Development and testing of the Geriatric Care Assessment Practices (G-CAP) survey.

BACKGROUND: While the Resident Assessment Instrument-Home Care (RAI-HC) tool was designed to support comprehensive geriatric assessment in home care, it is more often used for service allocation and little is known about how point-of-care providers collect the information they need to plan and provide care. The purpose of this pilot study was to develop and test a survey to explore the geriatric care assessment practices of nurses, occupational therapists (OTs) and physiotherapists (PTs) in home care. METHODS: Literature review and expert consultation informed the development of the Geriatric Care Assessment Practices (G-CAP) survey-a 33 question, online, self-report tool exploring assessment and information-sharing methods, attitudes, knowledge, experience and demographic information. The survey was pilot tested at a single home care agency in Ontario, Canada (N = 27). Test-retest reliability (N = 20) and construct validity were explored. RESULTS: The subscales of the G-CAP survey showed fair to good test-retest reliability within a population of interdisciplinary home care providers [ICC2 (A,1) (M ICC = 0.58) for continuous items; weighted kappa (M kappa = 0.63) for categorical items]. Statistically significant differences between OT, PT and nurse responses [M t = 3.0; M p = 0.01] and moderate correlations between predicted related items [M r = |0.39|] provide preliminary support for our hypotheses around survey construct validity in this population. Pilot participants indicated that they use their clinical judgment far more often than standardized assessment tools. Client input was indicated to be the most important source of information for goal-setting. Most pilot participants had heard of the RAI-HC; however, few used it. Pilot participants agreed they could use assessment information from others but also said they must conduct their own assessments and only sometimes share and rarely receive information from other providers. CONCLUSIONS: The G-CAP survey shows promise as a measure of the geriatric care assessment practices of interdisciplinary home care providers. Findings from the survey have the potential to inform improvements to integrated care planning. Next steps include making adaptations to the G-CAP survey to further improve the reliability and validity of the tool and a broad administration of the survey in Ontario home care.

Health care transitions for persons living with dementia and their caregivers.

BACKGROUND: Persons with dementia are likely to require care from various health care providers in multiple care settings, necessitating navigation through an often-fragmented care system. This study aimed to create a better understanding of care transition experiences from the perspectives of persons living with dementia and their caregivers in Ontario, Canada, through the development of a theoretical framework. METHODS: Constructivist grounded theory guided the study. Seventeen individual caregiver interviews, and 12 dyad interviews including persons with dementia and their caregivers, were recorded and transcribed verbatim. The data were coded using NVivo 10 software; analysis occurred iteratively until saturation was reached. RESULTS: A theoretical framework outlining the context, processes, and influencing factors of care transitions was developed and refined. Gaining an in-depth understanding of the complex care transitions of individuals with dementia and their caregivers is an important step in improving the quality of care and life for this population. CONCLUSION: The framework developed in this study provides a focal point for efforts to improve the health care transitions of persons living with dementia.

A national intervention to support frail older adults in primary care: a protocol for an adapted implementation framework.

BACKGROUND: Older Canadians are high users of health care services, however the health care system is not well-designed to meet the complex needs of many older adults. Older persons often look to their primary care practitioners to assess their needs and coordinate their care. The intervention seeks to improve primary care for older persons living with frailty and will be implemented in six primary care clinics in three Canadian provinces. Presently, more than 1.6 million older Canadians are living with frailty, and this is projected to increase to 2.5 million within a decade (Canadian Frailty Network, Frailty Matters, 2020). The model will include frailty screening, an online portal to expedite referrals and improve coordination with community services, and several tools and techniques to support patient and family engagement and shared decision-making. Our project is guided by the Consolidated Framework for Implementation Research (CFIR) (Damschroder LJ, et al. Implement Scil, 4, 50, 2009). As others have done, we adapted the CFIR for our work. Our adapted framework combines elements of the socio-ecological model, key concepts from the CFIR, and elements from other implementation science frameworks. Nested within a broader mixed-method implementation study, the focus of this paper is to outline our guiding conceptual framework and qualitative methods protocol. METHODS: We will use the adapted CFIR framework to inform the data we collect and our analytic approach. Our work is divided into three phases: (1) baseline assessment of 'usual care'; (2) tailoring and implementing a new primary care model; and (3) evaluation. In each of these phases we will engage in qualitative data collection, including clinical observations, focus groups, in-depth interviews and extensive field notes. At each site we will collect data with health care providers, key informants (e.g., executive directors), and rostered patients ≥ 70 years. We will engage in team-based analysis across multiple sites, three provinces and two languages through regular telephone conferences, a comprehensive analysis codebook, leadership from our Qualitative Working Group and a collective appreciation that "science is a team sport" (Clinical Orthopaedics and Related Research 471, 701-702, 2013). DISCUSSION: Outcomes of this research may be used by other research teams who chose to adapt the CFIR framework to reflect the unique contexts of their work, and clinicians seeking to implement our model, or other models of care for frail older patients in primary care. TRIAL REGISTRATION: U.S. National Library of Medicine, NCT03442426 . Registered 22 February 2018- Retrospectively registered.

