The champion for improved delivery of care to older people in long-term care settings: effects on professional practice, quality of care and resident outcomes

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effectiveness of the champion on professional practice, quality of care and resident outcomes in long-term care for older people

Champions for improved adherence to guidelines in long-term care homes: a systematic review

Background The champion model is increasingly being adopted to improve uptake of guideline-based care in long-term care (LTC). Studies suggest that an on-site champion may improve the quality of care residents’ health outcomes. This review assessed the effectiveness of the champion on staff adherence to guidelines and subsequent resident outcomes in LTC homes. Method This was a systematic review and meta-analyses of randomised controlled trials. Eligible studies included residents aged 65 or over and nursing staff in LTC homes where there was a stand-alone or multi-component intervention that used a champion to improve staff adherence to guidelines and resident outcomes. The measured outcomes included staff adherence to guidelines, resident health outcomes, quality of life, adverse events, satisfaction with care, or resource use. Study quality was assessed with the Cochrane Risk of Bias tool; evidence certainty was assessed using the GRADE approach. Results After screening 4367 citations, we identified 12 articles that included the results of 1 RCT and 11 cluster-RCTs. All included papers evaluated the effects of a champion as part of a multicomponent intervention. We found low certainty evidence that champions as part of multicomponent interventions may improve staff adherence to guidelines. Effect sizes varied in magnitude across studies including unadjusted risk differences (RD) of 4.1% [95% CI: − 3%, 9%] to 44.8% [95% CI: 32%, 61%] for improving pressure ulcer prevention in a bed and a chair, respectively, RD of 44% [95% CI: 17%, 71%] for improving depression identification and RD of 21% [95% CI: 12%, 30%] for improving function-focused care to residents. Conclusion Champions may improve staff adherence to evidence-based guidelines in LTC homes. However, methodological issues and poor reporting creates uncertainty around these findings. It is premature to recommend the widespread use of champions to improve uptake of guideline-based care in LTC without further study of the champion role and its impact on cost

Law and Economics in the RIA World

More than three decades ago, lawyers and economists met in Chicago for “the greatest gig in the sky” in the history of law and economics: the Symposium on “Efficiency as a legal concern”, where many of the most authoritative law and economic scholars of that time discussed the merit of adopting efficiency criteria in legal adjudication, and ended up digging quite thoroughly into the virtues and hidden traps of the Kaldor-Hicks criterion as a normative basis for deciding about complex and controversial legal issues. That was also the time in which scholars like Richard Posner, William Landes, George Priest and Paul Rubin – all in favor of replacing legal criteria in adjudication with Kaldor-Hicks efficiency – were challenged by others, such as Ronald Dworkin, Richard Epstein, Anthony Kronman, Duncan Kennedy, Charles Fried, Gerald O’Driscoll Jr. and Mario Rizzo, who considered that efficiency criteria could lead to potential distortions in the making of value judgments when adjudicating legal controversies