Adjusting client-level risks impacts on home care organization ranking

Quality indicators (QIs) based on the Resident Assessment Instrument-Home Care (RAI-HC) offer the opportunity to assess home care quality and compare home care organizations’ (HCOs) performance. For fair comparisons, providers’ QI rates must be risk-adjusted to control for different case-mix. The study’s objectives were to develop a risk adjustment model for worsening or onset of urinary incontinence (UI), measured with the RAI-HC QI bladder incontinence, using the database HomeCareData and to assess the impact of risk adjustment on quality rankings of HCOs. Risk factors of UI were identified in the scientific literature, and multivariable logistic regression was used to develop the risk adjustment model. The observed and risk-adjusted QI rates were calculated on organization level, uncertainty addressed by nonparametric bootstrapping. The differences between observed and risk-adjusted QI rates were graphically assessed with a Bland-Altman plot and the impact of risk adjustment examined by HCOs tertile ranking changes. 12,652 clients from 76 Swiss HCOs aged 18 years and older receiving home care between 1 January 2017, and 31 December 2018, were included. Eight risk factors were significantly associated with worsening or onset of UI: older age, female sex, obesity, impairment in cognition, impairment in hygiene, impairment in bathing, unsteady gait, and hospitalization. The adjustment model showed fair discrimination power and had a considerable effect on tertile ranking: 14 (20%) of 70 HCOs shifted to another tertile after risk adjustment. The study showed the importance of risk adjustment for fair comparisons of the quality of UI care between HCOs in Switzerland

Verbesserung der Datenlage zur Spitex in der Schweiz : Potenziale für eine zukünftige Nutzung des Datenpools HomeCareData (HCD). Ergebnisbericht von Interviews mit Expertinnen und Experten im Rahmen des NFP 74 Projekts «Bessere Daten zur Qualität der häuslichen Pflege (Spitex)»

Die Studie entstand unter Mitwirkung der HCD Research Group.Im Rahmen des NFP 74 Projektes «Bessere Daten zur Qualität der häuslichen Pflege (Spitex)» wurden Interviews mit Expertinnen und Experten durchgeführt mit dem Ziel, Bedürfnisse, Chancen, Hindernisse und Erwartungen zur Datennutzung aus dem Datenpool HomeCareData (HCD) zu identifizieren. Insgesamt wurden 16 Interviews mit Expertinnen und Experten aus verschiedenen potenziellen Nutzungsgruppen durchgeführt. Alle interviewten Expertinnen und Experten hatten gute Kenntnisse sowie Erfahrungen in der Datennutzung im Gesundheitswesen und rund die Hälfte der Interviewten hatten zudem genauere Kenntnisse zu Inhalten und bisherigen Nutzungsmöglichkeiten von HCD. Die Interviews wiederspiegeln unterschiedliche Wahrnehmungen und Bedürfnisse aus den Blickwinkeln der potenziellen Nutzungsgruppen, aber nicht in allen Punkten die aktuelle Datenlage. HCD bietet gemäss den interviewten Expertinnen und Experten unterschiedliche Chancen für eine Vielzahl von möglichen Nutzungsgruppen. Gemäss den interviewten Expertinnen und Experten kann aktuell das Potenzial von HCD noch nicht ausgeschöpft werden, und es besteht ein klares Bedürfnis nach zusätzlichen und zuverlässigen Daten im Spitex Bereich. Vermisst werden u.a. repräsentative und auf Individualebene ausdifferenzierte Daten zu den Klientinnen und Klienten oder den erbrachten Leistungen. Anhand der Interviews mit Expertinnen und Experten und aufbauend auf Erkenntnissen aus anderen Teilstudien des Projektes «Bessere Daten zur Qualität der häuslichen Pflege (Spitex)» können Empfehlungen zu Ansatzpunkten für die Weiterentwicklung der Datenlage im Spitex Bereich mit Fokus auf HCD formuliert werden. (A) Verbesserung der Qualität und Repräsentativität der HCD Daten: Die Grundlage für eine zukünftige umfassendere Nutzung von Daten ist deren Qualität und Repräsentativität. Die mangelnde Repräsentativität von HCD hängt damit zusammen, dass zurzeit nur ein kleiner Teil der Spitex-Organisationen Daten an HCD liefert. Gründe dafür sehen die Expertinnen und Experten hauptsächlich darin, dass in vielen Organisationen der Nutzen des HCD zu wenig erkannt wird, was die Motivation zur Datenlieferung reduziert. Als problematisch wird zudem die Zuverlässigkeit der Datenerhebung betrachtet. Gemäss den Befragten ist bspw. zu wenig klar, nach welchen Kriterien die verschiedenen Instrumente des Resident Assessment Instrument-Home Care (RAI-HC) in den Spitex-Organisationen eingesetzt werden. Deshalb wird empfohlen, bereits bestehende Prozesse zu stärken und eine nachhaltige Struktur zur Unterstützung von Spitex-Organisationen zu entwickeln, um eine höhere Teilnahme und Datenqualität zu erreichen. Im Rahmen dieser Struktur könnten Organisationen sowohl in der korrekten RAI-HC Anwendung und Standardisierung wie auch in der Nutzung von HCD und Qualitätsindikatoren kontinuierlich begleitet werden. (B) Erweiterung der Datengrundlagen zum Spitex Bereich: Die interviewten Expertinnen und Experten erachten eine Erweiterung von HCD mit Informationen aus anderen Datensätzen als wünschenswert. Weitere Ansatzpunkte zur Verbesserung der Datenlage finden sich deshalb in der Verknüpfung von HCD zu verschiedenen anderen bestehenden Daten und in der Entwicklung neuer anschlussfähiger Instrumente. Bezüglich einer Verknüpfung bietet sich inhaltlich die Spitex-Statistik an. Hier zeigt sich aber ein Problem der Verknüpfungen. Da die Spitex-Statistik gemäss den Expertinnen und Experten in ihrer aktuellen Struktur zu wenig granular ist, müssten auch diese Daten auf Ebene der Klientinnen und Klienten erheben. Bezüglich der Entwicklung neuer Instrumente sollte u.a. die Möglichkeiten der Integration von Daten zur Zufriedenheit und den Erfahrungen der Klientinnen und Klienten weiterverfolgt werden, wie dies mit dem PREM (Patient-reported experience measure) «Client Satisfaction Instrument – Home Care» in einer Teilstudie dieses Projektes vorbereitet wurde. In weiterführenden Projekten könnte dieses auf Klienten-Erfahrungen basierende Messinstrument dann auch mit PROMs (Patient-reported outcome measures) weiterentwickelt werden. (C) Ressourcen zur Weiterentwicklung von HCD mit Fokus auf die Datenverwendung: In den Interviews hat sich gezeigt, dass verschiedene Nutzungsgruppen darauf angewiesen sind, dass HCD Daten in Form von Auswertungen in Berichten zugänglich gemacht werden, und dass gleichzeitig HCD noch wenig bekannt ist. Deshalb wird empfohlen, HCD mittels der Bereitstellung von Ressourcen für 1) Datenauswertungen und Berichte und 2) Vermittlung des Nutzens breiter bekannt zu machen. Diese Ressourcen können innerhalb vorhandener Strukturen aber auch in Neuen und mit zusätzlichen Stakeholdern etabliert werden. Alle drei Empfehlungen wurden von 34 antwortenden Stakeholdern in einer Befragung zu diesem Bericht als relevant eingestuft. Die Online-Befragung diente dem Einholen einer Resonanz zum Bericht und den Empfehlungen. Die höchste Relevanz wurde der Verbesserung der Qualität und Repräsentativität der HCD Daten beigemessen