Innovation processes for ageing-related health technologies.

Innovative technologies offer potential benefits for the health and care needs of an ageing population, but the processes by which these innovations are developed and implemented are not well understood. As part of a Canadian research network focused on ageing and technology, we explored how technologies currently being developed to support older adults and their caregivers fare through the processes of innovation. We conducted a multiple case study focused on development of four technology products. Interviews were conducted with project members (n = 8) during site visits to the locations of the four cases, as well as with other key informants (n = 12). Directed coding, guided by the Accelerating Diffusion of Proven Technologies for Older Adults (ADOPT) model was used to analyse the data. Findings illustrate the complexities of innovation processes, including the challenges in developing a business case as well as benefits of a collaborative network.

Perspectives of older adults, caregivers, and healthcare providers on frailty screening: a qualitative study.

BACKGROUND: Screening is an important component of understanding and managing frailty. This study examined older adults', caregivers' and healthcare providers' perspectives on frailty and frailty screening. METHODS: Fourteen older adults and caregivers and 14 healthcare providers completed individual or focus group interviews. Interviews were audio recorded, transcribed verbatim, and analyzed using line-by-line emergent coding techniques and inductive thematic analysis. RESULTS: The interviews yielded several themes with associated subthemes: definitions and conceptualizations of frailty, perceptions of "frail", factors contributing to frailty (physical,, cognitive, social, pharmaceutical, nutritional), and frailty screening (current practices, tools in use, limitations, recommendations). CONCLUSION: Older adults, caregivers and healthcare providers have similar perspectives regarding frailty; both identified frailty as multi-dimensional and dynamic. Healthcare providers need clear "next steps" to provide meaning to frailty screening practices, which may improve use of frailty-screening tools.

"We've got the home care data, what do we do with it?": understanding data use in decision making and quality improvement.

BACKGROUND: In the past decade the provision of home care services in Canada has doubled; with this increase there has been a growing interest in improving quality and safety. National-level data are captured in the Home Care Reporting System (HCRS), using the interRAI-HC tools. Data in the HCRS provide decision-makers and administrators with actionable evidence to inform quality and safety improvement initiatives. The objective of this study was to determine how providers and administrators were using these data, and if there were any opportunities to enhance their use. METHODS: We collaborated with the Canadian Patient Safety Institute to conduct this qualitative study. To understand data use in home care, we recruited participants in management and/or data analysis roles from home care organizations across Canada. We conducted three individual interviews and three focus group interviews with a total of eleven participants from five Canadian provinces. Individual and focus group interviews were audio recorded, transcribed, and analysed using a combination of emergent coding and thematic analysis. RESULTS: Several participants provided powerful examples of how interRAI data have been used to guide patient safety and quality improvement initiatives; however, all participants recognized challenges in using these data. Leveraging interRAI data in the complex home care environment is limited by several factors: the general "newness" of these data in many jurisdictions; the sheer volume of data; limited capacity and resources to interpret and analyse the data; and connectivity issues in rural areas. Participants recognized and appreciated the training that has been provided, and made several recommendations for additional training. CONCLUSIONS: Mandated clinical datasets, such as the suite of interRAI tools, have the potential to improve quality and inform decision-making. However, in order to utilize these data, home care agencies require additional education, personnel and supports. Additional training and resources for these organizations could improve the use of available data by home care agencies, as well as outcomes for individuals receiving home care services.

