Methods to derive composite indicators used for quality and safety measurement and monitoring in healthcare: a scoping review protocol.

INTRODUCTION: Composite indicators of quality and safety in healthcare summarise performance across multiple indicators into a single performance measure. Composite indicators can identify domains and drivers of quality, improve the ability to detect differences, aid prioritisation for quality improvement and facilitate decision making about future healthcare needs. However, the use of composite indicators can be controversial, particularly when used to rank healthcare providers. Many of the concerns around transparency, appropriateness and uncertainty may be addressed by a robust and transparent development and review process.The aim of this scoping review is to describe methodologies used at each of the stages of development of composite indicators of quality and safety in healthcare. This review will provide those tasked with developing or reviewing composite indicators with a valuable consolidated analysis of a substantial and wide-ranging literature. METHODS AND ANALYSIS: The framework proposed by the Joanna Briggs Institute and enhancements proposed by Peters et al (2015, 2017, 2020) will be used in conducting this scoping review, and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews will guide the reporting. Grey literature and peer-reviewed documents will be in-scope. Electronic databases (PubMed, Embase, CINAHL, ABI/INFORM and SafetyLit) will be searched, and publications will be screened by two reviewers. Discussion, policy and guidance publications will be included if they discuss any aspect of the methods used in the development of a composite indicator of quality or safety in a healthcare setting. The search period ranges from 1 January 2000 to 31 December 2022. Data extraction will capture information on 11 stages of composite indicator development, augmenting a 10-stage framework developed by the European Commission Joint Research Centre. ETHICS AND DISSEMINATION: Ethical approval is not required. Review findings will be published in a peer-reviewed journal and presented at scientific conferences.

Corrigendum: A novel approach to utilizing the essential public health functions in Ireland's health system recovery and reform.

[This corrects the article DOI: 10.3389/fpubh.2023.1074356.].

A novel approach to utilizing the essential public health functions in Ireland's health system recovery and reform.

This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict.' The COVID-19 pandemic presented a challenge to health systems and exposed weaknesses in public health capacities globally. As Ireland looks to recovery, strengthening public health capacities to support health systems resilience has been identified as a priority. The Essential Public Health Functions (EPHFs) provide an integrated approach to health systems strengthening with allied sectors and their operationalization supports health systems and multi-sectoral engagement to meet population needs and anticipate evolving demands. The Health Systems Resilience team (World Health Organization, HQ) in collaboration with the Department of Health (Ireland) developed a novel approach to the assessment of the EPHFs in Ireland. The approach involved a strategic and focused review of the delivery and consideration of EPHFs in relation to policy and planning, infrastructure, service delivery, coordination and integration, monitoring and evaluation and learning. Informed by a literature review and key document search, key stakeholder mapping and key informant interviews, lessons learned from experience with COVID-19 nationally and internationally, strengths as well as potential areas of improvement to optimize delivery of EPHFs were identified. Mapping of the EPHFs in Ireland revealed that there is evidence of delivery of all 12 EPHFs to varying degrees; however a number of challenges were identified, as well as numerous strengths and opportunities. Recommendations to optimize the delivery of EPHFs in Ireland include to integrate and coordinate EPHFs, increase the visibility of the public health agenda, leverage existing mechanisms, recognize and develop the workforce, and address issues with the Health Information System. There is a public health reform process currently underway in Ireland, with some of these recommendations already being addressed. The findings of this process can help further inform and support the reform process. Given the current focus on strengthening public health capacities globally, the findings in Ireland have applicability and relevance in other WHO regions and member states for health systems recovery and building back better, fairer and more resilient health systems.

Global cognitive performance at 4-year follow-up in individuals with atrial fibrillation-findings from The Irish Longitudinal Study on Ageing.

