37 results on '"Smalbrugge, Martin"'
Search Results
2. Urinary Tract Infection Guideline Adherence in a Dutch Sentinel Nursing Home Surveillance Network.
- Author
-
Yeung, Gary Y.C., Smalbrugge, Martin, van Buul, Laura W., Rutten, Jeanine J.S., van Houten, Paul, Gerridzen, Ineke J., de Bruijne, Martine C., Joling, Karlijn J., and Hertogh, Cees M.P.M.
- Subjects
- *
ANTIBIOTICS , *URINARY tract infections , *MEDICAL protocols , *PUBLIC health surveillance , *MEDICAL prescriptions , *SCIENTIFIC observation , *DECISION making in clinical medicine , *NURSING care facilities , *LONGITUDINAL method , *PHYSICIAN practice patterns , *SOCIAL networks , *DRUG prescribing , *OLD age - Abstract
To investigate guideline adherence 3 years after the introduction of a national guideline on urinary tract infections (UTIs) in frail older adults. Appropriate use of urine dipstick tests, treatment decisions, and antibiotic drug choices in residents with (suspected) UTIs without a catheter were examined. Observational prospective study. Nineteen nursing homes participating in a Dutch Sentinel Nursing Home Surveillance Network. As of September 2021, for a 3-month period, medical practitioners recorded additional clinical information in the electronic health record in case of a (suspected) UTI. Based on this information, adherence to guideline recommendations was assessed. Nonadherence was classified into 2 categories: (1) "intentional nonadherence" as reported by practitioners and (2) "nonadherence otherwise" applied to all other cases where the recorded information was discordant with the guideline recommendations. A total of 532 cases of (suspected) UTIs from 469 residents were analyzed. In 455 cases (86%), dipsticks were used. For the 231 cases where clinical signs and symptoms already indicated no UTI treatment according to the guideline, a dipstick was still inappropriately ordered in 196 cases (85%). The decision to prescribe or withhold antibiotics was in 69% of the cases adherent, in 6% intentionally nonadherent, and in 25% nonadherent otherwise. The type of prescribed antibiotic was adherent to the recommended antibiotics for cystitis in 88% and for UTIs with signs of tissue invasion in 48%. Overall, for 40% of suspected UTIs, adherence to all relevant recommendations could be established, and in 9% practitioners reported intentional nonadherence to the guideline. There is considerable room for improvement in all clinical stages of managing a suspected UTI in Dutch nursing homes, particularly with regard to the importance of patient's clinical signs and symptoms for appropriate dipstick use and antibiotic UTI treatments. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
3. Urinary Tract Infection Guideline Adherence in Dutch Nursing Home Network.
- Author
-
Yeung, Gary Y.C., Smalbrugge, Martin, van Buul, Laura, Rutten, Jeanine J.S., Van Houten, Paul, Gerridzen, Ineke J., De Bruijne, Martine C., Joling, Karlijn J., and Hertogh, Cees M.P.M.
- Subjects
- *
MEDICAL protocols , *URINARY tract infections , *NURSING care facilities - Published
- 2024
- Full Text
- View/download PDF
4. A Process Evaluation of an Antibiotic Stewardship Intervention for Urinary Tract Infections in Nursing Homes.
- Author
-
Rutten, Jeanine J.S., Smalbrugge, Martin, van Buul, Laura W., van Eijk, Jorna, Geerlings, Suzanne E., Natsch, Stephanie, Sloane, Philip D., van der Wouden, Johannes C., Hertogh, Cees M.P.M., and Gerritsen, Debby L.
- Subjects
- *
ANTIBIOTICS , *ANTIMICROBIAL stewardship , *NURSING care facility administration , *CLINICAL decision support systems , *EVALUATION of human services programs , *CONFIDENCE , *URINARY tract infections , *RESEARCH methodology , *ATTITUDES of medical personnel , *INTERVIEWING , *HUMAN services programs , *QUESTIONNAIRES , *DESCRIPTIVE statistics , *DRUG prescribing , *PHYSICIAN practice patterns , *CORPORATE culture ,RESEARCH evaluation - Abstract
To assess the internal and external validity of a cluster randomized controlled trial (cRCT) evaluating a decision tool with supportive interventions for the empirical treatment of urinary tract infections (UTIs) in nursing homes (NHs), and to identify facilitators and barriers in implementing this antibiotic stewardship intervention. Mixed-methods process evaluation study. Physicians, nursing staff, client council members, and residents of Dutch NHs. We used cRCT data of the ANNA study (Antibiotic Prescribing and Non-prescribing in Nursing Home Residents With Signs and Symptoms Ascribed to Urinary Tract Infection). In addition, we sent out an online evaluation questionnaire, conducted semistructured interviews with physicians and nursing staff, and consulted client council members. Internal validity was lowered: control group physicians participated in several non–study-related activities regarding UTI. External validity was good: almost all intervention components had a high fidelity (52%-74%) and were perceived as relevant (physicians: 7.2-8.6 of 10, nursing staff: 6.5-8.5 of 10) and feasible (physicians: 7.5 of 10, nursing staff 6.4 of 10), with feasibility for residents with dementia and urine incontinence needing attention. The most common reason for deviating from the advice generated by the decision tool was an unclear illness presentation. Identified facilitators to implementation were confidence in the intervention, repeated intervention encounter, and having "champions" in the NH. Barriers were limited involvement of nursing staff, unstable nursing teams, residents' and representatives' belief that antibiotics should be prescribed, and a low antibiotic prescribing threshold within the NH culture. Lowered internal validity may have reduced the study effect. Attention should be paid to the feasibility of the intervention in residents with dementia and urinary incontinence. Improvement opportunities for implementation were higher nursing staff involvement and repeated intervention offering. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
5. Prevalence of Pain in Nursing Home Residents: The Role of Dementia Stage and Dementia Subtypes.
- Author
-
van Kooten, Janine, Smalbrugge, Martin, van der Wouden, Johannes C., Stek, Max L., and Hertogh, Cees M.P.M.
- Subjects
- *
DEMENTIA , *NURSING care facilities , *SCIENTIFIC observation , *PAIN , *TIME , *DISEASE prevalence , *CROSS-sectional method - Abstract
Objectives To study pain prevalence, pain type, and its pharmacological treatment in Dutch nursing home residents in relation to dementia subtype and dementia severity. Design Data were collected as part of the PAINdemiA study, an observational cross-sectional study conducted between May 2014 and December 2015. Setting Ten nursing homes in the Netherlands. Participants A total of 199 nursing home residents in various stages of dementia. Measurements We collected data on pain (by observation: MOBID-2 Pain Scale and by self-report scales), pain type, pain medication, dementia subtype, dementia severity (GDS), and demographic features. Results In the whole sample, the prevalence of pain was 43% (95% confidence interval 36%–50%) using the MOBID-2 Pain Scale. Regardless of regularly scheduled analgesics, approximately one-third of the residents with pain suffered from moderate to severe pain. Pain assessment with the MOBID-2 Pain Scale showed no difference in pain between dementia subtypes, but residents with more severe dementia experienced pain more often than those with less severe dementia (27% vs 15%). The prevalence of self-reported pain was significantly higher in residents with vascular dementia (VaD) (54%) compared with those with Alzheimer disease (18%) and other dementia subtypes (14%). Nociceptive pain was the predominant type of pain (72%) followed by mixed pain (25%). Acetaminophen was the most prescribed analgesic (80%). Conclusion Most of the participating nursing home residents had no pain; however, pain was observed more often in residents with severe dementia, whereas residents in the early stages of VaD self-reported pain more often that those with other dementia subtypes. As one-third of the residents with clinically relevant pain had moderate to severe pain regardless of using pain medication, more focus should be on how pain management could use more tailored approaches and be regularly adjusted to individual needs. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
6. The Difficulty With Studying Challenging Behavior.
- Author
-
Gerritsen, Debby L., Smalbrugge, Martin, Veldwijk-Rouwenhorst, Annelies E., Wetzels, Roland, Zuidema, Sytse U., and Koopmans, Raymond T.C.M.
- Subjects
- *
COMMUNICATION , *DEMENTIA , *DEMENTIA patients , *INTELLECT , *INVECTIVE , *LANGUAGE & languages , *BEHAVIOR disorders , *SYMPTOMS - Published
- 2019
- Full Text
- View/download PDF
7. The Prevalence of Burnout Among Nursing Home Physicians: An International Perspective.
- Author
-
Nazir, Arif, Smalbrugge, Martin, Moser, Andrea, Karuza, Jurgis, Crecelius, Charles, Hertogh, Cees, Feldman, Sid, and Katz, Paul R.
- Subjects
- *
PSYCHOLOGICAL burnout , *LONG-term health care , *MEDICAL quality control , *NURSING care facilities , *PSYCHOLOGY of physicians , *QUESTIONNAIRES , *RESEARCH , *SURVEYS , *DISEASE prevalence - Abstract
Physician burnout is a critical factor influencing the quality of care delivered in various healthcare settings. Although the prevalence and consequences of burnout have been well documented for physicians in various jurisdictions, no studies to date have reported on burnout in the postacute and long-term care setting. In this exploratory study, we sought to quantify the prevalence of burnout among 3 cohorts of physicians, each practicing in nursing homes in the United States (US), Canada, or The Netherlands. International comparisons were solicited to highlight cultural and health system factors potentially impacting burnout levels. Using standard survey techniques, a total of 721 physicians were solicited to participate (Canada 393; US 110; The Netherlands 218). Physicians agreeing to participate were asked to complete the “Maslach Burnout Inventory” using the Survey Monkey platform. A total of 118 surveys were completed from The Netherlands, 59 from Canada, and 65 from the US for response rates of 54%, 15%, and 59%, respectively. While US physicians demonstrated more negative scores in the emotional exhaustion subscale compared with their counterparts in Canada and The Netherlands, there were no meaningful differences on the depersonalization and personal accomplishments subscales. Factors explaining these differences are explored as well as approaches to future research on physician burnout in postacute and long-term care. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
8. From Admission to Death: Prevalence and Course of Pain, Agitation, and Shortness of Breath, and Treatment of These Symptoms in Nursing Home Residents With Dementia.
