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1.
BMJ Open ; 9(8): e030104, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31399462

RESUMO

OBJECTIVE: A rapid molecular diagnostic test (RMDT) offers a fast and accurate detection of respiratory viruses, but its impact on the timeliness of care in the emergency department (ED) may depend on the timing of the test. The aim of the study was to determine if the timing of respiratory virus testing using a RMDT in the ED had an association with patient care outcomes. DESIGN: Retrospective observational study. SETTING: Linked ED and laboratory data from six EDs in New South Wales, Australia. PARTICIPANTS: Adult patients presenting to EDs during the 2017 influenza season and tested for respiratory viruses using a RMDT. The timing of respiratory virus testing was defined as the time from a patient's ED arrival to time of sample receipt at the hospital laboratory. OUTCOME MEASURES: ED length of stay (LOS), >4 hour ED LOS and having a pending RMDT result at ED disposition. RESULTS: A total of 2168 patients were included. The median timing of respiratory virus testing was 224 min (IQR, 133-349). Every 30 min increase in the timing of respiratory virus testing was associated with a 24.0 min increase in the median ED LOS (95% CI, 21.8-26.1; p<0.001), a 51% increase in the likelihood of staying >4 hours in ED (OR, 1.51; 95% CI, 1.41 to 1.63; p<0.001) and a 4% increase in the likelihood of having a pending RMDT result at ED disposition (OR, 1.04; 95% CI, 1.02 to 1.05; p<0.001) after adjustment for confounders. CONCLUSION: The timing of respiratory virus molecular testing in EDs was significantly associated with a range of outcome indicators. Results suggest the potential to maximise the benefits of RMDT by introducing an early diagnostic protocol such as triage-initiated testing.

2.
Stud Health Technol Inform ; 263: 205-218, 2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31411164

RESUMO

In this chapter, we reflect on the aim and objectives of the textbook and address known gaps in our theory coverage. We reinforce the importance of theory in health informatics and review the varying disciplinary origins of the theories considered in the book. We discuss the question of what makes a good theory and how to know which one is relevant for a given study. We recognize the limitations of the body of theory that we have presented and suggest what might be regarded as "native" theory that is original to health informatics. Finally, we propose topics to form a research agenda for theory in health informatics.


Assuntos
Informática Médica , Modelos Teóricos , Pesquisa/tendências
3.
Stud Health Technol Inform ; 264: 744-748, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438023

RESUMO

Evaluating and optimising 'fit' between technology and clinical work is critical to ensure the intended benefits of technology implementations are achieved. Using a mixed method approach (structured observation, interviews, field notes) we collected data regarding users, tasks, technology, and factors impeding technology use from a sample of 38 clinicians on two wards at an Australian hospital. We used the FITT framework to assess the relationships between users, tasks, and technology. Our findings showed that even when adequate fit between users, tasks, and technology was attained additional factors related to the environment (including the temporal rhythms of a ward, infection control rooms, or space limitations) ultimately affected technology use. Thus, we propose the fit between individuals, task, technology and environment (FITTE) framework as a means to evaluate and optimise technology use by explicating the relationships between users, tasks, technology, and the environment in which they operate.


Assuntos
Informática Médica , Resinas Acrílicas , Austrália , Assistência à Saúde , Humanos , Ácidos Ftálicos
4.
Stud Health Technol Inform ; 264: 591-595, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31437992

RESUMO

Diagnostic informatics encompasses the role of information technology in key areas of the diagnostic testing (pathology and medical imaging) process, including the selection of appropriate tests and interpretation and follow-up of test results. We present three case studies employing diagnostic informatics methodologies to demonstrate their potential use and value in health services research: (1) Data analytics applied to diagnostic data linked with patient outcome data as a means of enhanancing the monitoring of the quality and appropriateness of diagnostic test choices; (2) Business process modelling which can help to highlight healthcare processes in the diagnostic pathway as a means of improving safety and performance, and (3) Consumer involvement in the diagnostic research process to assist in the establishment of person-centred test result management systems. The case studies provide evidence of the role that diagnostic informatics can have in improving the quality and safety of patient care.