User-Centered Design and Evaluation of a Web-Based Decision Aid for Older Adults Living With Mild Cognitive Impairment and Their Health Care Providers: Mixed Methods Study.

BACKGROUND: Mild cognitive impairment (MCI) is often considered a transitional state between normal and pathologic (eg, dementia) cognitive aging. Although its prognosis varies largely, the diagnosis carries the risk of causing uncertainty and overtreatment of older adults with MCI who may never progress to dementia. Decision aids help people become better informed and more involved in decision making by providing evidence-based information about options and possible outcomes and by assisting them in clarifying their personal values in relation to the decision to be made. OBJECTIVE: This study aimed to incorporate features that best support values clarification and adjust the level of detail of a web-based decision aid for individuals with MCI. METHODS: We conducted a rapid review to identify options to maintain or improve cognitive functions in individuals with MCI. The evidence was structured into a novel web-based decision aid designed in collaboration with digital specialists and graphic designers. Qualitative and user-centered evaluations were used to draw on users' knowledge, clarify values, and inform potential adoption in routine clinical practice. We invited clinicians, older adults with MCI, and their caregivers to evaluate the decision aid in 6 consecutive rounds, with new participants in each round. Quantitative data were collected using the Values Clarity and Informed subscales of the Decisional Conflict Scale, the System Usability Scale, the Ottawa Acceptability questionnaire, and a 5-point satisfaction rating scale. We verified their comprehension using a teach-back method and recorded usability issues. We recorded the audio and computer screen during the session. An inductive thematic qualitative analysis approach was used to identify and describe the issues that arose. After each round, an expert panel met to prioritize and find solutions to mitigate the issues. An integrated analysis was conducted to confirm our choices. RESULTS: A total of 7 clinicians (social workers, nurses, family physicians, psychologists) and 12 older (≥60 years) community-dwelling individuals with MCI, half of them women, with education levels going from none to university diploma, were recruited and completed testing. The thematic analysis revealed 3 major issues. First, the user should be guided through the decision-making process by tailoring the presentation of options to users' priorities using the values clarification exercise. Second, its content should be simple, but not simplistic, notably by using information layering, plain language, and pictograms. Third, the interface should be intuitive and user friendly, utilize pop-up windows and information tips, avoid drop-down menus, and limit the need to scroll down. The quantitative assessments corroborated the qualitative findings. CONCLUSIONS: This project resulted in a promising web-based decision aid that can support decision making for MCI intervention, based on the personal values and preferences of the users. Further ongoing research will allow its implementation to be tested in clinical settings.

Seven lessons from the field: Research on transformation of health systems for older adults.

Research can play a key role in efforts to transform healthcare systems. Our group's long-standing research program has been aimed at understanding how to support greater integration and coordination of healthcare services for older adults with complex conditions. Drawing on this experience, we outline seven "lessons from the field" that highlight research-related challenges that may hinder health system transformation. These challenges relate to conducting research in a complex and constantly changing system; co-design approaches that are simultaneously deemed essential yet too ambiguous to fund; patient, family caregiver, and citizen engagement; limited funding for health systems research; and lack of use of research findings. We hope that these reflections will help to inform an ongoing conversation about how these challenges might be overcome.

Building a Rehabilitative Care Measurement Instrument to Improve the Patient Experience.

