Browsing by Author "Dening, T."

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    Measuring health related quality of life of care home residents: comparison of self-report with staff proxy responses
    (Oxford University Press, 2018-09-04) Hinsliff-Smith, K.; Usman, A.; Lewis, S.; Long, A.; Housley, G.; Jordan, J.; Gage, H.; Dening, T.; Gladman, J.R.F.; Gordon, Adam Lee
    Introduction: Care home residents are often unable to complete Health Related Quality of Life questionnaires for themselves because of prevalent cognitive impairment. This study compared care home resident and staff proxy responses for two measures, the EQ-5D-5L and HowRU. Methods: A prospective cohort study recruited residents ≥ 60 years across 24 care homes who were not receiving short stay, respite or terminal care. Resident and staff proxy EQ-5D-5L and HowRu responses were collected monthly for three months. Weighted kappa statistics and intra-class correlation coefficients (ICCs) adjusted for clustering at the care home level were used to measure agreement between resident and proxies for each time point. The effect of staff and resident baseline variables on agreement was considered using a multilevel mixed-effect regression model. Results: 117, 109 and 104 matched pairs completed the questionnaires at 1, 2 and 3 months respectively. When clustering was controlled for, agreement between resident and staff proxy EQ-5D-5L responses was fair for mobility (ICC: 0.29) and slight for all other domains (ICC  0.20). EQ-5D Index and Quality Adjusted Life Year scores (proxy scores higher than residents) showed better agreement than EQ-5D-VAS (residents scores higher than proxy). HowRU showed only slight agreement (ICC  0.20) between residents and proxies. Staff and resident characteristics did not influence level of agreement for either index. Discussion: The levels of agreement for EQ-5D-5L and HowRU raise questions about their validity in this population.
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    Measuring health related quality of life of care home residents: comparison of self-report with staff proxy responses for EQ-5D-5L and HowRu: protocol for assessing proxy reliability in care home outcome testing
    (BMJ, 2018-06-01) Gage, H.; Gladman, J. R. F.; Usman, A.; Lewis, S.; Hinsliff-Smith, K.; Long, A.; Housley, G.; Jordan, J.; Gage, H.; Dening, T.; Gordon, Adam Lee
    Introduction: Care home residents are often unable to complete Health Related Quality of Life questionnaires for themselves because of prevalent cognitive impairment. This study compared care home resident and staff proxy responses for two measures, the EQ-5D-5L and HowRU. Methods: A prospective cohort study recruited residents ≥ 60 years across 24 care homes who were not receiving short stay, respite or terminal care. Resident and staff proxy EQ-5D-5L and HowRu responses were collected monthly for three months. Weighted kappa statistics and intra-class correlation coefficients (ICCs) adjusted for clustering at the care home level were used to measure agreement between resident and proxies for each time point. The effect of staff and resident baseline variables on agreement was considered using a multilevel mixed-effect regression model. Results: 117, 109 and 104 matched pairs completed the questionnaires at 1, 2 and 3 months respectively. When clustering was controlled for, agreement between resident and staff proxy EQ-5D-5L responses was fair for mobility (ICC: 0.29) and slight for all other domains (ICC  0.20). EQ-5D Index and Quality Adjusted Life Year scores (proxy scores higher than residents) showed better agreement than EQ-5D-VAS (residents scores higher than proxy). HowRU showed only slight agreement (ICC  0.20) between residents and proxies. Staff and resident characteristics did not influence level of agreement for either index.
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    A Quality Improvement Collaborative Aiming for Proactive HEAlthcare of Older People in Care Homes (PEACH): a realist evaluation protocol
    (BMJ, 2018-11-12) Devi, R; Banerjee, J; Chadborn, N; Hinsliff-Smith, K.; Dening, T.; Goodman,; Gordon, Adam Lee; Meyer, J; Fletcher Gladman, J; Long, A.; Usman, A.; Housley, G.; Bowman, C; Martin, F; Logan, P; Lewis, S.
