023; 10:1160588. [PMID: 37200965 PMCID: PMC10185798 DOI: 10.3389/fmed.2023.1160588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/10/2023] [Indexed: 05/20/2023] Open
Abstract
Introduction Music is of vital importance for cognition, human care, and the formation of social communities throughout life. Dementia is a neurocognitive disorder that affects cognitive domains, and in late-stage dementia, care is needed in all aspects of daily living. Within residential care home contexts, carers play a significant role for the "caring culture" but often lack professional training in verbal and non-verbal communication skills. Thus, there is a need for training carers to respond to the multidimensional needs of persons with dementia. Music therapists use musical interactions but are not trained to train carers. Therefore, our aim was to explore person-attuned musical interactions (PAMI), and additionally, to develop and evaluate a training manual to be used by music therapists when supporting and training carers in non-verbal communication with persons with late-stage dementia in residential care home contexts. Research process With a realist perspective and systems thinking and within the framework for complex intervention research, the research group integrated several overlapping subprojects by applying a non-linear and iterative research process. Core elements related to person-centered dementia care as well as learning objectives were considered through the following four phases; Developing, Feasibility, Evaluation, and Implementation. Results The result was a training manual for qualified music therapists to use when teaching and collaborating with carers about how to implement PAMI in dementia care. The manual included comprehensive resources, a clear structure for training, defined learning objectives, and integration of theory. Discussion With increased knowledge about caring values and non-verbal communication, residential care home cultures may develop carer competencies and provide professional attuned care for persons with dementia. Further piloting and testing to examine the general effect on caring cultures is needed.
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Affiliation(s)
- Hanne Mette Ridder
- Centre for Documentation and Research in Music Therapy, Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
- *Correspondence: Hanne Mette Ridder
| | - Julie Kolbe Krøier
- Centre for Documentation and Research in Music Therapy, Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
| | - Jens Anderson-Ingstrup
- Centre for Documentation and Research in Music Therapy, Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
| | - Orii McDermott
- Centre for Documentation and Research in Music Therapy, Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom
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Leighton PA, Darby J, Allen F, Cook M, Evley R, Fox C, Godfrey M, Gordon A, Gladman J, Horne J, Robertson K, Logan P. A realist evaluation of a multifactorial falls prevention programme in care homes. Age Ageing 2022; 51:6872690. [PMID: 36469088 PMCID: PMC9721241 DOI: 10.1093/ageing/afac263] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/17/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND falls in care homes are common, costly and hard to prevent.Multifactorial falls programmes demonstrate clinical and cost-effectiveness, but the heterogeneity of the care home sector is a barrier to their implementation. A fuller appreciation of the relationship between care home context and falls programme delivery will guide development and support implementation. METHODS this is a multi-method process evaluation informed by a realist approach.Data include fidelity observations, stakeholder interviews, focus groups, documentary review and falls-rate data. Thematic analysis of qualitative data and descriptive statistics are synthesised to generate care home case studies. RESULTS data were collected in six care homes where a falls programme was trialled. Forty-four interviews and 11 focus groups complemented observations and document review.The impact of the programme varied. Five factors were identified: (i) prior practice and (ii) training may inhibit new ways of working; (iii) some staff may be reluctant to take responsibility for falls; (iv) some may feel that residents living with dementia cannot be prevented from falling; and, (v) changes to management may disturb local innovation.In some care homes, training and improved awareness generated a reduction in falls without formal assessments being carried out. CONCLUSIONS different aspects of the falls programme sparked different mechanisms in different settings, with differing impact upon falls.The evaluation has shown that elements of a multifactorial falls programme can work independently of each other and that it is the local context (and local challenges faced), which should shape how a falls programme is implemented.
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Affiliation(s)
- Paul A Leighton
- Lifespan and Population Health, School of Medicine (LPH), University of Nottingham, Nottingham UK
| | - Janet Darby
- Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Nottingham UK
| | - Frances Allen
- Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Nottingham UK
| | - Marie Cook
- College of Health and Psychology, University of Derby, Derby UK
| | - Rachel Evley
- Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Nottingham UK
| | - Chris Fox
- College of Medicine and Health, University of Exeter, Exeter UK.,Norfolk and Suffolk NHS Foundation Trust, Norwich UK
| | | | - Adam Gordon
- Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Nottingham UK
| | - John Gladman
- Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Nottingham UK.,Nottingham University Hospitals NHS Trust, Nottingham UK.,NIHR Nottingham Biomedical Research Centre, Queens Medical Centre, Nottingham UK.,NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham UK
| | - Jane Horne
- Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Nottingham UK
| | - Kate Robertson
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham UK
| | - Pip Logan
- Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Nottingham UK
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11
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van den Hoed MW, Backhaus R, de Vries E, Hamers JPH, Daniëls R. Factors contributing to innovation readiness in health care organizations: a scoping review. BMC Health Serv Res 2022; 22:997. [PMID: 35932012 PMCID: PMC9354428 DOI: 10.1186/s12913-022-08185-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/14/2022] [Indexed: 12/03/2022] Open
Abstract
Background Increasing innovation readiness of healthcare organizations is necessary to meet upcoming challenges, including population aging, staff shortages and reduced funding. Health care organizations differ in the extent to which they are innovation ready. This review aims to clarify the concept of innovation readiness and identify which factors contribute to innovation readiness in health care organizations. Methods A scoping review was conducted based on the framework from Arksey and O’Malley. PubMed/MEDLINE, CINAHL and Web of Science were searched for studies that (a) aimed to contribute to scientific knowledge about innovation readiness of health care organizations, (b) were peer-reviewed, (c) reported empirical data and (d) were written in English, Dutch or German. Factors researched in the included studies were bundled into 4 overarching main factors and 10 sub-factors. Results Of the 6,208 studies identified, 44 were included. The majority (n = 36) of the studies had been conducted since 2011 and almost half of the studies (n = 19) were performed in hospitals. Of the 44 studies, 21 researched factors contributing to innovation readiness in the implementation stage of the innovation process. The authors used a variety of words and descriptions addressing innovation readiness, with hardly any theoretical frameworks for innovation readiness presented. Four main factors and 10 sub-factors contributing to the innovation readiness of health care organizations were summarized: strategic course for innovation, climate for innovation, leadership for innovation and commitment to innovation. Climate for innovation (n = 16) was studied the most and individual commitment to innovation (n = 6) was the least studied. Conclusion Our study identified four main factors contributing to the innovation readiness of health care organizations. Research into innovation readiness of health care organizations is a rather new field. Future research could be directed towards defining the concept of innovation readiness and the development of a framework for innovation readiness. More understanding of the interplay of factors contributing to innovation readiness in all stages of the innovation process and in diverse health care settings can support health care managers to structurally embed innovation. This review contributes to the first stage of theory building on factors contributing to innovation readiness of health care organizations. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08185-x.
