72.0% of the variance and partially deviated from original CBI dimensions. Results suggest that t... more 72.0% of the variance and partially deviated from original CBI dimensions. Results suggest that the CBI may be a valid measure of the MCI caregiver's experience of burden. The newly emerged constructs-"expectations of the future" and "relationship strain"-are relevant to caregivers intervening in the early phase of cognitive impairment. Future directions include additional CBI validation with confirmatory factor analysis in a separate MCI caregiver sample.
The purpose of this study was to obtain information on the perceptions of persons with diabetes r... more The purpose of this study was to obtain information on the perceptions of persons with diabetes regarding participation in a tele-health program. We conducted three focus groups among diabetics who had used a monitoring and messaging device (MMD), a commonly used tele-health care system. Analysis involved open and axial coding to identify major themes and relationships. Results suggest that these systems enhance communication, care-manager relationships, self-discipline, and clinical follow-up. The results suggest mechanisms by which tele-health systems influence the health care system and point to areas for further tele-health development.
The growing number of older adults with heart failure (HF) suggests the need for more information... more The growing number of older adults with heart failure (HF) suggests the need for more information about how people with this condition experience their illness and strategies for coping with this condition. To address this need, the authors conducted a systematic review of the literature and an in-depth, thematic analysis of qualitative first-person accounts on the lived experience of HF. Results suggest that people with HF face many challenges, including those associated with the formal health care system, life disruption, social isolation, symptoms, and uncertainty about prognosis and symptoms. Coping strategies include HF management, dealing with the dying process, and social support. Social workers, who encounter people with HF in a variety of practice settings, can play a key role by focusing on the needs of people with HF, addressing and strengthening their ability to manage their condition, facilitating social support, and helping them to cope with the dying process. Greater attention to these issues in the social work literature is needed, with a particular focus on the role of racial and ethnic diversity as they pertain to people with HF facing end-of-life issues.
Purpose: To explore a self-report measure of social network features among a sample of older peop... more Purpose: To explore a self-report measure of social network features among a sample of older people living with multiple chronic conditions based on the conceptual model of Social Network Influences on Health. Design: A cross-sectional descriptive study design using a telephone survey methodology was used. Methods: An exploratory principle component analysis with a varimax rotation was performed on items that measured the identified components (reciprocity, size, proximity, density, general activation, activation when sick, duration, closeness, involvement in health, interaction frequency) of social networks. All items were standardized prior to analyses. Results: Self-report social network data were collected from eighty-four older people living in the community and managing multiple chronic conditions. The principal components model, operationalized as tie strength, contained six items based on factorability: reciprocity, social network size, proximity, density and perception of the activation in general and when sick of close social network members. Results yielded acceptable factorability (KMO = 0.781, Bartlett p 0.70). Two components that had eigenvalues greater than 1.0, explained 61.7% of the total variance. The first factor was interpreted as total social network resources, while the second factor was identified as social network availability. Conclusion: Exploratory principal component analysis supports a measure of social network features, tie strength, that can be tested in future studies. Assessing these variables is useful in identifying specific relationship features critical to managing chronic conditions in older age and advances current measurement of social networks important to living well in older age.
This article describes the role of social workers in addressing the needs of people with heart fa... more This article describes the role of social workers in addressing the needs of people with heart failure. Although previous studies have explored the role of social workers in health care settings, few studies have addressed the challenges of specific chronic diseases such as heart failure. To address this gap in the literature, this study used qualitative interviews with health care social workers (n = 8) to obtain in-depth information about activities and challenges related to heart failure care. Findings suggest that health care social workers perceive heart failure as characterized by an uncertain illness trajectory, frequent hospitalizations, and difficulties accessing formal and informal care. These findings suggest the importance of what we term illness-informed social work, a practice that combines heart failure knowledge with so cial work competencies to address the complex psychosocial issues in heart failure care.