    Introduction This protocol describes a study of a Quality Improvement Collaborative (QIC) to support implementation and delivery of Comprehensive Geriatric Assessment (CGA) in UK care homes. The QIC will be formed of health and social care professionals working in and with care homes and will be supported by clinical, quality improvement, and research specialists. QIC participants will receive quality improvement training using the Model for Improvement. An appreciative approach to working with care homes will be encouraged through facilitated shared learning events, quality improvement coaching, and assistance with project evaluation. Methods and analysis The QIC will be delivered across a range of partnering organisations which plan, deliver and evaluate health services for care home residents in 4 local areas of one geographical region. A realist evaluation framework will be used to develop a programme theory informing how QICs are thought to work, for whom, and in what ways when used to implement and deliver CGA in care homes. Data collection will involve participant observations of the QIC over 18 months, and interviews/focus groups with QIC participants to iteratively define, refine, test, or refute the programme theory. Two researchers will analyse field notes, and interview/focus group transcripts, coding data using inductive and deductive analysis. The key findings and linked programme theory will be summarised as context-mechanism-outcome configurations (CMOs) describing what needs to be in place to use QICs to implement service improvements in care homes. Ethics and dissemination The study protocol was reviewed by the NHS Health Research Authority (London Bromley research ethics committee reference: 205840) and the University of Nottingham ethics committee (reference: LT07092016). Both determined that the PEACH study was as a service and quality improvement initiative. Findings will be shared nationally and internationally through conference presentations, publication in peer-reviewed journals, a graphic illustration, and a dissemination video.
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    USING INTERNATIONAL COLLABORATIONS TO SHAPE RESEARCH AND INNOVATION INTO CARE HOMES IN BRAZIL: A WHITE PAPER
    (Serdi Publisher, 2020) Hinsliff-Smith, K.; Jacinto, A.F.; Achterberg, W.; Wachholz, P.A.; Dening, T.
    The Brazilian care home sector is underdeveloped, and the limited available evidence suggests that care quality falls below international standards. Development of the Brazilian care home sector could be associated with better outcomes for those receiving care, and more efficient use of resources across health and social care. Research has an important role to play. This article summarises research priorities for Brazilian long-term care homes developed as part of an international workshop held in Brazil and the UK, and attended by 71 clinicians and researchers from 6 Brazilian Universities, supported by an international faculty of 8 Brazilian, 8 British, 2 Dutch and 1 Austrian academics. The research priorities identified were: understanding and supporting multidisciplinary working in care homes, with emphasis on describing availability of multidisciplinary teams and how they operate; dignity and sensitivity to cultural needs, with emphasis on collating accounts from Brazilian stakeholders about dignity in care and how it can be delivered; enriching the care home environment with art, music and gardens, with a focus on developing arts in the care home space in a way that is sensitive to Brazilian cultural identity; and benchmarking quality of care, with emphasis on exploring how international quality benchmarking tools can be adapted for use in Brazilian care homes, taking account of new initiatives to include person-centred outcomes as part of benchmarking. Instrumental to research in these priority areas will be establishing care home research capacity in Brazil.
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    What do we know about the application of the Mental Capacity Act (2005) in healthcare practice regarding decision making for frail and older people?: a systematic literature review
    (Wiley, 2015-11-26) Hinsliff-Smith, K.; Feakes, R.; Whitworth, G.; Maghaddam, N.; Cox, K.; Dening, T.; Seymour, Jane
    In England and Wales, decision‐making in cases of uncertain mental capacity is regulated by the Mental Capacity Act 2005. The Act provides a legal framework for decision‐making for adults (16 and over) who are shown to lack capacity and where best interest decisions need to be made on their behalf. Frail older people with cognitive impairments represent a growing demographic sector across England and Wales for whom the protective principles of the Act have great relevance, as they become increasingly dependent on the care of others. However, while the Act articulates core principles, applying the Act in everyday healthcare contexts raises challenges for care providers in terms of interpretation and application. This paper presents a review of the published evidence documenting the use of the Act in healthcare practice, with particular reference to frail older people. Our aim was to identify, review and critically evaluate published empirical studies concerned with the implementation and application of the Act in healthcare settings. A systematic approach was undertaken with pre‐determined exclusion and inclusion criteria applied across five electronic bibliographic databases combined with a manual search of specific journals. This review reports on 38 empirical sources which met the inclusion criteria published between 2005 and 2013. From the 38 sources, three descriptive themes were identified: knowledge and understanding, implementation and tensions in applying the Act, and alternative perspectives of the Act. There is a need for improved knowledge and conceptualisation to enable successful incorporation of the Act into everyday care provision. Inconsistencies in the application of the Act are apparent across a variety of care settings. This review suggest staff need more opportunities to engage, learn and implement the Act, in order for it to have greater resonance to their individual practice and ultimately benefit patient care.