To vaccinate or not to vaccinate : this is the question among Swiss university students

This article belongs to the Special Issue "Vaccine Hesitancy and COVID-19"The speed and innovation of the COVID-19 vaccine development has been accompanied by insecurity and skepticism. Young adults’ attitude to vaccination remains under investigation, although herd immunity cannot be reached without them. The HEalth in Students during the Corona pandemic study (HES-C) provided the opportunity to investigate vaccination intention in 1478 students in the sixth survey wave (January 2021), including vaccination intention, psychological antecedents of vaccine hesitancy, trust in government’s vaccination strategy, and vaccination history. Associations with vaccination intention were analyzed with multivariate ordinal regression and predicted margins were calculated adjusting for gender, age, anxiety, health profession, and subjective health status. A third was decided (yes 25.1%, no 7.6%), and 68% were unsure about getting the COVID-19 vaccine when available. Next to demographic characteristics, vaccination history (influenza vaccination OR = 1.39; 95% CI: 1.06–1.83, travel vaccination OR = 1.29; 95% CI: 1.04–1.60), trust in vaccination strategy (OR = 2.40; 95% CI: 1.89–3.05), and 5C dimensions were associated with vaccination intention: confidence (OR = 2.52; 95% CI: 2.09–3.03), complacency (OR = 0.79; 95% CI: 0.66–0.96), calculation (OR = 0.79; 95% CI: 0.70–0.89), constraints (OR = 1.18; 95% CI: 0.99–1.41), and collective responsibility (OR = 4.47; 95% CI: 3.69–5.40). Addressing psychological antecedents and strengthening trust in official strategies through targeted campaigns and interventions may increase decisiveness and result in higher vaccination rates

Confident and altruistic – parents' motives to vaccinate their children against COVID-19 : a cross-sectional online survey in a Swiss vaccination centre