Journal of Gerontological Social Work, Dec 30, 2013
To address the need for more information concerning hospital decision making, we conducted in-dep... more To address the need for more information concerning hospital decision making, we conducted in-depth interviews among African Americans with heart failure and their family caregivers (n=11 dyads). Using a case scenario, we asked participants about their anticipated hospitalization decisions. Most patients indicated that they would seek care to avoid further deterioration or death from their worsening condition. Many family caregivers anticipated having an active influence on hospitalization decisions. Findings suggest that social workers should encourage the development of adequate home-based services, recognize diverse communication styles, and use this information to facilitate medical decision making by these patients and their caregivers.
American Journal of Hospice and Palliative Medicine, Feb 6, 2017
Background: Home-based palliative care programs have shown value in improving quality of care and... more Background: Home-based palliative care programs have shown value in improving quality of care and lowering costs for seriously ill patients. It is unknown what specific elements of these programs matter most to patients and caregivers. Aim: To identify what services are critical and why they matter to patients in a home-based palliative program. Setting/Participants: A mixed methods study of 18 participants in the At Home Support (AHS) program in Southeast Michigan. Measurements: Two semistructured interviews were conducted for each participant, one while enrolled in AHS and another 3 months after the program ended to elicit the impact of AHS on their care. Qualitative theme data were merged with quantitative data on demographics, social and financial resources, symptoms, medical conditions, functional status, and utilization of health care while in AHS. Results: Four major themes of critical services reported by distinct populations of participants were described-medical support, endorsed by nearly every participant; emotional and spiritual support, endorsed by those with serious illness and symptom burden; practical assistance, endorsed by those with functional disability and isolation; and social services, endorsed by those in poverty. Medical monitoring was also described as critical but only by healthier participants. Conclusion: This study presents a conceptual model of the critical services in home-based palliative care and why these services are important to high-risk patients. This model may be used to guide further research and evaluation work on the benefits of home-based palliative care.
Background: Given the volume and cost of inpatient care during the last year of life, there is a ... more Background: Given the volume and cost of inpatient care during the last year of life, there is a critical need to identify patterns of dying as a means of planning end-of-life care services, especially for the growing number of older persons who receive services from the Veterans Health Administration (VHA). Methods: A retrospective computerized record review was conducted of 20,933 VHA patients who died as inpatients between October 1, 2001 and September 30, 2002. Diagnoses were aggregated into one of five classification patterns of death and analyzed in terms of health care resource utilization (mean number of inpatient days and cumulative outpatient visits in the year preceding the patient's death). Results: Cancer deaths were the most common (30.4%) followed by end-stage renal disease (ESRD) (23.2%), cardiopulmonary failure (21.4%), frailty (11.6%), "other" diagnoses (7.3%), and sudden deaths (6.1%). Those with ESRD were more likely to be male and nonwhite (p Ͻ 0.05) and those with frailty were more likely to be older and married (p Ͻ 0.05). Controlling for demographic variables, those with frailty had the highest number of inpatient days while those with ESRD had the highest number of outpatient visits. Nonmarried status was associated with more inpatient days, especially among younger decedents. Conclusion: As a recognized leader in end-of-life care, the VHA can play a unique role in the development of specific interventions that address the diverse needs of persons with different dying trajectories identified through this research.
This study addresses the need for more information about how urban African-American elders experi... more This study addresses the need for more information about how urban African-American elders experience advanced heart failure. Participants included 35 African Americans aged 60 and over with advanced heart failure, identified through records from a community hospital in Detroit, Michigan. Four focus groups (n = 13) and 22 individual interviews were conducted. We used thematic analysis to examine qualitative focus groups and interviews. Themes identified included life disruption, which encompassed the sub-themes of living scared, making sense of heart failure, and limiting activities. Resuming life was a contrasting theme involving culturally relevant coping strategies, and included the sub-themes of resiliency, spirituality, and self-care that helped patients regain and maintain a sense of self amid serious illness. Participants faced numerous challenges and invoked a variety of strategies to cope with their illness, and their stories of struggles, hardship, and resilience can serve as a model for others struggling with advanced illness.
