The acceptability and feasibility of using the Adult Social Care Outcomes Toolkit (ASCOT) to inform practice in care homes

Background: The Adult Social Care Outcomes Toolkit (ASCOT) measures social care related quality of life (SCRQoL) and can be used to measure outcomes and demonstrate impact across different social care settings. This exploratory study built on previous work by collecting new inter-rater reliability data on the mixed-methods version of the toolkit and exploring how it might be used to inform practice in four case study homes. Method: We worked with two care home providers to agree an in-depth study collecting SCRQoL data in four case-study homes. Data was collected about residents’ age, ethnicity, cognitive impairment, ability to perform activities of daily living and SCRQoL in the four homes. Feedback sessions with staff and managers were held in the homes two weeks after baseline and follow-up data collected three months later. Interviews with managers explored their views of the feedback and recorded any changes that had been made because of it. Results: Participant recruitment was challenging, despite working in partnership with the homes. Resident response rates ranged from 23 to 54 % with 58 residents from four care homes taking part in the research. 53 % lacked capacity to consent. Inter-rater reliability for the ASCOT ratings of SCRQoL were good at time one (IRR = 0.72) and excellent at time two (IRR = 0.76). During the study, residents’ ability to perform activities of daily living declined significantly (z = -2.67, p < .01), as did their expected needs in the absence of services (z = -2.41, p < .05). Despite these rapid declines in functionings, residents’ current SCRQoL declined slightly but not significantly (Z = -1.49, p = .14). Staff responded positively to the feedback given and managers reported implementing changes in practice because of it. Conclusion: This exploratory study faced many challenges in the recruitment of residents, many of whom were cognitively impaired. Nevertheless, without a mixed-methods approach many of the residents living in the care homes would have been excluded from the research altogether or had their views represented only by a representative or proxy. The value of the mixed-methods toolkit and its potential for use by providers is discussed

Quality of Life Outcomes of Housing with Care for Older People in England

Housing with care has become increasingly popular in recent years, and has been viewed by policy-makers and commissioners as offering a more enabling, homely and cost effective alternative to care homes. However, most residents enter with fewer care needs than those admitted to care homes, and with different expectations. Although a previous study (Bäumker et al., 2011) compared the functional outcomes for matched groups of residents, most comparative studies have used unmatched groups. This paper will compare the social care related quality of life (SCRQoL) obtained using the Adult Social Care Outcomes Toolkit (ASCOT) for residents in housing with care and those receiving home care. The housing with care residents were drawn from the ASSET (Adult Social Services Environments and Settings) project, which was commissioned and funded by the Department of Health’s NIHR School for Social Care Research. The home care recipients were drawn from the OSCA (Outcomes for Social Care for Adults) project. Matched groups of 124 individuals in each were created using propensity score matching. Residents in housing with care had less unmet need (current SCRQoL) than people receiving home care (p<0.0001); similar expected SCRQoL in the absence of social services (p>0.05); and a higher gain (current compared with expected) (p<0.0001). The improvements in outcomes were achieved without increased costs in providing personal care. Housing with care is relatively scarce, but this study adds further evidence for the value of developing more specialized housing and increasing the choice available to older people wishing to move from unsuitable accommodation

Algorithm engineering for parallel computation

Abstract. The emerging discipline of algorithm engineering has primarily focussed on transforming pencil-and-paper sequential algorithms into robust, efficient, well tested, and easily used implementations. As parallel computing becomes ubiquitous, we need to extend algorithm engineering techniques to parallel computation. Such an extension adds significant complications. After a short review of algorithm engineering achievements for sequential computing, we review the various complications caused by parallel computing, present some examples of successful efforts, and give a personal view of possible future research