Using data linkage for national surveillance of clinical quality indicators for dementia care among Australian aged care users

AbstractCare quality has important implications for people with dementia. We examined trends and geographical variation of four clinical quality indicators (CQIs) in Australia. This retrospective cohort study included all people with dementia using Australian government-subsidised aged care in 2008–2016 (n = 373,695). Quality indicator data were derived from linked national aged care, health, and pharmaceutical datasets. Negative binomial regression modelling assessed trends in CQI performance over time (2011–2016) and funnel plots examined geographical variation in performance. The incidence rate of antipsychotic medicine dispensing decreased slightly from 1.17/1000 person-days to 1.07/1000 person-days (adjusted incidence rate ratio (aIRR) = 0.98, 95%CI 0.98–0.99). Cholinesterase inhibitors and memantine dispensing did not change (aIRR = 1.02, 95%CI 1.00–1.04), while exposure to high sedative load increased slightly from 1.39/1000 person-days to 1.44/1000 person-days (aIRR = 1.01, 95%CI 1.00–1.01). Dementia and delirium-related hospitalisations increased slightly from 0.17/1000 person-days to 0.18/1000 person-days (aIRR = 1.02, 95%CI 1.01–1.03). There was marked variation in cholinesterase inhibitor and memantine dispensing by geographical area (0–41%). There has been little change in four indicators of dementia care quality in Australian aged care users over time. Cholinesterase inhibitor and memantine dispensing varied substantially by geographical region. Existing strategies to improve national performance on these indicators appear to be insufficient, despite the significant impact of these indicators on outcomes for people with dementia.

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How, why and under what circumstances does a quality improvement collaborative build knowledge and skills in clinicians working with people with dementia? A realist informed process evaluation

BMJ Open Quality ◽

10.1136/bmjoq-2020-001147 ◽

2021 ◽

Vol 10 (2) ◽

pp. e001147

Author(s):

Lenore de la Perrelle ◽

Monica Cations ◽

Gaery Barbery ◽

Gorjana Radisic ◽

Billingsley Kaambwa ◽

...

Keyword(s):

Quality Improvement ◽

Reflective Practice ◽

Process Evaluation ◽

Aged Care ◽

Dementia Care ◽

Quality Improvement Collaborative ◽

Programme Theory ◽

Post Intervention ◽

Knowledge And Skills ◽

People With Dementia

In increasingly constrained health and aged care services, strategies are needed to improve quality and translate evidence into practice. In dementia care, recent failures in quality and safety have led the WHO to prioritise the translation of known evidence into practice. While quality improvement collaboratives have been widely used in healthcare, there are few examples in dementia care.We describe a recent quality improvement collaborative to improve dementia care across Australia and assess the implementation outcomes of acceptability and feasibility of this strategy to translate known evidence into practice. A realist-informed process evaluation was used to analyse how, why and under what circumstances a quality improvement collaborative built knowledge and skills in clinicians working in dementia care.This realist-informed process evaluation developed, tested and refined the programme theory of a quality improvement collaborative. Data were collected pre-intervention and post-intervention using surveys and interviews with participants (n=28). A combined inductive and deductive data analysis process integrated three frameworks to examine the context and mechanisms of knowledge and skill building in participant clinicians.A refined program theory showed how and why clinicians built knowledge and skills in quality improvement in dementia care. Six mechanisms were identified: motivation, accountability, identity, collective learning, credibility and reflective practice. These mechanisms, in combination, operated to overcome constraints, role boundaries and pessimism about improved practice in dementia care.A quality improvement collaborative designed for clinicians in different contexts and roles was acceptable and feasible in building knowledge, skills and confidence of clinicians to improve dementia care. Supportive reflective practice and a credible, flexible and collaborative process optimised quality improvement knowledge and skills in clinicians working with people with dementia.Trial registration numberACTRN12618000268246.

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Ten Years of Improving Acute Stroke Management in a Metropolitan Area: A Population-Based Quantification of Quality Indicators

European Neurology ◽

10.1159/000518428 ◽

2021 ◽

pp. 1-11

Author(s):

Anna Alegiani ◽

Michael Rosenkranz ◽

Leonie Schmitz ◽

Susanne Lezius ◽

Günter Seidel ◽

...