In Switzerland, COVID-19 vaccines have been approved for children aged 5-11 years only recently, whereas vaccination of adolescents aged 12 years and older was approved in early summer 2021. Although the disease burden in children and adolescents has been reasonably mild, they can transmit COVID-19 to others, thus vaccinating this age group may help to curb the COVID-19 pandemic. The main objective was to investigate the association between five psychological antecedents of vaccination hesitancy in COVID-19 immunised parents and their intention to have their child vaccinated against COVID-19. Further, we examined if parental vaccination history and conviction of the benefits of Swiss paediatric vaccination recommendations are associated with child vaccination intention, and where parents would like the vaccination performed

Selecting home care quality indicators based on the Resident Assessment Instrument-Home Care (RAI-HC) for Switzerland : a public health and healthcare providers' perspective

Background: Despite an increasing importance of home care, quality assurance in this healthcare sector in Switzerland is hardly established. In 2010, Swiss home care quality indicators (QIs) based on the Resident Assessment Instrument-Home Care (RAI-HC) were developed. However, these QIs have not been revised since, although internationally new RAI-HC QIs have emerged. The objective of this study was to assess the appropriateness of RAI-HC QIs to measure quality of home care in Switzerland from a public health and healthcare providers’ perspective. Methods: First, the appropriateness of RAI-HC QIs, identified in a recent systematic review, was assessed by a multidisciplinary expert panel based on the RAND/UCLA Appropriateness Method taking into account indicators’ public health relevance, potential of influence, and comprehensibility. Second, the QIs selected by the experts were afterwards rated regarding their relevance, potential of influence, and practicability from a healthcare providers’ perspective in focus groups with home care nurses based on the Nominal-Group-Technique. Data were analyzed using median scores and the Disagreement Index. Results: 18 of 43 RAI-HC QIs were rated appropriate by the experts from a public health perspective. The 18 QIs cover clinical, psychosocial, functional and service use aspects. Seven of the 18 QIs were subsequently rated appropriate by home care nurses from a healthcare providers’ perspective. The focus of these QIs is narrow, because three of seven QIs are pain-related. From both perspectives, the majority of RAI-HC QIs were rated inappropriate because of insufficient potential of influence, with healthcare providers rating them more critically. Conclusions: The study shows that the appropriateness of RAI-HC QIs differs according to the stakeholder perspective and the intended use of QIs. The findings of this study can guide policy-makers and home care organizations on selecting QIs and to critically reflect on their appropriate use

Financial reasons for working beyond the statutory retirement age : risk factors and associations with health in late life

Despite an increasing trend of working life prolongation, little is known about the risk factors for financial reasons for working beyond the statutory retirement age (SRA), and how these reasons relate to health. The present study examined (1) the determinants of working beyond the SRA, (2) the workers’ self-reported reasons for working beyond the SRA, and (3) the association between these reasons and health in late life. Cross-sectional data of 1241 individuals from the Swiss survey “Vivre/Leben/Vivere” were analyzed. The results showed that people with a low level of education and with a low income have an 80% higher risk of working beyond the SRA for financial reasons than for other reasons (p < 0.001). Moreover, self-rated health was not significantly associated with working beyond the SRA for financial reasons but was significantly associated with education and income (p < 0.01). In conclusion, while previous studies have already identified financial difficulties as one important reason for working beyond the SRA, the present study indicated the socioeconomic factors that are crucial for increasing the risk for working beyond the SRA. Thus, our results help to guide the adaptation of social policies for better maintaining and promoting the health of particularly vulnerable older workers

NEMO oligomerization and its ubiquitin-binding properties

The IKK [IκB (inhibitory κB) kinase] complex is a key regulatory component of NF-κB (nuclear factor κB) activation and is responsible for mediating the degradation of IκB, thereby allowing nuclear translocation of NF-κB and transcription of target genes. NEMO (NF-κB essential modulator), the regulatory subunit of the IKK complex, plays a pivotal role in this process by integrating upstream signals, in particular the recognition of polyubiquitin chains, and relaying these to the activation of IKKα and IKKβ, the catalytic subunits of the IKK complex. The oligomeric state of NEMO is controversial and the mechanism by which it regulates activation of the IKK complex is poorly understood. Using a combination of hydrodynamic techniques we now show that apo-NEMO is a highly elongated, dimeric protein that is in weak equilibrium with a tetrameric assembly. Interaction with peptides derived from IKKβ disrupts formation of the tetrameric NEMO complex, indicating that interaction with IKKα and IKKβ and tetramerization are mutually exclusive. Furthermore, we show that NEMO binds to linear di-ubiquitin with a stoichiometry of one molecule of di-ubiquitin per NEMO dimer. This stoichiometry is preserved in a construct comprising the second coiled-coil region and the leucine zipper and in one that essentially spans the full-length protein. However, our data show that at high di-ubiquitin concentrations a second weaker binding site becomes apparent, implying that two different NEMO–di-ubiquitin complexes are formed during the IKK activation process. We propose that the role of these two complexes is to provide a threshold for activation, thereby ensuring sufficient specificity during NF-κB signalling

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries