Quality Of Long-term Care Research Articles

Measuring client experiences in long-term care in the Netherlands: a pilot study with the Consumer Quality Index Long-term Care.

BackgroundThis study aims to describe the development, testing and optimization of a new standard instrument, the Consumer Quality Index (CQ-index®) Long-term Care, for measuring client experiences with long-term care in the Netherlands.MethodsThree versions of the CQ-index questionnaires and protocols for study sampling and data collection were developed, designed for interviews with residents of nursing or residential care homes and postal surveys among representatives of psychogeriatric residents and homecare clients. From July to November 2006 a pilot study was conducted among 2,697 clients of 68 nursing or residential care homes, 2,164 representatives of clients in 57 psychogeriatric care institutions, and 1,462 clients of 19 homecare organizations. We performed psychometric analyses and descriptive analyses, and evaluated the pilot study.ResultsThe pilot study showed the feasibility and usability of the instruments, supported the multidimensionality of the questionnaires and showed first findings on client experiences and possibilities for quality improvement. Nine scales applied to all care settings: shared decision making, attitude and courtesy, information, body care, competence and safety of care, activities, autonomy, mental well-being, and availability of personnel. The pilot resulted in three optimized questionnaires and recommendations for nationwide implementation.ConclusionsThe CQ-index® Long-term Care provides a good basis to investigate the quality of nursing homes, residential care homes and homecare from the clients' perspective. This standardized instrument enables a nationwide comparison of the quality of long-term care for the purpose of transparency and quality assurance.

Preventing Avoidable Hospitalizations of Nursing Home Residents: A Multipronged Approach to a Perennial Problem

Preventing Avoidable Hospitalizations of Nursing Home Residents: A Multipronged Approach to a Perennial Problem

Improving Quality of Long-Term Care: It is Time for Collaboration

NC Med J March/April 2010, Volume 71, Number 2 Long-term care is a critical and necessary part of the health care continuum. Whether in a facility, in the community, or at home, how our society designs and delivers quality, accessible, and affordable long-term care for our oldest and sickest citizens is a huge challenge for families and policymakers. Many of us have experienced the task of determining the right level of care for our loved ones and then searching for high quality, affordable options to meet those needs. Historically, there has been conflict over what quality means and how to achieve it. And let’s face it, many of us have heard about or experienced a quality issue in residential and home care situations. In some cases the complaints are overblown or not factual. But clearly, in other cases, the abuse or negligence is proven, and the public confidence in our long-term care system is shaken. Over the years, a strong influential corps of state agency and non-governmental advocates has developed in North Carolina and they are working on behalf of family members and the general public to improve the quality of care in our communities. At the same time, the facilities and community care industries have strengthened their own cadre of advocates to address quality issues. Both sides have worked hard to impact policies, legislation, and public perception by encouraging legislation; providing input in the rule-making process; serving on task forces, commissions, and work groups; and mounting public awareness campaigns. Advocacy manifests itself differently across a variety of groups. Organizations like AARP, the Senior Tarheel Legislature, the Governor’s Advisory on Aging, the North Carolina Coalition on Aging, and Friends of Residents in LongTerm Care represent individuals, families, and the broad community by pushing for stronger consumer protections, more transparency, safer living and care environments, standards and requirements for training of care workers, and more funding from federal, state, and local entities. Staff and volunteers with these organizations frequently work together to craft priorities and campaigns designed to impact legislation and regulations and to educate the public with a wide range of informative booklets and guides. On the provider side, organizations like the North Carolina Health Care Facilities Association, the North

Applying Market-Based Reforms To Long-Term Care

Recent trends in U.S. long-term care policy reflect three broad goals Americans have for the quality of long-term care: improving quality of life, reducing fragmentation of delivery and financing, and increasing use of home and community-based care. At the same time, market-based reforms--namely, public reporting and pay-for-performance--have taken on their own momentum, aimed at improving the clinical quality of care among nursing home and home health care providers. The focus of reporting systems should be broadened to include quality of life in addition to clinical quality and to make measures less dependent on the setting in which care is delivered.