Assuntos
Informática Médica , Segurança do Paciente , Participação da Comunidade , Humanos
5.
Stud Health Technol Inform ; 265: 128-133, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31431588

RESUMO

Patient-centred care and the empowerment of patients through shared clinical decision-making is a key goal of healthcare systems internationally. The Emergency Department is one of the first opportunities for shared decision-making to occur, with information exchanged between patient and clinician, between clinical disciplines, across the continuum of care, and between clinicians and ancillary departments including radiology and pathology laboratories. The successful development and implementation of sustainable health information technology (HIT) to support shared decision-making in Emergency care requires an understanding of the factors affecting this context. From a purposive, maximum variation sample of clinicians and a convenience sample of patients across three metropolitan and regional Emergency Departments in Australia, we identified three divergent discourses from an in-depth qualitative exploration of issues around shared decision-making. This allowed us to identify unanticipated factors affecting patient-centred care to inform context-sensitive implementation of HIT in the Emergency Department.


Assuntos
Tomada de Decisões , Serviços Médicos de Emergência , Austrália , Serviço Hospitalar de Emergência , Humanos , Assistência Centrada no Paciente
6.
Artigo em Inglês | MEDLINE | ID: mdl-31389118

RESUMO

PURPOSE: People in residential aged care are at increased risk of adverse events from nonsteroidal anti-inflammatory drugs (NSAIDs) due to their age and health status, but little is known about use of NSAIDs in this setting. We aimed to estimate the prevalence of NSAID use by route, differences by high-risk conditions, prevalence of concurrent proton pump inhibitor (PPI) use, and prevalence of the "triple whammy" combination (oral NSAID, diuretic, and angiotensin-converting-enzyme inhibitor or angiotensin receptor antagonist). METHODS: We conducted a dynamic cohort study using medication administration data from 68 residential aged care facilities (RACFs) during 2014 to 2017. Descriptive statistics and regression were used to estimate the proportion of residents who used NSAIDs, NSAIDs long term, NSAIDs with PPIs, and the triple whammy combination. RESULTS: Ten thousand three hundred sixty-seven residents were included. Two thousand four hundred fourteen (23.3%) used at least one NSAID: 756 (7.3%) used only oral, 1326 (12.8%) used only topical, and 332 (3.2%) used both topical and oral NSAIDs. One thousand five hundred forty two (14.8%) used an NSAID long term, a majority of which only used topical NSAIDs 933/1542 (60.5%). Age, sex, and health status were associated with greater variation in long-term topical use relative to oral NSAID use. A majority of oral NSAID users concomitantly used a PPI, which varied according to age, sex, and health status. Among residents with any oral NSAID use, 182/1088 (16.7%) had triple whammy medication use. CONCLUSIONS: Targeted interventions to reduce NSAID use among RACF residents, to reduce triple whammy medication use, and increase PPI use for long-term oral NSAID users are warranted.

7.
Health Inf Manag ; : 1833358319864734, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31370712

RESUMO

BACKGROUND: This study examined the health literacy demands of My Health Record (MyHR) in the context of preparing for a government-announced opt-out system by repeating two studies of health information and usability conducted in 2016. OBJECTIVE: To examine whether Australia's MyHR meets the information and usability needs of people at risk of low health literacy and changes since 2016. METHOD: Content analysis: Informed by the 2016 methods and findings, measures of information quality, themes and target audiences were recorded and reported for each online consumer-facing health information resource. Heuristic evaluation: An evaluation of the MyHR and supporting information website was conducted using a predetermined checklist of usability criteria. A list of usability violations for both websites was identified. RESULTS: Total number of resources grew from 80 in 2016 to 233 in 2018. There was little change since 2016 to average readability levels, target audiences, presentation style, links between resources and usability of MyHR. Compared to 2016, this study demonstrated increases in resources from non-government organisations; video resources; translated resources; and resources with themes of privacy, security and post-registration use. CONCLUSION: This study identified some improvements in information quality since 2016, but gaps remain in information quality and usability which may negatively impact the ability for people with low health literacy to access and use MyHR. IMPLICATIONS: This study provides a framework for ongoing monitoring and evaluation of the suitability of MyHR for people at risk of low health literacy.

8.
Australas J Ageing ; 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31433129

RESUMO

OBJECTIVE: To estimate gout prevalence and examine associated factors in residential aged care facilities. METHODS: Electronic data from 11 548 residents aged 65+ during 2014-2017 from 68 residential aged care facilities in Australia were analysed. Gout prevalence was estimated, and regression was used to assess differences in comorbidities, sociodemographic factors and health status between residents with and without gout. RESULTS: Over 10% of residents had gout. Most common comorbidities in these residents were hypertension (71.3%), heart disease (37.9%) and diabetes (33.0%) and they were more likely to have renal disease and historical myocardial infarction. The interaction between comorbid gout had complex interactions between age, sex and comorbidities for diabetes and depression was complex. CONCLUSIONS: Gout is common among older people in residential care but may be under-recognised. Holistic management of gout is needed in this population, with careful consideration of chronic comorbidities and treatments.