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Affiliation(s)
- Monique W van den Hoed
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands. .,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands.
| | - Ramona Backhaus
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Erica de Vries
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Jan P H Hamers
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Ramon Daniëls
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands.,Expertise Centre for Innovative Care and Technology, Research Centre for Assistive Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands
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12
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Foundation Level Barriers to the Widespread Adoption of Digital Solutions by Care Homes: Insights from Three Scottish Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127407. [PMID: 35742667 PMCID: PMC9223833 DOI: 10.3390/ijerph19127407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/09/2022] [Accepted: 06/14/2022] [Indexed: 11/16/2022]
Abstract
The care home sector has great potential to benefit from technological innovations and to be at the forefront of developing novel digital solutions to improve the experiences of care home residents, their families, and the staff caring for them. The COVID-19 pandemic exposed variability in digital capabilities and longstanding data challenges within the care home sector. Paradoxically, however, it also increased the use of digital tools and services to support residents and staff. There are, however, a number of barriers to sustained and widespread adoption of digital solutions by care homes. Here, the focus is on foundation-level barriers and the groundwork required to overcome them. Using data from three Scottish-based studies, foundation-level barriers to the adoption of digital tools and services faced by care homes are discussed. These main barriers are the need for robust basic internet connectivity; capabilities for digital data collection; access to data to inform and drive digital solutions; the need for trust in the use of resident data by commercial companies; and the danger that poorly coordinated strategies undermine efforts to build a care home data platform and the digital solutions it can support. Sustained and widespread adoption of digital solutions by care homes will require these foundation-level barriers to be addressed. Strong and stable data and digital foundations supported by sector-specific scaffolding are major prerequisites to the widespread adoption of digital solutions by care homes.
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13
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Handley M, Bunn F, Dunn V, Hill C, Goodman C. Effectiveness and sustainability of volunteering with older people living in care homes: A mixed methods systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:836-855. [PMID: 34558761 DOI: 10.1111/hsc.13576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 08/14/2021] [Accepted: 09/10/2021] [Indexed: 06/13/2023]
Abstract
Older people living in care homes should be considered part of the wider local community; however, little is known about what enables them to connect with people not paid to look after them or family members. Volunteering can complement paid and familial support. While volunteering is common in community settings, care home residents are less likely to benefit from their input. We conducted a mixed methods systematic review and stakeholder consultation that aimed to identify volunteer activities in care homes and evidence for their effectiveness and sustainability. Databases were searched from 2000 to July 2021. Studies of all designs reporting volunteer-led activities with care home residents 65-years or over were included. Data on interventions, study population, study context, outcomes and implementation issues were extracted and synthesised. We identified 36 studies on the use, effectiveness and implementation of volunteering in care homes, although the overall strength of evidence was weak. Resident engagement and mood appeared to improve during volunteer-led activities, but there was little research examining the longer-term impact. Qualitative and stakeholder data suggest considerable investment is needed to initiate and maintain volunteering initiatives, but there are positive benefits for volunteers, residents and staff if an intervention is sustained. Financial cost for care home facilities is unclear. Interventions that address inequalities in accessing volunteer support within the resident population and between facilities should be considered.
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14
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Shenkin SD, Gordon AL, Johnston L, Henderson C, Achterberg WP. 'Don't let the trial kill the intervention': how can researchers and care home teams implement complex intervention trials in care homes? Age Ageing 2022; 51:6555264. [PMID: 35349628 PMCID: PMC8963727 DOI: 10.1093/ageing/afac068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Susan D Shenkin
- Ageing and Health Research Group & Advanced Care Research Centre, Usher Institute, University of Edinburgh, UK
| | - Adam L Gordon
- Academic Unit of Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham; NIHR Applied Research Collaboration-East Midlands (ARC-EM), Nottingham, UK
| | - Lucy Johnston
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | | | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
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15
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Peryer G, Kelly S, Blake J, Burton JK, Irvine L, Cowan A, Akdur G, Killett A, Brand SL, Musa MK, Meyer J, Gordon AL, Goodman C. Contextual factors influencing complex intervention research processes in care homes: a systematic review and framework synthesis. Age Ageing 2022; 51:6540144. [PMID: 35231097 PMCID: PMC8887840 DOI: 10.1093/ageing/afac014] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Indexed: 12/20/2022] Open
Abstract
Background Care homes are complex settings to undertake intervention research. Barriers to research implementation processes can threaten studies’ validity, reducing the value to residents, staff, researchers and funders. We aimed to (i) identify and categorise contextual factors that may mediate outcomes of complex intervention studies in care homes and (ii) provide recommendations to minimise the risk of expensive research implementation failures. Methods We conducted a systematic review using a framework synthesis approach viewed through a complex adaptive systems lens. We searched: MEDLINE, Embase, CINAHL, ASSIA databases and grey literature. We sought process evaluations of care home complex interventions published in English. Narrative data were indexed under 28 context domains. We performed an inductive thematic analysis across the context domains. Results We included 33 process evaluations conducted in high-income countries, published between 2005 and 2019. Framework synthesis identified barriers to implementation that were more common at the task and organisational level. Inductive thematic analysis identified (i) avoiding procedural drift and (ii) participatory action and learning as key priorities for research teams. Research team recommendations include advice for protocol design and care home engagement. Care home team recommendations focus on internal resources and team dynamics. Collaborative recommendations apply to care homes’ individual context and the importance of maintaining positive working relationships. Discussion Researchers planning and undertaking research with care homes need a sensitive appreciation of the complex care home context. Study implementation is most effective where an intervention is co-produced, with agreed purpose and adequate resources to incorporate within existing routines and care practices.