This study examined the prediction of preoperative faith factors for perceived spiritual support,... more This study examined the prediction of preoperative faith factors for perceived spiritual support, indicating existential relationship as a dimension of eudemonic well-being (EWB), at 30 months after cardiac surgery ( N=226). The study capitalized on data from preoperative surveys and the Society of Thoracic Surgeons’ National Database. Controlling for demographics, cardiac indices, and mental health, hierarchical regression showed that preoperative prayer coping, subjective religiousness, and internal control were positive predictors of spiritual support. Negative religious coping was a negative predictor. Internal control mediated the role of positive religious coping. Certain faith-based experiences may enhance aspects of EWB, but future research should investigate mechanisms.
Background: Monitoring and Messaging Devices (MMDs) are telehealth systems used by patients in th... more Background: Monitoring and Messaging Devices (MMDs) are telehealth systems used by patients in their homes, and are designed to promote patient self-management, patient education, and clinical monitoring and follow-up activities. Although these systems have been widely promoted by health care systems, including the Veterans Health Administration, very little information is available on factors that facilitate use of the MMD system, or on barriers to use. Methods: We conducted in-depth qualitative interviews with clinicians using MMD-based telehealth programs at two Veterans Affairs Medical Centers in the Midwestern United States. Results: Findings suggest that MMD program enrollment is limited by both clinical and non-clinical factors, and that patients have varying levels of program participation and system use. Telehealth providers see MMDs as a useful tool for monitoring patients who are interested in working on management of their disease, but are concerned with technical challenges and the time commitment required to use MMDs. Conclusion: Telehealth includes a rapidly evolving and potentially promising range of technologies for meeting the growing number of patients and clinicians who face the challenges of diabetes care, and future research should explore the most effective means of ensuring successful program implementation. Background Diabetes is a condition with serious consequences for morbidity, mortality, and the use of health care resources. Many persons with diabetes struggle to maintain selfmanagement practices such as attending to glucose levels, blood pressure, and medication management [1-4]. Home-based interventions that make use of innovative communication technologies have been suggested as a means of improving diabetes management [5,6], and home telehealth programs have been promoted as a means of improving chronic care management by offering patient education, promoting self-care practices, and
We used qualitative interviews to examine the perceptions of direct providers of telemedicine ser... more We used qualitative interviews to examine the perceptions of direct providers of telemedicine services, primary care providers (PCPs) and hospital administrators about opportunities and barriers to the implementation of telemedicine services in a network of Veterans Health Administration hospitals. A total of 37 interviews were conducted (response rate of 28%) with 17 direct telemedicine providers, nine PCPs and 11 administrators. The overall inter-coder reliability across all themes was high (Scott's pi = 0.94). Direct telemedicine providers generally agreed that telemedicine improved rapport with patients, and respondents in all three groups generally agreed that telemedicine improves access, productivity, and the quality and coordination of care. Respondents mentioned several benefits to home telemedicine, including the ability to better manage chronic diseases, provide frequent clinician contact, facilitate quick responses to patient needs and provide care in patient's homes. Most respondents anticipated future growth in telemedicine services. Barriers to telemedicine implementation included technical challenges, the need for more education and training for patients and staff, preferences for in-person care, the need for programme improvement and the need for additional staff time to provide telemedicine services.
Background: Along with the increasing prevalence of chronic illness has been an increase in inter... more Background: Along with the increasing prevalence of chronic illness has been an increase in interventions, such as nurse case management programs, to improve outcomes for patients with chronic illness. Evidence supports the effectiveness of such interventions in reducing patient morbidity, mortality, and resource utilization, but other studies have produced equivocal results. Often, little is known about how implementation of an intervention actually occurs in clinical practice. While studies often assume that interventions are used in clinical practice exactly as originally designed, this may not be the case. Thus, fidelity of an intervention's implementation reflects how an intervention is, or is not, used in clinical practice and is an important factor in understanding intervention effectiveness and in replicating the intervention in dissemination efforts. The purpose of this paper is to contribute to the understanding of implementation science by (a) proposing a methodology for measuring fidelity of implementation (FOI) and (b) testing the measure by examining the association between FOI and intervention effectiveness. Methods: We define and measure FOI based on organizational members' level of commitment to using the distinct components that make up an intervention as they were designed. Semistructured interviews were conducted among 18 organizational members in four medical centers, and the interviews were analyzed qualitatively to assess three dimensions of commitment to use-satisfaction, consistency, and quality-and to develop an overall rating of FOI. Mixed methods were used to explore the association between FOI and intervention effectiveness (inpatient resource utilization and mortality). Results: Predictive validity of the FOI measure was supported based on the statistical significance of FOI as a predictor of intervention effectiveness. The strongest relationship between FOI and intervention effectiveness was found when an alternative measure of FOI was utilized based on individual intervention components that had the greatest variation across medical centers. Conclusions: In addition to contextual factors, implementation research needs to consider FOI as an important factor in influencing intervention effectiveness. Our proposed methodology offers a systematic means for understanding organizational members' use of distinct intervention components, assessing the reasons for variation in use across components and organizations, and evaluating the impact of FOI on intervention effectiveness.
