The impact of electronic health records on risk management of information systems in Australian residential aged care homes

To obtain indications of the influence of electronic health records (EHR) in managing risks and meeting information system accreditation standard in Australian residential aged care (RAC) homes. The hypothesis to be tested is that the RAC homes using EHR have better performance in meeting information system standards in aged care accreditation than their counterparts only using paper records for information management. Content analysis of aged care accreditation reports from the Aged Care Standards and Accreditation Agency produced between April 2011 and December 2013. Items identified included types of information systems, compliance with accreditation standards, and indicators of failure to meet an expected outcome for information systems. The Chi-square test was used to identify difference between the RAC homes that used EHR systems and those that used paper records in not meeting aged care accreditation standards. 1,031 (37.4%) of 2,754 RAC homes had adopted EHR systems. Although the proportion of homes that met all accreditation standards was significantly higher for those with EHR than for homes with paper records, only 13 RAC homes did not meet one or more expected outcomes. 12 used paper records and nine of these failed the expected outcome for information systems. The overall contribution of EHR to meeting aged care accreditation standard in Australia was very small. Risk indicators for not meeting information system standard were no access to accurate and appropriate information, failure in monitoring mechanisms, not reporting clinical incidents, insufficient recording of residents\u27 clinical changes, not providing accurate care plans, and communication processes failure. The study has provided indications that use of EHR provides small, yet significant advantages for RAC homes in Australia in managing risks for information management and in meeting accreditation requirements. The implication of the study for introducing technology innovation in RAC in Australia is discussed

International Profiles of Health Care Systems, 2011

This publication presents overviews of the health care systems of Australia, Canada, Denmark, England, France, Germany, Japan, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization, quality of care, health disparities, efficiency and integration, use of health information technology, use of evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views

International Profiles of Health Care Systems, 2012

This publication presents overviews of the health care systems of Australia, Canada, Denmark, England, France, Germany, Japan, Iceland, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization, quality of care, health disparities, efficiency and integration, care coordination, use of health information technology, use of evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views

Instrumental swallowing assessment in adults in residential aged care homes : Practice patterns and opportunities

Objective To describe practice patterns in the use of instrumental swallowing assessment (ISA) for older adults in residential aged care homes (RACHs). Methods A retrospective audit of medical records of residents living in RACHs in Melbourne, Australia to extract data on speech-language pathologist (SLP) involvement, indications for ISA and ISA practice patterns. Results Medical files of 323 residents across four Melbourne facilities were reviewed. 36% (n = 115) of residents were referred to SLP for swallowing assessment. Referral to SLP was related to length of stay (U = 7393.00, p < 0.001), dementia status (χ2[1] = 7.06, p = 0.008), texture modification (χ2[1] = 93.34, p < 0.001) and an existing dysphagia diagnosis (χ2[1] = 112.89, p < 0.001). There were no referrals for ISA and no instances of ISA being used. Among 115 residents who were referred to SLP for swallowing assessment, there were 33 instances where ISA might be clinically relevant according to ISA indicators. Conclusions Instrumental swallowing assessment is not being used for the management of swallowing in RACHs in Australia despite a clinical need for ISA and a potential role for ISA to improve swallowing care quality. Lack of timely ISA may fail to meet the complex health-care needs of older adults living with dysphagia in RACHs, increasing their vulnerability to complications of dysphagia and its management

Development of the quality of Australian nursing documentation in aged care (QANDAC) instrument to measure paper-based and electronic resident records

Aim: To develop an Australian nursing documentation in aged care (Quality of Australian Nursing Documentation in Aged Care (QANDAC)) instrument to measure the quality of paper-based and electronic resident records. Methods: The instrument was based on the nursing process model and on three attributes of documentation quality identified in a systematic review. The development process involved five phases following approaches to designing criterion-referenced measures. The face and content validities and the inter-rater reliability of the instrument were estimated using a focus group approach and consensus model. Results: The instrument contains 34 questions in three sections: completion of nursing history and assessment, description of care process and meeting the requirements of data entry. Estimates of the validity and inter-rater reliability of the instrument gave satisfactory results. Conclusion: The QANDAC instrument has a potential as a useful audit tool for the purposes of quality improvement and research in aged care documentation