- Author
-
Hendriks, Simone A., Smalbrugge, Martin, Galindo-Garre, Francisca, Hertogh, Cees M.P.M., and van der Steen, Jenny T.
- Subjects
- *
BENZODIAZEPINES , *THERAPEUTIC use of narcotics , *ACETAMINOPHEN , *AGITATION (Psychology) , *TRANQUILIZING drugs , *BRONCHODILATOR agents , *CHRONIC diseases , *DEMENTIA , *DYSPNEA , *LONG-term health care , *LONGITUDINAL method , *EVALUATION of medical care , *NURSING home patients , *NURSING care facilities , *HEALTH outcome assessment , *PAIN , *PALLIATIVE treatment , *QUALITY of life , *RESEARCH funding , *TREATMENT effectiveness , *DESCRIPTIVE statistics , *SYMPTOMS , *THERAPEUTICS - Abstract
Objectives Burdensome symptoms frequently develop as part of the dementia trajectory and influence quality of life. We explore the course of symptoms and their treatment during nursing home stay to help target adequate symptom management. Design Data were collected as part of the Dutch End of Life in Dementia study, a longitudinal observational study with up to 3.5 years of follow-up. Physicians performed assessments at baseline, semiannually, and shortly after death of pain, agitation, shortness of breath, and treatment provided for these symptoms. Setting Long-term care facilities (28) in the Netherlands. Participants Newly admitted nursing home residents (372) in variable stages of dementia. Measurements We described prevalence and course of symptoms, and treatment provided for these symptoms. We used generalized estimating equations to evaluate the longitudinal change in symptoms and their treatment, and the associations between the symptoms of pain and agitation, as well as between stage of dementia and symptoms. Results Pain was common (varying from 47% to 68% across the semiannual assessments) and frequently persistent (36%–41% of all residents); it increased to 78% in the last week of life. Agitation was the most common symptom (57%–71%), and also frequently persistent (39%–53%), yet it decreased to 35% in the last week of life. Shortness of breath was less common (16%–26%), but it increased to 52% at the end of life. Pain was not significantly associated with agitation. Advanced dementia was associated with more pain only. Treatment changed in particular at the end of life. Pain was treated mostly with acetaminophen (34%–52%), and at the end of life with parenteral opioids (44%). Agitation was mostly treated nonpharmacologically (78%–92%), and at the end of life anxiolytics were the most frequently prescribed treatment (62%). Overall, aerosolized bronchodilators were the most frequently prescribed treatment for shortness of breath (29%–67%), but at the end of life, this was morphine (69%). Conclusion Pain and agitation were common and frequently persisted in residents with dementia during nursing home stay, but symptom management intensified only at the end of life. Symptom control may be suboptimal from admission, and a stronger focus on symptom control is needed at an earlier stage than the end of life. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
- View/download PDF
9. Factors Related to Psychotropic Drug Prescription for Neuropsychiatric Symptoms in Nursing Home Residents With Dementia.
- Author
-
Smeets, Claudia H.W., Smalbrugge, Martin, Zuidema, Sytse U., Derksen, Els, de Vries, Erica, van der Spek, Klaas, Koopmans, Raymond T.C.M., and Gerritsen, Debby L.
- Subjects
- *
PSYCHIATRIC drugs , *ELDER care , *COMMUNICATION , *CONCEPTUAL structures , *DEMENTIA , *DRUG utilization , *GERIATRIC nursing , *GROUNDED theory , *INTERPROFESSIONAL relations , *INTERVIEWING , *LONG-term health care , *RESEARCH methodology , *MEDICAL personnel , *MEDICAL prescriptions , *NURSING home patients , *NURSING care facilities , *PHYSICIANS , *PROFESSIONS , *THEMATIC analysis , *PATIENTS' families , *DATA analysis software , *SYMPTOMS - Abstract
Objectives The objective of this study is to explore factors that elucidate reasons for psychotropic drug (PD) prescription for neuropsychiatric symptoms (NPS) in nursing home (NH) residents with dementia. Design A qualitative study using a grounded theory approach. Setting Twelve NHs in The Netherlands. Participants Fifteen physicians and 14 nurses. Measurements Individual, face-to-face, in-depth semistructured interviews. Interviews were audio recorded, transcribed, and qualitatively analyzed using Atlas.ti. Results The qualitative analysis revealed 4 emerging themes with factors either or both enhancing or limiting PD prescription, which we used to develop a conceptual framework. First, the mindset of physicians and nurses toward NPS and PDs appeared to contribute. Second, inadequate knowledge of and experience with NPS and limited people skills of nurses may induce PD prescription. Also, knowledge of effectiveness and side effects of PDs from education, literature, and guidelines, and previous personal experiences was considered relevant. Third, effective communication and cooperation between professionals and with family may improve the appropriateness of PD prescription. Fourth, external factors including staffing issues, nursing home setting, access to consultants, national and local policies, and zeitgeist were considered to affect PD prescription. Conclusion We have developed a conceptual framework explaining how different factors influence PD prescription. This provides opportunities for improving PD prescription in NH residents with dementia. [ABSTRACT FROM AUTHOR]
- Published
- 2014
- Full Text
- View/download PDF
10. Prevalence of Antibiotic Resistance of the Commensal Flora in Dutch Nursing Homes
- Author
-
Hoogendoorn, Mirjam, Smalbrugge, Martin, Stobberingh, Ellen E., van Rossum, Saskia V., Vlaminckx, Bart J., and Thijsen, Steven F.
- Subjects
- *
ANTIBIOTICS , *ANUS , *DRUG resistance in microorganisms , *EPIDEMIOLOGICAL research , *ESCHERICHIA coli , *ESCHERICHIA coli diseases , *HOSPITAL care , *LONG-term health care , *LONGITUDINAL method , *MEDICAL rehabilitation , *MICROBIAL sensitivity tests , *NASAL mucosa , *NURSING home patients , *NURSING care facilities , *PATIENTS , *REHABILITATION centers , *STAPHYLOCOCCAL diseases , *STAPHYLOCOCCUS aureus , *URINARY catheters , *DESCRIPTIVE statistics - Abstract
Abstract: Objectives: To determine the prevalence of antibiotic resistance and multiresistance of Escherichia coli and Staphylococcus aureus in nursing homes and to determine which factors are associated with this prevalence. Design: Cohort study. Setting: Nursing homes. Participants: Residents of long-stay somatic care wards and rehabilitation patients were recruited from five nursing homes and two rehabilitation wards in hospitals in the central region of the Netherlands. Measurements: From each included patient, an anal swab was analyzed for E. coli and its antibiotic susceptibility and extended spectrum β-lactamase-producing Enterobacteriaceae. Nasal swabs were analyzed for S. aureus and its susceptibility, including methicillin-resistant S. aureus (MRSA). Associations were determined between resistance of E. coli to amoxicillin/co-amoxiclav and recent use (previous 6 months) of these antibiotics, hospital admission (previous 3 months), and presence of a urinary catheter. Results: A total of 125 patients were included in the study. The resistance and intermediate susceptibility of E. coli varied from 4% (ceftriaxone) to 43% (amoxicillin). Extended spectrum β-lactamase-producing Enterobacteriaceae were found in 6% of the patients. Amoxicillin and/or co-amoxiclav users were significantly more resistant to these antibiotics (69%) than nonusers (38%). No associations were found between amoxicillin and/or co-amoxiclav resistance and hospital admission or presence of a urine catheter. The resistance of S. aureus varied from 0% to 69% (penicillin). No MRSA was found. The ciprofloxacin resistance in E. coli and S. aureus was 14% and 39%, respectively. Conclusion: The prevalence of antibiotic-resistant E. coli and S. aureus in nursing homes was considerably high in this study, although no MRSA was found. This may lead to failing of empiric therapy of infections in patients in nursing homes. In particular, the high resistance to ciprofloxacin may make empiric quinolone therapy unreliable. Antibiotic use was associated with antibiotic resistance of E. coli. Therefore, antibiotic use should be restricted as much as possible. Analysis of risk factors for antibiotic resistance should be extended to be able to prevent further development of antibiotic resistance in nursing homes. [Copyright &y& Elsevier]
- Published
- 2013
- Full Text
- View/download PDF
11. Continuous Palliative Sedation in Nursing Home Residents With Dementia and Refractory Neuropsychiatric Symptoms.
- Author
-
Veldwijk-Rouwenhorst, Annelies E., Smalbrugge, Martin, Zuidema, Sytse U., Hanssen, Suzan A.J., Koopmans, Raymond T.C.M., and Gerritsen, Debby L.