included six competency-aligned educational modules with videos and interactive exercises that en... more included six competency-aligned educational modules with videos and interactive exercises that encourage reflection. Kirkpatrick Barr's healthcare training evaluation framework underpinned our mixed methods evaluation. We measured participant's reaction to the education (Level 1) and changes in learner's knowledge and confidence to work with FCGs (Level 2). Results: 352 healthcare providers completed the education online (caregivercare.ca). Learners were satisfied with quality of education (Mean 4.75/5; SD=.5) and the education increased their motivation to learn more about caregiver-centered care (Mean 4.75/5; SD .5). Student's paired samples T-test indicates pre-post education changes in knowledge and confidence to work with FCGs were significant [Pre (M=37.8, Sd=7.6) to post (M=47.2, SD=3.5) t (125) =-14.39, p<.0005 (two-tailed)]. Qualitative results derived from open responses mirrored the quantitative results. Conclusion: The Caregiver-Centered Care education provides a foundation for educating healthcare providers working with FCGs to provide care to FCGs to maintain their wellbeing and sustain care.
72.0% of the variance and partially deviated from original CBI dimensions. Results suggest that t... more 72.0% of the variance and partially deviated from original CBI dimensions. Results suggest that the CBI may be a valid measure of the MCI caregiver's experience of burden. The newly emerged constructs-"expectations of the future" and "relationship strain"-are relevant to caregivers intervening in the early phase of cognitive impairment. Future directions include additional CBI validation with confirmatory factor analysis in a separate MCI caregiver sample.
The purpose of this study was to obtain information on the perceptions of persons with diabetes r... more The purpose of this study was to obtain information on the perceptions of persons with diabetes regarding participation in a tele-health program. We conducted three focus groups among diabetics who had used a monitoring and messaging device (MMD), a commonly used tele-health care system. Analysis involved open and axial coding to identify major themes and relationships. Results suggest that these systems enhance communication, care-manager relationships, self-discipline, and clinical follow-up. The results suggest mechanisms by which tele-health systems influence the health care system and point to areas for further tele-health development.
The growing number of older adults with heart failure (HF) suggests the need for more information... more The growing number of older adults with heart failure (HF) suggests the need for more information about how people with this condition experience their illness and strategies for coping with this condition. To address this need, the authors conducted a systematic review of the literature and an in-depth, thematic analysis of qualitative first-person accounts on the lived experience of HF. Results suggest that people with HF face many challenges, including those associated with the formal health care system, life disruption, social isolation, symptoms, and uncertainty about prognosis and symptoms. Coping strategies include HF management, dealing with the dying process, and social support. Social workers, who encounter people with HF in a variety of practice settings, can play a key role by focusing on the needs of people with HF, addressing and strengthening their ability to manage their condition, facilitating social support, and helping them to cope with the dying process. Greater attention to these issues in the social work literature is needed, with a particular focus on the role of racial and ethnic diversity as they pertain to people with HF facing end-of-life issues.
