Factors influencing interprofessional collaboration in general and during multidisciplinary team meetings in long-term care and geriatric rehabilitation: a qualitative study.

BACKGROUND: Interprofessional collaboration is essential to maintain high-quality care in long-term care and geriatric rehabilitation. However, little is known regarding perceived factors influencing interprofessional collaboration by people involved in care. This concerns both long-term care and geriatric rehabilitation. Moreover, knowledge of using patient outcome measures to enhance interprofessional collaboration during multidisciplinary team meetings is insufficient. This study examined the perceived facilitators of and barriers to interprofessional collaboration in general and during multidisciplinary team meetings, specifically according to healthcare professionals, patients, and informal caregivers. Differences between long-term care and geriatric rehabilitation were also investigated. Finally, it was examined which patient outcome measures were used in multidisciplinary team meetings. METHODS: A constructivist qualitative study using 10 focus groups and 18 semi-structured interviews with 14 patients, 13 informal caregivers,10 managers, and 22 healthcare professionals from eight Dutch long-term care and geriatric rehabilitation facilities. A combined inductive and deductive approach to a thematic analysis was performed. RESULTS: The perceived influencing factors of interprofessional collaboration were classified into two general themes: (1) 'Involvement of patient, informal caregiver, and healthcare professional', categorised into: 'participation of patients and informal caregivers', 'behaviour and attitude of team members', 'expectations of team members towards each other', and 'exchange of information, knowledge, and reciprocity in communication'; and (2) 'A systematic approach to providing care for older people', consisting of: 'coordination of team procedures', and 'coordination of organisational procedures'. Also, one theme for multidisciplinary team meetings was identified: 'Organised participation of patient, informal caregiver, and healthcare professional in multidisciplinary team meeting, categorised into: 'team procedures', 'working systematically', and 'participation in multidisciplinary team meetings. Standardised patient outcome measures were scarcely used in multidisciplinary team meetings. CONCLUSION: People involved in long-term care and geriatric rehabilitation indicated that, apart from working systematically, being involved in care and multidisciplinary team meetings are essential factors for interprofessional collaboration. These factors must be taken into consideration to provide valuable, high-quality care to older people residing in long-term care and geriatric. TRIAL REGISTRATION: Not applicable.

Systematic review of measurement properties of the Canadian Occupational Performance Measure in geriatric rehabilitation.

PURPOSE: The Canadian Occupational Performance Measure (COPM) is used to inventory problems experienced by the patient to set goals and evaluate treatment. We aimed to make a systematic overview of measurement properties for people in geriatric rehabilitation. METHODS: Seven electronic databases were searched for psychometric studies investigating content validity, construct validity, responsiveness, or reliability of the COPM in geriatric rehabilitation populations aged ≥ 60 years. Two reviewers independently abstracted data and assessed methodological quality from included studies. RESULTS: Of 292 identified articles, 13 studies were included. The COPM showed good test-retest reliability (two studies), moderate inter-rater reliability (one study), and good content validity (one study with some risk of bias). Four studies with minimal risk of bias showed good construct validity as their hypotheses were confirmed. Responsiveness was moderate in three studies with adequate methodological quality. CONCLUSION: All measurement properties have been studied in geriatric rehabilitation populations, and indicate that the COPM gives relevant information for geriatric rehabilitation, and scores can be assessed reliably and are responsive to change. Although there were many studies on construct validity, authors had different opinions on what exactly COPM-scores tell us, as they used a variety of comparator instruments and different hypotheses. Consensus on exact interpretation of the scores is needed.

Interprofessional Collaboration in Long-Term Care and Rehabilitation: A Systematic Review.

OBJECTIVES: To examine facilitators of and barriers to interprofessional collaboration (IPC) in institutional long-term care (LTC) and geriatric rehabilitation (GR), and to provide an overview of instruments used to assess IPC in LTC and GR. DESIGN: Systematic integrative review. SETTING AND PARTICIPANTS: Institutional long-term care and geriatric rehabilitation. METHODS: We systematically searched relevant databases for articles using the terms interprofessional collaboration, interdisciplinary, long-term care, geriatric rehabilitation, elderly, facilitators, and barriers. We conducted a systematic integrative review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis method. Papers containing empirical data about barriers to and facilitators of IPC in LTC and GR were included. The Mixed Method Appraisal Tool was used for quality assessment. Data were analyzed using qualitative thematical analysis. RESULTS: Three interdependent themes regarding facilitators of and barriers to IPC emerged: Team performance, Organizational conditions, and Sharing information. Eight instruments were used to assess IPC in LTC and none for GR. Limited descriptions and insufficient psychometric qualities of the instruments were reported. CONCLUSIONS AND IMPLICATIONS: To enhance IPC, it is necessary to stimulate facilitators and limit barriers on all 3 themes. Furthermore, a reliable, validated instrument to assess IPC in LTC and GR, based on a clear definition of IPC is needed. Successful IPC when caring for patients with multimorbidity in LTC and GR requires integration, understanding, and recognition of the interdependency from all persons involved, including patients and family caregivers.