9.
Australas J Ageing ; 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31411384

RESUMO

OBJECTIVE: To determine what information from community aged care social participation and quality of life assessments needs to be captured, and meaningfully utilised as part of an integrated information and communication technology system. METHODS: Two think tank sessions comprised of community aged care staff and researchers (n = 9) were conducted over 5 weeks. The sessions were guided by the Continuous Quality Improvement framework. Thematic analysis was used to categorise the think tank data. RESULTS: To monitor progress over time, participants needed more contextual information captured in the assessment forms, such as client goals and outcomes of assessments. The aged care provider agreed to embed outcome measure score and action following assessment into its information and communication technology system. CONCLUSION: Collaboration between aged care staff and researchers resulted in adjustments to the aged care provider's information and communication technology system to better target the monitoring and planning of its clients' psychosocial needs.

10.
Int J Med Inform ; 129: 275-284, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31445267

RESUMO

BACKGROUND: Malnutrition is a serious clinical issue associated with adverse patient and hospital outcomes. Hospitals need to consider interventions that support the provision of optimal nutritional management and care for patients. Electronic meal ordering (EMO) systems provide an alternative to traditional paper-based meal ordering with the capacity to support appropriate orders, monitor nutritional status, and potentially improve clinical outcomes. METHODS: This review aimed to identify the impact of EMO systems on hospital and patient outcomes. We sought quantitative evidence (peer-reviewed and grey literature) from studies evaluating EMO systems in healthcare facilities, published after 1999 and available in the English language. RESULTS: We identified 23 studies evaluating one of three distinct EMO system-supported models: spoken menu, room service, and self-service. While limited, the evidence indicated that EMO systems were associated with: improved patient satisfaction; decreased food waste; increased consumption; and, for spoken menus, more time with patients. There was no substantive evidence of impact on clinical outcomes. CONCLUSIONS: Whether EMO systems meet their potential to support nutritional monitoring and positively impact clinical outcomes remains unanswered within the evidence. Thus, policy makers and hospital management currently have a poor evidence base upon which to make decisions about the value of implementing EMO. Whether these systems can provide support and guidance to patients during meal ordering, improve order appropriateness and accuracy through compliance checking, identify patients in need of dietary education or those at risk of malnutrition are critical areas of focus for future research.

11.
PLoS One ; 14(7): e0219488, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31295297

RESUMO

BACKGROUND: Physiotherapy can improve functional ability, prevent falls and reduce pain for older adults in nursing homes. However, there are no legislations or guidelines that specify the parameters of physiotherapy required in nursing homes. With the increasing healthcare demands of ageing populations worldwide, it is important to understand the current use of physiotherapy services to ensure they are both evidence-based and promote equity. OBJECTIVES: (1) When and how are physiotherapy services used by older adults living in nursing homes? (2) What are the factors associated with use of physiotherapy services in nursing homes? (3) How are physiotherapy services in nursing homes documented and monitored? METHODS: Several databases and grey literature (including MEDLINE, PubMed, Pedro and EMBASE) were searched following PRISMA guidelines in March 2018. Searches were limited to English language publications from 1997. Assessment for inclusion, data extraction and quality assessment were completed by two investigators independently using standardised forms. Studies were included if they considered any type of physiotherapy service that involved a qualified physiotherapist (such as exercise, massage and staff education) with older adults (aged 60 years and older) that were primarily permanent residents of a nursing home. Data extracted included proportion of clients that used physiotherapy services, type, frequency and duration of physiotherapy services, and factors associated with physiotherapy service use. RESULTS: Eleven studies were included. Between 10% and 67% of nursing home clients used physiotherapy services. Factors associated with greater use of physiotherapy services included larger size facilities, and if clients had a physical impairment and mild or no cognitive impairment. Types of physiotherapy services reported were pain management and pressure ulcer management. CONCLUSIONS: Physiotherapy service use in nursing homes varied widely. The development of physiotherapy benchmarks and quality standards are needed to support older adults in nursing homes. PROSPERO registration number: CRD42018082460.

