The resident assessment instrument-minimum data set 2.0 quality indicators : a systematic review

Background
The Resident Assessment Instrument-Minimum Data Set (RAI-MDS) 2.0 is designed to collect the minimum amount of data to guide care planning and monitoring for residents in long-term care settings. These data have been used to compute indicators of care quality. Use of the quality indicators to inform quality improvement initiatives is contingent upon the validity and reliability of the indicators. The purpose of this review was to systematically examine published and grey research reports in order to assess the state of the science regarding the validity and reliability of the RAI-MDS 2.0 Quality Indicators (QIs).

Methods
We systematically reviewed the evidence for the validity and reliability of the RAI-MDS 2.0 QIs. A comprehensive literature search identified relevant original research published, in English, prior to December 2008. Fourteen articles and one report examining the validity and/or reliability of the RAI-MDS 2.0 QIs were included.

Results
The studies fell into two broad categories, those that examined individual quality indicators and those that examined multiple indicators. All studies were conducted in the United States and included from one to a total of 209 facilities. The number of residents included in the studies ranged from 109 to 5758. One study conducted under research conditions examined 38 chronic care QIs, of which strong evidence for the validity of 12 of the QIs was found. In response to these findings, the 12 QIs were recommended for public reporting purposes. However, a number of observational studies (n=13), conducted in "real world" conditions, have tested the validity and/or reliability of individual QIs, with mixed results. Ten QIs have been studied in this manner, including falls, depression, depression without treatment, urinary incontinence, urinary tract infections, weight loss, bedfast, restraint, pressure ulcer, and pain. These studies have revealed the potential for systematic bias in reporting, with under-reporting of some indicators and over-reporting of others.

Conclusion
Evidence for the reliability and validity of the RAI-MDS QIs remains inconclusive. The QIs provide a useful tool for quality monitoring and to inform quality improvement programs and initiatives. However, caution should be exercised when interpreting the QI results and other sources of evidence of the quality of care processes should be considered in conjunction with QI results.

Public sector residential aged care: identifying novel associations between quality indicators and other demographic and health-related factors

Objective : To explore associations among quality indicators (QI; e.g. pressure ulcers, falls and/or fractures, physical restraint, use of multiple medications, unplanned weight loss) of the Victorian Public Sector Residential Aged Care Services (VPSRACS) with other demographic and health-related factors.

Methods : Data for 380 residents over a 3-month period were extracted retrospectively from client databases at four VPSRAC facilities.

Results : Four significant logistic regression models were developed. The strongest models related to falls and polypharmacy. Significant associations for these models included the following: (1) residents with a higher body mass index were 6% less likely (95% confidence interval (CI) 1%–11%) to fall, whereas high levels of cognitive impairment increased the risk of falling by 8% (95% CI 2%–14%); (2) being ambulant with a gait aid more than doubled the risk of falling compared with non-ambulant residents (95% CI 19%–546%); and (3) higher cognitive impairment was associated with a 6% (95% CI 1%–11%) reduction in the likelihood of polypharmacy.

Conclusions : Identification of significant relationships between the VPSRACS QI and other demographic and health-related factors is a preliminary step towards a more in-depth understanding of the factors that influence the QI and predict adverse events.

Understanding meal patterns: definitions, methodology and impact on nutrient intake and diet quality

Traditionally, nutrition research has focused on individual nutrients, and more recently dietary patterns. However, there has been relatively little focus on dietary intake at the level of a 'meal'. The purpose of the present paper was to review the literature on adults' meal patterns, including how meal patterns have previously been defined and their associations with nutrient intakes and diet quality. For this narrative literature review, a comprehensive search of electronic databases was undertaken to identify studies in adults aged ≥  19 years that have investigated meal patterns and their association with nutrient intakes and/or diet quality. To date, different approaches have been used to define meals with little investigation of how these definitions influence the characterisation of meal patterns. This review identified thirty-four and fourteen studies that have examined associations between adults' meals patterns, nutrient intakes and diet quality, respectively. Most studies defined meals using a participant-identified approach, but varied in the additional criteria used to determine individual meals, snacks and/or eating occasions. Studies also varied in the types of meal patterns, nutrients and diet quality indicators examined. The most consistent finding was an inverse association between skipping breakfast and diet quality. No consistent association was found for other meal patterns, and little research has examined how meal timing is associated with diet quality. In conclusion, an understanding of the influence of different meal definitions on the characterisation of meal patterns will facilitate the interpretation of the existing literature, and may provide guidance on the most appropriate definitions to use.

Pilot study of an innovative model for clinical education in dietetics

Aim: To pilot and evaluate a new model of clinical dietetics education to address the sustainability of dietetic placements in the clinical setting.