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Affiliation(s)
- Guy Peryer
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
- NIHR Applied Research Collaboration, East of England, England, UK
| | - Sarah Kelly
- Cambridge Public Health, University of Cambridge, East Forvie Site, Cambridge CB2 0SZ, UK
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0AH, UK
| | - Jessica Blake
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Jennifer K Burton
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow G31 2ER, UK
| | - Lisa Irvine
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Andy Cowan
- Cambridge Public Health, University of Cambridge, East Forvie Site, Cambridge CB2 0SZ, UK
| | - Gizdem Akdur
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Anne Killett
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
- NIHR Applied Research Collaboration, East of England, England, UK
| | - Sarah L Brand
- St Luke's Campus, Heavitree Road, University of Exeter, Exeter EX1 2LU, UK
- NIHR Applied Research Collaboration, South West Peninsula, England, UK
| | - Massirfufulay Kpehe Musa
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Julienne Meyer
- National Care Forum/Care for Older People, School of Health Sciences, Division of Nursing, City, University of London, London, UK
| | - Adam L Gordon
- School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham, UK
| | - Claire Goodman
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
- NIHR Applied Research Collaboration, East of England, England, UK
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16
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Fakha A, de Boer B, van Achterberg T, Hamers J, Verbeek H. Fostering the implementation of transitional care innovations for older persons: prioritizing the influencing key factors using a modified Delphi technique. BMC Geriatr 2022; 22:131. [PMID: 35172760 PMCID: PMC8848680 DOI: 10.1186/s12877-021-02672-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/26/2021] [Indexed: 12/03/2022] Open
Abstract
Background Transitions in care for older persons requiring long-term care are common and often problematic. Therefore, the implementation of transitional care innovations (TCIs) aims to improve necessary or avert avoidable care transitions. Various factors were recognized as influencers to the implementation of TCIs. This study aims to gain consensus on the relative importance level and the feasibility of addressing these factors with implementation strategies from the perspectives of experts. This work is within TRANS-SENIOR, an innovative research network focusing on care transitions. Methods A modified Delphi study was conducted with international scientific and practice-based experts, recruited using purposive and snowballing methods, from multiple disciplinary backgrounds, including implementation science, transitional care, long-term care, and healthcare innovations. This study was built on the findings of a previously conducted scoping review, whereby 25 factors (barriers, facilitators) influencing the implementation of TCIs were selected for the first Delphi round. Two sequential rounds of anonymous online surveys using an a priori consensus level of > 70% and a final expert consultation session were performed to determine the implementation factors’: i) direction of influence, ii) importance, and iii) feasibility to address with implementation strategies. The survey design was guided by the Consolidated Framework for Implementation Research (CFIR). Data were collected using Qualtrics software and analyzed with descriptive statistics and thematic analysis. Results Twenty-nine experts from 10 countries participated in the study. Eleven factors were ranked as of the highest importance among those that reached consensus. Notably, organizational and process-related factors, including engagement of leadership and key stakeholders, availability of resources, sense of urgency, and relative priority, showed to be imperative for the implementation of TCIs. Nineteen factors reached consensus for feasibility of addressing them with implementation strategies; however, the majority were rated as difficult to address. Experts indicated that it was hard to rate the direction of influence for all factors. Conclusions Priority factors influencing the implementation of TCIs were mostly at the organizational and process levels. The feasibility to address these factors remains difficult. Alternative strategies considering the interaction between the organizational context and the outer setting holds a potential for enhancing the implementation of TCIs. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02672-2.
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Affiliation(s)
- Amal Fakha
- CAPHRI Care and Public Health Research Institute, Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands. .,Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands. .,KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Kapucijnenvoer 35, 3000, Leuven, Belgium.
| | - Bram de Boer
- CAPHRI Care and Public Health Research Institute, Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Theo van Achterberg
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Kapucijnenvoer 35, 3000, Leuven, Belgium
| | - Jan Hamers
- CAPHRI Care and Public Health Research Institute, Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Hilde Verbeek
- CAPHRI Care and Public Health Research Institute, Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
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17
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Logan PA, Horne JC, Allen F, Armstrong SJ, Clark AB, Conroy S, Darby J, Fox C, Gladman JR, Godfrey M, Gordon AL, Irvine L, Leighton P, McCartney K, Mountain G, Robertson K, Robinson K, Sach TH, Stirling S, Wilson EC, Sims EJ. A multidomain decision support tool to prevent falls in older people: the FinCH cluster RCT. Health Technol Assess 2022; 26:1-136. [PMID: 35125131 DOI: 10.3310/cwib0236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Falls in care home residents are common, unpleasant, costly and difficult to prevent. OBJECTIVES The objectives were to evaluate the clinical effectiveness and cost-effectiveness of the Guide to Action for falls prevention in Care Homes (GtACH) programme. DESIGN A multicentre, cluster, parallel, 1 : 1 randomised controlled trial with embedded process evaluation and economic evaluation. Care homes were randomised on a 1 : 1 basis to the GtACH programme or usual care using a secure web-based randomisation service. Research assistants, participating residents and staff informants were blind to allocation at recruitment; research assistants were blind to allocation at follow-up. NHS Digital data were extracted blindly. SETTING Older people's care homes from 10 UK sites. PARTICIPANTS Older care home residents. INTERVENTION The GtACH programme, which includes care home staff training, systematic use of a multidomain decision support tool and implementation of falls prevention actions, compared to usual falls prevention care. OUTCOMES The primary trial outcome was the rate of falls per participating resident occurring during the 90-day period between 91 and 180 days post randomisation. The primary outcome for the cost-effectiveness analysis was the cost per fall averted, and the primary outcome for the cost-utility analysis was the incremental cost per quality adjusted life-year. Secondary outcomes included the rate of falls over days 0-90 and 181-360 post randomisation, activity levels, dependency and fractures. The number of falls per resident was compared between arms using a negative binomial regression model (generalised estimating equation). RESULTS A total of 84 care homes were randomised: 39 to the GtACH arm and 45 to the control arm. A total of 1657 residents consented and provided baseline measures (mean age 85 years, 32% men). GtACH programme training was delivered to 1051 staff (71% of eligible staff) over 146 group sessions. Primary outcome data were available for 630 GtACH participants and 712 control participants. The primary outcome result showed an unadjusted incidence rate ratio of 0.57 (95% CI 0.45 to 0.71; p < 0.01) in favour of the GtACH programme. Falls rates were lower in the GtACH arm in the period 0-90 days. There were no other differences between arms in the secondary outcomes. Care home staff valued the training, systematic strategies and specialist peer support, but the incorporation of the GtACH programme documentation into routine care home practice was limited. No adverse events were recorded. The incremental cost was £20,889.42 per Dementia Specific Quality of Life-based quality-adjusted life-year and £4543.69 per quality-adjusted life-year based on the EuroQol-5 dimensions, five-level version. The mean number of falls was 1.889 (standard deviation 3.662) in the GtACH arm and 2.747 (standard deviation 7.414) in the control arm. Therefore, 0.858 falls were averted. The base-case incremental cost per fall averted was £190.62. CONCLUSION The GtACH programme significantly reduced the falls rate in the study care homes without restricting residents' activity levels or increasing their dependency, and was cost-effective at current thresholds in the NHS. FUTURE WORK Future work should include a broad implementation programme, focusing on scale and sustainability of the GtACH programme. LIMITATIONS A key limitation was the fact that care home staff were not blinded, although risk was small because of the UK statutory requirement to record falls in care homes. TRIAL REGISTRATION This trial is registered as ISRCTN34353836. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 9. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Philippa A Logan