INTRODUCTION: Atrial fibrillation (AF) has been proposed as a risk factor for cognitive impairment, even in the absence of a history of stroke. This study investigates whether AF is associated with increased risk of cognitive decline in a community-dwelling population of adults over the age of 50. METHODS: Data from the 1st and 3rd waves of The Irish Longitudinal Study on Ageing (TILDA) were used (4-year follow-up period). TILDA is a large prospective cohort study of community-dwelling adults over the age of 50 in Ireland. AF was assessed via electrocardiogram. Global cognitive function was assessed at baseline and follow-up using Montreal Cognitive Assessment (MOCA). Analysis of global cognition was repeated stratifying by age. Mixed-effects Poisson regression was used to assess for change in rate of errors on MOCA and MOCA subdomains. RESULTS: A total of 3,417 participants were included in the study. Results found that participants with AF had a greater increase in rate of errors on MOCA over 4-year follow-up (incident rate ratio (IRR) 1.18; 95% confidence interval (CI) 1.02, 1.37; P-value 0.023). However, this was no longer significant on controlling for age, sex and level of education (IRR 1.08; 95% CI 0.93, 1.25; P-value 0.332). There was no difference when stratifying by age group, or when separating MOCA into subdomains. CONCLUSION: Individuals with AF were more likely to show an increase in rate of errors between waves 1 and 3 (4-year follow-up period) in the TILDA population; however, results were not significant when controlling for age, sex and level of education.

Unreported urinary incontinence: population-based prevalence and factors associated with non-reporting of symptoms in community-dwelling people ≥ 50 years.

PURPOSE: Concerns exist around under-detection and under-treatment of urinary incontinence (UI) in specific patient groups, particularly older people. The aim of this study is to ascertain the prevalence of unreported UI in a large sample of older adults, to profile factors associated with under-reporting of UI and the association of unreported UI with quality of life (QOL). METHODS: This study was embedded within the Irish Longitudinal Study on Ageing, involving a population-representative sample of almost 7,000 older adults (55% female, mean age 65 years). UI was defined as involuntary loss of urine from the bladder occurring on average at least twice per month. Unreported UI had not yet been reported to a healthcare professional. QOL was measured using the Control, Autonomy, Self-realisation and Pleasure-19 Scale (CASP-19). RESULTS: Almost 40% (285/750) of participants with UI had not reported symptoms to a healthcare professional despite visiting their general practitioner (GP) on average over 4 times in the last year. Logistic regression modelling demonstrated that under-reporting of UI was associated with female sex, taking < 5 medications, less severe symptoms and lower number of GP visits. Linear regression models show that unreported UI was associated with significantly lower CASP-19 (ß = - 1.20 (95% CI: - 2.19 to - 0.20)). CONCLUSION: Only 40% of older people with UI report symptoms to a healthcare professional despite frequent symptoms, and a significant association with poorer QOL. This highlights the need to educate older people around seeking help for UI, as well as opportunistically addressing UI as part of comprehensive age-attuned care.

Linking death registration and survey data: Procedures and cohort profile for The Irish Longitudinal Study on Ageing (TILDA).

Background: Research on mortality at the population level has been severely restricted by an absence of linked death registration and survey data in Ireland. We describe the steps taken to link death registration information with survey data from a nationally representative prospective study of community-dwelling older adults. We also provide a profile of decedents among this cohort and compare mortality rates to population-level mortality data. Finally, we compare the utility of analysing underlying versus contributory causes of death. Methods: Death records were obtained for 779 and linked to individual level survey data from The Irish Longitudinal Study on Ageing (TILDA).   Results: Overall, 9.1% of participants died during the nine-year follow-up period and the average age at death was 75.3 years. Neoplasms were identified as the underlying cause of death for 37.0%; 32.9% of deaths were attributable to diseases of the circulatory system; 14.4% due to diseases of the respiratory system; while the remaining 15.8% of deaths occurred due to all other causes. Mortality rates among younger TILDA participants closely aligned with those observed in the population but TILDA mortality rates were slightly lower in the older age groups. Contributory cause of death provides similar estimates as underlying cause when we examined the association between smoking and all-cause and cause-specific mortality. Conclusions: This new data infrastructure provides many opportunities to contribute to our understanding of the social, behavioural, economic, and health antecedents to mortality and to inform public policies aimed at addressing inequalities in mortality and end-of-life care.

Vitamin D Status Is Not Associated With Orthostatic Hypotension in Older Adults.

