The Resident Assessment Instrument-Minimum Data Set 2.0 quality indicators: a systematic review.

BACKGROUND: The Resident Assessment Instrument-Minimum Data Set (RAI-MDS) 2.0 is designed to collect the minimum amount of data to guide care planning and monitoring for residents in long-term care settings. These data have been used to compute indicators of care quality. Use of the quality indicators to inform quality improvement initiatives is contingent upon the validity and reliability of the indicators. The purpose of this review was to systematically examine published and grey research reports in order to assess the state of the science regarding the validity and reliability of the RAI-MDS 2.0 Quality Indicators (QIs). METHODS: We systematically reviewed the evidence for the validity and reliability of the RAI-MDS 2.0 QIs. A comprehensive literature search identified relevant original research published, in English, prior to December 2008. Fourteen articles and one report examining the validity and/or reliability of the RAI-MDS 2.0 QIs were included. RESULTS: The studies fell into two broad categories, those that examined individual quality indicators and those that examined multiple indicators. All studies were conducted in the United States and included from one to a total of 209 facilities. The number of residents included in the studies ranged from 109 to 5758. One study conducted under research conditions examined 38 chronic care QIs, of which strong evidence for the validity of 12 of the QIs was found. In response to these findings, the 12 QIs were recommended for public reporting purposes. However, a number of observational studies (n = 13), conducted in "real world" conditions, have tested the validity and/or reliability of individual QIs, with mixed results. Ten QIs have been studied in this manner, including falls, depression, depression without treatment, urinary incontinence, urinary tract infections, weight loss, bedfast, restraint, pressure ulcer, and pain. These studies have revealed the potential for systematic bias in reporting, with under-reporting of some indicators and over-reporting of others. CONCLUSION: Evidence for the reliability and validity of the RAI-MDS QIs remains inconclusive. The QIs provide a useful tool for quality monitoring and to inform quality improvement programs and initiatives. However, caution should be exercised when interpreting the QI results and other sources of evidence of the quality of care processes should be considered in conjunction with QI results.

Preference of continuing care staff for electronic surveys.

Do care staff feel they participate in too much research, and are electronic surveys a convenient way of collecting data? Care staff at Canada's largest public provider of facility-based continuing care were asked these questions in a questionnaire (i.e., electronic survey or paper survey) developed for this study. A total of 25 nursing managers and 32 other professional care staff indicated that they preferred electronic surveys and were satisfied with the extent of their research participation. They also indicated that workload was the main deterrent to their research participation. Use of electronic surveys could positively affect the researcher/care staff relationship that is so important to the quality of health-care research.

Correction: Dignity and Distress towards the End of Life across Four Non-Cancer Populations.

[This corrects the article DOI: 10.1371/journal.pone.0147607.].

Dignity and Distress towards the End of Life across Four Non-Cancer Populations.

OBJECTIVE: The purpose of this study was to identify four non-cancer populations that might benefit from a palliative approach; and describe and compare the prevalence and patterns of dignity related distress across these diverse clinical populations. DESIGN: A prospective, multi-site approach was used. SETTING: Outpatient clinics, inpatient facilities or personal care homes, located in Winnipeg, Manitoba and Edmonton, Alberta, Canada. PARTICIPANTS: Patients with advanced Amyotrophic Lateral Sclerosis (ALS), Chronic Obstructive Pulmonary Disease (COPD), End Stage Renal Disease (ESRD); and the institutionalized alert frail elderly. MAIN OUTCOME MEASURE: In addition to standardized measures of physical, psychological and spiritual aspects of patient experience, the Patient Dignity Inventory (PDI). RESULTS: Between February 2009 and December 2012, 404 participants were recruited (ALS, 101; COPD, 100; ESRD, 101; and frail elderly, 102). Depending on group designation, 35% to 58% died within one year of taking part in the study. While moderate to severe loss of sense of dignity did not differ significantly across the four study populations (4-11%), the number of PDI items reported as problematic was significantly different i.e. ALS 6.2 (5.2), COPD 5.6 (5.9), frail elderly 3.0 (4.4) and ESRD 2.3 (3.9) [p < .0001]. Each of the study populations also revealed unique and distinct patterns of physical, psychological and existential distress. CONCLUSION: People with ALS, COPD, ESRD and the frail elderly face unique challenges as they move towards the end of life. Knowing the intricacies of distress and how they differ across these groups broadens our understanding of end-of-life experience within non-cancer populations and how best to meet their palliative care needs.

Mobility of Vulnerable Elders study: effect of the sit-to-stand activity on mobility, function, and quality of life.