- School of Medicine, University of Nottingham, Nottingham, UK.,Community Rehabilitation Team, Nottingham CityCare Partnership, Nottingham, UK.,National Institute for Health Research Applied Research Collaboration East Midlands, Leicester General Hospital, Leicester, UK.,National Institute for Health Research Nottingham Biomedical Research Centre, Queen's Medical Centre, Nottingham, UK
| | - Jane C Horne
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Frances Allen
- School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Allan B Clark
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Simon Conroy
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Janet Darby
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Chris Fox
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - John Rf Gladman
- School of Medicine, University of Nottingham, Nottingham, UK.,National Institute for Health Research Applied Research Collaboration East Midlands, Leicester General Hospital, Leicester, UK.,National Institute for Health Research Nottingham Biomedical Research Centre, Queen's Medical Centre, Nottingham, UK.,Health Care of the Elderly Directorate, Nottingham University Hospitals, Nottingham, UK
| | - Maureen Godfrey
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Adam L Gordon
- School of Medicine, University of Nottingham, Nottingham, UK.,National Institute for Health Research Applied Research Collaboration East Midlands, Leicester General Hospital, Leicester, UK.,National Institute for Health Research Nottingham Biomedical Research Centre, Queen's Medical Centre, Nottingham, UK.,Medical School, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Lisa Irvine
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Paul Leighton
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Karen McCartney
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Gail Mountain
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Kate Robertson
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Katie Robinson
- School of Medicine, University of Nottingham, Nottingham, UK.,Health Care of the Elderly Directorate, Nottingham University Hospitals, Nottingham, UK
| | - Tracey H Sach
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Susan Stirling
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Erika J Sims
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
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18
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Warmoth K, Lynch J, Darlington N, Bunn F, Goodman C. Using video consultation technology between care homes and health and social care professionals: a scoping review and interview study during COVID-19 pandemic. Age Ageing 2022. [PMCID: PMC8824765 DOI: 10.1093/ageing/afab279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background the COVID-19 pandemic disproportionately affected care home residents’ and staffs’ access to health care and advice. Health and social care professionals adapted rapidly to using video consultation (videoconferencing) technology without guidance. We sought to identify enablers and barriers to their use in supporting care home residents and staff. Methods a scoping review of the evidence on remote consultations between healthcare services and care homes. Interviews with English health and social care professionals about their experiences during the pandemic. Findings were synthesised using the non-adoption, abandonment, scale-up, spread, sustainability framework. Results 18 papers were included in the review. Twelve interviews were completed. Documented enablers and barriers affecting the uptake and use of technology (e.g. reliable internet; reduced travelling) resonated with participants. Interviews demonstrated rapid, widespread technology adoption overcame barriers anticipated from the literature, often strengthening working relationships with care homes. Novel implementation issues included using multiple platforms and how resident data were managed. Healthcare professionals had access to more bespoke digital platforms than their social care counterparts. Participants alternated between platforms depending on individual context or what their organisation supported. All participants supported ongoing use of technologies to supplement in-person consultations. Conclusions the evidence on what needs to be in place for video consultations to work with care homes was partly confirmed. The pandemic context demolished many documented barriers to engagement and provided reassurance that residents’ assessments were possible. It exposed the need to study further differing resident requirements and investment in digital infrastructure for adequate information management between organisations.
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Affiliation(s)
- Krystal Warmoth
- Centre for Research in Public Health and Community Care (CRIPACC), University of Hertfordshire, AL10 9AB Hatfield, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration East of England, CB2 8AH Cambridge, UK
| | - Jennifer Lynch
- Centre for Research in Public Health and Community Care (CRIPACC), University of Hertfordshire, AL10 9AB Hatfield, UK
| | - Nicole Darlington
- Centre for Research in Public Health and Community Care (CRIPACC), University of Hertfordshire, AL10 9AB Hatfield, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration East of England, CB2 8AH Cambridge, UK
| | - Frances Bunn
- Centre for Research in Public Health and Community Care (CRIPACC), University of Hertfordshire, AL10 9AB Hatfield, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration East of England, CB2 8AH Cambridge, UK
| | - Claire Goodman
- Centre for Research in Public Health and Community Care (CRIPACC), University of Hertfordshire, AL10 9AB Hatfield, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration East of England, CB2 8AH Cambridge, UK
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19
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Devi R, Gordon A, Dening T. Enhancing the Quality of Care in Long-Term Care Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031409. [PMID: 35162431 PMCID: PMC8834779 DOI: 10.3390/ijerph19031409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Reena Devi
- School of Healthcare, University of Leeds, Leeds LS2 9JT, UK
- Nurturing Innovation in Care Home Excellence in Leeds (NICHE-Leeds), Leeds, UK
- Correspondence:
| | - Adam Gordon
- School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK; (A.G.); (T.D.)
- National Institute of Health Research (NIHR) Applied Research Collaboration-East Midlands (ARC-EM), Nottingham, UK
| | - Tom Dening
- School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK; (A.G.); (T.D.)
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20
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Musa MK, Akdur G, Brand S, Killett A, Spilsbury K, Peryer G, Burton JK, Gordon AL, Hanratty B, Towers AM, Irvine L, Kelly S, Jones L, Meyer J, Goodman C. The uptake and use of a minimum data set (MDS) for older people living and dying in care homes: a realist review. BMC Geriatr 2022; 22:33. [PMID: 34996391 PMCID: PMC8739629 DOI: 10.1186/s12877-021-02705-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 12/07/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Care homes provide long term care for older people. Countries with standardised approaches to residents' assessment, care planning and review (known as minimum data sets (MDS)) use the aggregate data to guide resource allocation, monitor quality, and for research. Less is known about how an MDS affects how staff assess, provide and review residents' everyday care. The review aimed to develop a theory-driven understanding of how care home staff can effectively implement and use MDS to plan and deliver care for residents. METHODS The realist review was organised according to RAMESES (Realist And Meta-narrative Evidence Synthesis: and Evolving Standards) guidelines. There were three overlapping stages: 1) defining the scope of the review and theory development on the use of minimum data set 2) testing and refining candidate programme theories through iterative literature searches and stakeholders' consultations as well as discussion among the research team; and 3) data synthesis from stages 1 and 2. The following databases were used MEDLINE via OVID, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ASSIA [Applied Social Sciences Citation Index and Abstracts]) and sources of grey literature. RESULTS Fifty-one papers informed the development of three key interlinked theoretical propositions: motivation (mandates and incentives for Minimum Data Set completion); frontline staff monitoring (when Minimum Data Set completion is built into the working practices of the care home); and embedded recording systems (Minimum Data Set recording system is integral to collecting residents' data). By valuing the contributions of staff and building on existing ways of working, the uptake and use of an MDS could enable all staff to learn with and from each other about what is important for residents' care CONCLUSIONS: Minimum Data Sets provides commissioners service providers and researchers with standardised information useful for commissioning planning and analysis. For it to be equally useful for care home staff it requires key activities that address the staff experiences of care, their work with others and the use of digital technology. REGISTRATION PROSPERO registration number CRD42020171323.