12.
Artigo em Inglês | MEDLINE | ID: mdl-31343414

RESUMO

INTRODUCTION: Guidelines recommend short-term targeted use of antipsychotic medications for behavioral and psychological symptoms of dementia only when other strategies have failed. Antipsychotic prescribing in dementia is common internationally, but data on duration of use are limited. Our objectives were to determine duration, time to initiation, and prevalence of antipsychotic use among people with dementia. METHODS: This work was a retrospective dynamic cohort study of people aged 65 years or above with dementia in 68 residential aged facilities during the period spanning from 2014 to 2017. Medication administration records were used to identify antipsychotic medication use. Medication outcomes (prevalence, duration, and time to initiation) were estimated using regression. Covariates included comorbidities and sociodemographic and facility characteristics. RESULTS: A total of 5825 residents with dementia were identified. The annual prevalence of antipsychotic use ranged from 27.6% to 32.6%. Mean time to initiation after admission was 308.4 days (for female individuals) and 173.2 days (for male individuals). An overall 65% of people who used antipsychotics did so for >3 months even without psychiatric comorbidities; mean durations were 212.74 (95% confidence interval: 170.24, 255.25) days (for female individuals) and 216.10 (95% confidence interval: 165.31, 266.89) days (for male individuals) at median ages. DISCUSSION: Antipsychotics are often used longer than recommended. Current guidelines and restrictions may be insufficient to limit antipsychotic medication use. Further efforts are needed to ensure that antipsychotic medications are used as recommended in dementia.

13.
BMJ Open ; 9(6): e030988, 2019 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-31243038

RESUMO

INTRODUCTION: The aged population is increasing rapidly across the world and this is expected to continue. People living in residential aged care facilities (RACFs) represent amongst the sickest and frailest cohort of the aged population, with a high prevalence of chronic conditions and complex comorbidities. Given the vulnerability of RACF residents and the demands on the system, there is a need to determine the extent that care is delivered in line with best practice ('appropriate care') in RACFs. There is also a recognition that systems should provide care that optimises quality of life (QoL), which includes support for physical and psychological well-being, independence, social relationships, personal beliefs and a caring external environment. The aims of CareTrack Aged are to develop sets of indicators for appropriate care and processes of care for commonly managed conditions, and then assess the appropriateness of care delivered and QoL of residents in RACFs in Australia. METHODS AND ANALYSIS: We will extract recommendations from clinical practice guidelines and, using expert review, convert these into sets of indicators for 15 common conditions and processes of care for people living in RACFs. We will recruit RACFs in three Australian states, and residents within these RACFs, using a stratified multistage sampling method. Experienced nurses, trained in the CareTrack Aged methods ('surveyors'), will review care records of recruited residents within a 1-month period in 2019 and 2020, and assess the care documented against the indicators of appropriate care. Surveyors will concurrently assess residents' QoL using validated questionnaires. ETHICS AND DISSEMINATION: The study has been reviewed and approved by the Human Research Ethics Committee of Macquarie University (5201800386). The research findings will be published in international and national journals and disseminated through conferences and presentations to interested stakeholder groups, including consumers, national agencies, healthcare professionals, policymakers and researchers.

14.
BMJ Open ; 9(6): e029495, 2019 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-31209095

RESUMO

INTRODUCTION: Social networks play a role in slowing the development of dementia. However, there is a need for further investigation of the effects of improving social networks on health-related quality of life and cognitive performance. Targeted community aged care services are a central strategy for supporting older adults to initiate and maintain their social engagement with other individuals at all stages of later life. This protocol describes a prospective observational cohort study aimed at (1) characterising interpersonal relationships in older adults receiving community care services, (2) assessing the relationship social networks and health-related quality of life and cognition and (3) identifying the association between community care use, social networks and cognition. The findings will contribute to our understanding of how specific social network structures and social support services can maintain cognitive function in community-dwelling older adults. METHODS AND ANALYSIS: This is a prospective, observational cohort study of 201 older Australians residing in the community and receiving care services from one of three aged care organisations. Clients with a history of neurological injury will be excluded. Participants will undergo baseline measures of social networks, health-related quality of life and cognitive function, and a follow-up at 6 months. Service use and sociodemographic variables will also be collected. The primary outcome is cognitive function, and secondary outcomes include social networks and health-related quality of life. Multivariable linear regression will test the hypothesis that increased social networks are associated with an increase in cognitive function. ETHICS AND DISSEMINATION: Approval of the study by Macquarie University Research Ethics Committee (reference number 5201831394062) has been obtained. This work will be disseminated by publication of peer-reviewed manuscripts, presentations in abstract form at scientific meetings and results will be made available to home and community-based care older adults and care staff of the involved organisations. TRIAL REGISTRATION NUMBER: ACTRN12618001723279; Pre-results.