The Basis for Improving and Reforming Long-Term Care, Part 2: Clinical Problem Solving and Evidence-Based Care

There are intense efforts to improve the quality of long-term care. However, it is unclear whether these efforts are based on understanding root causes of the deficits in quality. This article focuses on processes of clinical problem solving and decision making as a means to enable safe, effective, efficient, and person-centered care that reflects key principles discussed in the initial article in this series. The care delivery process is the means for applying these principles to deliver care. The techniques used in clinical decision-making and problem-solving activities are not unique to health care. Whether or not it is recognized, clinical problem-solving and decision-making activities are occurring continually in all long-term care facilities. But only some staff and practitioners do them well. There is much talk about applying "evidence-based care" in all settings, including the nursing home. However, the term is widely misunderstood and only sometimes applied properly. True evidence-based care requires combining scientific evidence with sufficiently detailed evidence about the individual patient. This article applies the discussion to identify criteria for "expertise" in long-term care. We may identify characteristics of "experts" in long-term care, regardless of discipline, as well as factors that distinguish levels of expertise. Experts have the skill and judgment to apply knowledge effectively to individual patient situations. Based on these criteria, only some of the claims to expertise in caring for, advising about, or overseeing long-term care residents and patients are warranted.

Who Cares? We Do and We Always Will

Who Cares? We Do and We Always Will

Japanese healthcare system: lessons to be learned

Naoki Ikegami is Professor and Chair of the Department of Health Policy and Management at the Keio University School of Medicine (Tokyo, Japan), from which he received his MD and PhD. He also received a Master of Arts degree in health services studies with Distinction from Leeds University (UK). During 1990–1991, he was a visiting Professor at the University of Pennsylvania’s Wharton School and Medical School (PA, USA). His publications include “The Art of Balance in Health Policy – Maintaining Japan’s Low-Cost Egalitarian System” (Cambridge University Press, 1998) with John C Campbell, and “Measuring the quality of long-term care in institutional and community settings. In: “Measuring Up – Improving Health Care Performance in OECD Countries” (OECD, 2002) with John Hirdes and Iain Carpenter. His interests are comparative health policy, long-term care and reimbursement systems. He is currently president of the Japan Society on Healthcare Administration, and the Japan Healtheconomics Society. Here, Naoki Ikegami talks to Expert Review of Pharmacoeconomics & Outcomes Research about how Japan is dealing with the health policy issues of today.

Integrated dementia care in The Netherlands: a multiple case study of case management programmes

The number of dementia patients is growing, and they require a variety of services, making integrated care essential for the ability to continue living in the community. Many healthcare systems in developed countries are exploring new approaches for delivering health and social care. The purpose of this study was to describe and analyse a new approach in extensive case management programmes concerned with long-term dementia care in The Netherlands. The focus is on the characteristics, and success and failure factors of these programmes.A multiple case study was conducted in eight regional dementia care provider networks in The Netherlands. Based on a literature study, a questionnaire was developed for the responsible managers and case managers of the eight case management programmes. During 16 semistructured face-to-face interviews with both respondent groups, a deeper insight into the dementia care programmes was provided. Project documentation for all the cases was studied. The eight programmes were developed independently to improve the quality and continuity of long-term dementia care. The programmes show overlap in terms of their vision, tasks of case managers, case management process and the participating partners in the local dementia care networks. Differences concern the targeted dementia patient groups as well as the background of the case managers and their position in the local dementia care provider network. Factors for success concern the expert knowledge of case managers, investment in a strong provider network and coherent conditions for effective inter-organizational cooperation to deliver integrated care. When explored, caregiver and patient satisfaction was high. Further research into the effects on client outcomes, service use and costs is recommended in order to further analyse the impact of this approach in long-term care. To facilitate implementation, with a focus on joint responsibilities of the involved care providers, policy recommendations are to develop incentives for collaborative financial contracts between insurers and providers.

