The Effect of Race and Dementia Prevalence on a COVID-19 Infection Control Intervention in Massachusetts Nursing Homes

Background Nursing home (NH) residents, especially those who were Black or with dementia, had the highest infection rates during the COVID-19 pandemic. A 9-week COVID-19 infection control intervention in 360 Massachusetts NHs showed adherence to an infection control checklist with proper personal protective equipment (PPE) use and cohorting was associated with declines in weekly infection rates. NHs were offered weekly webinars, answers to infection control questions, resources to acquire PPE, backup staff, and SARS-CoV-2 testing. We asked whether the effect of this intervention differed by racial and dementia composition of the NHs. Methods Data were obtained from 4 state audits using infection control checklists, weekly infection rates, and Minimum Data Set variables on race and dementia to determine whether adherence to checklist competencies was associated with decline in average weekly rates of new COVID-19 infections. Results Using a mixed-effects hurdle model, adjusted for county COVID-19 prevalence, we found the overall effect of the intervention did not differ by racial composition, but proper cohorting of residents was associated with a greater reduction in infection rates among facilities with ≥20% non-Whites (n = 83). Facilities in the middle (>50%–62%; n = 121) and upper (>62%; n = 115) tertiles of dementia prevalence had the largest reduction in infection rates as checklist scores improved. Cohorting was associated with greater reductions in infection rates among facilities in the middle and upper tertiles of dementia prevalence. Conclusions Adherence to proper infection control procedures, particularly cohorting of residents, can reduce COVID-19 infections, even in facilities with high percentages of high-risk residents (non-White and dementia).

The uptake and use of a minimum data set (MDS) for older people living and dying in care homes: a realist review

Background Care homes provide long term care for older people. Countries with standardised approaches to residents’ assessment, care planning and review (known as minimum data sets (MDS)) use the aggregate data to guide resource allocation, monitor quality, and for research. Less is known about how an MDS affects how staff assess, provide and review residents’ everyday care. The review aimed to develop a theory-driven understanding of how care home staff can effectively implement and use MDS to plan and deliver care for residents. Methods The realist review was organised according to RAMESES (Realist And Meta-narrative Evidence Synthesis: and Evolving Standards) guidelines. There were three overlapping stages: 1) defining the scope of the review and theory development on the use of minimum data set 2) testing and refining candidate programme theories through iterative literature searches and stakeholders’ consultations as well as discussion among the research team; and 3) data synthesis from stages 1 and 2. The following databases were used MEDLINE via OVID, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ASSIA [Applied Social Sciences Citation Index and Abstracts]) and sources of grey literature. Results Fifty-one papers informed the development of three key interlinked theoretical propositions: motivation (mandates and incentives for Minimum Data Set completion); frontline staff monitoring (when Minimum Data Set completion is built into the working practices of the care home); and embedded recording systems (Minimum Data Set recording system is integral to collecting residents’ data). By valuing the contributions of staff and building on existing ways of working, the uptake and use of an MDS could enable all staff to learn with and from each other about what is important for residents’ care Conclusions Minimum Data Sets provides commissioners service providers and researchers with standardised information useful for commissioning planning and analysis. For it to be equally useful for care home staff it requires key activities that address the staff experiences of care, their work with others and the use of digital technology. Registration PROSPERO registration number CRD42020171323.

DUS(Soil)—A Framework for Developing a Minimum Data Set of Soil Health Indicators and Management Guidelines for Farmers

Soil health information is still not widely used in decision making in agriculture. One of the reasons is the lack of a simple and effective method for selection of soil health indicators that have direct relevance to management decisions. A framework for soil health indicators selection and developing location-specific management practices that improve soil health are presented. The framework involves selection of a minimum data set of soil health indicators based on ‘DUS(Soil)’ criteria. In this framework ‘D’ represents Distinctness (indicators representing distinct functional soil processes), ‘U’ represents Utility (amenability for amelioration of the status of the indicator or altering its impact through management practices) and ‘S’ represents Simplicity (amenability for measurement in the field/small laboratories using simple protocols). This study also outlines a method for developing management guidelines for farmers based on the status of the selected soil health indicators. This involved classifying the status of each of the indicators into three classes. Thereafter, taking cognizance of the agroecological context, suitable field management schedules were developed for each class of the indicators, based on literature and local expert knowledge. The use of this framework was demonstrated by developing management guidelines for a coarse textured soil with optimum pH, low soil carbon, poor in water stable aggregates (highly slaking), optimum porosity and poor in soil macro fauna in Mandla district, Madhya Pradesh, India. The study showed that the framework is flexible, generic as well as simple and is useful to develop site-specific management guidelines logically, to overcome the soil quality constraints.

