Reliability and Validity of a New Preadmission Acuity Tool for Long-Term Care

1995 ◽  
Vol 3 (1) ◽  
pp. 77-88
Author(s):  
Elizabeth A. Swanson ◽  
Orpha J. Click
Keyword(s):  
Health Care Professionals ◽  
Long Term Care ◽  
A Priori ◽  
Reliability And Validity ◽  
Cost Effective ◽  
Functional Independence ◽  
Term Care ◽  
Effective Manner ◽  
New Instrument

The purpose of this project was to develop a new tool designed to assess the acuity of applicants to long-term facilities. Using a known groups method, residents of long-term care facilities were categorized as independent (n=68), assist (n=71), and dependent (n=65) and assessed using the Preadmission Acuity Inquiry Tool (PAI) to generate the data base for examining its psychometric properties. The progression of the mean scores from independent to assist to dependent demonstrates the ability of the tool to differentiate across varying levels of functional independence. Using discriminant analysis, the degree of accuracy in predicting group membership for the independent group was 88%, for the dependent group 75%, and for the assist group 17% with the overall agreement between PAI scores and a priori classifications at 60%. Kappa coefficients for interrater reliability ranged from .54 to 1.0 with a mean of .90. The Cronbach’s alpha coefficient was .81. The PAI has demonstrated sufficient reliability and validity to warrant further refinement and testing. This new instrument may enable health care professionals to provide the appropriate level of care in a cost-effective manner.

A Right to Personal Assistance Services: “Most Integrated Setting Appropriate” Requirements and the Independent Living Model of Long-term Care

2001 ◽  
Vol 27 (1) ◽  
pp. 17-43
Author(s):  
Andrew I. Batavia
Keyword(s):  
Independent Living ◽  
Long Term Care ◽  
Cost Effective ◽  
Chronically Ill ◽  
The United States ◽  
Term Care ◽  
Care Services ◽  
Effective Manner ◽  
Care Capacity

The United States is currently entering a period in which the demand for longterm care services is growing at a particularly rapid rate; it is projected that the inflation-adjusted expenditures for long-term care will double between 1993 and 2018. As the population continues to age and become more chronically ill and disabled, the need to expand our long-term care capacity, and the long-term care options available, has become self-evident. The question is how we can meet this need in a cost-effective manner that is satisfactory to the consumer of services.

The Brief Anxiety and Depression Scale (BADS): a new instrument for detecting anxiety and depression in long-term care residents

2014 ◽  
Vol 27 (4) ◽  
pp. 673-681 ◽  
Author(s):  
William E. Mansbach ◽  
Ryan A. Mace ◽  
Kristen M. Clark
Keyword(s):  
Health Care Professionals ◽  
Long Term Care ◽  
Depression Scale ◽  
Anxiety And Depression ◽  
Depression And Anxiety ◽  
Term Care ◽  
New Instrument ◽  
Major Depressive Episodes ◽  
Depressive Episodes

ABSTRACTBackground:Depression and anxiety are common among long-term care residents, yet both appear to be under-recognized and under-treated. In our survey of 164 geriatric health care professionals from 34 U.S. states, 96% of respondents reported that a new instrument that rapidly assesses both depression and anxiety is needed. The Brief Anxiety and Depression Scale (BADS) is a new screening tool that can identify possible major depressive episodes (MDE) and generalized anxiety disorders (GAD) in long-term care residents.Methods:The psychometric properties of the BADS were investigated in a sample of 224 U.S. long-term care residents (aged 80.52 ± 9.07). Participants completed a battery of several individually administered mood and cognitive tests, including the BADS. MDE and GAD were diagnosed based on the DSM-IV-TR criteria.Results:Adequate internal consistency and construct validity were found. A principle component analysis (PCA) revealed an Anxiety Factor and a Depression Factor, which explained 50.26% of the total variance. The Anxiety Factor had a sensitivity of 0.73 and specificity of 0.81 for identifying GAD (PPV = 0.69, NPV = 0.84). The Depression Factor had a sensitivity of 0.76 and a specificity of 0.73 for identifying MDE (PPV = 0.77, NPV = 0.72).Conclusions:The BADS appears to be a reliable and valid screening instrument for MDE and GAD in long-term residents. The BADS can be rapidly administered, is sensitive to mood diagnoses in both patients without dementia and with dementia, and produces separate depression and anxiety factor scores that can be used clinically to identify probable mood diagnoses.

