Development of an experienced quality measure for clients, informal and formal caregivers in home care in the Netherlands:A participatory action research

To optimise home care provision and to identify potential improvements in the care process, it is important to gain insight into the care experiences that influence care quality. The aim was to develop a qualitative experienced quality measure for home care in The Netherlands, facilitating conversations between clients and caregivers in generating possible points of improvement for the primary care process. A participatory action research design to develop the measure following three iterative cycles, using various data sources in evaluating requirements related to the goal, feasibility in care setting, and usability in the care process. The final design comprises an instruction meeting for district nurses and a structured approach to evaluate experienced quality with clients, informal caregivers, and formal caregivers. The measure encompasses cards to visually support communicating on experienced quality themes (e.g., personal needs and expectations), sub-themes (e.g., preferred way of communicating needs), exemplary questions, and a reporting sheet. The first evaluation gave indications of the measure results in formulating concrete points of improvement for the primary care process. This study indicates that the developed experienced quality measure seems promising relating to requirements for its goal, feasibility in the care setting, and usability in the care process. More insight is needed if and how improvements are communicated, documented, and followed-up in practice. In the next step, the measure should be extensively tested and evaluated in a more diverse sample (e.g., clients with dementia) for measuring experienced quality and reflecting on its outcomes

Development of an experienced quality measure for clients, informal and formal caregivers in home care in the Netherlands: A participatory action research

To optimise home care provision and to identify potential improvements in the care process, it is important to gain insight into the care experiences that influence care quality. The aim was to develop a qualitative experienced quality measure for home care in The Netherlands, facilitating conversations between clients and caregivers in generating possible points of improvement for the primary care process. A participatory action research design to develop the measure following three iterative cycles, using various data sources in evaluating requirements related to the goal, feasibility in care setting, and usability in the care process. The final design comprises an instruction meeting for district nurses and a structured approach to evaluate experienced quality with clients, informal caregivers, and formal caregivers. The measure encompasses cards to visually support communicating on experienced quality themes (e.g., personal needs and expectations), sub-themes (e.g., preferred way of communicating needs), exemplary questions, and a reporting sheet. The first evaluation gave indications of the measure results in formulating concrete points of improvement for the primary care process. This study indicates that the developed experienced quality measure seems promising relating to requirements for its goal, feasibility in the care setting, and usability in the care process. More insight is needed if and how improvements are communicated, documented, and followed-up in practice. In the next step, the measure should be extensively tested and evaluated in a more diverse sample (e.g., clients with dementia) for measuring experienced quality and reflecting on its outcomes. Experience Framework This article is associated with the Policy & Measurement lens of The Beryl Institute Experience Framework. (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

Can resources moderate the impact of levels of frailty on adverse outcomes among (pre-) frail older people? A longitudinal study

Abstract Background Higher levels of frailty result in higher risks of adverse frailty outcomes such as hospitalisation and mortality. There are, however, indications that more factors than solely frailty play a role in the development of these outcomes. The presence of resources, e.g. sufficient income and good self-management abilities, might slow down the pathway from level of frailty to adverse outcomes (e.g. mortality). In the present paper we studied whether resources (i.e. educational level, income, availability of informal care, living situation, sense of mastery and self-management abilities) moderate the impact of the level of frailty on the adverse outcomes mortality, hospitalisation and the development of disability over a two-year period. Methods Longitudinal data on a sample of 2420 community-dwelling pre-frail and frail older people were collected. Participants filled out a questionnaire every six months, including measures of frailty, resources and outcomes. To study the moderating effects of the selected resources their interaction effects with levels of frailty on outcomes were studied by means of multiple logistics and linear regression models. Results Frail older participants had increased odds of mortality and hospitalisation, and had more deteriorating disability scores compared to their pre-frail counterparts. No moderating effects of the studied resources were found for the outcomes mortality and hospitalisation. Only for the outcome disability statistically significant moderating effects were present for the resources income and living situation, yet these effects were in the opposite direction to what we expected. Overall, the studied resources showed hardly any statistically significant moderating effects and the directions of the trends were inconsistent. Conclusions Frail participants were more at risk of mortality, hospitalisation, and an increase in disability. However, we were unable to demonstrate a clear moderating effect of the studied resources on the adverse outcomes associated with frailty (among pre-frail and frail participants). More research is needed to increase insight into the role of moderating factors. Other resources or outcome measures should be considered

Behavioral-graded activity compared with usual care after first-time disk surgery: Considerations of the design of a randomized clinical trial

Objective: To present the design of a trial on the effectiveness of a behavioral-graded activity model. Design: Randomized clinical trial. Patients: Patients undergoing first-time lumbar disk surgery who still have low-back pain at the 6-week neurosurgical consultation. Interventions: A patient-tailored behavioral graded activity program that is based on operant therapy. The key elements of this program are baseline measurements, goal-setting, and time-contingency. This program is compared with usual care in physiotherapy, which is pain-contingent. Outcome Measures: Primary measures are the patient's global impression of the effect and their functional status. Secondary measures are kinesiophobia, catastrophizing, pain, main complaint, range of motion, and relapses. The direct and indirect costs will also be assessed. The effect measures are rated before randomization and 3, 6, and 12 months later. Discussion: Several trials have been conducted on the effectiveness of behavioral treatments. Subjects were always patients with chronic low-back pain. In this trial, we apply such a treatment in patients after first-time disk surgery in a primary care setting