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Affiliation(s)
- Massirfufulay Kpehe Musa
- Centre for Research in Public health and Community Care (CRIPACC), School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| | - Gizdem Akdur
- Centre for Research in Public health and Community Care (CRIPACC), School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| | - Sarah Brand
- National Institute for Health Research Applied Research Collaboration South West Peninsula (PenARC), University of Exeter Medical School, St Luke’s Campus, Heavitree Road, Exeter, UK
| | - Anne Killett
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Karen Spilsbury
- School of Healthcare, University of Leeds, Leeds, UK
- NIHR Applied Research Collaboration, Yorkshire and Humber, Leeds, UK
| | - Guy Peryer
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | | | - Adam Lee Gordon
- School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Applied Research Collaboration, East Midlands (ARC-EM), Leicester, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
- NIHR Applied Research Collaboration, North East and North Cumbria, Newcastle, UK
| | - Ann-Marie Towers
- Centre for Health Services Studies, University of Kent, Canterbury, UK
- NIHR Applied Research Collaboration, Surrey and Sussex, Kent, UK
| | - Lisa Irvine
- Centre for Research in Public health and Community Care (CRIPACC), School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| | - Sarah Kelly
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Liz Jones
- National Care Forum, Friars House, Manor House Drive, Coventry, UK
| | - Julienne Meyer
- Care for Older People, School of Health Sciences, Division of Nursing, City, University of London, London, UK
| | - Claire Goodman
- Centre for Research in Public health and Community Care (CRIPACC), School of Health and Social Work, University of Hertfordshire, Hatfield, UK
- NIHR Applied Research Collaboration East of England, Cambridge, UK
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21
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Handley M, Parker D, Bunn F, Goodman C. A qualitative comparison of care home staff and palliative care specialists' experiences of providing end of life care to people living and dying with dementia in care homes in two countries: A focus group study. Palliat Med 2022; 36:114-123. [PMID: 34479468 PMCID: PMC8793290 DOI: 10.1177/02692163211043374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Palliative care for people with dementia dying in care homes is an important aspect of long-term care. Whilst there is consensus about the principles of palliative care, less is known about how care home staff negotiate and influence decisions around end of life and how organisational context shapes that process. AIM To explore the views and experiences of care home staff and palliative care specialists on end of life care in care homes and understand how care home settings affected palliative care provision in England and Australia. DESIGN/PARTICIPANTS Eight focus groups in Australia and England with care home staff and palliative care specialists (n = 49). Reflexive thematic analysis was undertaken. FINDINGS Australian participants reported collaboration between care home staff, visiting professions and family members though case conferences. English participants discussed resident-focussed involvement from specialists that was less formally organised. Negotiating roles and responsibilities in end of life care; the importance of relationships to overcome deficiencies in formal processes; and the legitimacy and authority of advance care planning at times of crisis were recurring themes. The organisation and embedding of end of life care in processes and practices of care homes differed; this closely linked to care home procedures in Australia but was less apparent in England. CONCLUSION In both countries, partnership working was recognised and valued as key to effective palliative care. Work that enables care home staff to identify challenges with visiting professionals, such as agreeing priorities for care and negotiating their shared responsibilities, may lead to context-sensitive, sustainable solutions.
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Affiliation(s)
- Melanie Handley
- University of Hertfordshire, Hatfield, Hertfordshire, England, UK
| | | | - Frances Bunn
- University of Hertfordshire, Hatfield, Hertfordshire, England, UK
| | - Claire Goodman
- University of Hertfordshire, Hatfield, Hertfordshire, England, UK
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22
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Logan PA, Horne JC, Gladman JRF, Gordon AL, Sach T, Clark A, Robinson K, Armstrong S, Stirling S, Leighton P, Darby J, Allen F, Irvine L, Wilson ECF, Fox C, Conroy S, Mountain G, McCartney K, Godfrey M, Sims E. Multifactorial falls prevention programme compared with usual care in UK care homes for older people: multicentre cluster randomised controlled trial with economic evaluation. BMJ 2021; 375:e066991. [PMID: 34876412 PMCID: PMC8649897 DOI: 10.1136/bmj-2021-066991] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To determine the clinical and cost effectiveness of a multifactorial fall prevention programme compared with usual care in long term care homes. DESIGN Multicentre, parallel, cluster randomised controlled trial. SETTING Long term care homes in the UK, registered to care for older people or those with dementia. PARTICIPANTS 1657 consenting residents and 84 care homes. 39 were randomised to the intervention group and 45 were randomised to usual care. INTERVENTIONS Guide to Action for Care Homes (GtACH): a multifactorial fall prevention programme or usual care. MAIN OUTCOME MEASURES Primary outcome measure was fall rate at 91-180 days after randomisation. The economic evaluation measured health related quality of life using quality adjusted life years (QALYs) derived from the five domain five level version of the EuroQoL index (EQ-5D-5L) or proxy version (EQ-5D-5L-P) and the Dementia Quality of Life utility measure (DEMQOL-U), which were self-completed by competent residents and by a care home staff member proxy (DEMQOL-P-U) for all residents (in case the ability to complete changed during the study) until 12 months after randomisation. Secondary outcome measures were falls at 1-90, 181-270, and 271-360 days after randomisation, Barthel index score, and the Physical Activity Measure-Residential Care Homes (PAM-RC) score at 91, 180, 270, and 360 days after randomisation. RESULTS Mean age of residents was 85 years. 32% were men. GtACH training was delivered to 1051/1480 staff (71%). Primary outcome data were available for 630 participants in the GtACH group and 712 in the usual care group. The unadjusted incidence rate ratio for falls between 91 and 180 days was 0.57 (95% confidence interval 0.45 to 0.71, P<0.001) in favour of the GtACH programme (GtACH: six falls/1000 residents v usual care: 10 falls/1000). Barthel activities of daily living indices and PAM-RC scores were similar between groups at all time points. The incremental cost was £108 (95% confidence interval -£271.06 to 487.58), incremental QALYs gained for EQ-5D-5L-P was 0.024 (95% confidence interval 0.004 to 0.044) and for DEMQOL-P-U was 0.005 (-0.019 to 0.03). The incremental costs per EQ-5D-5L-P and DEMQOL-P-U based QALY were £4544 and £20 889, respectively. CONCLUSIONS The GtACH programme was associated with a reduction in fall rate and cost effectiveness, without a decrease in activity or increase in dependency. TRIAL REGISTRATION ISRCTN34353836.