Co-designing a dashboard of predictive analytics and decision support to drive care quality and client outcomes in aged care: a mixed-method study protocol

IntroductionThere is a clear need for improved care quality and quality monitoring in aged care. Aged care providers collect an abundance of data, yet rarely are these data integrated and transformed in real-time into actionable information to support evidence-based care, nor are they shared with older people and informal caregivers. This protocol describes the co-design and testing of a dashboard in residential aged care facilities (nursing or care homes) and community-based aged care settings (formal care provided at home or in the community). The dashboard will comprise integrated data to provide an 'at-a-glance' overview of aged care clients, indicators to identify clients at risk of fall-related hospitalisations and poor quality of life, and evidence-based decision support to minimise these risks. Longer term plans for dashboard implementation and evaluation are also outlined.MethodsThis mixed-method study will involve (1) co-designing dashboard features with aged care staff, clients, informal caregivers and general practitioners (GPs), (2) integrating aged care data silos and developing risk models, and (3) testing dashboard prototypes with users. The dashboard features will be informed by direct observations of routine work, interviews, focus groups and co-design groups with users, and a community forum. Multivariable discrete time survival models will be used to develop risk indicators, using predictors from linked historical aged care and hospital data. Dashboard prototype testing will comprise interviews, focus groups and walk-through scenarios using a think-aloud approach with staff members, clients and informal caregivers, and a GP workshop.Ethics and disseminationThis study has received ethical approval from the New South Wales (NSW) Population & Health Services Research Ethics Committee and Macquarie University's Human Research Ethics Committee. The research findings will be presented to the aged care provider who will share results with staff members, clients, residents and informal caregivers. Findings will be disseminated as peer-reviewed journal articles, policy briefs and conference presentations

Exploring staff diabetes medication knowledge and practices in regional residential care: triangulation study

Aims and objectives: This study is drawn from a larger project that aimed to identify the staffing and organisational factors influencing the quality of diabetes care for older people living in residential care in regional Victoria, Australia. The focus of the current study is on medication management for residents with diabetes. Background: With a continuous rise in diabetes in the population, there is an associated increase in the prevalence of diabetes in aged care residential settings. However, there is little specific guidance on how to manage diabetes in older people living in institutional settings who experience multiple concurrent chronic conditions. Design: A triangulation strategy consisting of three phases. Methods: A one-shot cross-sectional survey (n = 68) focus group interviews and a case file audit (n = 20). Data were collected between May 2009-January 2010. Findings: Staff knowledge of diabetes and its contemporary medication management was found to be suboptimal. Challenges to managing residents with diabetes included limited time, resident characteristics and communication systems. Additionally, the variability in medical support available to residents and a high level of polypharmacy added to the complexity of medication management of resident. Conclusions: The current study suggests administering medicine to residents in aged care settings is difficult and has potentially serious medical, professional and economic consequences. Limitations to staff knowledge of contemporary diabetes care and medications potentially place residents with diabetes at risk of receiving less than optimal diabetes care. Relevance to clinical practice: Providing evidence-based guidelines about diabetes care in residential care settings is essential to achieve acceptable outcomes and increase the quality of life for residents in public aged care. Continuing education programs in diabetes care specifically related to medication must be provided to all health professionals and encompass scope of practice. © 2013 John Wiley & Sons Ltd

Setting priorities to inform assessment of care homes’ readiness to participate in healthcare innovation: a systematic mapping review and consensus process

© 2020 The Author(s). This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly citedOrganisational context is known to impact on the successful implementation of healthcare initiatives in care homes. We undertook a systematic mapping review to examine whether researchers have considered organisational context when planning, conducting, and reporting the implementation of healthcare innovations in care homes. Review data were mapped against the Alberta Context Tool, which was designed to assess organizational context in care homes. The review included 56 papers. No studies involved a systematic assessment of organisational context prior to implementation, but many provided post hoc explanations of how organisational context affected the success or otherwise of the innovation. Factors identified to explain a lack of success included poor senior staff engagement, non-alignment with care home culture, limited staff capacity to engage, and low levels of participation from health professionals such as general practitioners (GPs). Thirty-five stakeholders participated in workshops to discuss findings and develop questions for assessing care home readiness to participate in innovations. Ten questions were developed to initiate conversations between innovators and care home staff to support research and implementation. This framework can help researchers initiate discussions about health-related innovation. This will begin to address the gap between implementation theory and practice.Peer reviewe