- Subjects
- *
MENTAL illness drug therapy , *CONTENT analysis , *DEMENTIA patients , *INTERVIEWING , *RESEARCH methodology , *PALLIATIVE treatment , *RESEARCH , *QUALITATIVE research , *THEMATIC analysis - Abstract
Extreme neuropsychiatric symptoms can be a heavy burden for nursing home (NH) residents, relatives, and caregivers. Sometimes, when extreme neuropsychiatric symptoms are considered refractory, continuous palliative sedation is administered. The aim of this study was to explore the trajectory leading to continuous palliative sedation and its administration in NH residents with dementia and refractory neuropsychiatric symptoms. A qualitative interview and explorative study was performed. Relatives, elderly care physicians, and other staff members involved with 3 NH residents with dementia and extreme refractory neuropsychiatric symptoms who received continuous palliative sedation were interviewed. These NH residents lived on dementia special care units of 3 NHs in the Netherlands. Consecutive sampling was used to select participants. Medical files were studied. Semistructured interviews were conducted. Transcriptions were analyzed with thematic analysis, including directed content analysis. Nine in-depth interviews with 13 participants were held. Analysis resulted in 6 main themes, with several subthemes reflecting phases of the continuous palliative sedation trajectory: (1) run-up, describing an unbearable struggle of the resident; (2) turning point, at which hope was lost; (3) considering continuous palliative sedation and administration of intermittent sedation; (4) decision to start continuous palliative sedation based on 1 decisive trigger; (5) administration of continuous palliative sedation with stakeholders experiencing relief; and (6) evaluation. The trajectory leading up to continuous palliative sedation in NH residents with dementia and extreme refractory neuropsychiatric symptoms was complex and burdensome, but the initiation led to relief and contentment for all those involved. This study highlights that continuous palliative sedation can be a valuable treatment option among these residents. A recommendation is to include external consultation in the decision process and to administer intermittent sedation as a preceding step when continuous palliative sedation is considered. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
12. An Electronic Health Record Integrated Decision Tool and Supportive Interventions to Improve Antibiotic Prescribing for Urinary Tract Infections in Nursing Homes: A Cluster Randomized Controlled Trial.
- Author
-
Rutten, Jeanine J.S., van Buul, Laura W., Smalbrugge, Martin, Geerlings, Suzanne E., Gerritsen, Debby L., Natsch, Stephanie, Sloane, Philip D., van der Wouden, Johannes C., Twisk, Jos W.R., and Hertogh, Cees M.P.M.
- Subjects
- *
ANTIBIOTICS , *EVALUATION of medical care , *PATIENT aftercare , *EXPERIMENTAL design , *SOCIAL support , *MEDICAL databases , *INFORMATION storage & retrieval systems , *CONFIDENCE intervals , *URINARY tract infections , *TIME , *SURGICAL complications , *NURSING care facilities , *DECISION support systems , *RANDOMIZED controlled trials , *DRUG prescribing , *MEDICAL referrals , *HOSPITAL care , *HEALTH care teams , *ELECTRONIC health records , *PHYSICIAN practice patterns , *CLUSTER analysis (Statistics) , *DECISION making in clinical medicine , *ODDS ratio , *NURSING interventions , *DISEASE complications - Abstract
To investigate whether an electronic health record (EHR)–integrated decision tool, combined with supportive interventions, results in more appropriate antibiotic prescribing in nursing home (NH) residents with suspected urinary tract infection (UTI), without negative consequences for residents. Cluster randomized controlled trial with NHs as the randomization unit; intervention group NHs received the EHR-integrated decision tool and supportive interventions, and control group NHs provided care as usual. 212 residents with suspected UTI, from 16 NHs in the Netherlands. Physicians collected data at index consultation (ie, UTI suspicion) and during a 21-day follow-up period (March 2019–March 2020). Overall antibiotic prescribing data at NH level, 12 months prior to and during the study, was derived from the electronic prescribing system. The primary study outcome was the percentage of antibiotic prescriptions for suspected UTI that was appropriate, at index consultation. Secondary study outcomes included changes in treatment decision, complications, UTI-related hospitalization, and mortality during follow-up; and pre-post study changes in antibiotic prescribing at the NH level. 295 suspected UTIs were included (intervention group: 189; control group: 106). The between-group difference in appropriate antibiotic prescribing was 13% [intervention group: 62%, control group: 49%; adjusted odds ratio (OR) 1.43, 95% CI 0.57-3.62]. In both groups, complications (2% vs 3%), UTI-related hospitalization (2% vs 1%), and possible UTI-related mortality (2% vs 2%) were rare. The pre-post study difference in antibiotic prescriptions per 1000 resident-care days was −0.95 in the intervention group NHs and −0.05 in the control group NHs (P =.02). Although appropriate antibiotic prescribing improved in the intervention group, this does not provide sufficient evidence for our multidisciplinary intervention. Despite this inconclusive result, our intervention could potentially still be effective, because we established a large reduction in the number of antibiotic prescriptions in the intervention group. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
13. Focusing on Provider Quality Measurement: Continued Consensus and Feasibility Testing of Practice-Based Quality Measures for Primary Care Providers in Long-Term Care.
- Author
-
Dash, Darly, Moser, Andrea, Feldman, Sid, Saliba, Debra, Bakaev, Innokentiy, Smalbrugge, Martin, Robert, Benoît, Karuza, Jurgis, Heckman, George, Katz, Paul R., and Costa, Andrew P.
- Subjects
- *
CONSENSUS (Social sciences) , *PILOT projects , *EVIDENCE-based medicine , *RETROSPECTIVE studies , *MEDICAL personnel , *NURSING care facilities , *PSYCHOMETRICS , *COMPARATIVE studies , *QUALITY assurance , *EXPERTISE , *LONG-term health care , *DELPHI method - Abstract
Medical providers in long-term care (LTC) use a unique skillset in delivering comprehensive resident care. Publicly reported quality measures (QMs) do not directly emphasize medical provider competency and their role in care. The impact of providers is understudied and to a large extent, unknown. Our objective was to define, test, and validate QMs to pragmatically measure the practice-based quality of medical providers in a pilot study. We included 7 North American LTC homes with data from practicing medical providers for LTC residents. We engaged in a 4-phased approach. In phase 1, experts rated 95 candidate QMs using 5 pragmatic-focused criteria in a RAND-modified Delphi process. Phase 2 involved specifying 37 QMs for collection (4 QMs were dropped during pilot testing). We created an abstraction manual and data collection tool for all QMs. Phase 3 involved a retrospective chart review in 7 LTC homes on 33 QMs with trained data abstractors. Data were sufficient to analyze performance for 26 QMs. Lastly, in phase 4 results and psychometric properties were reviewed with an expert panel. They ranked the tested measures for validity and feasibility for use by a nonphysician auditor to evaluate medical provider performance based on medical record review. In total, we examined data from 343 resident charts from 7 LTC homes and 49 providers. Our process yielded 10 QMs as being specified for measurement, feasible to collect, and had good test performance. This is the only study to systematically identify a subset of QMs for feasible collection from the medical record by various data collectors. This pragmatic approach to measuring practice-based quality and quantifying select medical provider competencies allows for the evaluation of individual and facility-level performance and facilitates quality improvement initiatives. Future work should perform broader testing and validate and refine operationalized QMs. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
14. Bayesian Analyses Showed More Evidence for Apathy than for Depression Being Associated With Cognitive Functioning in Nursing Home Residents.
- Author
-
Leontjevas, Ruslan, Fredrix, Lily, Smalbrugge, Martin, Koopmans, Raymond T.C.M., and Gerritsen, Debby L.
- Subjects
- *
APATHY , *COGNITION disorders , *MENTAL depression , *NURSING home patients , *PROBABILITY theory , *PSYCHOLOGICAL tests , *REGRESSION analysis , *CROSS-sectional method - Abstract
Abstract Objectives Depression, apathy, and cognitive impairments are widespread in nursing home (NH) residents. Scarce research that explicitly compares apathy to depression suggests that the association between apathy and cognitive functioning is stronger than the association between depression and cognitive functioning. This study in Dutch NH residents aimed to use Bayesian methods for comparing the evidence for the relationship of cognitive performance with apathy to that with depression. Design Cross-sectional. Setting and Participants Sixteen NH somatic care units (N = 190 residents; mean age 77.2 years, standard deviation 12.9), and 17 dementia special care units (N = 243 residents; mean age 82.8 years standard deviation, 6.8]). Measures The Frontal Assessment Battery (FAB) and Mini-Mental State Examination (MMSE) were administered in residents for cognitive performance. Professional carers were interviewed for the Apathy Evaluation Scale and the Cornell Scale for Depression in Dementia. Results Regression models built with the BayesFactor package in R showed Bayesian factors (BFs) that implied extremely strong evidence in terms of the Jeffrey classification for the relationship of apathy with MMSE [standardized effect size, −0.57 (−0.66 to −0.48), BF = 3.4E+28], and with FAB [−0.50 (−0.59 to −0.42), BF = 3.0E+24]. Regarding depression, evidence was a minor fraction of that for apathy [MMSE, −0.17 (−0.27 to −0.06), BF = 15.45; FAB, −0.12 (−0.22 to −0.02), BF = 2.11]. The most evidence existed for the associations of apathy with MMSE orientation problems, especially orientation in time. Conclusions/Implications The study implies that cognitive assessments are important to differentiate apathy from depression in NH residents both with dementia and without dementia. More research is needed to clarify whether disorientation in time is a specific cognitive marker of apathy that may be used to reduce false positive depression diagnoses. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
15. Feedback Regarding Pain: An Effective Strategy to Optimize Pain Treatment in Long-Term Care Residents with Advanced Dementia?