LTC Community Wants Inclusion in Reform

LTC Community Wants Inclusion in Reform

Long-term urethral catheter audit in patients' own homes

Auditing of urinary catheter care generally occurs in clinical environments, either in acute trusts, community hospitals or general practices. This paper reports on an audit that sought to establish the quality of long-term urethral catheter care provided for patients in their own homes. The outcomes identify opportunities to improve the care of these long-term devices, through improved clinical practice by healthcare staff, and opportunites to improve the training and education of patients and their carers.

Integrating person-centered, outcome-driven long-term care planning and quality assurance: The PEONIES approach

Integrating person-centered, outcome-driven long-term care planning and quality assurance: The PEONIES approach

再議台灣長期照護政策的性別正義問題與出路

LANGUAGE NOTE | Document text in Chinese; abstract also in English.面對快速高齡化的社會實況，台灣政府於2007年提出“長期照顧十年計劃”作為長期照護政策的依據。但是，該計劃卻未能具體而微地列明關乎性別正義的政策內容，例如：對於照護勞務的提供與分配尚未建立一套合於“性別主流化”要求的體制與實踐。就台灣長期照護政策與其實踐未能彰顯性別正義的現況，本文首先提出台灣社會從政府到家庭以至個體的性別觀點，尚未具備性別正義之充分實踐的因素。本文再進而探討道德與政治之間，為何必須以及應該如何考量性別正義，是合理且可證成的。女性主義者常批判長期照護是對女性的一種不公義的制度。女性主義者中的關懷倫理學家則嘗試以關懷的角度去說明女性之互相倚待性，並以關懷去疏解此中的性別歧視。但關懷倫理學是不能證立家庭在長期照護中的特殊角色和義務。對照於“性別主流化”的時代要求，本文認為孔孟的仁義思想實能就道德規範根源回應政治原則的合理性問題。儒家以家庭為倫理實踐的起點，家庭成員對長期照護有一自然的承擔義務而不必是性別歧視的。為確立本文觀點，進一步論述儒家“各盡其性分”的原則在道德與政治的面向之間，如何能於政策規範之內涵與實踐上回應政府、家庭以及個體合於性別正義的要求，並且有所殊勝於主張關懷倫理的女性主義之論說。Facing the ever increasing pace of ageing in society, the Taiwanese government proposed a “Ten-year Plan for Long-term Care” in 2007 as the basis of its long-term care policy. However, the plan clearly does not pay attention to the issue of gender justice in Taiwanese society. For example, the supply and distribution of care-giving labor as determined in the plan does not establish a system and practice that would conform to mainstream Taiwanese thought on gender issues. Feminists are keen to criticize that the long-term care of the elderly has been a burden and an indication of gender injustice in treating women. Care ethicists try to indicate the interdependence of family members and propose a fair share of the care burden between the sexes. However, they fail to offer an adequate justification for the share of the burden among family members or a proper account of the special role of the family in long-term care.In this essay I first explore the main factors that explain why the long-term care policy and practice are unable to achieve gender justice from the perspectives of the government, the family and the individual. I then argue that it is morally and politically reasonable to develop policy concerning gender justice. From the Confucian viewpoint, the family is the core of human life and the starting point of individual moral practice and family flourishing. The family is the basic unit that could offer a suitable ground for a proper public policy to enhance the quality of long-term care without gender discrimination. I argue that Confucius and Mencius’ ideas of Jen (benevolence) and Yi (righteousness) provide the moral foundation for a proper response to the demand for gender justice in government policy. To illustrate this point, I elaborate how the Confucian principle of the “utmost fulfillment of each being’s mandate” could be applied to the policy and action of the government, the family and individuals to accomplish gender justice. I conclude that this Confucian principle is better than the feminist care ethic in directing the formulation of a proper long-term care policy.DOWNLOAD HISTORY | This article has been downloaded 250 times in Digital Commons before migrating into this platform.