OBJECTIVE: To develop and test face and content validity, and user interface design of a rehabilitative care patient experience measure. DESIGN: Mixed methods, cross-sectional validation study that included subject matter expert input. Cognitive interviewing tested user interface and design. SETTING: Outpatient rehabilitative care settings. PARTICIPANTS: Subject matter experts (n=3), health care providers (n=137), and patients and caregivers (n=5) contributed to the question development. Convenience and snowball sampling were used to recruit rehabilitative care patients postdischarge (n=9) for cognitive interviews to optimize survey design and user interface (N=154). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: This novel survey instrument measures 6 concepts previously identified as key to outpatient rehabilitative care patients' experience: ecosystem issues, client and informal caregiver engagement, patient and health care provider relations, pain and functional status, group and individual identity, and open-ended feedback. RESULTS: 502 survey questions from psychometrically tested instruments, secondary data from a related ethnographic study, and consultations with health care providers, patients, caregivers, and subject matter experts, were analyzed to create a 10-item questionnaire representing 6 key constructs that influence patient experience quality. Cognitive interviewing with 9 patients (3 rounds of 3 participants each), produced 3 progressively edited versions of the survey instrument. A final version required no further modifications. DISCUSSION: Rehabilitative care clients have characteristics that differentiate their experience from that of other sectors and patient groups, warranting a distinct experience measure. The survey instrument includes a parsimonious set of questions that address strategic issues in the ongoing improvement of care delivery and the patient experience in the rehabilitative care sector. CONCLUSION: The rehabilitative care patient experience survey instrument developed has an acceptable user interface, and content and face validity. Psychometric testing of the survey instrument is reported elsewhere.

Quality assurance as a foundational element for an integrated system of dementia care.

PURPOSE: Many countries are developing primary care collaborative memory clinics (PCCMCs) to address the rising challenge of dementia. Previous research suggests that quality assurance should be a foundational element of an integrated system of dementia care. The purpose of this paper is to understand physicians' and specialists' perspectives on such a system and identify barriers to its implementation. DESIGN/METHODOLOGY/APPROACH: The authors used interviews and a constructivist framework to understand the perspectives on a quality assurance framework for dementia care and barriers to its implementation from ten primary care and ten specialist physicians affiliated with PCCMCs. FINDINGS: Interviewees found that the framework reflects quality dementia care, though most could not relate quality assurance to clinical practice. Quality assurance was viewed as an imposition on practitioners rather than as a measure of system integration. Disparities in resources among providers were seen as barriers to quality care. Greater integration with specialists was seen as a potential quality improvement mechanism. Standardized electronic medical records were seen as important to support both quality assurance and clinical care. PRACTICAL IMPLICATIONS: This work identified several challenges to the implementation of a quality assurance framework to support an integrated system of dementia care. Clinicians require education to better understand quality assurance. Additional challenges include inadequate resources, a need for closer collaboration between specialists and PCCMCs, and a need for a standardized electronic medical record. ORIGINALITY/VALUE: Greater health system integration is necessary to provide quality dementia care, and quality assurance could be considered a foundational element driving system integration.

Psychometric Testing of a Rehabilitative Care Patient Experience Instrument.

OBJECTIVE: To evaluate the internal consistency and test-retest reliability, construct validity, and feasibility of the WatLX, a measure of the experience of patients in rehabilitative care. DESIGN: Multisite, cross-sectional, and test-retest self-report study. SETTING: Outpatient rehabilitative care settings. PARTICIPANTS: The WatLX was administered to English-speaking, cognitively intact outpatients (N=1174) over 18 years old who had completed a program of cardiac, musculoskeletal, neurologic, stroke, pulmonary, or speech language rehabilitative care, at 2 separate time points: (1) immediately following completion of their rehabilitation program, and (2) 2 weeks later (n=29). A subsequent feasibility study was conducted with 1013 patients from 19 clinics. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The WatLX measures 6 concepts, previously identified as key to outpatient rehabilitative care patients' experience: (1) ecosystem issues, (2) client and informal caregiver engagement, (3) patient and health care provider relations, (4) pain and functional status, (5) group and individual identity, and (6) open-ended feedback. RESULTS: Reliability analyses were conducted on 2 versions of the WatLX. Using a 7-point versus a 5-point Likert scale resulted in higher internal consistency and reliability scores. Cronbach's alpha coefficients were .863 and .957 for the 5- and 7-point scale, respectively, and the ICC scores were .827 and .880, respectively. The proof of concept study recruited 1013 patients with little interruption of workflow; results displayed strong internal consistency (Cronbach's alpha coefficient =.906). There is evidence of ceiling effects. CONCLUSIONS: The WatLX is a parsimonious question set that is feasible for administration in ambulatory rehabilitative care settings, and which shows promising psychometric properties.

Geographic Clustering of Admissions to Inpatient Psychiatry among Adults with Cognitive Disorders in Ontario, Canada: Does Distance to Hospital Matter?