- Author
-
van Kooten, Janine, Smalbrugge, Martin, van der Wouden, Johannes, Stek, Max, and Hertogh, Cees
- Subjects
- *
ANALGESIA , *DEMENTIA , *LONG-term health care , *NURSING home patients , *EVALUATION research , *PAIN measurement - Published
- 2016
- Full Text
- View/download PDF
16. Prevalence of Pain in Nursing Home Residents with Advanced Dementia.
- Author
-
van Kooten, Janine, Smalbrugge, Martin, van der Wouden, Johannes, Stek, Max, and Hertogh, Cees
- Subjects
- *
PAIN management , *ELDER care , *ANALGESIA , *DEMENTIA , *EPIDEMIOLOGICAL research , *LONG-term health care , *NURSING home patients , *PAIN , *SEVERITY of illness index - Published
- 2016
- Full Text
- View/download PDF
17. Physician Treatment Orders in Dutch Nursing Homes.
- Author
-
Bouwstra, Hylco, Smalbrugge, Martin, and Hertogh, Cees M.
- Subjects
- *
DO-not-resuscitate orders , *HOSPITAL admission & discharge , *LIFE support systems in critical care , *LONG-term health care , *LONGITUDINAL method , *NURSING home patients , *NURSING care facilities , *PALLIATIVE treatment , *PATIENTS , *RESUSCITATION , *ADVANCE directives (Medical care) , *RETROSPECTIVE studies , *DESCRIPTIVE statistics - Abstract
Objectives Physician treatment orders (PTOs) prevent burdensome unnecessary medical treatment of frail nursing home patients. The aim was to determine the prevalence of PTOs and time duration between nursing home admittance and PTO completion. Design Population-based, retrospective cohort study. Setting Nursing homes across the Netherlands. Data Collection Digital medical records of patients who subsequently were submitted to 14 Dutch nursing homes across The Netherlands were studied between 2010 and 2013. The prevalence's of do-resuscitate, do-not-resuscitate, life-sustaining, and palliative care PTOs and the time intervals between nursing home admittance and documentation of PTOs were measured. Information regarding demographic patient characteristics, type of nursing home ward, and mention of a discussion of PTOs with the patient or caregivers was obtained. Results Eighty-two percent of the nursing home patients received a PTO regarding resuscitation, life-sustaining, or palliative care treatment. Twenty-four percent of the patients received a do-resuscitation PTO, 55% received a do-not-resuscitate PTO, 44% a life-sustaining PTO, and 16% a palliative care PTO. The median duration between nursing home admittance and documentation of the first PTO was 1 day. Most nursing home patients had PTOs within 1 week after admittance. Conclusion A minority (18%) of Dutch nursing home patients has no documented PTOs during their nursing home stay, which could have negative effects on end-of-life care of nursing home residents. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
- View/download PDF
18. Nursing Staff Distress Associated With Neuropsychiatric Symptoms in Young-Onset Dementia and Late-Onset Dementia.
- Author
-
van Duinen-van den IJssel, Jeannette C.L., Mulders, Ans J.M.J., Smalbrugge, Martin, Zwijsen, Sandra A., Appelhof, Britt, Zuidema, Sytse U., de Vugt, Marjolein E., Verhey, Frans R.J., Bakker, Christian, and Koopmans, Raymond T.C.M.
- Subjects
- *
TREATMENT of dementia , *NEUROLOGICAL disorders , *THERAPEUTICS , *PSYCHOSES , *AGE factors in disease , *AGGRESSION (Psychology) , *APATHY , *CAREGIVERS , *DELUSIONS , *EMOTIONS , *HOSPITAL medical staff , *MULTIVARIATE analysis , *NURSES' attitudes , *NURSING care facilities , *SEX distribution , *SLEEP , *AGITATION (Psychology) , *MULTIPLE regression analysis , *SOCIAL support , *BURDEN of care , *RETROSPECTIVE studies , *SEVERITY of illness index , *HOSPITAL nursing staff , *ODDS ratio , *DELAYED onset of disease - Abstract
Objective The aims of this study were (1) to investigate the relationship between different neuropsychiatric symptoms (NPS) and the level of distress experienced by nurses caring for residents with young-onset dementia (YOD) and (2) to compare these findings with those for nurses caring for residents with late-onset dementia (LOD). Design/Setting This is a retrospective study conducted in Dutch long-term care facilities. Data were used from the Behavior and Evolution of Young-ONset Dementia studies (BEYOND) Parts I and II and the WAAL Behavior in Dementia-II (Waalbed-II) study. Participants A total of 382 nursing home residents with YOD and 261 nursing home residents with LOD were included. Measurements The Neuropsychiatric Inventory, nursing home version, was used to assess nursing staff distress and the frequency (F) and severity (S) of NPS. Multilevel logistic regression analysis was used to investigate the relationships between nursing staff distress related to NPS and YOD and LOD care units, the F × S score per symptom, gender, dementia subtype, and dementia severity. Results Nurses working in YOD care units rated sleep and nighttime behavior disorders, delusions, and agitation/aggression most often as highly distressing and euphoria most often as not distressing. Multivariate analyses indicated that the frequency and severity of NPS were significantly associated with staff distress in all symptoms, except for apathy. Comparison of the 2 groups of nurses demonstrated that the odds for distress related to sleep and nighttime behavior disorders were higher for nurses in YOD care units than for nurses in LOD units. For both the YOD and LOD nurses, irritability in male residents had higher impact than similar behavior in female residents. Conclusion This study provides important insight into distress related to individual NPS and the interaction with residents' characteristics. All NPS result in distress. The frequency and severity of the behavior is an important predictor. Sleep and nighttime behavior disorders are more likely to result in distress in YOD nurses than in LOD nurses. The amount of distress related to NPS emphasizes the urgent need for adequate management of NPS and the support of professional caregivers. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
19. Coming to Grips With Challenging Behavior: A Cluster Randomized Controlled Trial on the Effects of a Multidisciplinary Care Program for Challenging Behavior in Dementia.
- Author
-
Zwijsen, Sandra A., Smalbrugge, Martin, Eefsting, Jan A., Twisk, Jos W.R., Gerritsen, Debby L., Pot, Anne Margriet, and Hertogh, Cees M.P.M.
- Subjects
- *
ANTIDEPRESSANTS , *TREATMENT of dementia , *ANTIPSYCHOTIC agents , *ELDER care , *GERIATRIC assessment , *COMPARATIVE studies , *CONFIDENCE intervals , *DEMENTIA , *DRUG utilization , *GERIATRIC nursing , *HEALTH care teams , *LONG-term health care , *LONGITUDINAL method , *EVALUATION of medical care , *NURSING home patients , *PSYCHOLOGICAL tests , *RESEARCH funding , *RESTRAINT of patients , *PROFESSIONAL practice , *RANDOMIZED controlled trials , *DESCRIPTIVE statistics , *ODDS ratio , *SYMPTOMS - Abstract
Abstract: Objectives: The Grip on Challenging Behavior care program was developed using the current guidelines and models on managing challenging behavior in dementia in nursing homes. It was hypothesized that the use of the care program would lead to a decrease in challenging behavior and in the prescription of psychoactive drugs without increase in use of restraints. Design: A randomized controlled trial was undertaken using a stepped-wedge design to implement the care program and to evaluate the effects. An assessment of challenging behavior and psychoactive medication was undertaken every 4 months on all participating units followed by the introduction of the care program in a group of 3 to 4 units. A total of 6 time assessments took place over 20 months. Setting: Seventeen dementia special care units of different nursing homes. Participants: A total of 659 residents of dementia special care units. All residents with dementia on the unit were included. Units were assigned by random allocation software to 1 of 5 groups with different starting points for the implementation of the care program. Intervention: A care program consisting of various assessment procedures and tools, which ensure a multidisciplinary approach and which structure the process of managing challenging behavior in dementia. Measurements: Challenging behavior was measured using the Cohen-Mansfield Agitation Inventory (CMAI) and the Neuropsychiatric Inventory. Research assistants (blinded for intervention status of the unit) interviewed nurses on the units about challenging behavior. Data on psychoactive drugs and restraints were retrieved from resident charts. Results: A total of 2292 assessments took place involving 659 residents (1126 control measurements, 1166 intervention measurements). The group of residents who remained in the intervention condition compared with the group in the control condition differed significantly in the CMAI change scores between successive assessments [–2.4 CMAI points, 95% confidence interval (CI) –4.3 to –0.6]. No significant effects were found for the control-to-intervention group compared with the group who remained in the control group (0.0 CMAI points, 95% CI –2.3 to 2.4). Significant effects were found on 5 of the 12 Neuropsychiatric Inventory items and on the use of antipsychotics (odds ratio 0.54, 95% CI 0.37– 0.80) and antidepressants (odds ratio 0.65, 95% CI 0.44–0.94). No effect on use of restraints was observed. Conclusions: The Grip on Challenging behavior program was able to diminish some forms of challenging behavior and the use of psychoactive drugs. [Copyright &y& Elsevier]
- Published
- 2014
- Full Text
- View/download PDF
20. Psychological Resilience in Older Residents of Long-Term Care Facilities: Occurrence and Associated Factors.
- Author
-
Angevaare, Milou J., Joling, Karlijn J., Smalbrugge, Martin, Choi, Hyoungshim, Twisk, Jos W.R., Hertogh, Cees M.P.M., and van Hout, Hein P.J.