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Affiliation(s)
- Pip A Logan
- School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
- Nottingham CityCare Partnership, Nottingham, UK
- NIHR Applied Research Collaboration - East Midlands, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Jane C Horne
- School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
| | - John R F Gladman
- School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
- NIHR Applied Research Collaboration - East Midlands, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Adam L Gordon
- School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
- NIHR Applied Research Collaboration - East Midlands, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Tracey Sach
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Allan Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Katie Robinson
- School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sarah Armstrong
- School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Sue Stirling
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Paul Leighton
- School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Janet Darby
- School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Fran Allen
- School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
| | | | - Ed C F Wilson
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Chris Fox
- Exeter Medical School, University of Exeter, Exeter, UK
| | | | | | - Karen McCartney
- School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
| | | | - Erika Sims
- Norwich Medical School, University of East Anglia, Norwich, UK
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23
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Steinskog TLD, Tranvåg O, Ciliska D, Nortvedt MW, Graverholt B. Integrated knowledge translation in nursing homes: exploring the experiences of practice development nurses. BMC Health Serv Res 2021; 21:1283. [PMID: 34844600 PMCID: PMC8628377 DOI: 10.1186/s12913-021-07282-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 11/11/2021] [Indexed: 11/24/2022] Open
Abstract
Background Practice Development Nurses (PDNs) in Norwegian nursing homes (NHs) hold a specific responsibility for knowledge translation in this increasingly complex healthcare setting. They were involved as end users in an integrated knowledge translation (IKT) study, developing, testing and evaluating the IMPAKT (IMPlementation of Action to Knowledge Translation) intervention. PDNs participated in an educational programme tailored to their own defined needs. In a second intervention component, the PDNs applied their new skills with facilitation, in implementing the National Early Warning Score (NEWS2) in their respective NHs. The aim of this study was to explore 1) the PDNs’ experiences of participating in an IKT educational intervention, and 2) how they applied the learning in planning, tailoring and initial implementation of the NEWS2. Methods This is a qualitative exploratory study based on a phenomenological hermeneutical method. Study participants were PDNs working in the nine NHs in the intervention group of the IMPAKT trial. We conducted nine in-depth interviews and eight non-participatory observational sessions of the intervention delivery. Results The PDNs expressed that the educational programme met their needs and enhanced their understanding about leading knowledge translation (KT). They reported a move from operating in a “big black box of implementation” to a professional and structured mode of KT. The gamechanger was a shift from KT as the PDNs’ individual responsibility to KT as an organizational matter. The PDNs reported enhanced competencies in KT and in their ability to involve and collaborate with others in their facility. Organizational contextual factors challenged their KT efforts and implementation of the NEWS2. Conclusions This study demonstrates that an IKT approach has the potential to advance and improve staff competencies and NH readiness for KT. However, individual motivations and competencies were challenged within an organizational culture which was less receptive to this new leadership role and level of KT activity. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07282-7.
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Affiliation(s)
| | - Oscar Tranvåg
- Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway.,Norwegian Research Centre for Women's Health, Oslo University Hospital, Rikshospitalet, P.O. Box 4950 Nydalen, 0424, Oslo, Norway
| | - Donna Ciliska
- Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway.,McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | | | - Birgitte Graverholt
- Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway
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24
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Chadborn NH, Devi R, Williams C, Sartain K, Goodman C, Gordon AL. GPs’ involvement to improve care quality in care homes in the UK: a realist review. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background
Organising health-care services for residents living in care homes is an important area of development in the UK and elsewhere. Medical care is provided by general practitioners in the UK, and the unique arrangement of the NHS means that general practitioners are also gatekeepers to other health services. Despite recent focus on improving health care for residents, there is a lack of knowledge about the role of general practitioners.
Objectives
First, to review reports of research and quality improvement (or similar change management) in care homes to explore how general practitioners have been involved. Second, to develop programme theories explaining the role of general practitioners in improvement initiatives and outcomes.
Design
A realist review was selected to address the complexity of integration of general practice and care homes.
Setting
Care homes for older people in the UK, including residential and nursing homes.
Participants
The focus of the literature review was the general practitioner, along with care home staff and other members of multidisciplinary teams. Alongside the literature, we interviewed general practitioners and held consultations with a Context Expert Group, including a care home representative.
Interventions
The primary search did not specify interventions, but captured the range of interventions reported. Secondary searches focused on medication review and end-of-life care because these interventions have described general practitioner involvement.
Outcomes
We sought to capture processes or indicators of good-quality care.
Data sources
Sources were academic databases [including MEDLINE, EMBASE™ (Elsevier, Amsterdam, the Netherlands), Cumulative Index to Nursing and Allied Health Literature, PsycInfo® (American Psychological Association, Washington, DC, USA), Web of Science™ (Clarivate Analytics, Philadelphia, PA, USA) and Cochrane Collaboration] and grey literature using Google Scholar (Google Inc., Mountain View, CA, USA).
Methods
Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) guidelines were followed, comprising literature scoping, interviews with general practitioners, iterative searches of academic databases and grey literature, and synthesis and development of overarching programme theories.
Results
Scoping indicated the distinctiveness of the health and care system in UK and, because quality improvement is context dependent, we decided to focus on UK studies because of potential problems in synthesising across diverse systems. Searches identified 73 articles, of which 43 were excluded. To summarise analysis, programme theory 1 was ‘negotiated working with general practitioners’ where other members of the multidisciplinary team led initiatives and general practitioners provided support with the parts of improvement where their skills as primary care doctors were specifically required. Negotiation enabled matching of the diverse ways of working of general practitioners with diverse care home organisations. We found evidence that this could result in improvements in prescribing and end-of-life care for residents. Programme theory 2 included national or regional programmes that included clearly specified roles for general practitioners. This provided clarity of expectation, but the role that general practitioners actually played in delivery was not clear.
Limitations
One reviewer screened all search results, but two reviewers conducted selection and data extraction steps.
Conclusions
If local quality improvement initiatives were flexible, then they could be used to negotiate to build a trusting relationship with general practitioners, with evidence from specific examples, and this could improve prescribing and end-of-life care for residents. Larger improvement programmes aimed to define working patterns and build suitable capacity in care homes, but there was little evidence about the extent of local general practitioner involvement.
Future work
Future work should describe the specific role, capacity and expertise of general practitioners, as well as the diversity of relationships between general practitioners and care homes.
Study registration
This study is registered as PROSPERO CRD42019137090.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 20. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Neil H Chadborn
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK
- NIHR Applied Research Collaboration – East Midlands (ARC-EM), Nottingham, UK
| | - Reena Devi
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | | | - Kathleen Sartain
- Dementia and Frail Older Persons Patient and Public Involvement Group, Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Claire Goodman
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
- NIHR Applied Research Collaboration – East of England (ARC-EoE), Cambridge, UK
| | - Adam L Gordon
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK
- NIHR Applied Research Collaboration – East Midlands (ARC-EM), Nottingham, UK
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25
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Damery S, Flanagan S, Jones J, Jolly K. The Effect of Providing Staff Training and Enhanced Support to Care Homes on Care Processes, Safety Climate and Avoidable Harms: Evaluation of a Care Home Quality Improvement Programme in England. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147581. [PMID: 34300034 PMCID: PMC8307011 DOI: 10.3390/ijerph18147581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 11/22/2022]
Abstract
Older people living in care homes are at risk from avoidable harms, which may require hospital attendance or admission. This paper describes a mixed methods evaluation of a large quality improvement (QI) programme that provides skills training and facilitated support to staff in 29 care homes across two localities in the West Midlands, UK. The Safety Attitudes Questionnaire (SAQ) is used to assess changes to care home safety climate between baseline and programme end at 24 months. We use routinely collected data to assess pre- and post-programme avoidable harms and hospital attendance/admission rates. Semi-structured interviews with programme managers (n = 18), and staff (n = 49) in four case study homes are also used to assess perspectives on programme implementation. Our results show that safety climate scores increase by 1.4 points. There are significant reductions in falls (p = 0.0006), severe pressure ulcers (p = 0.014), UTIs (p = 0.001) and ‘any’ events (p = 0.0003). Emergency hospital attendances reduced, but admissions increased. Interview participants report improvements to teamwork, working practices, information sharing, knowledge and skills. Upskilling care home staff can improve working practices and attitudes towards resident safety and care quality, which may be associated with significant reductions in avoidable harms rates. Care staff turnover rates are high, which may impact the potential for longer-term sustainability of the changes observed.