OBJECTIVE: This study examined relationships among hospital accessibility, socio-economic context, and geographic clustering of inpatient psychiatry admissions for adults with cognitive disorders in Ontario, Canada. METHOD: A retrospective cross-sectional analysis was conducted using admissions data from 71 hospitals with inpatient psychiatry beds in Ontario, Canada between 2011 and 2014. Data included 7,637 unique admissions for 4,550 adults with a DSM-IV diagnosis of Delirium, Dementia, Amnestic and other Cognitive Disorders. Bayesian spatial Poisson regression was employed to examine the relationship between accessibility of general hospitals with psychiatric beds and psychiatric hospitals, area-level marginalization, and hospitalization rate with the risk of admission to inpatient psychiatry among adults with cognitive disorders across 516 Forward Sortation Areas (FSA) in Ontario. RESULTS: Residential instability and the overall hospitalization rate were significantly associated with an increase in the relative risk of admissions to inpatient psychiatry. Accessibility to general hospitals and psychiatric hospitals were marginally insignificant at the 95% credible interval in the final model. Significant geographic clustering of admissions was identified where individuals residing in FSA's with the highest relative risk were 2.0 to 7.1 times more likely to be admitted to inpatient psychiatry compared to the average. CONCLUSIONS: Geographic clustering of inpatient psychiatry admissions for adults with cognitive disorders exists across the Province of Ontario, Canada. At the geographic level, the risk of admission was positively associated with residential instability and the overall hospitalization rate, but not distance to the closest general or psychiatric hospital.

A qualitative study of healthcare provider perspectives on measuring functional outcomes in geriatric rehabilitation.

OBJECTIVES: To explore, from the perspective of healthcare providers, the barriers to and facilitators of using standardized outcome measures of physical function in geriatric rehabilitation settings. METHODS: In-depth semi-structured interviews with medical doctors, nurses, physiotherapists and occupational therapists were conducted from three geriatric rehabilitation hospitals in Ontario. Qualitative content analysis through an inductive approach was used to identify barriers to and facilitators of outcome measurement in geriatric rehabilitation settings. RESULTS: A total of 20 healthcare providers from different disciplines were interviewed. Barriers are standardized outcome measures that (1) cannot be used in isolation to inform clinical decision-making for older patients, (2) are difficult to complete and interpret in older complex patients, (3) may not be useful for all members of the clinical team and (4) are used for reasons unrelated to patient care. Facilitators are to (1) divide the standardized outcome measure into components that are useful for each team member's practice, (2) encourage standardized outcome measures as tools for improving daily communication and (3) provide adequate education and support for their daily use. CONCLUSION: This study revealed important barriers to using standardized outcome measures in geriatric rehabilitation from the perspective of healthcare providers. However, it also identified multiple factors that may help facilitate their use.

AGING AND HEALTH TECHNOLOGY ASSESSMENT: AN IDEA WHOSE TIME HAS COME.

OBJECTIVES: With the increase in technologies to support an aging population, health technology assessment (HTA) of aging-related technologies warrants special consideration. At Health Technology Assessment international (HTAi) 2016 and HTAi 2017, an international panel explored interests in HTA focused on aging. METHODS: Panelists from five countries shared the state of aging and HTA in their countries. Opportunities were provided for participants to discuss and rate the themes identified by the panelists. RESULTS: In 2016, the highest ranked themes were: (i) identifying unmet needs of older adults that could be met by technology-how can HTA help?; (ii) differences in assessment of aging-related technologies-what is the scope?; and (iii) involvement of older adults and caregivers. These themes became the starting point for discussion in 2017, for which the highest ranked themes were: (i) identification of challenges in HTA and aging; and (ii) approaches to advancing effectiveness of HTA for aging. CONCLUSION: These discussions allowed for examination of future directions for HTA and aging: engagement of older adults to inform the agenda of HTA and the broader public policy enterprise; a systems approach to thinking about needs of older persons should support the type and level of care desired by the individual rather than the health institutions, and HTA should reflect these desires when evaluating technological aides; and there is potential for health information systems and "big data" to support HTA activities that assess usability of technologies for older adults. We hope to build on the momentum of this community to continue exploring opportunities for aging and HTA.