- Subjects
- *
SOCIAL participation , *AFFECT (Psychology) , *SELF-evaluation , *COGNITION , *CONFLICT (Psychology) , *COMMUNICATION , *FAMILY relations , *PSYCHOLOGICAL distress , *PSYCHOLOGICAL resilience , *LONG-term health care , *MENTAL illness , *LONGITUDINAL method - Abstract
The researchers aimed to (1) explore the occurrence of psychological resilience in the face of a major life stressor and conflict in older residents of long-term care facilities (LTCFs), and (2) identify factors associated with resilience in this population. Longitudinal cohort study using the Dutch InterRAI-LTCF cohort. Older residents (≥60 years old) of 21 LTCFs in the Netherlands. The researchers selected 2 samples of residents who had at least 2 assessments surrounding (1) an incident major life stressor, or (2) incident conflict with other resident or staff. A resilient outcome was operationalized as not having clinically meaningful mood symptoms at the post-stressor assessment and equal or fewer mood symptoms at the post-stressor relative to the pre-stressor assessment. The researchers used 2 resilience outcomes per stressor: 1 based on observer-reported mood symptoms and 1 based on self-reported mood symptoms. The most important factors from among 21 potential resilience factors for each of the 4 operationalizations of resilience were identified using a backward selection procedure with 2-level generalized estimating equations analyses. Forty-eight percent and 50% of residents were resilient in the face of a major life stressor, based on observer-reported (n = 248) and self-reported (n = 211) mood, respectively. In the face of conflict, 26% and 51% of the residents demonstrated resilience, based on the observer-reported (n = 246) and self-reported (n = 183) mood, respectively. Better cognitive functioning, a strong and supportive relationship with family, participation in social activities, and better self-reported health were most strongly associated with resilience in the face of a major life stressor. Better communicative functioning, absence of psychiatric diagnoses, a strong and supportive relationship with family, not being lonely, social engagement, and not reminiscing about life were most strongly associated with resilience in the face of conflict. Factors with a social aspect appear to be particularly important to psychological resilience in older LTCF residents, and provide a potential target for intervention in the LTCF setting. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
21. Medication Appropriateness for Older Nursing Home Patients With a Limited Life Expectancy: From STOPP/START Version 2 to the ReNeWAL Criteria.
- Author
-
Dijk, Margaretha T., A.M. Pouw, Catharina, Hertogh, Cees M.P.M., van Marum, Rob J., Hugtenburg, Jacqueline G., and Smalbrugge, Martin
- Subjects
- *
MEDICATION error prevention , *INAPPROPRIATE prescribing (Medicine) , *CONSENSUS (Social sciences) , *LIFE expectancy , *POLYPHARMACY , *DELPHI method , *OLD age - Abstract
To adapt the 2015 Screening Tool of Older Persons' Prescriptions (STOPP)/Screening Tool to Alert to Right Treatment (START) criteria to older nursing home patients with a limited life expectancy of 1.5 to 2 years. A modified Delphi consensus study. The study was established in The Netherlands and conducted online. The international panel consisted of 23 experts with experience in medicine for older people. The expert panel was presented with the 2015 STOPP/START criteria using an online survey program (Survey Monkey). The panelists were asked for their opinion on the appropriateness of the STOPP and START criteria, and adaptations to these criteria for older nursing home patients with a limited life expectancy on 4-point Likert scales. Consensus was defined as ≥70% of the panelists answering (very) inappropriate or (very) appropriate, and (completely) disagree or (completely) agree. Twenty-one panelists completed all 3 Delphi rounds. The final list of "Represcribing for Nursing home residents With A Limited life expectancy (ReNeWAL)" criteria comprises 132 criteria: 98 criteria to stop (70 original STOPP criteria and 28 adapted) and 34 criteria to start (16 original START criteria and 18 adapted) for older nursing home patients with a limited life expectancy. Considerations that panelists mentioned for adapting criteria were mainly prevention and treatment of discomfort. It is clear that represcribing for older nursing home patients is highly complex and requires the consideration of various elements. The ReNeWAL criteria may be useful in enhancing represcribing for older nursing home patients with a limited life expectancy. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
22. Compiling a Set of Actionable Quality Indicators for Medical Practitioners in Dutch Nursing Homes: A Delphi Study.
- Author
-
Yeung, Gary Y.C., Joling, Karlijn J., Dash, Darly, Jepma, Patricia, Costa, Andrew P., Katz, Paul R., Hertogh, Cees M.P.M., de Bruijne, Martine C., and Smalbrugge, Martin
- Subjects
- *
PSYCHOLOGY of physicians , *CLINICAL medicine , *CONSENSUS (Social sciences) , *PHYSICIANS' assistants , *MEDICAL prescriptions , *KEY performance indicators (Management) , *MEDICAL care , *DESCRIPTIVE statistics , *NURSING care facilities , *NURSE practitioners , *DELPHI method , *QUALITY assurance , *HEALTH care teams , *PSYCHOSOCIAL factors - Abstract
Most quality indicators (QIs) currently used in nursing homes reflect the care delivered by the entire multidisciplinary team and are not specific for medical practitioners. International experts have proposed a set of QIs that specifically reflect the quality of medical care in nursing homes. The objective of the Delphi study described here was to compile a set of actionable QIs tailored for medical practitioners working within Dutch nursing homes. This was achieved through the evaluation of 15 existing national QIs and 35 international QIs by a panel of medical practitioners, comprising medical specialists, nurse practitioners, and physician assistants, who are working in Dutch nursing homes. Panelists rated each QI on (1) level of direct control by medical practitioners and (2) its relevance to the quality of medical care. QIs progressing to subsequent rounds required panel agreement on both direct control (≥70% ≥3 points on a 4-point scale) and relevance (≥70% ≥8 on a 10-point scale). In the last round, each panelist selected the 5 most relevant QIs and arranged them in order of importance. These top 5 rankings were converted into points for an overall final ranking. There was consensus on 42 QIs being under the control of medical practitioners, and 21 of these QIs were considered relevant for quality of care. Most of the 21 QIs originated from the international QI set. This finding supports the transferability of the internationally developed QIs to the Dutch nursing home context and provides opportunities to compare the quality of medical care in nursing homes across countries. In the final ranking, the QI related to new medication prescriptions received the highest rating, followed by 3 QIs related to advance care planning. Future research should focus on evaluating the feasibility of measuring the selected QIs and assessing their measurement properties before implementing them in professional learning and quality improvement initiatives for medical practitioners in nursing homes. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
23. The Effects of the 2020 COVID-19 Lockdown on Mood, Behavior, and Social and Cognitive Functioning in Older Long-Term Care Residents.
- Author
-
Angevaare, Milou J., Joling, Karlijn J., Smalbrugge, Martin, Hertogh, Cees M.P.M., Twisk, Jos W.R., and van Hout, Hein P.J.
- Subjects
- *
AFFECT (Psychology) , *BEHAVIOR , *DESCRIPTIVE statistics , *STAY-at-home orders , *SOCIAL skills , *DATA analysis software , *COVID-19 pandemic , *LONG-term health care , *COGNITION in old age , *LONGITUDINAL method - Abstract
We aimed to explore the effects of the Dutch COVID-19 lockdown (March 20–May 25, 2020) on mood, behavior, and social and cognitive functioning of older residents of long-term care facilities (LTCFs) prospectively. Mixed methods: historically controlled longitudinal cohort study and focus groups. Residents of Dutch LTCFs. Residents who were assessed during and prior to the lockdown were compared to residents of the same wards with 2 assessments prior to the lockdown. We used mixed models and generalized estimating equation analyses to explore differences in changes in mood, withdrawal and aggressive behavior, loneliness and conflict, and cognition and delirium. We also explored whether the effect of the lockdown differed for different subgroups. In 2 online focus groups, LTCF care professionals, ranging from care staff to physicians, reflected on their experiences of the effect of the lockdown and the cohort study results. The lockdown group of 298 residents was compared to the control group of 625 residents. Self-reported mood symptoms showed a slightly greater increase during the lockdown. During the first half of the lockdown, the level of conflict with other residents decreased whereas it increased in the control group. The subgroup with moderate-severe cognitive impairment showed a decrease in withdrawal during the lockdown, whereas the group with no-mild cognitive impairment showed a statistically nonsignificant relative increase. Professionals described great individual variation in the effects of the lockdown on residents. Facilities attempted to preserve the experienced positive effects, for example, by promoting tranquility in shared rooms and continuing to organize individualized ward-based activities. We did not find clinically relevant negative effects of the lockdown on mood, behavior, and social and cognitive functioning in older residents of LTCFs at the group level. Possibly, staff mitigated the negative effects at the group level. Meanwhile, they learned lessons that they continue to apply to enhance resident well-being. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
24. Institutionalized Stroke Patients: Status of Functioning of an Under Researched Population
- Author
-
van Almenkerk, Suzanne, Depla, Marja F.I.A., Smalbrugge, Martin, Eefsting, Jan A., and Hertogh, Cees M.P.M.
