Browsing by Author "Gladman, J.R.F."

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    How Quality Improvement Collaboratives Work to Improve Healthcare in Care Homes: A Realist Evaluation
    (Oxford University Press, 2021-02-16) Hinsliff-Smith, K.; Devi, Reena; Gordon, Adam; Chadborn, Neil; Goodman, Claire; Meyer, Julienne; Dening, Tom; Housley, Gemma; Long, Annabelle; Lewis, Sarah; Banerjee, J.; Gladman, J.R.F.; Long, A.; Usman, A.; Housley, G.; Glover, M.; Gage, H.; Logan, P.A.; Martin, F.C.; Gordon, Adam Lee
    Background Quality Improvement Collaboratives (QICs) bring together multidisciplinary teams in a structured process to improve care quality. How QICs can be used to support healthcare improvement in care homes is not fully understood. Methods A realist evaluation to develop and test a programme theory of how QICs work to improve healthcare in care homes. A multiple case study design considered implementation across 4 sites and 29 care homes. Observations, interviews and focus groups captured contexts and mechanisms operating within QICs. Data analysis classified emerging themes using context-mechanism-outcome configurations to explain how NHS and care home staff work together to design and implement improvement. Results QICs will be able to implement and iterate improvements in care homes where they: have a broad and easily understandable remit; recruit staff with established partnership working between the NHS and care homes; use strategies to build relationships and minimise hierarchy; protect and pay for staff time; enable staff to implement improvements aligned with existing work; help members develop plans in manageable chunks through QI coaching; encourage QIC members to recruit multidisciplinary support through existing networks; facilitate meetings in care homes; and use shared learning events to build multidisciplinary interventions stepwise. Teams did not use measurement for change, citing difficulties integrating this into pre-existing and QI-related workload. Conclusions These findings outline what needs to be in place for health and social care staff to work together to effect change. Further research needs to consider ways to work alongside staff to incorporate measurement for change into QI.
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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.