Coordinating care for older adults in primary care settings: understanding the current context.

BACKGROUND: It is well known that older adults are high users of the health care system. Older adults with chronic conditions receive care from multiple providers, across multiple settings, and this care is often unorganized and confusing. In 2005, Ontario established a model of inter-professional primary care (family health teams) with the aim of providing enhanced interdisciplinary primary care to patients. Primary care requires an in-depth understanding of the operations of primary care teams and their relationships with other community services. The aim of this study was to develop a deeper understanding of the current operations of two family health teams in Ontario, including their current processes for referrals, information sharing, and engagement of patients in decision-making. METHODS: Focus group and individual semi-structured interviews with health care providers were conducted. Purposeful sampling was used to ensure information was obtained from different professional perspectives. Interviews were audio-recorded and transcribed verbatim. Using NVivo 10, data were analyzed using line by line thematic analysis techniques. A cluster technique was then applied to group similar codes into themes. RESULTS: Three focus group interviews (involving 4-6 health care providers/focus group) and six individual interviews were conducted with health care providers from two primary care teams and surrounding community care organizations. Six key themes were identified: 1) challenges engaging older adults in decisions about their care; 2) who is responsible for coordinating the care? 3) fragmented information sharing between health care providers; 4) lack of standardized referral processes and follow-up; 5) identifying services in the community for older adults; and 6) caring for older adults in rural communities. CONCLUSIONS: The results of this study provide an in-depth understanding of the current context in which the primary care teams are currently operating. Improved primary care will require stronger processes of coordination, greater knowledge of and connections with other community services, and enhanced patient engagement processes. This information provides a helpful basis for implementing interventions in primary care.

Health care provider experiences in primary care memory clinics: a phenomenological study.

BACKGROUND: There is a growing need for community-based services for persons with Alzheimer's disease and related dementias (ADRD). Memory clinic (MC) teams in primary care settings have been established to provide care to people with ADRD. To consider wider adoption of these MC teams, insight is needed into the experiences of practitioners working in these models. The purpose of the current study is to explore the experiences of health care providers (HCPs) who work in primary care Memory Clinic (MC) teams to provide care to persons with Alzheimer's disease and related dementias (ADRD). METHODS: This study utilized a phenomenological methodology to explore experiences of 12 HCPs in two primary care MCs. Semi-structured interviews were completed with each HCP. Interviews were recorded and transcribed verbatim. Colaizzi's steps for analyzing phenomenological data was utilized by the authors. RESULTS: Three themes emerged from the analysis to describe HCP experiences: supporting patients and family members during ADRD diagnosis and treatment, working in a team setting, and personal and professional rewards of caring for people with ADRD and their family members. CONCLUSIONS: Findings provide insight into current practices in primary care MCs and on the motivation of HCPs working with persons with ADRD.

The role of unregulated care providers in managing heart failure patients in long-term care facilities.

AIMS AND OBJECTIVES: Heart failure is a complex syndrome in which abnormal heart function results in clinical symptoms and signs of low cardiac output and/or pulmonary or systemic congestion. Heart failure is common among long-term care residents, and is associated with significant morbidity and acute care utilisation. Heart failure guidelines endorse standard therapies, yet long-term care residents are less likely to receive recommended treatments. The objective of this study is to understand the perceptions and potential role of unregulated care providers in contributing to better heart failure management among long-term care residents. DESIGN: Focus group interviews. METHODS: This qualitative study employed focus groups to explore perceptions from 24 unregulated care providers in three Ontario, Canada long-term care homes, about barriers to the optimal management of heart failure. RESULTS: Three overarching concepts emerged characterising unregulated care providers' experiences in caring for residents with heart failure in long-term care: (1) the complexity of providing heart failure care in a long-term care setting, (2) striving for resident-centred decision making and (3) unregulated care providers role enactment nested within an interprofessional team in long-term care. These concepts reflect the complex interplay between individual unregulated care providers and residents, and heart failure-related, socio-cultural and organisational factors that influence heart failure care processes in the long-term care system. CONCLUSIONS: Optimising the management of heart failure in long-term care is contingent on greater engagement of unregulated care providers as active partners in the interprofessional care team. Interventions to improve heart failure management in long-term care must ensure that appropriate education is provided to all long-term care staff, including unregulated care providers, and in a manner that fosters greater and more effective interprofessional collaboration. RELEVANCE TO CLINICAL PRACTICE: Active and collaborative engagement unregulated care providers has the potential to improve the management of heart failure in long-term care residents.