Minimum data and core outcomes for subacute rehabilitation: A scoping review

Objective In clinical practice and research, standardised sets of data and outcomes are routinely collected to facilitate data comparison, benchmarking and quality improvement. Most existing data sets are condition-specific and cannot be applied to all patients in a given clinical setting. This review aimed to determine whether the development of a minimum data set for subacute rehabilitation is feasible by collating and comparing existing rehabilitation minimum data sets and core outcome sets. Data sources Published literature was identified through database searches (Scopus, PubMed, EMBASE, CINAHL and the COMET Initiative) in September 2021. Additional data sets were identified through a grey literature search. Review methods This review was conducted in alignment with the PRISMA-ScR recommendations. Datasets were included if they were published in English, designed for adults, and intended for use in subacute rehabilitation. Data were extracted and taxonomically organised to identify commonalities. Items present in ≥50% of data sets were considered common. Results Twenty minimum data sets and seven core outcome sets were included. There were 29 common minimum data set domains, with 19 relating to Patient Information, seven relating to Outcomes, two relating to Service Delivery and one relating to Provider Demographics. Four common domains were identified within the Core Outcome Set analysis, which all related to Life Impact, specifically Physical Functioning (86%) , Emotional Functioning/Wellbeing (57%) , Social Functioning (86%) and Global Quality of Life (100%). Conclusion Common item domains in conditions requiring subacute rehabilitation have been identified, suggesting that development of a dataset for subacute rehabilitation may be feasible.

Effect of Race and Dementia Prevalence on a COVID-19 Infection Control Intervention in Massachusetts Nursing Homes

Nursing home (NH) residents, especially those who were Black or had dementia, had the highest infection rates during the COVID-19 pandemic. A 9-week COVID-19 infection control intervention in 360 Massachusetts NHs showed that adherence to an infection control checklist with proper PPE use and cohorting, was associated with declines in weekly infection rates. NHs were offered weekly webinars, answers to infection control questions, resources to acquire personal protective equipment, backup staff, and SARS-CoV-2 testing. We asked whether the effect of this intervention differed by racial and dementia composition of the NHs. Data were obtained from 4 state audits using infection control checklists, weekly infection rates, and Minimum Data Set variables on race and dementia to determine whether adherence to the checklist competencies was associated with decline in average weekly rates of new COVID-19 infections. Using a mixed effects hurdle model, adjusted for county COVID-19 prevalence, we found that the overall effect of the intervention did not differ by race, but proper cohorting of residents was associated with a greater reduction in infection rates among facilities with ≥20% non-whites (n=83). Facilities in the middle (50-61%; n=116) and upper (>61%; n=118) tertiles of dementia prevalence had the largest reduction in infection rates as checklist scores improved. Cohorting was associated with greater reductions in infection rates among facilities in the middle and upper tertiles of dementia prevalence. Thus, adherence to proper infection control procedures, particularly cohorting, can reduce COVID-19 infections, even in facilities with high percentages of high-risk residents (non-white and dementia).

Development of a Minimum Data Set for Drug Module of Computerized Physician Order Entry System

Introduction: One way to reduce medication errors in the cardiovascular settings is to electronically prescribe medication through the computerized physician order entry system (CPOE). Improper design and non-compliance with users' needs are obstacles to implementing this system. Therefore, it is necessary to consider the standard minimum data set (MDS) of this system in order to meet the basic needs of its users. The aim of this study was to introduce MDS in the cardiovascular CPOE drug system to standardize data items as well as to facilitate data sharing and integration with other systems.Material and Methods: This study was a survey study conducted in 1399 in Iran. The study population was all cardiologists in Iran. The data collection tool was a researcher-made questionnaire consisting of 33 questions. Data were analyzed in SPSS-24 using descriptive statistics.Results: A total of 31 cardiologists participated in this study. The participants identified 19 of the 25 drug data items as essential for drug MDS. Five data items (Medication name, Medication dosage, Medication frequency, Medication start date and Patient medication history) were considered essential by more than 90% of the participants.Conclusion: The results of this study identified drug MDS for the cardiovascular CPOE system. The results of this study can be a model for CPOE system designers to develop new systems or upgrade existing systems.