Reliability of the PEONIES approach to consumer-centered to long-term care quality assurance/quality improvement

Reliability of the PEONIES approach to consumer-centered to long-term care quality assurance/quality improvement

LTC Has Been Focus of Policies but Not Politics

LTC Has Been Focus of Policies but Not Politics

Long-Term Care Quality Improvement as Research

Long-Term Care Quality Improvement as Research

Shifting focus to cancer survivorship in prostate cancer: challenges and opportunities

As strides have been achieved in cancer control, issues faced by survivors have become increasingly relevant. Currently, there are more than 10 million cancer survivors living in the US and consequently cancer survivorship has become a major health priority. Approximately 2 million prostate cancer survivors face a host of long-term and late effects following cancer therapy. Although progress has been made in recognizing many of the issues faced by survivors, gaps in comprehensive surveillance and management still exist. In its recent report, From Cancer Patient to Cancer Survivor: Lost in Transition, the Institute of Medicine outlined deficits in the care provided to cancer survivors and proposed several mechanisms to improve the coordination and quality of follow-up care. Measures to achieve these objectives include improving communication between healthcare providers through a survivorship care plan, developing an evidence base to better support surveillance guidelines, and assessing different models of survivorship care. Potential shortcomings in the recognition and management of ongoing issues faced by prostate cancer survivors may impact the overall quality of long-term care in this growing population. Although programs to address these issues have been proposed, they are in the earliest phase of development.

Primary care and emergency physician attitudes and beliefs related to patients with psychogenic nonepileptic spells

Psychogenic nonepileptic spells (PNES) are typically evaluated by primary care and emergency physicians before neurologists. The attitudes and beliefs of such physicians about PNES may impact long-term outcomes and quality of care for these challenging patients. A 21-question survey was created to assess knowledge of, beliefs about, and attitudes toward the diagnosis and management of PNES. The survey found misperceptions that PNES are voluntary, that video/EEG monitoring is not needed to confirm the diagnosis of PNES, and that clinical history is sufficient for diagnosis. Ninety-five percent believe that counseling and psychotherapy are the most appropriate therapies. Ongoing education and outreach to referring physicians about PNES are indicated, especially because early diagnosis of PNES has been associated with better outcomes.

Measuring Quality in Long-Term Care: A 360-Degree Approach

Policy makers and providers have taken steps to address quality concerns in acute and Long-term care (LTC); however, serious quality problems remain. Efforts to measure quality have focused primarily on technical quality, assessing whether certain healthcare outcomes are achieved. Advocates for a patient-centered approach urge a shift to an assessment of functional quality that would include an overall evaluation of the service encounter that is heavily reliant on input from the service recipient. This article provides a discussion of why measuring quality in LTC is more challenging. Because a more comprehensive approach to quality is warranted in LTC, recommendations are made for using a 360-degree approach.

Toward Maintaining and Improving the Quality of Long-Term Care: The Current State and Issues Regarding Home Helpers in Japan under the Long-Term Care Insurance System

In Japan, where the population is aging at a speed unequaled by any other country in the world, there has been a rapid increase in the use of long-term care services, following the adoption of the Long-Term Care Insurance System. The increase is seen mostly in home-visit care services, and the need for such services is expected to increase even further in the years ahead. This paper reviews previous studies on long-term care insurance service market in Japan, focusing especially on home helpers. The first section of this paper introduces the framework of the Long-Term Care Insurance System and the current state of the long-term care insurance service market. The second section examines the systems and working conditions regarding home helpers. Finally, the third section analyzes the job performance skills of home helpers and development thereof. Through these observations, this paper aims to introduce the measures proposed to be effective for maintaining and improving the quality of long-term care services, and for consistent provision of such services, by focusing mainly on employment management that enables helper skill development.

Interpretive Guidelines Lead Facilities To Refocus on Their Efforts to Reduce Falls

Interpretive Guidelines Lead Facilities To Refocus on Their Efforts to Reduce Falls