15.
J Am Med Inform Assoc ; 26(7): 678-688, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31192362

RESUMO

OBJECTIVE: To investigate the impact of health information technology (IT) systems on clinicians' work practices and patient engagement in the management and follow-up of test results. MATERIALS AND METHODS: A search for studies reporting health IT systems and clinician test results management was conducted in the following databases: MEDLINE, EMBASE, CINAHL, Web of Science, ScienceDirect, ProQuest, and Scopus from January 1999 to June 2018. Test results follow-up was defined as provider follow-up of results for tests that were sent to the laboratory and radiology services for processing or analysis. RESULTS: There are some findings from controlled studies showing that health IT can improve the proportion of tests followed-up (15 percentage point change) and increase physician awareness of test results that require action (24-28 percentage point change). Taken as whole, however, the evidence of the impact of health IT on test result management and follow-up is not strong. DISCUSSION: The development of safe and effective test results management IT systems should pivot on several axes. These axes include 1) patient-centerd engagement (involving shared, timely, and meaningful information); 2) diagnostic processes (that involve the integration of multiple people and different clinical settings across the health care spectrum); and 3) organizational communications (the myriad of multi- transactional processes requiring feedback, iteration, and confirmation) that contribute to the patient care process. CONCLUSION: Existing evidence indicates that health IT in and of itself does not (and most likely cannot) provide a complete solution to issues related to test results management and follow-up.

16.
Aust Health Rev ; 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31248474

RESUMO

ObjectiveThe aim of this study was to determine baseline information technology (IT) sophistication in New South Wales (NSW), Australia, residential aged care facilities.MethodIT sophistication measures IT capabilities, extent of IT use and IT integration in two domains, resident care and clinical support. A survey was administered to all NSW residential aged care facilities (n = 876) between February and May 2017. A 15% response rate was achieved (130/876). Facilities were organised by organisational type, total residential places and remoteness. Using post-stratification weights, estimates of IT sophistication scores for NSW were determined. Regression was used to examine whether there was a linear relationship between IT sophistication and the ratio of residents receiving high care.ResultsParticipating facilities were similar to other NSW facilities in residential places and remoteness, but different in organisational type. IT sophistication was highest in IT capabilities and integration in resident care. IT sophistication was lowest in clinical support. Respondents had a mean of 1.2 years of IT experience. IT sophistication varied among aged care facilities. There was a linear relationship (P < 0.05) with the proportion of high-care residents and total IT sophisticationConclusionRoutine reports of IT sophistication in aged care are not available. If data were available, determining the influence of IT sophistication on the quality care for residential aged care would be possible.What is known about the topic?Aged care settings that deliver care to the older population need to be contemporary in their approach to delivering high-quality and safe care. Health IT holds great potential for improving the quality and safety of care of older residents in aged care facilities.What does this paper add?This report provides a baseline assessment of IT capabilities, extent of IT use and IT integration, called IT sophistication, among aged care facilities with variable characteristics.What are implications for practitioners?Increasing IT sophistication has the potential to improve the quality of care delivered by aged care staff.

17.
Yearb Med Inform ; 28(1): 128-134, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31022752

RESUMO

OBJECTIVES: This paper draws attention to: i) key considerations for evaluating artificial intelligence (AI) enabled clinical decision support; and ii) challenges and practical implications of AI design, development, selection, use, and ongoing surveillance. METHOD: A narrative review of existing research and evaluation approaches along with expert perspectives drawn from the International Medical Informatics Association (IMIA) Working Group on Technology Assessment and Quality Development in Health Informatics and the European Federation for Medical Informatics (EFMI) Working Group for Assessment of Health Information Systems. RESULTS: There is a rich history and tradition of evaluating AI in healthcare. While evaluators can learn from past efforts, and build on best practice evaluation frameworks and methodologies, questions remain about how to evaluate the safety and effectiveness of AI that dynamically harness vast amounts of genomic, biomarker, phenotype, electronic record, and care delivery data from across health systems. This paper first provides a historical perspective about the evaluation of AI in healthcare. It then examines key challenges of evaluating AI-enabled clinical decision support during design, development, selection, use, and ongoing surveillance. Practical aspects of evaluating AI in healthcare, including approaches to evaluation and indicators to monitor AI are also discussed. CONCLUSION: Commitment to rigorous initial and ongoing evaluation will be critical to ensuring the safe and effective integration of AI in complex sociotechnical settings. Specific enhancements that are required for the new generation of AI-enabled clinical decision support will emerge through practical application.