Purpose: To explore a self-report measure of social network features among a sample of older peop... more Purpose: To explore a self-report measure of social network features among a sample of older people living with multiple chronic conditions based on the conceptual model of Social Network Influences on Health. Design: A cross-sectional descriptive study design using a telephone survey methodology was used. Methods: An exploratory principle component analysis with a varimax rotation was performed on items that measured the identified components (reciprocity, size, proximity, density, general activation, activation when sick, duration, closeness, involvement in health, interaction frequency) of social networks. All items were standardized prior to analyses. Results: Self-report social network data were collected from eighty-four older people living in the community and managing multiple chronic conditions. The principal components model, operationalized as tie strength, contained six items based on factorability: reciprocity, social network size, proximity, density and perception of the activation in general and when sick of close social network members. Results yielded acceptable factorability (KMO = 0.781, Bartlett p 0.70). Two components that had eigenvalues greater than 1.0, explained 61.7% of the total variance. The first factor was interpreted as total social network resources, while the second factor was identified as social network availability. Conclusion: Exploratory principal component analysis supports a measure of social network features, tie strength, that can be tested in future studies. Assessing these variables is useful in identifying specific relationship features critical to managing chronic conditions in older age and advances current measurement of social networks important to living well in older age.
This article describes the role of social workers in addressing the needs of people with heart fa... more This article describes the role of social workers in addressing the needs of people with heart failure. Although previous studies have explored the role of social workers in health care settings, few studies have addressed the challenges of specific chronic diseases such as heart failure. To address this gap in the literature, this study used qualitative interviews with health care social workers (n = 8) to obtain in-depth information about activities and challenges related to heart failure care. Findings suggest that health care social workers perceive heart failure as characterized by an uncertain illness trajectory, frequent hospitalizations, and difficulties accessing formal and informal care. These findings suggest the importance of what we term illness-informed social work, a practice that combines heart failure knowledge with so cial work competencies to address the complex psychosocial issues in heart failure care.
Journal of Gerontological Social Work, Dec 30, 2013
To address the need for more information concerning hospital decision making, we conducted in-dep... more To address the need for more information concerning hospital decision making, we conducted in-depth interviews among African Americans with heart failure and their family caregivers (n=11 dyads). Using a case scenario, we asked participants about their anticipated hospitalization decisions. Most patients indicated that they would seek care to avoid further deterioration or death from their worsening condition. Many family caregivers anticipated having an active influence on hospitalization decisions. Findings suggest that social workers should encourage the development of adequate home-based services, recognize diverse communication styles, and use this information to facilitate medical decision making by these patients and their caregivers.
American Journal of Hospice and Palliative Medicine, Feb 6, 2017
Background: Home-based palliative care programs have shown value in improving quality of care and... more Background: Home-based palliative care programs have shown value in improving quality of care and lowering costs for seriously ill patients. It is unknown what specific elements of these programs matter most to patients and caregivers. Aim: To identify what services are critical and why they matter to patients in a home-based palliative program. Setting/Participants: A mixed methods study of 18 participants in the At Home Support (AHS) program in Southeast Michigan. Measurements: Two semistructured interviews were conducted for each participant, one while enrolled in AHS and another 3 months after the program ended to elicit the impact of AHS on their care. Qualitative theme data were merged with quantitative data on demographics, social and financial resources, symptoms, medical conditions, functional status, and utilization of health care while in AHS. Results: Four major themes of critical services reported by distinct populations of participants were described-medical support, endorsed by nearly every participant; emotional and spiritual support, endorsed by those with serious illness and symptom burden; practical assistance, endorsed by those with functional disability and isolation; and social services, endorsed by those in poverty. Medical monitoring was also described as critical but only by healthier participants. Conclusion: This study presents a conceptual model of the critical services in home-based palliative care and why these services are important to high-risk patients. This model may be used to guide further research and evaluation work on the benefits of home-based palliative care.