Methods: Final-year dietetics students (n = 14) completed all nine weeks of clinical placement in the pilot program at two large tertiary referral and teaching health services in metropolitan Melbourne. Staff and students completed surveys about their experience within a week of completing placement. Data collected included paid and unpaid staff working hours, hours in clinical and teaching activity, hours of student attendance and student clinical work hours. Data for the last month of the placement programs in the preceding three years were used for comparison with the pilot program.

Results: Combined data for the two providers showed that the model reduced the amount of supervision hours per student hour on placement by 16% while maintaining quality indicators during the pilot compared with previous years. Students in the pilot program were more positive about their experience compared with students in the existing program. The overall trend of responses in the staff surveys was positive for the pilot program, but the trend was not as marked as that of student responses.

Conclusion: The new model of clinical dietetics education was successfully piloted and demonstrated the potential to increase student training capacity without a negative impact on student achievement or major resource demands. Refinements to the model and opportunities to enhance integration into the dietetics degree program were identified during the project. The learning needs of non-English-speaking background students require further scrutiny.

The development of biological objectives for streams in a single catchment: a case study on the catchment of western port bay, Victoria, Australia

Government environment protection policies for waterways have traditionally relied on water quality indicators and their objectives. In this paper we describe the development of biological objectives based on invertebrate indicators for inclusion in a government policy for the catchment of Western Port Bay, Victoria. The first step of defining segments (areas with streams in which the same objectives are applied) was problematic, requiring two different approaches, as follows. Site groups initially based on invertebrate community composition derived using multivariate techniques (ordination and classification) proved to be unsuitable for policy segments. Segment boundaries were subsequently defined using topographical (e.g. boundary of foothills and lowland plains), climate (e.g. rainfall) and land-use (e.g. urban) features. We used information and data from reference sites inside as well outside the catchment to derive specific biological objectives based on aquatic invertebrates for these segments. Objectives were specified for the following four indicators – number of invertebrate families, the SIGNAL index, the AUSRIVAS predictive model and the number of key families.

Optimisation and analysis of three polymerase chain reaction (PCR) systems for the detection of environmentally significant microorganisms

Conventional assessments of water quality are based on the determination of bacterial indicator numbers. The detection of an indicator organism only provides presumptive evidence of the presence of harmful organisms By using polymerase chain reaction (PCR) to monitor water quality, indicators and pathogenic organisms can be specifically detected with a high sensitivity. The research illustrates the importance of optimisation and the maintenance of reaction efficiency in the accuracy and precision of the PCR.

‘Inspired and assisted’, or ‘berated and destroyed’? Research leadership, management and performativity in troubled times

Research leadership in Australian universities takes place against a backdrop of policy reforms concerned with measurement and comparison of institutional research performance. In particular, the Excellence in Research in Australian initiative undertaken by the Australian Research Council sets out to evaluate research quality in Australian universities, using a combination of expert review process, and assessment of performance against ‘quality indicators’. Benchmarking exercises of this sort continue to shape institutional policy and practice, with inevitable effects on the ways in which research leadership, mentoring and practice are played out within university faculties and departments. In an exploratory study that interviewed 32 Australian academics in universities in four Australian states, we asked participants, occupying formal or informal research leadership roles, to comment on their perceptions of research leadership as envisioned and enacted in their particular workplaces. We found a pervasive concern amongst participants that coalesced around binaries characterized in metaphoric terms of ‘carrots and whips’. Research leadership was seen by many as managerial in nature, and as such, largely tethered to instrumentalist notions of productivity and performativity, while research cultures were seen as languishing under the demoralizing weight of reward and punishment systems. Here, we consider what is at stake for the future of the academic workforce under such conditions, arguing that new models of visionary research leadership are urgently needed in the ‘troubled times’ of techno-bureaucratic university reforms.

Development of a tool for evaluation of academic library spaces (TEALS) (0242)

The paper provides a brief description of the tool for evaluating the quality and utilisation of academic library spaces (TEALS). Supported by Deakin University Library, TEALS has been developed out of a research project in the School of Architecture and Building, Deakin University, Geelong Waterfront Campus. The tool is intended to establish the setting for evaluation of physical spaces at different phases of development of new academic library spaces and refurbishment of existing ones as well as throughout the life of buildings. The methodological framework of the tool consists of four key elements; establishing Criteria of Quality (CoQ), determining Quality Indicators, evaluating library spaces against QIs and interpreting results for future improvements. The characteristics that distinguish TEALS from existing evaluation models include adopting an approach that focus on people (students, faculty and library staff), acting as a “reflective” and “empowering” tool and being user-friendly, quick and easy to use.

'I'm a sick person, not a bad person': patient experiences of treatments for alcohol use disorders

BACKGROUND: Emerging research indicates that standard treatments for alcohol use disorders may not fully meet the needs of patients with co-occurring severe mental health symptoms. Investigating health quality indicators may provide insight into how current treatment might be improved.