Keyword(s):

Acute Stroke ◽

Quality Indicators ◽

Metropolitan Area ◽

Stroke Care ◽

Care Quality ◽

Acute Stroke Care ◽

Stroke Units ◽

Stroke Treatment ◽

Acute Stroke Treatment ◽

Over Time

Background and Purpose: Rapid access to acute stroke treatment improves clinical outcomes in patients with ischemic stroke. We aimed to shorten the time to admission and to acute stroke treatment for patients with acute stroke in the Hamburg metropolitan area by collaborative multilevel measures involving all hospitals with stroke units, the Emergency Medical Services (EMS), and health-care authorities. Methods: In 2007, an area-wide stroke care quality project was initiated. The project included mandatory admission of all stroke patients in Hamburg exclusively to hospitals with stroke units, harmonized acute treatment algorithms among all hospitals, repeated training of the EMS staff, a multimedia educational campaign, and a mandatory stroke care quality monitoring system based on structured data assessment and quality indicators for procedural measures. We analyzed data of all patients with acute stroke who received inhospital treatment in the city of Hamburg during the evaluation period from the quality assurance database data and evaluated trends of key quality indicators over time. Results: From 2007 to 2016, a total of 83,395 patients with acute stroke were registered. During this period, the proportion of patients admitted within ≤3 h from symptom onset increased over time from 27.8% in 2007 to 35.2% in 2016 (p < 0.001). The proportion of patients who received rapid thrombolysis (within ≤30 min after admission) increased from 7.7 to 54.1% (p < 0.001). Conclusions: Collaborative stroke care quality projects are suitable and effective to improve acute stroke care.

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A cross-country comparison of family carers experiences with residential aged care facilities during the COVID-19 pandemic

International Psychogeriatrics ◽

10.1017/s1041610221001575 ◽

2021 ◽

Vol 33 (S1) ◽

pp. 26-26

Author(s):

Katarzyna M Lion ◽

Clarissa Giebel ◽

Ilaria Chirico ◽

Monica Cations ◽

Rabih Chattat ◽

...

Keyword(s):

Thematic Analysis ◽

Aged Care ◽

Care Quality ◽

Residential Aged Care ◽

Care Provision ◽

Family Carers ◽

Country Comparison ◽

People With Dementia ◽

Cross Country ◽

The Uk

Background:The number of research projects into residential aged care (RAC) during the COVID-19 pandemic is increasing, however there are limited data on the cross-country comparison of experiences residents living with dementia and their families. Our study aimed to 1) give an overview of the RAC restrictions and changes (visiting policy, governmental & health authorities’ advice, service delivery) implemented during the pandemic in Australia, Italy and the UK and 2) and their impact on people with dementia in RAC facilities and their families.Methods:A total of 56 informal family carers of people with dementia residing in RAC took part in semi- structured interviews over the telephone or via Skype in Australia (n=6), Italy (n=25) and the UK (n=26) between July 2020 and March 2021. The interviews were recorded and translated verbatim. Transcripts were analysed by researchers in each country using thematic analysis, then combined across sites.Results:Inductive thematic analysis identified four overarching themes: 1) Adaptations implemented in RAC facilities due to the COVID-19 pandemic in Australia, Italy and the UK; 2) means of communication between RAC facility personnel, people with dementia living in RAC and family members; 3) impact of the implemented restrictions and changes in care provision due to the COVID-19 pandemic on people with dementia in RAC facilities and 4) impact of the implemented restrictions and changes in care provision due to the COVID-19 pandemic on families of people with dementia in RAC facilities. While differences between countries and facilities were identified, the restrictions and changes within the residential care system impacted families’ well-being, increased their worries about care quality and safety of people with dementia. The consequences of a lack or modified services for people with dementia included noticeable physical and mental health changes. Although the majority of the facilities implemented some form of video-communication between families and residents, those solutions were unable to replace face-to-face contact.Conclusions:These findings demonstrate the need for implementing safe solutions which might facilitate more frequent in-person contact between families and residents with dementia preventing consequences in mental and physical health in both groups.

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People with dementia and their family carers' satisfaction with a memory service: A qualitative evaluation generating quality indicators for dementia care

Journal of Mental Health ◽

10.1080/09638230701529681 ◽

2009 ◽

Vol 18 (1) ◽

pp. 26-37 ◽

Cited By ~ 18

Author(s):

Rosalind Willis ◽

Jeni Chan ◽

Joanna Murray ◽

David Matthews ◽

Sube Banerjee

Keyword(s):

Quality Indicators ◽

Qualitative Evaluation ◽

Dementia Care ◽

Family Carers ◽

People With Dementia

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Large-scale training in the essentials of dementia care in Australia: Dementia Care Skills for Aged Care Workers project

International Psychogeriatrics ◽

10.1017/s1041610209008722 ◽

2009 ◽

Vol 21 (S1) ◽

pp. S53-S57 ◽

Cited By ~ 6

Author(s):

Richard Fleming ◽

Diana FitzGerald

Keyword(s):

Large Scale ◽

Aged Care ◽

Dementia Care ◽

Cultural Backgrounds ◽

Research Education ◽

People With Dementia ◽

Care Workers ◽

Wide Range ◽

Making A Difference ◽

National Programs

ABSTRACTDementia has been identified as a national health priority in Australia. National programs in the areas of research, education and training have been established. The Dementia Care Skills for Aged Care Workers program is a three-year project that commenced in 2006. It has the goal of providing training in the essentials of dementia care to 17,000 staff of aged care services across Australia. Successful completion of the training results in the award of a nationally recognized qualification. Although the delivery of the training has been difficult in some areas – because of the long distances to be covered by trainers and trainees, a wide range of cultural backgrounds, and difficulties in finding staff to cover for people attending the training – the seven training organizations providing this training are on target to meet the goal. The project is being evaluated independently. The anecdotal reports available to date strongly suggest that the training is being well received and is making a difference to practice.A surprisingly large proportion of attendees (9%) have been registered nurses, which demonstrates the need among this group of staff for training in the care of people with dementia.