There has been much interest in investigating vitamin D status with orthostatic hypotension. However, studies have been small, inconsistent, and with a lack of standardization. The aim of this study was to investigate the association with vitamin D status in a large, nationally representative older adult population using a traceable standard of measurement and an accurate assessment of beat-to-beat blood pressure (BP). This study used participants aged >50 years from The Irish Longitudinal Study on Ageing. Impaired stabilization of BP on standing was defined as a sustained drop of ≥20 mm Hg systolic BP or ≥10 mm Hg diastolic BP up to 40 seconds post stand (impaired stabilization of BP on standing). We also analyzed participants who sustained a drop of ≥20 mm Hg systolic BP or ≥10 mm Hg diastolic BP throughout the 110 seconds stand (OH110). Vitamin D was categorized into sufficient (≥50 nmol/L), insufficient (30-50 nmol/L), and deficient (<30 nmol/L) status. After exclusion criteria 4209 participants were included. Those with deficiency were more likely to be smokers, take antihypertensive medications and had higher levels of cardiovascular disorders compared with those with sufficient status. In a univariate logistic regression those with deficient (odds ratio, 1.18; 95% CI, 0.86-1.61; P=0.303) or insufficient (odds ratio, 1.13; 95% CI, 0.91; P=0.272) status were no more likely to have evidence of impaired stabilization of BP on standing on active stand compared with sufficiency. Similar findings were found for OH110: deficient (odds ratio, 0.85; 95% CI, 0.52-1.40; P=0.528) or insufficient (odds ratio, 0.86; 95% CI, 0.61-1.21; P=0.384) versus sufficiency. In conclusion, vitamin D is not significantly associated with orthostatic hypotension in older adults.

Do Differences in Spatiotemporal Gait Parameters Predict the Risk of Developing Depression in Later Life?

BACKGROUND/OBJECTIVES: There is growing interest in the association between gait disturbance and depression in later life. The aim of this study is to clarify the longitudinal relationship between specific gait parameters and incident depression within a population-representative sample of older people. DESIGN: Longitudinal analysis of spatiotemporal gait parameters at baseline (wave 1) and incident depression at 2 and 4 years (waves 2/3). Logistic regression models were used to assess the relationship between tertiles of gait parameters and incident depression. SETTING: The Irish Longitudinal Study on Aging. PARTICIPANTS: Over 3600 nondepressed community-dwelling people aged 50 years or older. MEASUREMENTS: A score of 9 or greater on the eight-item Center for Epidemiological Studies Depression Scale at wave 2 or 3 was indicative of incident depression. The GAITRite system was used to measure gait speed, step length, step width, and double support phase during usual speed walking and under dual task conditions. RESULTS: Participants with incident depression (344/3615) had slower gait speed (129.9 [95% confidence interval {CI} = 127.2-132.6] cm/s vs 134.1 [95% CI = 133.0-135.1] cm/s; F = 8.82; P = .003) and shorter step length (68.0 [95% CI = 66.9-69.2] cm vs 70.3 [95% CI = 69.9-70.7] cm; F = 13.99; P < .001) at baseline than those who did not develop depression. Logistic regression models demonstrated that those within the slowest tertile for gait speed and shortest tertile for step length had significantly increased likelihood of incident depression in fully adjusted models, with odds ratios of 1.54 (95% CI = 1.08-2.19) and 1.54 (95% CI = 1.01-2.35), respectively. Measures of step width and double support time were not associated with depression. CONCLUSIONS: This study demonstrates that older people with incident depression have significantly slower gait speed and shorter step length at initial assessment. These findings are clinically significant given the impact both conditions have on functional status in later life, as well as the possibility that gait problems may represent a potentially modifiable risk factor for depression. J Am Geriatr Soc 67:1050-1056, 2019.

The association between frontal lobe perfusion and depressive symptoms in later life.