OBJECTIVE: To better understand the experiences of patients receiving treatment for alcohol use disorders and compare the experiences of patients with and without co-occurring severe mental health symptoms.

DESIGN: Cross-sectional qualitative research design using semi-structured interviews methods and framework analysis approach.

SETTING: Inpatient hospital, outpatient service, inpatient detoxification clinic and a residential/ therapeutic community.

PARTICIPANT'S: Thirty-four patients receiving treatment for an alcohol use disorder.

MAIN VARIABLES STUDIED: Themes relating to patients' experiences of continuity of care, treatment need and satisfaction with treatment were studied. The qualitative data were divided into two groups: patients with (n = 15) and without (n = 19) severe mental health symptoms.

RESULTS: Five themes relating to patient satisfaction with treatment were identified, including: perceived effectiveness of treatment, supportive relationships, specialized but holistic care, patient autonomy and continuity of care. A diverse range of patient treatment needs, staff and service continuity and stigma were also identified as major themes. Five basic themes were identified as more critical to the experiences of patients with severe mental health symptoms.

DISCUSSION AND CONCLUSIONS: Findings suggest that patients look for supportive relationships with others, to be involved in treatment decisions, effective specialized and holistic approaches to care and a non-judgemental treatment environment.

Quality in disability service - whose indicators?

The study identified indicators of disability service quality used by three stakeholder groups (service users, providers and managers) in order to develop an explanatory schema regarding stakeholders' perceptions of quality and its indicators. The different perspectives were identified and the emerging quality indicator framework had a complex socio-ecological basis.

Land use, water quality and ecological responses in Lake Colac – trends from Australia

Purpose - Recently, Colac Otway Shire in Australia released its management plan for Lake Colac, claiming over-enrichment of the lake with nutrients and degraded water quality. This paper aims to investigate these claims by establishing a correlation between key water and ecological indicators and land uses.

Design/methodology/approach - Examines the correlation between impairment and stressors in Lake Colac. This was achieved by identifying the likely sources of pollutants into Lake Colac; identifying any existing monitoring program; and characterizing the water and sediment inputs. The likely impacts of increased nutrients and sediment levels on indigenous flora and fauna were also examined. The use of meiofauna (very small benthic metazoan animals) was investigated as an indicator of degraded sites. Plankton diversity as a measure of water health was also assessed.

Findings - Water quality in Lake Colac was found to vary both temporally and spatially, and exhibited low attainment against acceptable trigger values/objectives. At current levels the lake can be classified as poorly degraded. Likely sources of pollution were identified to be related to land uses in the catchments. The biota of the lake, investigated at four study sites, yielded a sparse, benthic macrofaunal assemblage that was dominated by oligochaetes. In contrast, an abundant and taxonomically diverse meiofaunal assemblage was noted. Future meiofaunal analyses are likely to resolve suitable biotic indicator species of free-living nematodes in response to land use and waterway threats specified in the study. Originality value - This work will provide a better understanding of integrated environmental systems to enable development of best management practices, thus transforming the way the land and water are used in the future. Following the present work, other key water and ecological indicators (increased dispersion and dominance of biological species) at five additional sites were studied. Alternative management options for the effluent generated at Colac Sewage Treatment Plant and possible ecological effects of each option were also evaluated. More recently, a sediment characterization study was also carried out at sensitive sites representative of locations where build up of sediments and algae outbreaks are reported. This will enable classification of sediment and evaluation of dredging options.

A longitudinal evaluation of nursing home care quality in Taiwan

Aging populations worldwide have important implications for elderly care composition and quality, particularly with regard to care provided by nursing homes. Our study investigated quality of nursing home care in Taiwan using resident satisfaction and clinical outcomes as indicators.
We randomly recruited 306 residents in 13 nursing homes and assessed them at initial, 3, 6, and 12-months follow-up. The outcomes of the nursing home care in the 12-month follow-up period showed significant decreases in pressure sores and moderate satisfaction of nursing home care, but increases in physical restraints and psychological loneliness. Study results suggest that longterm nursing home care may improve residents' quality of life. However, to achieve this, nursing homes must provide improved psychological support for residents and decrease the use ofphysical
restraints.

Social indicators and social development

This paper concerns the use of social indicators to improve social development and the happiness of populations. A distinction will be drawn between the traditional indicators of wealth and health and the new subjective social indicators. These latter measures concern the subjective side of life quality, or happiness, which in contemporary science is more commonly referred to as subjective wellbeing (SWB). The SWB construct is described within the theoretical context of SWB homeostasis. This is a proposed management system which has the role of maintaining a positive view of the self. It will be described how the homeostatic system can be challenged by hardship and defended by a variety of resources. Recommended forms of SWB measurement will be considered. It is concluded that both objective and subjective social indicators should be consulted by policy makers in order to plan the most effective initiatives to enhance population wellbeing.