Background: Given the volume and cost of inpatient care during the last year of life, there is a ... more Background: Given the volume and cost of inpatient care during the last year of life, there is a critical need to identify patterns of dying as a means of planning end-of-life care services, especially for the growing number of older persons who receive services from the Veterans Health Administration (VHA). Methods: A retrospective computerized record review was conducted of 20,933 VHA patients who died as inpatients between October 1, 2001 and September 30, 2002. Diagnoses were aggregated into one of five classification patterns of death and analyzed in terms of health care resource utilization (mean number of inpatient days and cumulative outpatient visits in the year preceding the patient's death). Results: Cancer deaths were the most common (30.4%) followed by end-stage renal disease (ESRD) (23.2%), cardiopulmonary failure (21.4%), frailty (11.6%), "other" diagnoses (7.3%), and sudden deaths (6.1%). Those with ESRD were more likely to be male and nonwhite (p Ͻ 0.05) and those with frailty were more likely to be older and married (p Ͻ 0.05). Controlling for demographic variables, those with frailty had the highest number of inpatient days while those with ESRD had the highest number of outpatient visits. Nonmarried status was associated with more inpatient days, especially among younger decedents. Conclusion: As a recognized leader in end-of-life care, the VHA can play a unique role in the development of specific interventions that address the diverse needs of persons with different dying trajectories identified through this research.
This study addresses the need for more information about how urban African-American elders experi... more This study addresses the need for more information about how urban African-American elders experience advanced heart failure. Participants included 35 African Americans aged 60 and over with advanced heart failure, identified through records from a community hospital in Detroit, Michigan. Four focus groups (n = 13) and 22 individual interviews were conducted. We used thematic analysis to examine qualitative focus groups and interviews. Themes identified included life disruption, which encompassed the sub-themes of living scared, making sense of heart failure, and limiting activities. Resuming life was a contrasting theme involving culturally relevant coping strategies, and included the sub-themes of resiliency, spirituality, and self-care that helped patients regain and maintain a sense of self amid serious illness. Participants faced numerous challenges and invoked a variety of strategies to cope with their illness, and their stories of struggles, hardship, and resilience can serve as a model for others struggling with advanced illness.
This study examined the prediction of preoperative faith factors for perceived spiritual support,... more This study examined the prediction of preoperative faith factors for perceived spiritual support, indicating existential relationship as a dimension of eudemonic well-being (EWB), at 30 months after cardiac surgery ( N=226). The study capitalized on data from preoperative surveys and the Society of Thoracic Surgeons’ National Database. Controlling for demographics, cardiac indices, and mental health, hierarchical regression showed that preoperative prayer coping, subjective religiousness, and internal control were positive predictors of spiritual support. Negative religious coping was a negative predictor. Internal control mediated the role of positive religious coping. Certain faith-based experiences may enhance aspects of EWB, but future research should investigate mechanisms.
Background: Monitoring and Messaging Devices (MMDs) are telehealth systems used by patients in th... more Background: Monitoring and Messaging Devices (MMDs) are telehealth systems used by patients in their homes, and are designed to promote patient self-management, patient education, and clinical monitoring and follow-up activities. Although these systems have been widely promoted by health care systems, including the Veterans Health Administration, very little information is available on factors that facilitate use of the MMD system, or on barriers to use. Methods: We conducted in-depth qualitative interviews with clinicians using MMD-based telehealth programs at two Veterans Affairs Medical Centers in the Midwestern United States. Results: Findings suggest that MMD program enrollment is limited by both clinical and non-clinical factors, and that patients have varying levels of program participation and system use. Telehealth providers see MMDs as a useful tool for monitoring patients who are interested in working on management of their disease, but are concerned with technical challenges and the time commitment required to use MMDs. Conclusion: Telehealth includes a rapidly evolving and potentially promising range of technologies for meeting the growing number of patients and clinicians who face the challenges of diabetes care, and future research should explore the most effective means of ensuring successful program implementation. Background Diabetes is a condition with serious consequences for morbidity, mortality, and the use of health care resources. Many persons with diabetes struggle to maintain selfmanagement practices such as attending to glucose levels, blood pressure, and medication management [1-4]. Home-based interventions that make use of innovative communication technologies have been suggested as a means of improving diabetes management [5,6], and home telehealth programs have been promoted as a means of improving chronic care management by offering patient education, promoting self-care practices, and
We used qualitative interviews to examine the perceptions of direct providers of telemedicine ser... more We used qualitative interviews to examine the perceptions of direct providers of telemedicine services, primary care providers (PCPs) and hospital administrators about opportunities and barriers to the implementation of telemedicine services in a network of Veterans Health Administration hospitals. A total of 37 interviews were conducted (response rate of 28%) with 17 direct telemedicine providers, nine PCPs and 11 administrators. The overall inter-coder reliability across all themes was high (Scott&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s pi = 0.94). Direct telemedicine providers generally agreed that telemedicine improved rapport with patients, and respondents in all three groups generally agreed that telemedicine improves access, productivity, and the quality and coordination of care. Respondents mentioned several benefits to home telemedicine, including the ability to better manage chronic diseases, provide frequent clinician contact, facilitate quick responses to patient needs and provide care in patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s homes. Most respondents anticipated future growth in telemedicine services. Barriers to telemedicine implementation included technical challenges, the need for more education and training for patients and staff, preferences for in-person care, the need for programme improvement and the need for additional staff time to provide telemedicine services.