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26
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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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27
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Fakha A, Groenvynck L, de Boer B, van Achterberg T, Hamers J, Verbeek H. A myriad of factors influencing the implementation of transitional care innovations: a scoping review. Implement Sci 2021; 16:21. [PMID: 33637097 PMCID: PMC7912549 DOI: 10.1186/s13012-021-01087-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/01/2021] [Indexed: 12/12/2022] Open
Abstract
Background Care transitions of older persons between multiple care settings are frequently hampered by various issues such as discontinuous care delivery or poor information transfer among healthcare providers. Therefore, several innovations have been developed to optimize transitional care (TC). This review aims to identify which factors influence the implementation of TC innovations. Methods As part of TRANS-SENIOR, an international innovative training and research network focusing on enhancing or avoiding care transitions, a scoping review was conducted. The five stages of the Arksey and O’Malley framework were followed. PubMed/MEDLINE, EMBASE, and CINAHL were searched, and eligible studies published between years 2000 and 2020 were retrieved. Data were extracted from the included studies and mapped to the domains and constructs of the Consolidated Framework for Implementation Research (CFIR) and Care Transitions Framework (CTF). Results Of 1537 studies identified, 21 were included. Twenty different TC innovations were covered and aimed at improving or preventing transitions between multiple care settings, the majority focused on transitions from hospital to home. Key components of the innovations encompassed transition nurses, teach-back methods, follow-up home visits, partnerships with community services, and transfer units. Twenty-five prominent implementation factors (seven barriers, seven facilitators, and eleven factors with equivalent hindering/facilitating influence) were shown to affect the implementation of TC innovations. Low organizational readiness for implementation and the overall implementation climate were topmost hindering factors. Similarly, failing to target the right population group was commonly reported as a major barrier. Moreover, the presence of skilled users but with restricted knowledge and mixed attitudes about the innovation impeded its implementation. Among the eminent enabling factors, a high-perceived advantage of the innovation by staff, along with encouraging transition roles, and a continuous monitoring process facilitated the implementation of several innovations. Other important factors were a high degree of organizational networks, engaging activities, and culture; these factors had an almost equivalent hindering/facilitating influence. Conclusions Addressing the right target population and instituting transition roles in care settings appear to be specific factors to consider during the implementation of TC innovations. Long-term care settings should simultaneously emphasize their organizational readiness for implementation and change, in order to improve transitional care through innovations. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-021-01087-2.
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Affiliation(s)
- Amal Fakha
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands. .,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands. .,Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35, 3000, Leuven, Belgium.
| | - Lindsay Groenvynck
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands.,Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35, 3000, Leuven, Belgium
| | - Bram de Boer
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Theo van Achterberg
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35, 3000, Leuven, Belgium
| | - Jan Hamers
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Hilde Verbeek
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
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Downs M, Blighe A, Carpenter R, Feast A, Froggatt K, Gordon S, Hunter R, Jones L, Lago N, McCormack B, Marston L, Nurock S, Panca M, Permain H, Powell C, Rait G, Robinson L, Woodward-Carlton B, Wood J, Young J, Sampson E. A complex intervention to reduce avoidable hospital admissions in nursing homes: a research programme including the BHiRCH-NH pilot cluster RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
An unplanned hospital admission of a nursing home resident distresses the person, their family and nursing home staff, and is costly to the NHS. Improving health care in care homes, including early detection of residents’ health changes, may reduce hospital admissions. Previously, we identified four conditions associated with avoidable hospital admissions. We noted promising ‘within-home’ complex interventions including care pathways, knowledge and skills enhancement, and implementation support.
Objectives
Develop a complex intervention with implementation support [the Better Health in Residents in Care Homes with Nursing (BHiRCH-NH)] to improve early detection, assessment and treatment for the four conditions. Determine its impact on hospital admissions, test study procedures and acceptability of the intervention and implementation support, and indicate if a definitive trial was warranted.
Design
A Carer Reference Panel advised on the intervention, implementation support and study documentation, and engaged in data analysis and interpretation. In workstream 1, we developed a complex intervention to reduce rates of hospitalisation from nursing homes using mixed methods, including a rapid research review, semistructured interviews and consensus workshops. The complex intervention comprised care pathways, approaches to enhance staff knowledge and skills, implementation support and clarity regarding the role of family carers. In workstream 2, we tested the complex intervention and implementation support via two work packages. In work package 1, we conducted a feasibility study of the intervention, implementation support and study procedures in two nursing homes and refined the complex intervention to comprise the Stop and Watch Early Warning Tool (S&W), condition-specific care pathways and a structured framework for nurses to communicate with primary care. The final implementation support included identifying two Practice Development Champions (PDCs) in each intervention home, and supporting them with a training workshop, practice development support group, monthly coaching calls, handbooks and web-based resources. In work package 2, we undertook a cluster randomised controlled trial to pilot test the complex intervention for acceptability and a preliminary estimate of effect.
Setting
Fourteen nursing homes allocated to intervention and implementation support (n = 7) or treatment as usual (n = 7).
Participants
We recruited sufficient numbers of nursing homes (n = 14), staff (n = 148), family carers (n = 95) and residents (n = 245). Two nursing homes withdrew prior to the intervention starting.
Intervention
This ran from February to July 2018.
Data sources
Individual-level data on nursing home residents, their family carers and staff; system-level data using nursing home records; and process-level data comprising how the intervention was implemented. Data were collected on recruitment rates, consent and the numbers of family carers who wished to be involved in the residents’ care. Completeness of outcome measures and data collection and the return rate of questionnaires were assessed.
Results
The pilot trial showed no effects on hospitalisations or secondary outcomes. No home implemented the intervention tools as expected. Most staff endorsed the importance of early detection, assessment and treatment. Many reported that they ‘were already doing it’, using an early-warning tool; a detailed nursing assessment; or the situation, background, assessment, recommendation communication protocol. Three homes never used the S&W and four never used care pathways. Only 16 S&W forms and eight care pathways were completed. Care records revealed little use of the intervention principles. PDCs from five of six intervention homes attended the training workshop, following which they had variable engagement with implementation support. Progression criteria regarding recruitment and data collection were met: 70% of homes were retained, the proportion of missing data was < 20% and 80% of individual-level data were collected. Necessary rates of data collection, documentation completion and return over the 6-month study period were achieved. However, intervention tools were not fully adopted, suggesting they would not be sustainable outside the trial. Few hospitalisations for the four conditions suggest it an unsuitable primary outcome measure. Key cost components were estimated.
Limitations
The study homes may already have had effective approaches to early detection, assessment and treatment for acute health changes; consistent with government policy emphasising the need for enhanced health care in homes. Alternatively, the implementation support may not have been sufficiently potent.