COVID-19 management in nursing homes by outbreak teams (MINUTES) - study description and data characteristics: a qualitative study.

OBJECTIVES: Nursing homes are hit relatively hard by the COVID-19 pandemic. Dutch long-term care (LTC) organisations installed outbreak teams (OTs) to coordinate COVID-19 infection prevention and control. LTC organisations and relevant national policy organisations expressed the need to share experiences from these OTs that can be applied directly in COVID-19 policy. The aim of the 'COVID-19 management in nursing homes by outbreak teams' (MINUTES) study is to describe the challenges, responses and the impact of the COVID-19 pandemic in Dutch nursing homes. In this first article, we describe the MINUTES Study and present data characteristics. DESIGN: This large-scale multicentre study has a qualitative design using manifest content analysis. The participating organisations shared their OT minutes and other meeting documents on a weekly basis. Data from week 16 (April) to week 53 (December) 2020 included the first two waves of COVID-19. SETTING: National study with 41 large Dutch LTC organisations. PARTICIPANTS: The LTC organisations represented 563 nursing home locations and almost 43 000 residents. RESULTS: At least 36 of the 41 organisations had one or more SARS-CoV-2 infections among their residents. Most OTs were composed of management, medical staff, support services staff, policy advisors and communication specialists. Topics that emerged from the documents were: crisis management, isolation of residents, personal protective equipment and hygiene, staff, residents' well-being, visitor policies, testing and vaccination. CONCLUSIONS: OT meeting minutes are a valuable data source to monitor the impact of and responses to COVID-19 in nursing homes. Depending on the course of the COVID-19 pandemic, data collection and analysis will continue until November 2021. The results are used directly in national and organisational COVID-19 policy.

Psychometrics of the observational scales of the Utrecht Scale for Evaluation of Rehabilitation (USER): Content and structural validity, internal consistency and reliability.

INTRODUCTION: Establish content and structural validity, internal consistency, inter-rater reliability, and measurement error of the physical and cognitive scales of the Utrecht Scale for Evaluation clinical Rehabilitation (USER) in geriatric rehabilitation. MATERIAL AND METHODS: First, an expert consensus-meeting (N=7) was organised for content validity wherein scale content validity index (CVI) was measured. Second, in a sample of geriatric rehabilitation patient structural validity (N=616) was assessed by confirmatory factor analyses for exploring unidimensionality. Cut-off criteria were: Root Mean Square Error of Approximation (RMSEA) ≤0.08; Comparative Fit Index (CFI) and Tucker Lewis Index (TLI) ≥0.95. Local independence (residual correlation<0.20) and monotonicity (Hi-coefficient ≥0.30 and Hs-coefficient ≥0.50) were also calculated. Cronbach alphas were calculated for internal consistency. Alpha's > 0.7 was considered adequate. Third, two nurses independently administered the USER to 37 patients. Intraclass-correlation coefficients (ICC) were calculated for inter-rater reliability (IRR), standard error of measurement (SEM) and Smallest Detectable Change (SDC). RESULTS: The CVI for physical functioning was moderate (0.73) and excellent for cognitive functioning (0.97). Structural validity physical scale was acceptable (CFI;0.95, TLI;0.93, RMSEA;0.07, ECV;0.78, OmegaH;0.87; Monotonicity;(Hi;0.52-0.75 and Hs;0.63)). Cognitive scale was good (CFI;0.98, TLI;0.96, RMSEA;0.05, ECV;0.66 and OmegaH;0.90. Monotonicity;(Hi;0.30 -0.70 and Hs;0.61)). Cronbach's alpha were high: physical scale;0.92 and cognitive scale;0.94. Reliability physical scale ICC;0.94, SEM;5 and SDC;14 and cognitive scale ICC;0.88, SEM;5 and SDC;13. CONCLUSION: The observational scales of the USER have shown sufficient content and structural validity, internal consistency, and interrater reliability for measuring physical and cognitive function in geriatric rehabilitation. TRIAL REGISTRATION: N/A.