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Abstract Background High-quality outpatient medical care can prevent care-dependent people from having to move to a nursing home. Quality of care is determined by the behaviour and cooperation of providers, which, when sharing patient collectives, can be understood as functionally defined informal provider networks (PN). There is still a lack of knowledge about the relationship between the quality of care in the interaction among service providers as a structural characteristic of a PN and nursing home admissions (NHA). We therefore examined associations between treatment quality, compositional characteristics, such as the number of general practicioners in the PN and NHA. Methods German statutory health insurance claims data from 2006 to 2016 was used in a retrospective cohort study. The observation cohort comprised community-dwelling people ≥ 65 years of age who initially became care-dependent in 2006 (n = 117,942). PN were constructed using the Speaker-Listener Label Propagation Algorithm. The quality of care provided by such networks was assessed by further including all people ≥ 65 years of age who were cared for by service providers of the observation cohort. Quality of care in the PN was measured using 67 quality indicators (QI). Event-time series analyses in three proportional hazard models, taking into account random effects, determined the association of treatment quality characteristics and compositional characteristics of the PN with NHA. Results 35,540 admissions occurred in 406 PN. The majority of QI and individual predictors show significant associations with NHA, as well as a few compositional characteristics of the PN. Out of 67 QI, 37 were significant in two of three models, 19 of which were associated with a lower risk and 18 with an increased risk for NHA. Conclusions Associations between quality characteristics of the PN and the risk of NHA constitute a relevant influence as they remain significant when controlled for individual predictors. Most compositional characteristics had no influence on NHA. Aspects of treatment quality thus do play a role in determining how long care-dependent people continue to live at home after onset of care-dependency. The results contribute to revealing informal relationships between service providers that constitute a special characteristic of the German health care system and to the identification of starting points for further education in high quality treatment of selected populations and in formalizing care collaborations by joining voluntary PN. Further, sensitising service providers to the evaluation of care processes and to reflecting on the relevance of their role in PN can improve quality development and outcomes.

Abstract Background Multimorbidity poses a challenge for high quality primary care provision for nursing care-dependent people with (PWD) and without (PWOD) dementia. Evidence on the association of primary care quality of multimorbid PWD and PWOD with the event of a nursing home admission (NHA) is missing. This study aimed to investigate the contribution of individual quality of primary care for chronic diseases in multimorbid care-dependent PWD and PWOD on the duration of ongoing residence at home before the occurrence of NHA. Methods We conducted a retrospective cohort study among elderly care-dependent PWD and PWOD in Germany for six combinations of chronic diseases using statutory health insurance claims data (2007–2016). Primary care quality was measured by 21 process and outcome indicators for hypertension, diabetes, depression, chronic obstructive pulmonary disease and heart failure. The primary outcome was time to NHA after initial onset of care-dependency. Multivariable Cox proportional hazard models were used to compare the time-to-event between PWD and PWOD. Results Among 5876 PWD and 12,837 PWOD 5130 NHA occurred. With the highest proportion of NHA for PWD with hypertension and depression and for PWOD with hypertension, diabetes and depression. Average duration until NHA ranged from 6.5 to 8.9 quarters for PWD and from 9.6 to 13.5 quarters for PWOD. Adjusted analyses show consistent associations of the quality of diabetes care with the duration of remaining in one’s own home regardless of the presence of dementia. Process indicators assessing guideline-fidelity are associated with remaining in one’s home longer, while indicators assessing complications, such as emergency inpatient treatment (HR = 2.67, 95% CI 1.99–3.60 PWD; HR = 2.81, 95% CI 2.28–3.47 PWOD) or lower-limb amputation (HR = 3.10, 95% CI 1.78–5.55 PWD; HR = 2.81, 95% CI 1.94–4.08 PWOD) in PWD and PWOD with hypertension and diabetes, increase the risk of NHA. Conclusions The quality of primary care provided to care-dependent multimorbid PWD and POWD, influences the time individuals spend living in their own homes after onset of care-dependency before a NHA. Health care professionals should consider possibilities and barriers of guideline-based, coordinated care for multimorbid care-dependent people. Further research on quality indicator sets that acknowledge the complexity of care for multimorbid elderly populations is needed.

Robotic manipulators can interact with large, heavy objects through whole-arm manipulation. Combined with direct physical interaction between humans and robots, the patient can be anchored in care. However, the complexity of this scenario requires control by a caregiver. We are investigating how such a complex form of manipulation can be controlled by nurses and whether the use of such a system creates physical relief. The use case chosen was washing the back of a patient in the lateral position. The operability of the remote control from the tele-nurse’s point of view, the change in the posture of the nurse on site, the execution times, the evaluation of the cooperation between human and robot, and the evaluation of the system from the nurse’s point of view and from the patient’s point of view were evaluated. The results show that the posture of the worker improved by 11.93% on average, and by a maximum of 26.13%. Ease of use is rated as marginally high. The manipulator is considered helpful. The study shows that remote whole-arm manipulation can anchor bedridden patients in the lateral position and that this system can be operated by nurses and leads to an improvement in working posture.