OBJECTIVES: The aim of this study is to assess the effect of the sit-to-stand activity on the mobility, function, and health-related quality of life of nursing home residents with dementia. DESIGN: A longitudinal quasi-experimental intervention study with intervention and control groups. SETTING: The study was conducted in 7 nursing homes (4 intervention; 3 control) in Edmonton, Canada. PARTICIPANTS: Eligible residents had a diagnosis of dementia and were able to transfer independently, or with the assistance of 1 person. INTERVENTION: Health care aides prompted residents to repeat the sit-to-stand activity daily during care routines on day and evening shifts. MEASUREMENTS: Mobility was measured using the 30-second sit-to-stand test and the time to complete one sit-to-stand. Function (Functional Independence Measure), health status (Health Utilities Index Mark 2 & 3) and disease-specific quality of life (Quality of Life-Alzheimer's Disease instrument) were also measured. Outcome measures were collected at baseline, and at 3 and 6 months. The covariates cognition, depression, and medical instability were derived from the Resident Assessment Instrument Minimum Data Set (Version 2.0), and the facility context covariate was measured using the Alberta Context Tool. RESULTS: A total of 111 residents completed the 6-month trial (56 intervention; 55 control). Residents in the intervention facilities maintained mobility, as measured by the time to complete one sit-to-stand (P = .01), and experienced a slower functional decline, as measured by the Functional Independence Measure (P = .01), from baseline to 6 months compared with residents in the control facilities, after adjusting for age, sex, cognition, depression, medical instability, and context. CONCLUSIONS: Maintaining the ability to transfer using the sit-to-stand activity is a promising means of optimizing the mobility and function for residents with dementia in nursing homes.

Nutrition status among residents living in a veterans' long-term care facility in Western Canada: a pilot study.

OBJECTIVE: To examine nutrition status and to explore risk factors for malnutrition in an urban veterans' long-term care (LTC) facility in Western Canada to determine whether nutrition should be a higher priority for managers, physicians, and staff. DESIGN: A descriptive cross-sectional study design was used. SETTING: A LTC facility for Canadian veterans with a resident population of 120 adults who are 65 years or older. PARTICIPANTS: The sample consisted of 55 residents. Mean age was 86.5 years for the 50 men and 88.4 years for the 5 women. MEASUREMENTS: The Mini Nutritional Assessment (MNA) tool was used to examine the nutrition status. Selected items and scales from the Minimum Data Set-Resident Assessment Instrument (MDS-RAI 2.0) were used to substitute for 10 MNA items. RESULTS: Six (11%) residents were assessed as well nourished. Thirty-two (58%) residents were considered at risk for malnutrition and 17 (31%) were rated malnourished. A linear regression model revealed that malnutrition was associated with depression (P = .002), instability in health (P = .005), and severity of dementia (P = .011). CONCLUSION: Most residents were found to be at risk or actually malnourished. Analyses of the results indicate that managers, physicians, and staff need to focus on residents with depression and dementia, and those whose health is unstable. Ethical considerations are important in choosing appropriate interventions because many LTC residents are at an end-of-life stage. Effective nutrition interventions (eg, adding resources to support residents during meals, changing environmental factors) exist but what has not been well investigated are the methods for translating such knowledge into practice.

A longitudinal evaluation of restraint reduction within a multi-site, multi-model Canadian continuing care organization.

While American literature on sustaining restraint reduction is relatively robust, there is a lack of research published on the same issue in Canadian continuing care (CC) settings. Statistics from Canada's largest publicly funded and operated CC organization have revealed telling patterns in mechanical restraint use. Over a 4-year study period during a campaign to reduce mechanical restraint use, the organizational prevalence dropped from 24.68 per cent to 16.01 per cent. There was substantial variability in restraint prevalence among the organization's 11 centres (range: 0-39.86% of residents restrained) and all but 1 was able to achieve mechanical restraint reduction. Specific facilitators to achieving and sustaining restraint reduction are identified, including small facility size, provision of specialized care (e.g., Alzheimer's disease), and an on-site champion . Specific barriers, such as large facility size and an off-site champion are also discussed.

Comparison of U.S., Canadian, and Australian participants' performance on the Algase Wandering Scale-Version 2 (AWS-V2).

Although wandering in dementia is seen in various cultures, cross-cultural comparisons have not been reported. We examined wandering in residents of long-term care settings (LTCs) in three English-speaking countries (n = 96, America; n = 42, Canada; n = 13, Australia) using the Algase Wandering Scale-Version 2 (AWS-V2). Participants differed by country on age and medical diagnosis. The Americans were significantly older; the Canadians had a greater rate of Alzheimer's disease (AD). In one-way ANOVAs, AWS-V2 ratings from nurse aides revealed significant differences in the AWS-V2 and three subscales (spatial disorientation, attention shifting, eloping behavior), but not for two others (persistent walking, shadowing). Where significant, Canadians had consistently lower ratings than others. Post-hoc analyses by age of participants failed to reveal significant differences. However, participants with AD had significantly lower AWS-V2 scores than those with mixed-type dementia. Lower MMSE score predicted higher AWS-V2, spatial disorientation, and eloping behavior. Post-hoc analyses of respondent characteristics revealed no significant differences on AWS-V2 or subscales by frequency of attending dementia classes and level of experience with dementia. Thus the nature of wandering in these three countries is not substantially different. However, variations in care environments may contribute to differences in attention shifting. Further, limited sample size, particularly among Australians and Canadians, make findings tentative.