scholarly journals Real-Time Digital Contact Tracing: Development of a System to Control COVID-19 Outbreaks in Nursing Homes and Long-Term Care Facilities

10.2196/20828 ◽  
2020 ◽  
Vol 6 (3) ◽  
pp. e20828 ◽  
Author(s):  
Gerald Wilmink ◽  
Ilyssa Summer ◽  
David Marsyla ◽  
Subhashree Sukhu ◽  
Jeffrey Grote ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Compartmental Model ◽  
Long Term Care ◽  
Contact Tracing ◽  
Term Care ◽  
Viral Spread ◽  
Effective Manner ◽  
Conventional Methods ◽  
The Impact

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can spread rapidly in nursing homes and long-term care (LTC) facilities. Symptoms-based screening and manual contact tracing have limitations that render them ineffective for containing the viral spread in LTC facilities. Symptoms-based screening alone cannot identify asymptomatic people who are infected, and the viral spread is too fast in confined living quarters to be contained by slow manual contact tracing processes. Objective We describe the development of a digital contact tracing system that LTC facilities can use to rapidly identify and contain asymptomatic and symptomatic SARS-CoV-2 infected contacts. A compartmental model was also developed to simulate disease transmission dynamics and to assess system performance versus conventional methods. Methods We developed a compartmental model parameterized specifically to assess the coronavirus disease (COVID-19) transmission in LTC facilities. The model was used to quantify the impact of asymptomatic transmission and to assess the performance of several intervention groups to control outbreaks: no intervention, symptom mapping, polymerase chain reaction testing, and manual and digital contact tracing. Results Our digital contact tracing system allows users to rapidly identify and then isolate close contacts, store and track infection data in a respiratory line listing tool, and identify contaminated rooms. Our simulation results indicate that the speed and efficiency of digital contact tracing contributed to superior control performance, yielding up to 52% fewer cases than conventional methods. Conclusions Digital contact tracing systems show promise as an effective tool to control COVID-19 outbreaks in LTC facilities. As facilities prepare to relax restrictions and reopen to outside visitors, such tools will allow them to do so in a surgical, cost-effective manner that controls outbreaks while safely giving residents back the life they once had before this pandemic hit.

scholarly journals Evaluating the implementation of the PACE Steps to Success Programme in long-term care facilities in seven countries according to the RE-AIM framework

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Mariska Oosterveld-Vlug ◽  
◽  
Bregje Onwuteaka-Philipsen ◽  
Maud ten Koppel ◽  
Hein van Hout ◽  
...  
Keyword(s):  
Process Evaluation ◽  
Long Term Care ◽  
Controlled Trial ◽  
A Priori ◽  
Evaluation Study ◽  
Care Staff ◽  
Term Care ◽  
Factors Affecting ◽  
Care Facilities