Adapting the community sector for climate extremes

Abstract&nbsp;People experiencing poverty and inequality will be affected first and worst by the impacts of climate change to infrastructure and human settlements, including those caused by increasingly frequent and intense extreme weather events and natural disasters. They have the least capacity to cope, to adapt, to move and to recover. Community service organisations (CSOs) play a critical role in supporting individuals, families and communities experiencing poverty and inequality to build resilience and respond to adverse changes in circumstances. As such, the services they provide comprise a critical component of social infrastructure in human settlements. However, very little is understood about CSOs own vulnerability to – or their role in managing and mitigating risks to their clients and the community from – climate change impacts to physical infrastructure.&nbsp;The Extreme Weather, Climate Change and the Community Sector – Risks and Adaptations project examined the relationship between physical and social infrastructure (in the form of CSO service provision). Specifically, the ways in which the climate-driven failure of CSO service delivery worsens risks to the individuals and communities they serve and, on the other hand, how preparedness may reduce vulnerability to climate change and extreme weather impacts to human settlements and infrastructure.The research comprised a comprehensive and critical scoping, examination and review of existing research findings and an audit, examination and judgment-based evaluation of the current vulnerabilities and capacities of CSOs under projected climate change scenarios. It employed three key methods of consultation and data collection. A literature review examined research conducted to date in Australia and comparative countries internationally on the vulnerability and climate change adaptation needs of CSOs. A program of 10 Community Sector Professional Climate Workshops consulted over 150 CSO representatives to develop a qualitative record of extreme event and climate change risks and corresponding adaptation strategies specific to CSOs. A national survey of CSOs, which resulted in the participation of approximately 500 organisations, produced a quantitative data set about the nature of CSO vulnerability to climate change and extreme weather impacts to infrastructure, whether and how CSOs are approaching the adaptation task and key barriers to adaptation.While the methods employed and the absence of empirical data sets quantifying CSO vulnerability to climate change impacts create limitations to the evidence-base produced, findings from the research suggest that CSOs are highly vulnerable and not well prepared to respond to climate change and extreme weather impacts to physical infrastructure and that this underlying organisational vulnerability worsens the vulnerability of people experiencing poverty and inequality to climate change. However, the project results indicate that if well adapted, CSOs have the willingness, specialist skills, assets and capacity to make a major contribution to the resilience and adaptive capacity of their clients and the community more broadly (sections of which will be plunged into adversity by extreme events). Despite this willingness, the evidence presented shows that few CSOs have undertaken significant action to prepare for climate change and worsening extreme weather events. Key barriers to adaptation identified through the research are inadequate financial resources, lack of institutionalised knowledge and skills for adaptation and the belief that climate change adaptation is beyond the scope of CSOs core business. On the other hand, key indicators of organisational resilience to climate change and extreme weather impacts include: level of knowledge about extreme weather risks, past experience of an extreme weather event and organisational size.Given its size, scope and the critical role the Australian community sector plays in building client and community resilience and in assisting communities to respond to and recover from the devastating impacts of extreme weather events and natural disasters, the research identifies serious gaps in both the policy frameworks and the research base required to ensure the sector’s resilience and adaptive capacity – gaps which appear to have already had serious consequences. To address these gaps, a series of recommendations has been prepared to enable the development and implementation of a comprehensive, sector-specific adaptation and preparedness program, which includes mechanisms to institutionalise knowledge and skills, streamlined tools appropriate to the needs and capacity of a diverse range of organisations and a benchmarking system to allow progress towards resilience and preparedness to be monitored. Future research priorities for adaptation in this sector have also been identified