18.
J Am Med Inform Assoc ; 26(10): 1120-1128, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-30990522

RESUMO

OBJECTIVE: To assess measurement practice in clinical decision support evaluation studies. MATERIALS AND METHODS: We identified empirical studies evaluating clinical decision support systems published from 1998 to 2017. We reviewed titles, abstracts, and full paper contents for evidence of attention to measurement validity, reliability, or reuse. We used Friedman and Wyatt's typology to categorize the studies. RESULTS: There were 391 studies that met the inclusion criteria. Study types in this cohort were primarily field user effect studies (n = 210) or problem impact studies (n = 150). Of those, 280 studies (72%) had no evidence of attention to measurement methodology, and 111 (28%) had some evidence with 33 (8%) offering validity evidence; 45 (12%) offering reliability evidence; and 61 (16%) reporting measurement artefact reuse. DISCUSSION: Only 5 studies offered validity assessment within the study. Valid measures were predominantly observed in problem impact studies with the majority of measures being clinical or patient reported outcomes with validity measured elsewhere. CONCLUSION: Measurement methodology is frequently ignored in empirical studies of clinical decision support systems and particularly so in field user effect studies. Authors may in fact be attending to measurement considerations and not reporting this or employing methods of unknown validity and reliability in their studies. In the latter case, reported study results may be biased and effect sizes misleading. We argue that replication studies to strengthen the evidence base require greater attention to measurement practice in health informatics research.

19.
Patient Educ Couns ; 102(8): 1413-1426, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31010602

RESUMO

OBJECTIVES: To integrate findings on the information infrastructure for people with intellectual or developmental disability (I/DD) living in supported accommodation, to understand how documentation use impacts person-centred support. METHODS: We conducted an integrative literature review. Following screening by two independent reviewers, we included English language peer-reviewed empirical studies (n = 34) on documentation use for people with I/DD in domestic-scale supported accommodation. We appraised quality and extracted information for iterative comparative thematic and content analysis. RESULT: All studies reported written documentation regarding either the person with disability or the residence. Eighteen studies focused on health-specific information. We identified three key themes impacting on the person-centred support; 1) level of inclusion and independence of people with I/DD, 2) the culture of support within group homes, and 3) the quality use of information. CONCLUSIONS: Information infrastructure is closely aligned with the support culture in residences and can affect whether and to what extent key stakeholders (i.e., people with I/DD, family members) are involved in making decisions about healthcare and support needs. PRACTICE IMPLICATIONS: Surveying local service health information infrastructure can provide crucial insights which can be leveraged to improve the safety and quality of supports provided for people living in supported accommodation.

20.
BMC Geriatr ; 19(1): 78, 2019 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-30871472

RESUMO

BACKGROUND: Several outcome measures can be utilised to measure social participation and Quality of Life (QoL) in research and clinical practice. However there have been few large-scale trials of these tools in community care to identify their value to clients and providers. This study aims to evaluate the implementation of the Australian Community Participation Questionnaire (ACPQ) and the ICEpop CAPability measure for Older people (ICECAP-O) as tools to measure social participation and QoL for clients receiving community aged care services. The specific research questions focus on determining: (1) the levels and predictors of social participation and QoL among older adults using community aged care services; (2) the acceptability and feasibility of implementation of ACPQ and ICECAP-O tools into routine community aged care assessments; (3) if implementation of the tools change service provision and outcomes for older adults receiving community aged care services. METHODS: A mixed method design will be used to collect data from a large Australian aged care provider. Community aged care clients' ACPQ and ICECAP-O scores, as well as other key outcomes (e.g. services used, hospitalisation and admission to permanent residential care), will be examined at baseline and 12-monthly follow-up assessments. Interviews and focus groups with community aged care clients and staff who administer the tools will also be completed. Descriptive statistics and multiple linear regression will be used to examine the levels and predictors of social participation and QoL. Thematic analysis of interviews and focus groups will be used to determine the acceptability and feasibility of implementing the ACPQ and ICECAP-O into routine needs assessments in community aged care. Case-controlled analyses will be used to determine whether the implementation of the ACPQ and ICECAP-O changes service use and outcomes. DISCUSSION: The novel use of the ACPQ and the ICECAP-O tools as part of routine needs assessments for community aged care clients has the potential to improve the quality and effectiveness of community aged care services and outcomes. TRIAL REGISTRATION: Australian and New Zealand clinical trial registry number: ACTRN12617001212347 . Registered 18/08/2017.

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