Development of quality indicators for monitoring outcomes of frail elderly hospitalised in acute care health settings: Study Protocol

Background: Frail older people admitted to acute care hospitals are at risk of a range of adverse outcomes, including geriatric syndromes, although targeted care strategies can improve health outcomes for these patients. It is therefore important to assess inter-hospital variation in performance in order to plan and resource improvement programs. Clinical quality outcome indicators provide a mechanism for identifying variation in performance over time and between hospitals, however to date there has been no routine use of such indicators in acute care settings. A barrier to using quality indicators is lack of access to routinely collected clinical data. The interRAI Acute Care (AC) assessment system supports comprehensive geriatric assessment of older people within routine daily practice in hospital and includes process and outcome data pertaining to geriatric syndromes. This paper reports the study protocol for the development of aged care quality indicators for acute care hospitals. Methods/Design. The study will be conducted in three phases:. 1. Development of a preliminary inclusive set of quality indicators set based on a literature review and expert panel consultation,. 2. A prospective field study including recruitment of 480 patients aged 70 years or older across 9 Australian hospitals. Each patient will be assessed on admission and discharge using the interRAI AC, and will undergo daily monitoring to observe outcomes. Medical records will be independently audited, and. 3. Analysis and compilation of a definitive quality indicator set, including two anonymous voting rounds for quality indicator inclusion by the expert panel. Discussion. The approach to quality indicators proposed in this protocol has four distinct advantages over previous efforts: the quality indicators focus on outcomes; they can be collected as part of a routinely applied clinical information and decision support system; the clinical data will be robust and will contribute to better understanding variations in hospital care of older patients; The quality indicators will have international relevance as they will be built on the interRAI assessment instrument, an internationally recognised clinical system

The impact of knowledge, attitudes and beliefs on the engagement of primary and community-based healthcare professionals in cancer care: a literature review

Background: Primary health services are well placed to reinforce prevention, early intervention, and connected care. Despite this important role, primary care providers (PCPs) have a limited capacity to meet the varied needs of people with cancer and their carers – furthermore, the reasons for this largely remain unexplored. Scope: To identify: (1) the knowledge, attitudes, and beliefs held by health professionals and patients that can influence the engagement of PCPs with the early detection of cancer and follow-up care; (2) evidence that attitudes and beliefs can be modified with measureable impact on the engagement of PCPs with cancer care; and (3) potential targets for intervention. This was achieved through a review of English publications from 2000 onwards, sourced from six academic databases and complemented with a search for grey literature. Findings: A total of 4212 articles were reviewed to identify studies conducted in the UK, Canada, Holland (or The Netherlands), Australia, or New Zealand given the comparable role of PCPs. Several factors hinder PCP participation in cancer care, all of which are related to knowledge, attitudes, and beliefs. Patients and specialists are uncertain about the role that primary care could play and whether their primary care team has the necessary expertise. PCPs have varied opinions about the ideal content of follow-up programs. Study limitations include: the absence of well accepted definitions of key terms; the indexing systems used by databases to code publications, which may have obscured all relevant publications; the paucity of robust research; and possible researcher bias which was minimized through independent review by trained reviewers and the implementation of rigorous inter-rater reliability measures.Conclusions: Knowledge, attitudes, and beliefs influence PCP engagement in cancer care. It is important to develop shared understandings of these terms because the knowledge, attitudes, and beliefs of PCPs, specialists, patients, and their families can influence the effectiveness of treatment plans