Implementation of an interprofessional communication and collaboration intervention to improve care capacity for heart failure management in long-term care.

Heart failure affects up to 20% of nursing home residents and is associated with high morbidity, mortality, and transfers to acute care. A major barrier to heart failure management in nursing home settings is limited interprofessional communication. Guideline-based heart failure management programs in nursing homes can reduce hospitalisation rates, though sustainability is limited when interprofessional communication is not addressed. A pilot intervention, 'Enhancing Knowledge and Interprofessional Care for Heart Failure', was implemented on two units in two conveniently selected nursing homes to optimise interprofessional care processes amongst the care team. A core heart team was established, and participants received tailored education focused on heart failure management principles and communication processes, as well as weekly mentoring. Our previous work provided evidence for this intervention's acceptability and implementation fidelity. This paper focuses on the preliminary impact of the intervention on staff heart failure knowledge, communication, and interprofessional collaboration. To determine the initial impact of the intervention on selected staff outcomes, we employed a qualitative design, using a social constructivist interpretive framework. Findings indicated a perceived increase in team engagement, interprofessional collaboration, communication, knowledge about heart failure, and improved clinical outcomes. Individual interviews with staff revealed innovative ways to enhance communication, supporting one another with knowledge and engagement in collaborative practices with residents and families. Engaging teams, through the establishment of core heart teams, was successful to develop interprofessional communication processes for heart failure management. Further steps to be undertaken include assessing the sustainability and effectiveness of this approach with a larger sample.

A review of Canadian and international dementia strategies.

To inform future strategy development in Canada and other jurisdictions, we undertook an Internet search to identify existing national and Canadian provincial dementia strategies and their major themes. Twenty-two dementia strategies were identified through an Internet search, supplemented by hand searches of reference lists of retrieved documents. Thematic analysis identified 17 strategic themes; common themes included improved diagnoses and assessments, increased access to care, and improved education of the healthcare workforce. This review reinforces the importance of a multi-faceted response to dementia and illustrates that, despite variation in needs across populations and geographies, there are many common priorities. The strategic themes identified in this review may provide a useful starting point for the development of new national strategies or, alternatively, as a check to determine if important priority areas have been missed in strategy development.

Measuring Patients' Experience of Rehabilitation Services Across the Care Continuum. Part I: A Systematic Review of the Literature.

OBJECTIVE: To identify empirically tested survey instruments designed to measure patient experience across a rehabilitative care system. DATA SOURCES: A comprehensive search was conducted of the MEDLINE (PubMed), CINAHL (EBSCO), and PsycINFO (APA PsycNET) databases from 2004 to 2014. Further searches were conducted in relevant journals and the reference lists of the final accepted articles. STUDY SELECTION: Of 2472 articles identified, 33 were selected for inclusion and analysis. Articles were excluded if they were unrelated to rehabilitative care, were anecdotal or descriptive reports, or had a veterinary, mental health, palliative care, dental, or pediatric focus. Four reviewers performed the screening process. Interrater reliability was confirmed through 2 rounds of title review (30 articles each) and 1 round of abstract review (10 articles), with an average κ score of .69. DATA EXTRACTION: Data were extracted related to the instrument, study setting, and patient characteristics, including treated disease, type of rehabilitation (eg, occupational or physical therapy), methodology, sample size, and level of evidence. DATA SYNTHESIS: There were 25 discrete measurement instruments identified in the 33 articles evaluated. Seven of the instruments originated outside of the rehabilitative care sector, and only 1 measured service experience across the care continuum. CONCLUSIONS: As providers move to integrate rehabilitative care across the continuum from hospital to home, patients experience a system of care. Research is required to develop psychometrically tested instruments that measure patients' experience across a rehabilitative system.