BACKGROUND: Deficits in frontal lobe perfusion have been demonstrated in late-life depression; however, studies to date have generally involved small numbers, used neuroimaging rather than bedside testing and have not controlled for important covariates.AimsWe aimed to examine the association between depressive symptoms and frontal lobe perfusion during standing, in a large cohort of community-dwelling older people. METHOD: Participants aged ≥50 years underwent continuous measurement of orthostatic blood pressure by finometry, and frontal lobe perfusion by near-infrared spectroscopy. Depressive symptoms were assessed by the eight-item Centre for Epidemiological Studies Depression Scale. Real-time frontal lobe cerebral oxygenation was measured by the Portalite System, detecting changes in frontal lobe perfusion and reporting a tissue saturation index score. RESULTS: Almost 8% (209 out of 2616) had clinically significant depressive symptoms. Multilevel models demonstrated a significantly lower tissue saturation index in participants with depressive symptoms at both 60 and 90 s post-stand, with coefficients of -0.43 (95% CI -0.63 to -0.22) and -0.37 (95% CI -0.57 to -0.16), respectively. Controlling for relevant covariates did not significantly attenuate these associations. After addition of systolic blood pressure this association was no longer significant, suggesting lower blood pressure may modify this relationship. CONCLUSIONS: This study demonstrates that lower frontal lobe perfusion, related to lower values of baseline systolic blood pressure, is associated with clinically significant depressive symptoms in a cohort of community-dwelling older people. Given the recognised longitudinal association between lower blood pressure and depression in older people, this may represent a potential therapeutic target for prevention of incident depression.Declaration of interestNone.

Is Baseline Orthostatic Hypotension Associated With a Decline in Global Cognitive Performance at 4-Year Follow-Up? Data From TILDA (The Irish Longitudinal Study on Ageing).

Background It is postulated that orthostatic hypotension ( OH ), a reduction in blood pressure (≥20/10 mm Hg) within 3 minutes of standing, may increase cognitive decline because of cerebral hypoperfusion. This study assesses the impact of OH on global cognition at 4-year follow-up, and the impact of age and hypertension on this association. Methods and Results Data from waves 1 and 3 of TILDA (The Irish Longitudinal Study on Ageing) were used. Baseline blood pressure response to active stand was assessed using beat-to-beat blood pressure monitoring. Two measures of OH were used-at 40 seconds ( OH 40) and 110 seconds ( OH 110). Global cognition was measured using the Montreal Cognitive Assessment. Mixed-effects Poisson regression assessed whether baseline OH was associated with a decline in global cognition at 4-year follow-up. The analysis was repeated, stratifying by age (age 50-64 years and age ≥65 years), and including an interaction between OH and hypertension. Baseline OH 110 was associated with an increased error rate in Montreal Cognitive Assessment at follow-up (incident rate ratio 1.17, P=0.028). On stratification by age, the association persists in ages 50 to 64 years (incident rate ratio 1.25, P=0.048), but not ages ≥65 years. Including an interaction with hypertension found those with co-existent OH 110 and hypertension (incident rate ratio 1.27, P=0.011), or OH 40 and hypertension (incident rate ratio 1.18, P=0.017), showed an increased error rate; however, those with isolated OH 110, OH 40, or isolated hypertension did not. Conclusions OH is associated with a decline in global cognition at 4-year follow-up, and this association is dependent on age and co-existent hypertension.

Genioglossus fatigue in obstructive sleep apnea.

Obstructive sleep apnea (OSA) is a prevalent disorder that may cause cardiovascular disease and fatal traffic accidents but the pathophysiology remains incompletely understood. Increased fatigability of the genioglossus (the principal upper airway dilator muscle) might be important in OSA pathophysiology but the existing literature is uncertain. We hypothesized that the genioglossus in OSA subjects would fatigue more than in controls. In 9 OSA subjects and 9 controls during wakefulness we measured maximum voluntary tongue protrusion force (Tpmax). Using surface electromyography arrays we measured the rate of decline in muscle fiber conduction velocity (MFCV) during an isometric fatiguing contraction at 30% Tpmax. The rate of decline in MFCV provides an objective means of quantifying localized muscle fatigue. Linear regression analysis of individual subject data demonstrated a significantly greater decrease in MFCV in OSA subjects compared to control subjects (29.2 ± 20.8% [mean ± SD] versus 11.2 ± 20.8%; p=0.04). These data support increased fatigability of the genioglossus muscle in OSA subjects which may be important in the pathophysiology of OSA.