Conclusion
A definitive trial is feasible, but the intervention is unlikely to be effective. Participant recruitment, retention, data collection and engagement with family carers can guide subsequent studies, including service evaluation and quality improvement methodologies.
Future work
Intervention research should be conducted in homes which need to enhance early detection, assessment and treatment. Interventions to reduce avoidable hospital admissions may be beneficial in residential care homes, as they are not required to employ nurses.
Trial registration
Current Controlled Trials ISRCTN74109734 and ISRCTN86811077.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 2. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Murna Downs
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Alan Blighe
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Robin Carpenter
- Department of Primary Care and Population Health and Priment Clinical Trials Unit, University College London, London, UK
| | - Alexandra Feast
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Katherine Froggatt
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Sally Gordon
- National Institute for Health Research Clinical Research Network Yorkshire and Humber, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Rachael Hunter
- Department of Primary Care and Population Health and Priment Clinical Trials Unit, University College London, London, UK
| | - Liz Jones
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Natalia Lago
- Department of Primary Care and Population Health and Priment Clinical Trials Unit, University College London, London, UK
| | - Brendan McCormack
- Division of Nursing and Division of Occupational Therapy and Arts Therapies, School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - Louise Marston
- Department of Primary Care and Population Health and Priment Clinical Trials Unit, University College London, London, UK
| | | | - Monica Panca
- Department of Primary Care and Population Health and Priment Clinical Trials Unit, University College London, London, UK
| | - Helen Permain
- Research Department, Harrogate and District NHS Foundation Trust, Harrogate, UK
| | - Catherine Powell
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Greta Rait
- Department of Primary Care and Population Health and Priment Clinical Trials Unit, University College London, London, UK
| | - Louise Robinson
- Institute for Ageing and Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - John Wood
- Department of Primary Care and Population Health and Priment Clinical Trials Unit, University College London, London, UK
| | - John Young
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Leeds, UK
- Bradford Institute for Health Research, Bradford, UK
| | - Elizabeth Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
- Barnet Enfield and Haringey Mental Health Trust Liaison Psychiatry Team, North Middlesex University Hospital, London, UK
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Dupont C, De Schreye R, Cohen J, De Ridder M, Van den Block L, Deliens L, Leemans K. Pilot Study to Develop and Test Palliative Care Quality Indicators for Nursing Homes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:829. [PMID: 33478066 PMCID: PMC7835963 DOI: 10.3390/ijerph18020829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/15/2021] [Accepted: 01/15/2021] [Indexed: 11/17/2022]
Abstract
An increasingly frail population in nursing homes accentuates the need for high quality care at the end of life and better access to palliative care in this context. Implementation of palliative care and its outcomes can be monitored by using quality indicators. Therefore, we developed a quality indicator set for palliative care in nursing homes and a tailored measurement procedure while using a mixed-methods design. We developed the instrument in three phases: (1) literature search, (2) interviews with experts, and (3) indicator and measurement selection by expert consensus (RAND/UCLA). Second, we pilot tested and evaluated the instrument in nine nursing homes in Flanders, Belgium. After identifying 26 indicators in the literature and expert interviews, 19 of them were selected through expert consensus. Setting-specific themes were advance care planning, autonomy, and communication with family. The quantitative and qualitative analyses showed that the indicators were measurable, had good preliminary face validity and discriminative power, and were considered to be useful in terms of quality monitoring according to the caregivers. The quality indicators can be used in a large implementation study and process evaluation in order to achieve continuous monitoring of the access to palliative care for all of the residents in nursing homes.
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Affiliation(s)
- Charlèss Dupont
- VUB-UGhent End-of-life Care Research Group, Vrije Universiteit Brussel (VUB), 1090 Brussel, Belgium; (R.D.S.); (J.C.); (L.V.d.B.); (L.D.)
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), 1090 Brussel, Belgium
| | - Robrecht De Schreye
- VUB-UGhent End-of-life Care Research Group, Vrije Universiteit Brussel (VUB), 1090 Brussel, Belgium; (R.D.S.); (J.C.); (L.V.d.B.); (L.D.)
| | - Joachim Cohen
- VUB-UGhent End-of-life Care Research Group, Vrije Universiteit Brussel (VUB), 1090 Brussel, Belgium; (R.D.S.); (J.C.); (L.V.d.B.); (L.D.)
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), 1090 Brussel, Belgium
| | - Mark De Ridder
- Department of Radiotherapy, University Hospital Brussels, 1090 Brussel, Belgium;
| | - Lieve Van den Block
- VUB-UGhent End-of-life Care Research Group, Vrije Universiteit Brussel (VUB), 1090 Brussel, Belgium; (R.D.S.); (J.C.); (L.V.d.B.); (L.D.)
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), 1090 Brussel, Belgium
| | - Luc Deliens
- VUB-UGhent End-of-life Care Research Group, Vrije Universiteit Brussel (VUB), 1090 Brussel, Belgium; (R.D.S.); (J.C.); (L.V.d.B.); (L.D.)
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), 1090 Brussel, Belgium
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Kathleen Leemans
- VUB-UGhent End-of-life Care Research Group, Vrije Universiteit Brussel (VUB), 1090 Brussel, Belgium; (R.D.S.); (J.C.); (L.V.d.B.); (L.D.)
- Department of Radiotherapy, University Hospital Brussels, 1090 Brussel, Belgium;
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Alves JF, Mendes CPG, Valadares VF, Bernardes JG, Gutierrez BAO, Silva HSD. Cross-cultural adaptation of the PEAK 2.0 instrument for the measurement of satisfaction and quality of care for institutionalized older adults. GERIATRICS, GERONTOLOGY AND AGING 2021. [DOI: 10.53886/gga.e0210063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE: To perform the Brazilian Portuguese cross-cultural adaptation of scales of satisfaction, quality of care, and quality of service constructed by the Promoting Excellent Alternatives in Kansas (PEAK 2.0) program for the measurement of person-centered care practices in the context of institutionalized older persons. METHODS: Cross-cultural adaptation was performed according to the following steps: translation; back translation; semantic, idiomatic, experiential, and conceptual equivalence; validation by an expert panel; and pre-test. This is an instrument with 32 individual items grouped into 4 subscales: overall satisfaction, quality of life, quality of care, and quality of service. RESULTS: The highest disagreement between experts was observed regarding verb conjugation and/or agreement aspects, which were adjusted. The pre-test, performed with 10 residents of long-term care facilities for older adults, showed that the “quality of life” and “quality of care” items had low levels of satisfaction. Although the residents demonstrated increased concern with the objective aspects of care, such as security and cleanliness, subjective aspects such as spirituality showed the lowest satisfaction levels. CONCLUSION: After cross-cultural adaptation, the overall satisfaction, quality of life, quality of care, and quality of service instruments of the PEAK 2.0 program were well understood by older adults and interviewers. The pre-test assessment showed that these instruments have a quick and easy application and can be used in Brazilian institutions.
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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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