Care Centers and Professional Caregivers: from the Project to a Sustainable Social Child Care Policy

In Lithuania the deinstitutionalisation of children left without parental care is being implemented since 2014. The term of transformation is more recognizable in the political context of the country. Various alternative services to institutional care are being developed during the transformation process, but some have become massive and overly institutional in nature (e.g., community children living homes), while the institute of professional caregivers has not gained popular attention when comparing child care rates across different alternatives. This article presents and discusses the activities of care centers that train permanent guardians (caregivers) and professional guardians. The article presents a research during which the staff of the care center evaluated the effectiveness of the activities of the care center and the guardians on duty. The results of the study revealed that care centers face the risk of projectivity at both micro and macro levels. Cooperation and support between the Ministry of Social security and labout and municipalities and other institutions is also very important for the effectiveness of care centers.

The impact of frailty Screening of Older adults with muLtidisciplinary assessment of those At Risk during emergency hospital attendance on the quality, safety and cost-effectiveness of care (SOLAR): a randomised controlled trial.

Background Older people account for 25% of all Emergency Department (ED) admissions. This is expected to rise with an ageing demographic. Older people often present to the ED with complex medical needs in the setting of multiple comorbidities. Comprehensive Geriatric Assessment (CGA) has been shown to improve outcomes in an inpatient setting but clear evidence of benefit in the ED setting has not been established. It is not feasible to offer this resource-intensive assessment to all older adults in a timely fashion. Screening tools for frailty have been used to identify those at most risk for adverse outcomes following ED visit. The overall aim of this study is to examine the impact of CGA on the quality, safety and cost-effectiveness of care in an undifferentiated population of frail older people with medical complaints who present to the ED and Acute Medical Assessment Unit. Methods This will be a parallel 1:1 allocation randomised control trial. All patients who are ≥ 75 years will be screened for frailty using the Identification of Seniors At Risk (ISAR) tool. Those with a score of ≥ 2 on the ISAR will be randomised. The treatment arm will undergo geriatric medicine team-led CGA in the ED or Acute Medical Assessment Unit whereas the non-treatment arm will undergo usual patient care. A dedicated multidisciplinary team of a specialist geriatric medicine doctor, senior physiotherapist, specialist nurse, pharmacist, senior occupational therapist and senior medical social worker will carry out the assessment, as well as interventions that arise from that assessment. Primary outcomes will be the length of stay in the ED or Acute Medical Assessment Unit. Secondary outcomes will include ED re-attendance, re-hospitalisation, functional decline, quality of life and mortality at 30 days and 180 days. These will be determined by telephone consultation and electronic records by a research nurse blinded to group allocation. Ethics and dissemination Ethical approval was obtained from the Health Service Executive (HSE) Mid-Western Regional Hospital Research Ethics Committee (088/2020). Our lay dissemination strategy will be developed in collaboration with our Patient and Public Involvement stakeholder panel of older people at the Ageing Research Centre and we will present our findings in peer-reviewed journals and national and international conferences. Trial registration ClinicalTrials.gov NCT04629690. Registered on November 16, 2020

The Impact of Frailty Screening of Older Adults With Multidisciplinary Assessment of Those at Risk During Emergency Hospital Attendance on the Quality, Safety and Cost-Effectiveness of Care (SOLAR): A Randomised Controlled Trial.