- Subjects
- *
ELDER care , *GERIATRIC assessment , *COGNITION , *MENTAL depression , *HEALTH status indicators , *LENGTH of stay in hospitals , *INTERVIEWING , *LIFE skills , *LONG-term health care , *RESEARCH methodology , *NURSES' aides , *NURSING home patients , *NURSING care facilities , *QUESTIONNAIRES , *STROKE , *ACTIVITIES of daily living , *PAIN measurement , *CROSS-sectional method , *STROKE patients , *DESCRIPTIVE statistics , *SYMPTOMS , *OLD age - Abstract
Abstract: Objectives: In view of the development of an integrated care and treatment program for institutionalized stroke patients tailored to their needs, we aimed to explore their status of functioning in the physical, cognitive, emotional, communicative and social domains. In addition, we explored the relation between status of functioning and stroke characteristics. Design: A cross-sectional, observational study. Setting: Dutch nursing homes (NHs). Participants: Residents with stroke as main diagnosis for NH-admission, who experienced a stroke ≥3 months ago and stayed ≥1 month in a long term care ward. Measurements: Attending physicians provided information about stroke subtype, stroke location and time post-stroke. Status of functioning was measured through an observation list comprising the Barthel Index, the Neuropsychiatric Inventory Questionnaire, and sections of the Resident Assessment Instrument for Long-Term Care Facilities. The list was filled out in a structured interview with a qualified nurse assistant who knew the resident well. Results: We included 274 residents (mean age 76.6, 58.4% female). The stroke that caused NH-dependency was in 81.3% ischemic, and in 49.8% right-sided. Median time post-stroke was 47 months; 90.9% of the residents were severely dependent in basic activities of daily living and 58% were in pain. Nearly half of the residents showed moderate (24.4%) or severe (23%) cognitive impairment. Irritability (52.9%), depressive symptoms (52.6%) and apathy (34.3%) occurred as the most frequent neuropsychiatric symptoms; 27.7% had a poor ability to express themselves and 30.3% had a low social engagement. We found more severe cognitive impairment, agitation/aggression and poor expression in left-sided strokes, more nighttime behavioral disturbances and delusions in right-sided strokes, and lower social engagement in residents with the largest time-interval post-stroke. Conclusion: This study among institutionalized stroke patients in Dutch NHs revealed very high prevalence of impairments on all domains of functioning, above the well-known severe disabilities in basic activities of daily living. The monitoring and management of both pain and neuropsychiatric symptoms should be key elements in an integrated care and treatment program. [Copyright &y& Elsevier]
- Published
- 2012
- Full Text
- View/download PDF
25. Quality Indicators of Primary Care Provider Engagement in Nursing Home Care.
- Author
-
Mays, Allison Moser, Saliba, Debra, Feldman, Sid, Smalbrugge, Martin, Hertogh, Cees M.P.M., Booker, Tina L., Fulbright, Kisa A., Hendriks, Simone A., and Katz, Paul R.
- Subjects
- *
CLINICAL competence , *CLINICAL medicine , *COMMUNICATION , *LEADERSHIP , *LONG-term health care , *MEDICAL care , *MEETINGS , *NURSING care facilities , *GENERAL practitioners , *EVIDENCE-based medicine , *ADVANCE directives (Medical care) , *SUBACUTE care , *KEY performance indicators (Management) , *RESIDENTIAL care - Abstract
Abstract The initiative described here aims to identify quality indicators (QIs) germane to the international practice of primary care providers (PCP) in post-acute and long-term care in order to demonstrate the added value of medical providers in nursing homes (NHs). A 7-member international team identified and adapted existing QIs to the AMDA competencies for medical providers. QI sources included the ACOVE 3 Quality Indicators (2007), NH Quality Indicators (2004), NH Residential Care Quality Indicators (2002), and AGS Choosing Wisely (2014). We recruited a technical expert panel (TEP) consisting of 11 panelists from the US, Canada, and the European Union, selected for their knowledge and leadership in post-acute and long-term care. The TEP, using a RAND Modified Delphi approach, provided pre-meeting ratings, discussed items in-person for clarification, and re-rated items following discussion. When panelists rated more than 1 option for a particular QI as valid and feasible, the most stringent option was selected for inclusion in the final candidate set of QIs. Panelists confidentially rated an initial 103 items on validity and feasibility of implementation. During the meeting, panelists added 18 QIs and modified 18. In post-meeting analysis, we eliminated 7 QIs rated not valid and 9 QIs for which a more stringent QI was rated valid and feasible. This resulted in a final set of 97 QIs rated valid and feasible and 8 rated valid but not feasible. This set of QIs for PCPs in the NH identified practices in which provider engagement adds value through expertise in geriatric syndromes, employing evidence-based practice, advocating for residents, delivering person-centered care, facilitating advance care planning, and communicating effectively to coordinate care. Next steps include pilot testing and evaluating the association between adherence to QIs, PCP staffing models, and better outcomes. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
26. Process Evaluation of an Intervention for the Management of Neuropsychiatric Symptoms in Young-Onset Dementia.
- Author
-
Appelhof, Britt, Bakker, Christian, van Duinen-van den IJssel, Jeannette C.L., Zwijsen, Sandra A., Smalbrugge, Martin, Verhey, Frans R.J., de Vugt, Marjolein E., Zuidema, Sytse U., and Koopmans, Raymond T.C.M.
- Subjects
- *
TREATMENT of dementia , *AGE distribution , *AGE factors in disease , *DEMENTIA , *INTERNET , *NEUROPSYCHOLOGY , *QUESTIONNAIRES , *SYMPTOMS - Abstract
Objectives A process evaluation was performed for an intervention aimed at improvement of the management of neuropsychiatric symptoms in young-onset dementia. Data about sample quality and intervention quality was evaluated to better understand internal and external validity. In addition, data about the implementation strategy and factors affecting implementation were evaluated to improve further implementation of the intervention. Design A model proposed by Leontjevas and colleagues consisting of first-order (validity) and second-order (implementation) data was used. Setting and Participants Care units delivering specialized treatment and support for residents with young-onset dementia. Measures A description of the recruitment, randomization procedure, and intervention reach was carried out to determine sample quality. To determine intervention quality, data on satisfaction, relevance, feasibility, and fidelity were collected through a questionnaire and reports logged on the server of the web-based intervention. A description of the implementation strategy was provided. Barriers and facilitators for implementation were collected by a questionnaire and analyzed by deductive content analysis. Results Care units varied in size and were recruited from different geographical regions in the Netherlands. The informed consent rate of the residents was 87.7%. The majority of the nursing home staff were satisfied with the intervention. However, parts of the intervention were perceived as less relevant for their own organization. The feasibility of the intervention was considered low. The fidelity differed between care units. The implementation strategy did not overcome all barriers. Factors affecting implementation covered 3 themes: organizational aspects, culture of the organization, and aspects of the intervention. Conclusions In general, our results showed sufficient internal and external validity, warranting further effect analyses. Adaptations to specific steps of the care program should be considered to increase feasibility and sustainability. In addition, integration of the care program into the electronic health records is expected to further improve implementation. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
27. Language as an Application of Mindfulness.
- Author
-
Zimmerman, Sheryl, Katz, Paul R., Sloane, Philip D., Boustani, Malaz, Brown, Mallory, Cesari, Matteo, Duque, Gustavo, Hyer, Kathryn, Landi, Francesco, Nace, David, Resnick, Barbara, Smalbrugge, Martin, Smith, David A., Steinberg, Karl E., Volicer, Ladislav, Warshaw, Gregg, and White, Heidi K.
- Subjects
- *
LANGUAGE & languages , *MINDFULNESS - Published
- 2018
- Full Text
- View/download PDF
28. Risk of Death in Nursing Home Residents After COVID-19 Vaccination.
- Author
-
Wouters, Fenne, van Loon, Anouk M., Rutten, Jeanine J.S., Smalbrugge, Martin, Hertogh, Cees M.P.M., and Joling, Karlijn J.
- Subjects
- *
VACCINATION , *COVID-19 , *CONFIDENCE intervals , *COVID-19 vaccines , *ATTITUDE (Psychology) , *REGRESSION analysis , *RISK assessment , *HOSPITAL mortality , *COMPARATIVE studies , *KAPLAN-Meier estimator , *ELECTRONIC health records , *COMORBIDITY , *LONGITUDINAL method , *PROPORTIONAL hazards models , *OLD age ,MORTALITY risk factors - Abstract
In the first months of 2021, the Dutch COVID-19 vaccination campaign was disturbed by reports of death in Norwegian nursing homes (NHs) after vaccination. Reports predominantly concerned persons >65 years of age with 1 or more comorbidities. Also, in the Netherlands adverse events were reported after COVID-19 vaccination in this vulnerable group. Yet, it was unclear whether a causal link between vaccination and death existed. Therefore, we investigated the risk of death after COVID-19 vaccination in Dutch NH residents compared with the risk of death in NH residents prior to the COVID-19 pandemic. Population-based longitudinal cohort study with electronic health record data. We studied Dutch NH residents from 73 NHs who received 1 or 2 COVID-19 vaccination(s) between January 13 and April 16, 2021 (n = 21,762). As a historical comparison group, we included Dutch NH residents who were registered in the same period in 2019 (n = 27,591). Data on vaccination status, age, gender, type of care, comorbidities, and date of NH entry and (if applicable) discharge or date of death were extracted from electronic health records. Risk of death after 30 days was evaluated and compared between vaccinated residents and historical comparison residents with Kaplan-Meier and Cox regression analyses. Regression analyses were adjusted for age, gender, comorbidities, and length of stay. Risk of death in NH residents after one COVID-19 vaccination (regardless of whether a second vaccination was given) was decreased compared with historical comparison residents from 2019 (adjusted HR 0.77, 95% CI 0.69-0.86). The risk of death further decreased after 2 vaccinations compared with the historical comparison group (adjusted HR 0.57, 95% CI 0.50-0.64). We found no indication that risk of death in NH residents is increased after COVID-19 vaccination. These results indicate that COVID-19 vaccination in NH residents is safe and could reduce fear and resistance toward vaccination. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
29. A Comparative Validation of the Abbreviated Apathy Evaluation Scale (AES-10) With the Neuropsychiatric Inventory Apathy Subscale Against Diagnostic Criteria of Apathy
- Author
-
Leontjevas, Ruslan, Evers-Stephan, Alexandra, Smalbrugge, Martin, Pot, Anne Margriet, Thewissen, Viviane, Gerritsen, Debby L., and Koopmans, Raymond T.C.M.