Abstract Background The PACE ‘Steps to Success’ programme is a complex educational and development intervention for staff to improve palliative care in long-term care facilities (LTCFs). In a cluster randomized controlled trial, this programme has been implemented in 37 LTCFs in 7 European countries. Alongside an effectiveness study, a process evaluation study was conducted. This paper reports on the results of this process evaluation, of which the aim was to provide a more detailed understanding of the implementation of the PACE Programme across and within countries. Methods The process evaluation followed the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework and involved various measures and tools, including diaries for country trainers, evaluation questionnaires for care staff, attendance lists and interviews (online and face-to-face, individual and in groups) with country trainers, managers, PACE coordinators and other staff members. Based on key elements of the PACE Programme, a priori criteria for a high, medium and low level of the RE-AIM components Reach, Adoption, Implementation and intention to Maintenance were defined. Qualitative data on factors affecting each RE-AIM component gathered in the online discussion groups and interviews were analysed according to the principles of thematic analysis. Results The performance of the PACE Programme on the RE-AIM components was highly variable within and across countries, with a high or medium score for in total 28 (out of 37) LTCFs on Reach, for 26 LTCFs on Adoption, for 35 LTCFs on Implementation and for 34 LTCFs on intention to Maintenance. The factors affecting performance on the different RE-AIM components could be classified into three major categories: (1) the PACE Programme itself and its way of delivery, (2) people working with the PACE Programme and (3) contextual factors. Several country-specific challenges in implementing the PACE Programme were identified. Conclusions The implementation of the PACE Programme was feasible but leaves room for improvement. Our analysis helps to better understand the optimal levels of training and facilitation and provides recommendations to improve implementation in the LTC setting. The results of the process evaluation will be used to further adapt and improve the PACE Programme prior to its further dissemination. Trial registration The PACE study was registered at www.isrctn.com—ISRCTN14741671 (FP7-HEALTH-2013-INNOVATION-1 603111) July 30, 2015.

Implementation of Case Costing with Ontario Case Costing Initiative (OCCI)

2013 ◽  
pp. 79-88
Author(s):  
Thuy Thi Thanh Hoang
Keyword(s):  
Decision Making ◽  
Health Care Professionals ◽  
Long Term Care ◽  
Statistical Data ◽  
Evidence Based ◽  
Term Care ◽  
Patient Level ◽  
Evidence Based Decision Making ◽  
Gain Access

Over the past decade there has been a tremendous spread of computerized systems in hospitals. The advancement provided an opportunity for hospitals to gain access to computerized clinical, financial, and statistical data. Case costing information is the integration of clinical, financial, and statistical data to provide costing information at the patient level. Ontario Case Costing Initiative (OCCI) is an undertaking of the Ontario Ministry of Health and Long-Term Care (MOHLTC). This chapter focuses on the implementation of case costing using OCCI as a guideline for a hospital. It addresses the process of implementation by discussing proposals for planning, implementing, transitioning, and evaluation of case costing. The adoption of the OCCI allows health care professionals to analyze integrated health information and further enables evidence-based decision making.

Health care professionals’ perspectives of advance care planning for people with dementia living in long-term care settings: A narrative review of the literature

Dementia ◽  
2015 ◽  
Vol 16 (4) ◽  
pp. 486-512 ◽  
Author(s):  
Esther-Ruth Beck ◽  
Sonja McIlfatrick ◽  
Felicity Hasson ◽  
Gerry Leavey
Keyword(s):  
Health Care ◽  
Advance Care Planning ◽  
Health Care Professionals ◽  
Long Term Care ◽  
Care Planning ◽  
Term Care ◽  
Early Integration ◽  
People With Dementia ◽  
Advance Care

This paper provides an overview of the evidence on the perspective of health care professionals (HCPs) in relation to advance care planning (ACP) for people with dementia, residing in long-term care settings. A narrative approach was adopted to provide a comprehensive synthesis of previously published literature in the area. A systematic literature search identified 14 papers for inclusion. Following review of the studies four themes were identified for discussion; Early integration and planning for palliative care in dementia; HCPs ethical and moral concerns regarding ACP; Communication challenges when interacting with the person with dementia and their families and HCPs need for education and training. Despite evidence, that HCPs recognise the potential benefits of ACP, they struggle with its implementation in this setting. Greater understanding of dementia and the concept of ACP is required to improve consistency in practice. Synthesising the existing evidence will allow for further understanding of the key issues, potentially resulting in improved implementation in practice.

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