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Human Rights and Empowerment in Aged Care: Restraint, Consent and Dying with Dignity

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18157899 ◽

2021 ◽

Vol 18 (15) ◽

pp. 7899

Author(s):

Tiffany Jessop ◽

Carmelle Peisah

Keyword(s):

Human Rights ◽

Aged Care ◽

Care Quality ◽

Royal Commission ◽

Active Player ◽

Chemical Restraint ◽

People With Dementia ◽

Educational Engagement ◽

Care System

The aged care system in Australia is in crisis and people living with dementia are especially vulnerable to breaches of human rights to autonomy, dignity, respect, and equitable access to the highest quality of health care including meeting needs on account of disability. To be powerful advocates for themselves and others, people with dementia and the wider community with vested interests in quality aged care must be informed about their rights and what should be expected from the system. Prior to the Australian Royal Commission into Aged Care Quality and Safety, the Empowered Project was established to empower and raise awareness amongst people with dementia and their families about changed behaviours, chemical restraint, consent, end of life care, and security of tenure. A primary care-embedded health media campaign and national seminar tour were undertaken to meet the project aims of awareness-raising and empowerment, based on 10 Essential Facts about changed behaviours and rights for people with dementia, established as part of the project. Knowledge translation was assessed to examine the need and potential benefit of such seminars. We demonstrated that this brief educational engagement improved community knowledge of these issues and provided attendees with the information and confidence to question the nature and quality of care provision. With the completion of the Royal Commission and corresponding recommendations with government, we believe the community is ready to be an active player in reframing Australia’s aged care system with a human rights approach.

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Care trajectories through community and residential aged care services: disease effects

Ageing and Society ◽

10.1017/s0144686x11001231 ◽

2012 ◽

Vol 32 (8) ◽

pp. 1428-1445 ◽

Cited By ~ 12

Author(s):

ROSEMARY KARMEL ◽

DIANE GIBSON ◽

PHIL ANDERSON ◽

YVONNE WELLS ◽

STEPHEN DUCKETT

Keyword(s):

Cardiovascular Disease ◽

Nursing Home ◽

Aged Care ◽

Residential Aged Care ◽

Term Care ◽

Musculoskeletal Conditions ◽

Care Services ◽

People With Dementia ◽

Care Assessment ◽

Over Time

ABSTRACTAs in other ageing populations, dementia, musculoskeletal conditions and cardiovascular disease affect a high proportion of Australians aged over 65 years, and the prevalence of these conditions increases significantly with age. People with these conditions may need to access a range of care services over time to enable them to remain living in their homes. Many eventually need to move into a nursing home.In contrast to the considerable recent literature on the funding of long-term care systems for population ageing, studies on the care pathways followed by individuals are much less common. This paper explores the effect of disease on use of community care services and nursing homes over time, focusing on people with dementia, cardiovascular disease and musculoskeletal conditions. Care-use transitions are identified using linked administrative client data for a cohort of 33,300 community-living Australians who had an aged care assessment in 2003-04 and who had not previously used aged care services.The different symptoms and courses of diseases meant that the patterns of aged care service use, both in terms of care services accessed and the timing of this access, varied considerably for people with different health conditions. These differences persisted across a range of client characteristics. In particular, people with dementia or cerebrovascular disease as their main health condition were more likely to enter nursing home care than those with heart disease or musculoskeletal conditions.The variation in use of aged care services according to disease group need to be taken into account in any projections of demand for aged care. Such projections must allow for predictions of disease prevalence, or else they will yield inaccurate predictions of demand for both community and residential care.

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Improving adherence to guideline recommendations in dementia care through establishing a quality improvement collaborative of agents of change: an interrupted time series study

Implementation Science Communications ◽

10.1186/s43058-020-00073-x ◽

2020 ◽

Vol 1 (1) ◽

Author(s):

Kate Laver ◽

Monica Cations ◽

Gorjana Radisic ◽

Lenore de la Perrelle ◽

Richard Woodman ◽

...