BackgroundOlder people account for 25% of all Emergency Department (ED) admissions. This is expected to rise with an ageing demographic. Older people often present to the ED with complex medical needs in the setting of multiple comorbidities. Comprehensive Geriatric Assessment (CGA) has been shown to improve outcomes in an inpatient setting but clear evidence of benefit in the ED setting has not been established. It is not feasible to offer this resource intensive assessment to all older adults in a timely fashion. Screening tools for frailty have been used to identify those at most risk for adverse outcomes following ED visit. The overall aim of this study is to examine the impact of CGA on the quality, safety and cost-effectiveness of care in an undifferentiated population of frail older people with medical complaints who present to the ED and Acute Medical Assessment Unit. MethodsThis will be a parallel 1:1 allocation randomised control trial. All patients who are ≥75 years will be screened for frailty using the Identification of Seniors At Risk (ISAR) tool. Those with a score of ≥2 on the ISAR will be randomised. The treatment arm will undergo geriatric medicine team-led CGA in the ED or Acute Medical Assessment Unit whereas the non-treatment arm will undergo usual patient care. A dedicated multidisciplinary team of a specialist geriatric medicine doctor, senior physiotherapist, specialist nurse, pharmacist, senior occupational therapist and senior medical social worker will carry out the assessment, as well as interventions that arise from that assessment. Primary outcomes will be length of stay in the ED or Acute Medical Assessment Unit. Secondary outcomes will include ED re-attendance, re-hospitalisation, functional decline, quality of life and mortality at 30 days and 180 days. These will be determined by telephone consultation and electronic records by a research nurse blinded to group allocation.Ethics and DisseminationEthical approval was obtained from the Health Service Executive (HSE) Mid-Western Regional Hospital Research Ethics Committee (088/2020). Our lay dissemination strategy will be developed in collaboration with our Patient and Public Involvement stakeholder panel of older people at the Ageing Research Centre and we will present our findings in peer reviewed journals and national and international conferences. Trial Registration: Clinical Trials.gov NCT04629690

A multidimensional quality model: an opportunity for patients, their kin, healthcare providers and professionals to coproduce health

Background: It is twenty years since the US Institute of Medicine (IOM) defined quality in healthcare, as comprising six domains: person-centredness, timeliness, efficiency, effectiveness, safety and equity. Since then, a new quality movement has emerged, with the development of numerous interventions aimed at improving quality, with a focus on accessibility, safety and effectiveness of care. Further gains in equity and timeliness have proven even more challenging. The challenge: With the emergence of “service-oriented” systems, complexity science, the challenges of climate change, the growth of social media and the internet and the new reality of COVID-19, the original domains proposed by the IOM invite reflection on their relevance and possibility for improvement. The possible solution: In this paper we propose a revised model of quality that is built on never-ending learning and includes new domains, such as Ecology and Transparency, which reflect the changing worldview of healthcare. We also introduce the concept of person- or “kin-centred care” to emphasise the shared humanity of people involved in the interdependent work. This is a more expansive view of what “person-centredness” began. The delivery of health and healthcare requires people working in differing roles, with explicit attention to the lived realities of the people in the roles of professional and patient. The new model will provide a construct that may make the attainment of equity in healthcare more possible with a focus on kindness for all.

A Simulation Decision Support System for the Healthcare Emergency Department Optimization

Agent-based modeling and simulation methods have demonstrated efficiency in modeling and analyzing the dynamics of the healthcare systems. Simulation has become a crucial tool that facilitates understanding these systems that involve different and heterogeneous components interacting in diverse and complex ways. However, during the dynamic evolutions of these societies, the agents involve a massive amount of data that contain non-explicit and unknown information. The analysis of these data to study and discover the hidden relationships and the emerging phenomena is a well-known difficulty in the simulation systems. The call for powerful tools such as the data mining techniques to support the simulations analysis is the best solution that can be used to tackle this issue. The aim of this chapter is to develop a decision support system based on the integration of simulation systems and knowledge extraction techniques, to design a decisive tool to help healthcare managers to improve the quality and the effectiveness of care provided to the emergency departments.

A multidimensional quality model: an opportunity for patients, their kin, healthcare providers and professionals in the new COVID-19 period

Background: It is twenty years since the Institute of Medicine (IOM) defined quality in healthcare, as comprising six domains: person-centredness, timeliness, efficiency, effectiveness, safety and equity. Since then, a new quality movement has emerged, with the development of numerous interventions aimed at improving quality, with a focus on accessibility, safety and effectiveness of care. Further gains in equity and timeliness have proven even more challenging. The challenge: With the emergence of “service-oriented” systems, complexity science, the challenges of climate change, the growth of social media and the internet and the new reality of COVID-19, the original domains proposed by the IOM invite reflection on their relevance and possibility for improvement. The possible solution: In this paper we propose a revised model of quality that is built on never-ending learning and includes new domains, such as Ecology and Transparency, which reflect the changing worldview of healthcare. We also introduce the concept of person- or “kin-centred care” to emphasise the shared humanity of people involved in the interdependent work. This is a more expansive view of what “person-centredness” began. The delivery of health and healthcare requires people working in differing roles, with explicit attention to the lived realities of the people in the roles of professional and patient. The new model will provide a construct that may make the attainment of equity in healthcare more possible with a focus on kindness for all.