- Subjects
- *
ELDER care , *GERIATRIC assessment , *COMPARATIVE studies , *DEMENTIA , *DISCRIMINANT analysis , *GERIATRICIANS , *INTERVIEWING , *RESEARCH methodology , *NURSING home patients , *NURSING care facilities , *PROBABILITY theory , *PSYCHOLOGICAL tests , *PSYCHOLOGISTS , *SCALES (Weighing instruments) , *EMOTIONS in old age , *PREDICTIVE validity , *CROSS-sectional method , *RECEIVER operating characteristic curves , *RESEARCH methodology evaluation , *DESCRIPTIVE statistics , *SYMPTOMS , *PSYCHOLOGY - Abstract
Abstract: Objective: To compare the Neuropsychiatric Inventory apathy subscale (NPIa) with the abbreviated Apathy Evaluation Scale (AES-10) on discriminant validity and on their performance to distinguish residents as apathetic or nonapathetic. Design: Cross-sectional design. Setting: Nursing home. Participants: 100 residents of 4 dementia special care units (n = 58) and 3 somatic units (n = 42). Measurements: Primary professional caregivers were interviewed to score the AES-10 and NPIa. The elderly care physician and the psychologist of each unit examined residents for clinical apathy using diagnostic criteria. Results: The AES-10 and NPIa correlated moderately with each other (rs = 0.62, P < .0001). The AES-10 correlated weakly (rs = 0.27, P = .024) and the NPIa moderately (rs = 0.46, P = .001) with the Cornell Scale for Depression in Dementia. Receiver operating characteristic analysis showed an area under the curve (AUC) of 0.72 (P < .01) for AES-10 and 0.67 (P < .05) for NPIa. The AES-10 produced higher sums of sensitivity and negative predictive value than the NPIa. Explorative analyses revealed that both instruments produced higher scores in dementia independently of having an apathy diagnosis, whereas AUCs were significant in nondementia (AES-10: AUC = 0.88, P < .001; NPIa: AUC = 0.77, P = .023), but not in dementia. Conclusion: Both the AES-10 and NPIa may be used to distinguish apathetic from nonapathetic residents in a heterogeneous sample with and without dementia, or in residents without dementia. The AES-10 may be preferable to the NPIa apathy subscale when ruling out or screening for apathy. The performance of the scales against diagnostic criteria of apathy in dementia need to be further examined. [Copyright &y& Elsevier]
- Published
- 2012
- Full Text
- View/download PDF
30. Advance Care Planning in Dutch Nursing Homes During the First Wave of the COVID-19 Pandemic.
- Author
-
ter Brugge, Bastiaan P.H., van Atteveld, Vera A., Fleuren, Nienke, Douma, Margo H., van der Ploeg, Mieke B., Hoeksma, Jelle E., Smalbrugge, Martin, and Sizoo, Eefje M.
- Subjects
- *
DISCUSSION , *PHYSICIANS' attitudes , *MEDICAL care , *NURSING care facilities , *ADVANCE directives (Medical care) , *QUALITATIVE research , *INTERPERSONAL relations , *MEDICAL practice , *DECISION making in clinical medicine , *COVID-19 pandemic , *MEDICAL coding - Abstract
To explore how physicians in Dutch nursing homes practiced advance care planning (ACP) during the first wave of the COVID-19 pandemic, and to explore whether and how ACP changed during the first wave of the pandemic. Qualitative analysis of an online, mainly open-ended questionnaire on ACP among physicians working in nursing homes in the Netherlands during the first wave of the COVID-19 pandemic. Physicians in Dutch nursing homes. Respondents were asked to describe a recent case in which they had a discussion on anticipatory medical care decisions and to indicate whether ACP was influenced by the COVID-19 pandemic in that specific case and in general. Answers were independently coded and a codebook was compiled in which the codes were ordered by themes that emerged from the data. A total of 129 questionnaires were filled out. Saturation was reached after analyzing 60 questionnaires. Four main themes evolved after coding the questionnaires: reasons for ACP discussion, discussing ACP, topics discussed in ACP, and decision making in ACP. COVID-19–specific changes in ACP indicated by respondents included (1) COVID-19 infection as a reason for initiating ACP, (2) a higher frequency of ACP discussions, (3) less face-to-face contact with surrogate decision makers, and (4) intensive care unit admission as an additional topic in anticipatory medical decision making. ACP in Dutch nursing homes has changed because of the COVID-19 pandemic. Maintaining frequent and informal contact with surrogate decision makers fosters mutual understanding and aids the decision-making process in ACP. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
31. The Course of Quality of Life and Its Predictors in Nursing Home Residents With Young-Onset Dementia.
- Author
-
Pu, Lihui, Bakker, Christian, Appelhof, Britt, Zwijsen, Sandra A., Teerenstra, Steven, Smalbrugge, Martin, Verhey, Frans R.J., de Vugt, Marjolein E., Zuidema, Sytse U., and Koopmans, Raymond T.C.M.
- Subjects
- *
SCIENTIFIC observation , *NURSING home patients , *QUALITY of life , *PSYCHOSOCIAL factors , *DEMENTIA , *QUESTIONNAIRES , *HOSPITAL wards , *LONGITUDINAL method , *SECONDARY analysis - Abstract
To explore the course of quality of life (QoL) and possible resident-related predictors associated with this course in institutionalized people with young-onset dementia (YOD). An observational longitudinal study. A total of 278 residents with YOD were recruited from 13 YOD special care units in the Netherlands. Secondary analyses were conducted with longitudinal data from the Behavior and Evolution in Young-ONset Dementia (BEYOND)-II study. QoL was assessed with proxy ratings, using the Quality of Life in Dementia (QUALIDEM) questionnaire at 4 assessment points over 18 months. Predictors included age, gender, dementia subtype, length of stay, dementia severity, neuropsychiatric symptoms, and psychotropic drug use at baseline. Multilevel modeling was used to adjust for the correlation of measurements within residents and clustering of residents within nursing homes. The total QUALIDEM score (range: 0-111) decreased over 18 months with a small change of 0.65 (95% confidence interval −1.27, −0.04) points per 6 months. An increase in several domains of QoL regarding care relationship, positive self-image, and feeling at home was seen over time, whereas a decline was observed in the subscales positive affect, social relations, and having something to do. Residents with higher levels of QoL and more advanced dementia at baseline showed a more progressive decline in QoL over time. Sensitivity analyses indicated a more progressive decline in QoL for residents who died during the follow-up. This study shows that although overall QoL in nursing home residents with YOD was relatively stable over 18 months, there were multidirectional changes in the QoL subscales that could be clinically relevant. Higher levels of QoL and more advanced stages of dementia at baseline predicted a more progressive decline in QoL over time. More longitudinal studies are needed to verify factors influencing QoL in YOD. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
32. Reducing the Tension Between Patient Safety and Trainee Autonomy.
- Author
-
de Bruijne, Martine C., van Dijk, Nynke, Hertogh, Cees M.P.M., Smalbrugge, Martin, Helmich, Esther, and Noeverman-Poel, Nelleke
- Subjects
- *
PREVENTION of psychological stress , *ELDER care , *AUTONOMY (Psychology) , *FAMILY medicine , *FOCUS groups , *GROUNDED theory , *HOSPITAL medical staff , *INTERNSHIP programs , *INTERVIEWING , *MEDICAL quality control , *NURSING care facilities , *PATIENT safety , *PROFESSIONS , *RESEARCH funding , *SUPERVISION of employees , *MEDICAL coding - Published
- 2019
- Full Text
- View/download PDF
33. Clinical Suspicion of COVID-19 in Nursing Home Residents: Symptoms and Mortality Risk Factors.
- Author
-
Rutten, Jeanine J.S., van Loon, Anouk M., van Kooten, Janine, van Buul, Laura W., Joling, Karlijn J., Smalbrugge, Martin, and Hertogh, Cees M.P.M.
- Subjects
- *
CONFIDENCE intervals , *DEMENTIA patients , *LONGITUDINAL method , *COVID-19 testing , *MEDICAL records , *PARKINSON'S disease , *POLYMERASE chain reaction , *RISK assessment , *SURVIVAL analysis (Biometry) , *ELECTRONIC health records , *DESCRIPTIVE statistics , *ACQUISITION of data methodology , *ODDS ratio , *COVID-19 ,MORTALITY risk factors - Abstract
To describe the symptomatology, mortality, and risk factors for mortality in a large group of Dutch nursing home (NH) residents with clinically suspected COVID-19 who were tested with a reverse transcription–polymerase chain reaction (RT-PCR) test. Prospective cohort study. Residents of Dutch NHs with clinically suspected COVID-19 and who received RT-PCR test. We collected data of NH residents with clinically suspected COVID-19 via electronic health records between March 18 and May 13, 2020. Registration was performed on diagnostic status [confirmed (COVID-19+)/ruled out (COVID-19–)] and symptomatology (typical and atypical symptoms). Information on mortality and risk factors for mortality were extracted from usual care data. In our sample of residents with clinically suspected COVID-19 (N = 4007), COVID-19 was confirmed in 1538 residents (38%). Although symptomatology overlapped between residents with COVID-19+ and COVID-19–, those with COVID-19+ were 3 times more likely to die within 30 days [hazard ratio (HR), 3.1, 95% confidence interval (CI) 2.7-3.6]. Within this group, mortality was higher for men than for women (HR 1.8, 95% CI 1.5-2.2), and we observed a higher mortality for residents with dementia, reduced kidney function, and Parkinson's disease, even when corrected for age, gender, and comorbidities. About 40% of the residents with clinically suspected COVID-19 actually had COVID-19, based on the RT-PCR test. Despite an overlap in symptomatology, mortality rate was 3 times higher for residents with COVID-19+. This emphasizes the importance of using low-threshold testing in NH residents, which is an essential prerequisite to using limited personal protective equipment and isolation measures efficiently. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
34. Dilemmas With Restrictive Visiting Policies in Dutch Nursing Homes During the COVID-19 Pandemic: A Qualitative Analysis of an Open-Ended Questionnaire With Elderly Care Physicians.