Background: Along with the increasing prevalence of chronic illness has been an increase in inter... more Background: Along with the increasing prevalence of chronic illness has been an increase in interventions, such as nurse case management programs, to improve outcomes for patients with chronic illness. Evidence supports the effectiveness of such interventions in reducing patient morbidity, mortality, and resource utilization, but other studies have produced equivocal results. Often, little is known about how implementation of an intervention actually occurs in clinical practice. While studies often assume that interventions are used in clinical practice exactly as originally designed, this may not be the case. Thus, fidelity of an intervention's implementation reflects how an intervention is, or is not, used in clinical practice and is an important factor in understanding intervention effectiveness and in replicating the intervention in dissemination efforts. The purpose of this paper is to contribute to the understanding of implementation science by (a) proposing a methodology for measuring fidelity of implementation (FOI) and (b) testing the measure by examining the association between FOI and intervention effectiveness. Methods: We define and measure FOI based on organizational members' level of commitment to using the distinct components that make up an intervention as they were designed. Semistructured interviews were conducted among 18 organizational members in four medical centers, and the interviews were analyzed qualitatively to assess three dimensions of commitment to use-satisfaction, consistency, and quality-and to develop an overall rating of FOI. Mixed methods were used to explore the association between FOI and intervention effectiveness (inpatient resource utilization and mortality). Results: Predictive validity of the FOI measure was supported based on the statistical significance of FOI as a predictor of intervention effectiveness. The strongest relationship between FOI and intervention effectiveness was found when an alternative measure of FOI was utilized based on individual intervention components that had the greatest variation across medical centers. Conclusions: In addition to contextual factors, implementation research needs to consider FOI as an important factor in influencing intervention effectiveness. Our proposed methodology offers a systematic means for understanding organizational members' use of distinct intervention components, assessing the reasons for variation in use across components and organizations, and evaluating the impact of FOI on intervention effectiveness.
included six competency-aligned educational modules with videos and interactive exercises that en... more included six competency-aligned educational modules with videos and interactive exercises that encourage reflection. Kirkpatrick Barr's healthcare training evaluation framework underpinned our mixed methods evaluation. We measured participant's reaction to the education (Level 1) and changes in learner's knowledge and confidence to work with FCGs (Level 2). Results: 352 healthcare providers completed the education online (caregivercare.ca). Learners were satisfied with quality of education (Mean 4.75/5; SD=.5) and the education increased their motivation to learn more about caregiver-centered care (Mean 4.75/5; SD .5). Student's paired samples T-test indicates pre-post education changes in knowledge and confidence to work with FCGs were significant [Pre (M=37.8, Sd=7.6) to post (M=47.2, SD=3.5) t (125) =-14.39, p<.0005 (two-tailed)]. Qualitative results derived from open responses mirrored the quantitative results. Conclusion: The Caregiver-Centered Care education provides a foundation for educating healthcare providers working with FCGs to provide care to FCGs to maintain their wellbeing and sustain care.
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Papers by Faith Hopp