Changing the story
Translating Research in Elder Care
Colin Reid, PhD Co-Investigator & Regional Lead Interior Health, BC
TVN MindMerge Meeting November 21, 2014
Changing the story
There is no prevention, no cure, no effective treatment and the
single greatest risk factor is age
One in three Canadians over 85 now has an age-related dementia
− 1.125M by 2038
The majority of nursing home residents have dementia – most are
moderate to severe
Mitchell et al., The Clinical Course of Advanced Dementia. NEJM. 2009: 361(16).
Quality of care and quality of life & end of life are central to health and social care of older adults with dementia
Changing the story
• An applied health services and knowledge
translation research program
• Practical solutions to improve quality of
care, quality of life and quality of end of life for frail, vulnerable residents and quality of work life for their care providers
• Working in a fully integrated KT model.
Mode 2 Knowledge Production
Based on…
• the needs of end users
• non-hierarchical relationships
with stakeholders
• collaboration on research issues
situated in a specific health care
context
PARiHS Framework for Research Implementation
Context
Facilitation Evidence
Optimal best practice use
Kitson, et al., 1998, QSHC Kitson et al., 2008, Impl Sci
Framing TREC
TREC 1.0
TREC 2.0
But see Kaplan et al 2010 MBQ re Context & Quality
Context Evaluation Leadership Culture • Organizational slack • Formal interactions • Informal interactions • Structural & electronic resources • Social capital Adding to context Concepts in the Alberta Context Tool (ACT)
Changing the story
• An important focus for research and quality in residential LTC.
• Reporting only at facility levels masks important unit variation.
#2 A successful intervention pilot
#3 Clinical Microsystems Matter #1 Context Matters In st ru m en tal u se o f b est p ract ices (pr oc e dur a l)
Reflective use of best practices
• Care aide engagement • Leadership engagement • Resident improvements
• Job/vocational satisfaction • Physical and mental health • Burnout
• Best practice use
Key finding
Context and physical / mental health NH level using the SF-8 *generated by K-means cluster analysis using 10 ACT dimensions Mental Health SF-8(M) Physical Health SF-8(P)
13
Changing the story
Changing the story
The Research Plan for TREC 2.0
15 1.
The TREC Measurement System (TMS)
Launched Sept’14 in 91 sites
2.
The SCOPE Interventions
Launches Spring 2015
3.
The Social Network Analysis
Launched Atlantic node Nov’14, Western, northern node Jan’15
4. System Projects
6. 7. 5. Trainee projects
Scope sustainability June’16 Scope spread/scale Sept’16
The Research Plan
16 1. The TREC Measurement System (TMS)
Surveys: Staff, Unit, Facility RAI-MDS 2.0
Feedback
• Launched in Sept 2014
• 90 facilities stratified by region, size, ownership • Longitudinal building on TREC 1.0
• 3 waves ~15 mo. apart
• All online except care aides
(computer assisted interviews)
• Quarterly from custodians
• Reporting at unit and facility level • Will include 13 TREC 1.0 SK sites
• After survey waves
• During SCOPE and SNA • Other as determined
Changing the story
Site Visits Teleconferences Monthly Team Reports
Senior Leadership Stream
Care Aide led quality improvem ent team Learni ng Sessio n 1 Learni ng Sessio n 2 Learni ng Sessio n 3 Celebra tion Congres s Action
Period 1 Period 2Action
Action Period 3 A S P D A S P D A S P D
The Research Plan
3. The Social Network Analysis
• Online survey of directors of care/facility
administrators in 958 NH in west, east, north
• Looking for the advice seeking network in
this sector, where are there hubs (clusters) others look to, who links the hubs?
• Knowledge of the hubs and linking
members of the network can be used to accelerate spread
Changing the story
The Research Plan
19 4. 2014 System Projects • Canary • Trajectories • Aggression 4. 2015 System Projects
Changing the story
The Research Plan
20 5. Trainee projects (examples)
• Pain
• Depression
• Oral health
Changing the story
TREC is a Partnership
21 Is a collaboration of researchers: Bringing expertise from
different disciplines (nursing, medicine, social science, statistics etc.) from across Canada
Is a partnership approach: With meaningful contribution from decision makers and knowledge users ensuring that research meets the needs of our partners and has applicability
Aims to develop capacity: for research and quality improvement initiatives within the sector helping to ensure long-term,
sustainable improvements
Preparing future researcher leaders in long term care: Providing quality training to students and post-doctoral fellows
Changing the story