Abstract Background People prefer to age in place and not move into a nursing home as long as possible. The prevention of cognitive and functional impairments is feasible to support this goal. Health services play a key role in providing support for underlying medical conditions. We examined differentials in nursing home admissions between patient sharing networks in Germany and whether potential variations can be attributed to indicators of health care provision. Methods We conducted an ecological study using data of patients of 65 years and above from all 11 AOK statutory health insurance companies in Germany. Nursing home admissions were observed in a cohort of persons becoming initially care-dependent in 2006 (n = 118,213) with a follow-up of up to 10 years. A patient sharing network was constructed and indicators for quality of health care were calculated based on data of up to 6.6 million patients per year. Community detection was applied to gain distinct patient populations. Analyses were conducted descriptively and through regression analyses to identify the variation explained by included quality indicators. Results The difference in the proportion of nursing home admissions between identified clusters shows an interquartile range (IQR) of 12.6% and the average time between onset of care-dependency and admission to a nursing home an IQR of 10,4 quarters. Included quality indicators attributed for 40% of these variations for the proportion of nursing home admissions and 49% for the time until nursing home admission, respectively. Indicators of process quality showed the single highest contribution. Effects of single indicators were inconclusive. Conclusions Health services can support persons in their preference to age in place. Research and discussion on adequate health care for care-dependent persons and on conditions, where nursing home admission may be beneficial, is necessary.

Abstract Background Digital nursing technologies (DNT) comprise an expanding, highly diverse field of research, explored using a wide variety of methods and tools. Study results are therefore difficult to compare, which raises the question how effectiveness of DNT can be adequately measured. Methods currently used might not be sufficient for certain specific nursing contexts. A comprehensive outcome framework that shows the multitude of possible outcome areas could be useful to generate more comparable results. The aim of the present study is to develop an outcome framework for DNT and to indicate which outcome areas have been most frequently evaluated in previous studies and how this has been done. Methods We combined an inductive and deductive approach to develop the framework. The numerical analysis is based on a scoping review focussing on the effectiveness of DNT for persons in need of care, formal or informal caregivers or care institutions. Nine databases were included in the screening: Medline, Scopus, CINAHL, Cochrane Library, ACM Digital Library, IEEE Xplore, the Collection of Computer Science Bibliographies, GeroLit and CareLit. Additional literature searches and expert interviews were included. Results The developed framework comprises four outcome target groups and 47 outcome areas. There are considerable differences in the researched outcome areas for the individual outcome target groups. Persons in need of care were by far the most frequently surveyed, particularly with respect to their psychological health. There are much fewer studies on formal and informal caregivers, and it is particularly noticeable that the quality of life of both groups has rarely been investigated. Care process quality was most frequently researched for organisations. Conclusion We were able to provide a comprehensive DNT outcome framework, thereby identifying the outcome tools used and the less researched outcome areas. We recommend a detailed investigation of all areas and tools in future research projects with a view to initiating a discussion on the differing importance of existing outcome areas and on a standardisation of outcome tools. We also recommend the development of outcome areas for the macro level of effectiveness assessment.

BackgroundArtificial intelligence (AI) holds the promise of supporting nurses’ clinical decision-making in complex care situations or conducting tasks that are remote from direct patient interaction, such as documentation processes. There has been an increase in the research and development of AI applications for nursing care, but there is a persistent lack of an extensive overview covering the evidence base for promising application scenarios. ObjectiveThis study synthesizes literature on application scenarios for AI in nursing care settings as well as highlights adjacent aspects in the ethical, legal, and social discourse surrounding the application of AI in nursing care. MethodsFollowing a rapid review design, PubMed, CINAHL, Association for Computing Machinery Digital Library, Institute of Electrical and Electronics Engineers Xplore, Digital Bibliography & Library Project, and Association for Information Systems Library, as well as the libraries of leading AI conferences, were searched in June 2020. Publications of original quantitative and qualitative research, systematic reviews, discussion papers, and essays on the ethical, legal, and social implications published in English were included. Eligible studies were analyzed on the basis of predetermined selection criteria. ResultsThe titles and abstracts of 7016 publications and 704 full texts were screened, and 292 publications were included. Hospitals were the most prominent study setting, followed by independent living at home; fewer application scenarios were identified for nursing homes or home care. Most studies used machine learning algorithms, whereas expert or hybrid systems were entailed in less than every 10th publication. The application context of focusing on image and signal processing with tracking, monitoring, or the classification of activity and health followed by care coordination and communication, as well as fall detection, was the main purpose of AI applications. Few studies have reported the effects of AI applications on clinical or organizational outcomes, lacking particularly in data gathered outside laboratory conditions. In addition to technological requirements, the reporting and inclusion of certain requirements capture more overarching topics, such as data privacy, safety, and technology acceptance. Ethical, legal, and social implications reflect the discourse on technology use in health care but have mostly not been discussed in meaningful and potentially encompassing detail. ConclusionsThe results highlight the potential for the application of AI systems in different nursing care settings. Considering the lack of findings on the effectiveness and application of AI systems in real-world scenarios, future research should reflect on a more nursing care–specific perspective toward objectives, outcomes, and benefits. We identify that, crucially, an advancement in technological-societal discourse that surrounds the ethical and legal implications of AI applications in nursing care is a necessary next step. Further, we outline the need for greater participation among all of the stakeholders involved.