- Author
-
Sizoo, Eefje M., Monnier, Annelie A., Bloemen, Maryam, Hertogh, Cees M.P.M., and Smalbrugge, Martin
- Subjects
- *
ATTITUDE (Psychology) , *DECISION making , *GERIATRICIANS , *MANAGEMENT , *MEDICAL personnel , *NURSING care facility administration , *RESEARCH , *VISITING the sick , *QUALITATIVE research , *PSYCHOSOCIAL factors , *THEMATIC analysis , *COVID-19 pandemic - Abstract
To mitigate the spread of COVID-19, a nationwide restriction for all visitors of residents of long-term care facilities including nursing homes (NHs) was established in the Netherlands. The aim of this study was an exploration of dilemmas experienced by elderly care physicians (ECPs) as a result of the COVID-19 driven restrictive visiting policy. ECPs working in Dutch NHs. A qualitative exploratory study was performed using an open-ended questionnaire. A thematic analysis was applied. Data were collected between April 17 and May 10, 2020. Seventy-six ECPs answered the questionnaire describing a total of 114 cases in which they experienced a dilemma. Thematic analysis revealed 4 major themes: (1) The need for balancing safety for all through infection prevention measures versus quality of life of the individual residents and their loved ones; (2) The challenge of assessing the dying phase and how the allowed exception to the strict visitor restriction in the dying phase could be implemented; (3) The profound emotional impact on ECPs; (4) Many alternatives for visits highlight the wish to compensate for the absence of face-to-face contact opportunities. Many alternatives for visits highlight the wish to compensate for the absence of face-to-face opportunities but given the diversity of NH residents, alternatives were often only suitable for some of them. ECPs reported that the restrictive visitor policy deeply impacts NHs residents, their loved ones, and care professionals. The dilemmas encountered as a result of the policy highlight the wish by ECPs to offer solutions tailored to the individual residents. We identified an overview of aspects to consider when drafting future visiting policies for NHs during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
35. The Influence of Activity-Based Funding on Treatment Intensity and Length of Stay of Geriatric Rehabilitation Patients.
- Author
-
Bouwstra, Hylco, Wattel, Lizette M., de Groot, Aafke J., Smalbrugge, Martin, and Hertogh, Cees M.
- Subjects
- *
ENDOWMENTS , *LENGTH of stay in hospitals , *NURSING care facilities , *THERAPEUTICS , *TIME , *GERIATRIC rehabilitation , *RETROSPECTIVE studies , *PHYSICAL activity - Abstract
Aim Little is known about the impact of activity-based funding (ABF) to increase treatment intensity and decrease length of stay (LOS) of inpatient geriatric patients. In January 2014, ABF was implemented in The Netherlands with the aim to increase treatment intensity and shorten LOS in geriatric rehabilitation (GR). Objectives To describe the influence of ABF on treatment intensity and LOS of inpatient GR patients before and after ABF was implemented. Design Population-based, retrospective cohort study. Setting Thirty nursing homes providing inpatient GR across The Netherlands. Data Collection Digital medical records of patients who had received inpatient GR in Dutch nursing homes across The Netherlands were studied between January 1, 2013 and March 14, 2016. We calculated the mean treatment intensity in hours per week and median LOS in days in 3 cohorts according to the year of admittance. In addition, a historical representative cohort of GR patients who were admitted in 2007 was studied that represented the situation before the ABF reform was announced (eg, funding with a fixed price per day). In 2013, the funding with a fixed price per day was still in use but with compulsory ABF registration. In 2014 and 2015, the ABF was fully implemented. Statistical differences in treatment intensity and LOS were calculated between patients admitted in 2007 and 2013, 2013 and 2014, and 2013 and 2015. Statistical significance was set at a P value of <.02 (Bonferroni correction P = .05/3). Discharge destinations of patients discharged from March 1, 2015 to January 1, 2016 could be obtained and compared with 2007. Results The treatment intensity and LOS of 16,823 GR patients could be obtained and compared with the historical cohort from 2007 (n = 2950). Patients who were admitted in the year 2013 received higher treatment intensities and had the same median LOS compared with 2007. After the implementation of ABF in January 2014, the mean treatment intensity increased significantly by 37% (3.8 hours/week in 2013, 4.7 hours/week in 2014, and 5.2 hours/week in 2015). This trend was significant across all rehabilitation diagnoses. After the implementation of ABF, the median LOS decreased significantly by 7 days (46 days in 2013, 42 days in 2014, and 39 days in 2015), which was consistent in all rehabilitation categories except for patients with a total joint replacement or amputation. Conclusions Patients who received inpatient GR after introduction of ABF received higher treatment intensities and had a shorter LOS compared with the year before implementation. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
36. Process Evaluation to Explore Internal and External Validity of the “Act in Case of Depression” Care Program in Nursing Homes.
- Author
-
Leontjevas, Ruslan, Gerritsen, Debby L., Koopmans, Raymond T.C.M., Smalbrugge, Martin, and Vernooij-Dassen, Myrra J.F.J.
- Abstract
Abstract: Background: A multidisciplinary, evidence-based care program to improve the management of depression in nursing home residents was implemented and tested using a stepped-wedge design in 23 nursing homes (NHs): “Act in case of Depression” (AiD). Objective: Before effect analyses, to evaluate AiD process data on sampling quality (recruitment and randomization, reach) and intervention quality (relevance and feasibility, extent to which AiD was performed), which can be used for understanding internal and external validity. In this article, a model is presented that divides process evaluation data into first- and second-order process data. Methods: Qualitative and quantitative data based on personal files of residents, interviews of nursing home professionals, and a research database were analyzed according to the following process evaluation components: sampling quality and intervention quality. Setting: Nursing home. Results: The pattern of residents’ informed consent rates differed for dementia special care units and somatic units during the study. The nursing home staff was satisfied with the AiD program and reported that the program was feasible and relevant. With the exception of the first screening step (nursing staff members using a short observer-based depression scale), AiD components were not performed fully by NH staff as prescribed in the AiD protocol. Conclusion: Although NH staff found the program relevant and feasible and was satisfied with the program content, individual AiD components may have different feasibility. The results on sampling quality implied that statistical analyses of AiD effectiveness should account for the type of unit, whereas the findings on intervention quality implied that, next to the type of unit, analyses should account for the extent to which individual AiD program components were performed. In general, our first-order process data evaluation confirmed internal and external validity of the AiD trial, and this evaluation enabled further statistical fine tuning. The importance of evaluating the first-order process data before executing statistical effect analyses is thus underlined. [ABSTRACT FROM AUTHOR]
- Published
- 2012
- Full Text
- View/download PDF
37. Process Evaluation to Explore Internal and External Validity of the “Act in Case of Depression” Care Program in Nursing Homes
- Author
-
Leontjevas, Ruslan, Gerritsen, Debby L., Koopmans, Raymond T.C.M., Smalbrugge, Martin, and Vernooij-Dassen, Myrra J.F.J.
- Subjects
- *
MENTAL depression , *THERAPEUTICS , *ELDER care , *INTERVIEWING , *LONG-term health care , *RESEARCH methodology , *EVALUATION of medical care , *MEDICAL protocols , *NURSING home patients , *NURSING home employees , *PSYCHOLOGICAL tests , *QUALITY assurance , *SCALES (Weighing instruments) , *QUALITATIVE research , *QUANTITATIVE research , *EVALUATION of human services programs ,RESEARCH evaluation - Abstract
Abstract: Background: A multidisciplinary, evidence-based care program to improve the management of depression in nursing home residents was implemented and tested using a stepped-wedge design in 23 nursing homes (NHs): “Act in case of Depression” (AiD). Objective: Before effect analyses, to evaluate AiD process data on sampling quality (recruitment and randomization, reach) and intervention quality (relevance and feasibility, extent to which AiD was performed), which can be used for understanding internal and external validity. In this article, a model is presented that divides process evaluation data into first- and second-order process data. Methods: Qualitative and quantitative data based on personal files of residents, interviews of nursing home professionals, and a research database were analyzed according to the following process evaluation components: sampling quality and intervention quality. Setting: Nursing home. Results: The pattern of residents’ informed consent rates differed for dementia special care units and somatic units during the study. The nursing home staff was satisfied with the AiD program and reported that the program was feasible and relevant. With the exception of the first screening step (nursing staff members using a short observer-based depression scale), AiD components were not performed fully by NH staff as prescribed in the AiD protocol. Conclusion: Although NH staff found the program relevant and feasible and was satisfied with the program content, individual AiD components may have different feasibility. The results on sampling quality implied that statistical analyses of AiD effectiveness should account for the type of unit, whereas the findings on intervention quality implied that, next to the type of unit, analyses should account for the extent to which individual AiD program components were performed. In general, our first-order process data evaluation confirmed internal and external validity of the AiD trial, and this evaluation enabled further statistical fine tuning. The importance of evaluating the first-order process data before executing statistical effect analyses is thus underlined. [Copyright &y& Elsevier]
- Published
- 2012
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.