Keyword(s):

Time Series ◽

Quality Improvement ◽

Health Professionals ◽

Interrupted Time Series ◽

Aged Care ◽

Dementia Care ◽

Trial Registration ◽

Guideline Recommendation ◽

Quality Improvement Collaborative ◽

People With Dementia

Abstract Background Non-pharmacological interventions including physical activity programmes, occupational therapy and caregiver education programmes have been shown to lead to better outcomes for people with dementia and their care partners. Yet, there are gaps between what is recommended in guidelines and what happens in practice. The aim of this study was to bring together clinicians working in dementia care and establish a quality improvement collaborative. The aim of the quality improvement collaborative was to increase self-reported guideline adherence to three guideline recommendations. Methods Interrupted time series. We recruited health professionals from community, hospital and aged care settings across Australia to join the collaborative. Members of the collaborative participated in a start-up meeting, completed an online learning course with clinical and quality improvement content, formed a quality improvement plan which was reviewed by a team of experts, received feedback following an audit of their current practice and were able to share experiences with their peers. The primary outcome was self-reported adherence to their guideline recommendation of interest which was measured using checklists. Data were collected monthly over a period of 18 months, and the study used an interrupted time series design and multilevel Poisson regression analysis to evaluate changes in self-reported adherence. Results A total of 45 health professionals (78% therapists) from different sites joined the collaborative and 28 completed all requirements. Data from 1717 checklists were included in the analyses. Over the duration of the project, there was a significant increase in clinician self-reported adherence to guideline recommendations with a 42.1% immediate increase in adherence (incidence rate ratio = 1.42; 95% confidence interval = 1.08–1.87; p = 0.012). Conclusion Health professionals working with people with dementia are interested in and willing to join a quality improvement collaborative with the goal of improving non-pharmacological aspects of care. Participation in the collaborative improved the quality of care for people with dementia as measured through self-reported adherence to guideline recommendations. Although there are challenges in implementation of guideline recommendations within dementia care, the quality improvement collaborative method was considered successful. A strength was that it equipped and empowered clinicians to lead improvement activities and allowed for heterogeneity in terms of service and setting. Trial registration ACTRN12618000268246

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Beyond the shrinking world: dementia, localisation and neighbourhood

Ageing and Society ◽

10.1017/s0144686x21000350 ◽

2021 ◽

pp. 1-22

Author(s):

Richard Ward ◽

Kirstein Rummery ◽

Elzana Odzakovic ◽

Kainde Manji ◽

Agneta Kullberg ◽

...

Keyword(s):

International Study ◽

Social Experience ◽

Social Practices ◽

Dementia Care ◽

Loss Of Control ◽

Policy And Practice ◽

People With Dementia ◽

Care And Support ◽

Over Time ◽

World Concept

Abstract ‘Dementia-friendly communities’ herald a shift toward the neighbourhood as a locus for the care and support of people with dementia, sparking growing interest in the geographies of dementia care and raising questions over the shifting spatial and social experience of the condition. Existing research claims that many people with dementia experience a ‘shrinking world’ whereby the boundaries to their social and physical worlds gradually constrict over time, leading to a loss of control and independence. This paper reports a five-year, international study that investigated the neighbourhood experience of people with dementia and those who care for and support them. We interrogate the notion of a shrinking world and in so doing highlight an absence of attention paid to the agency and actions of people with dementia themselves. The paper draws together a socio-relational and embodied-material approach to question the adequacy of the shrinking world concept as an explanatory framework and to challenge reliance within policy and practice upon notions of place as fixed or stable. We argue instead for the importance of foregrounding ‘lived place’ and attending to social practices and the networks in which such practices evolve. Our findings have implications for policy and practice, emphasising the need to bolster the agency of people living with dementia as a route to fostering accessible and inclusive neighbourhoods.

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Interiority of a Disconnected Mind

10.26686/wgtn.17018894.v1 ◽

2021 ◽

Author(s):

◽

Sarah Cheetham

Keyword(s):

New Zealand ◽

Care Facility ◽

Aged Care ◽

Dementia Care ◽

Living Environment ◽

Rural People ◽

Urban Living ◽

People With Dementia ◽

Rural Context ◽

Staffing Requirements

As the population of New Zealand ages, the rate of people with dementia is also increasing, creating greater demand for specialised dementia facilities. However, few of these are located in the rural context that New Zealand is known for. In addition, as a society we have created a stigma around aged care, and tend to design un-home-like and institutional centres. The importance of creating a space that provides contextual features, appropriate wayfinding and therapeutic characteristics has been overtaken by the need to design for efficiency of staffing requirements. Current settings and the relocation to a more urban living environment increases the confusion for those rural people with dementia, as there is little to prompt their memory or make them feel at home. This thesis proposes the design of a dementia care facility that reflects the lifestyle rural people have come from. It examines how these three aspects: context, wayfinding and therapeutic design can be included to enhance the design of a dementia facility, as well as create a space that is enlivening for the residents.

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