Undertaking a Collaborative Rapid Realist Review to Investigate What Works in the Successful Implementation of a Frail Older Person’s Pathway

Shé, Éidín Ní; Keogan, Fiona; McAuliffe, Éilish; O’Shea, Diarmuid; McCarthy, Mary; McNamara, Rosa; Cooney, Marie Therese

doi:10.3390/ijerph15020199

Cited by 23 publications

(25 citation statements)

References 30 publications

(96 reference statements)

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“…[54] Future research should also focus on contextual factors supporting frailty interventions, such as health resources provisioning, [55] linkages between acute and long-term care services, [56] configuration of care packages, [57] and public and patient involvement in co-designing interventions. [58] There is also some incompatibility between frailty measures themselves, necessitating caution in comparing outcomes.…”

Section: Suggestions For Further Researchmentioning

confidence: 99%

Primary care interventions to address physical frailty among community-dwelling adults aged 60 years or older: A meta-analysis

et al. 2020

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IntroductionThe best interventions to address frailty among older adults have not yet been fully defined, and the diversity of interventions and outcome measures makes this process challenging. Consequently, there is a lack of guidance for clinicians and researchers regarding which interventions are most likely to help older persons remain robust and independent. This paper uses meta-analysis to assess effectiveness of primary care interventions for physical frailty among community-dwelling adults aged 60+ and provides an up-to-date synthesis of literature in this area. MethodsPubMed, CINAHL, Cochrane Register of Controlled Trials, and PEDro databases were searched, and RCTs, controlled pilot studies, or trials with similar study designs addressing frailty in the primary care setting among persons aged 60+ were chosen. Study data was abstracted following PRISMA guidelines, then meta-analysis was performed using the random effects model. OPEN ACCESS Citation: Macdonald SH-F, Travers J, Shé ÉN, Bailey J, Romero-Ortuno R, Keyes M, et al. (2020) Primary care interventions to address physical frailty among community-dwelling adults aged 60 years or older: A meta-analysis. PLoS ONE 15(2): e0228821. https://doi.org/10.1371/journal.

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Section: Suggestions For Further Researchmentioning

confidence: 99%

Primary care interventions to address physical frailty among community-dwelling adults aged 60 years or older: A meta-analysis

et al. 2020

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“…When a person registers to a Twitter account other users can follow them and see their tweets. Previous work has found that analysis of the content on social media has become a valuable source of information for health researchers [25][26][27] The information provides researchers with publicly available data that would not be accessible using more traditional methods for data collection [28]. Previous work has highlighted that peer interaction on social networks such as Twitter can contribute to policy development in health and social care [28,29].…”

Section: Breadthmentioning

confidence: 99%

New Ways of Working? A Rapid Exploration of Emerging Evidence Regarding the Care of Older People during COVID19

Shé

O’Donnell

O’Shea

et al. 2020

IJERPH

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Health and social care staff have had to quickly adapt, respond and improve teamwork, as a response to the COVID-19 pandemic. Our objective was to rapidly summarize the emerging evidence of new ways of working in the care of older people during this period. We conducted an exploration of the emerging evidence within the timeframe of 1 March 2020 to 11 May 2020. To capture a broad perspective, we undertook thematic analysis of Twitter data which was extracted through a broad search for new ways of working in health and social care. For a more in-depth focus on the health and social care of older people, we undertook a systematic scoping of newspapers using the Nexis UK database. We undertook a validation workshop with members of the interprofessional working group of the Irish National Integrated Care Programme for Older People, and with researchers. A total of 317 tweets were extracted related to six new ways of working. There was evidence of using telehealth to provide ongoing care to patients; interprofessional work; team meetings using online platforms; trust and collaboration within teams; as well as teams feeling empowered to change at a local level. 34 newspaper articles were extracted related to new ways of working in the care of older people, originating in England (n = 17), Wales (n = 6), Scotland (n = 6), Ireland (n = 4) and Germany (n = 1). Four main themes were captured that focused on role expansion, innovations in communication, environmental restructuring and enablement. The results of this exploration of emerging evidence show that health and social care teams can transform very rapidly. Much of the change was based on goodwill as a response to the pandemic. Further analysis of empirical evidence of changing practices should include the perspectives of older people and should capture the resources needed to sustain innovations, as well as evaluate gaps in service provision.

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“…Our focus within the ‘Systematic Approach to improving care for Frail older patients’ (SAFE) study was to co-design quality improvement initiatives within an integrated care pathway for frail older people in an acute setting [2]. As part of the SAFE study we undertook a review of the literature to capture what works in the successful implementation of a frail older person’s pathway [14]. A significant finding in the review was the absence of methodological studies which include patients and public groups in the co-design of frailty interventions and in the identification of priority areas for improvement initiatives.…”

Section: Introductionmentioning

confidence: 99%

Enabling public, patient and practitioner involvement in co-designing frailty pathways in the acute care setting

O’Donnell

Shé

McCarthy³

et al. 2019

BMC Health Serv Res

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BackgroundAlthough not an inevitable part of ageing, frailty is an increasingly common condition in older people. Frail older patients are particularly vulnerable to the adverse effects of hospitalisation, including deconditioning, immobility and loss of independence (Chong et al, J Am Med Dir Assoc 18:638.e7–638.e11, 2017). The ‘Systematic Approach to improving care for Frail older patients’ (SAFE) study co-designed, with public and patient representatives, quality improvement initiatives aimed at enhancing the delivery of care to frail older patients within an acute hospital setting. This paper describes quality improvement initiatives which resulted from a co-design process aiming to improve service delivery in the acute setting for frail older people. These improvement initiatives were aligned to five priority areas identified by patients and public representatives.MethodsThe co-design work was supported by four pillars of effective and meaningful public and patient representative (PPR) involvement in health research (Bombard et al, Implement Sci 13:98, 2018; Black et al, J Health Serv Res Policy 23:158–67, 2018). These pillars were: research environment and receptive contexts; expectations and role clarity; support for participation and inclusive representation and; commitment to the value of co-learning involving institutional leadership.ResultsFive priority areas were identified by the co-design team for targeted quality improvement initiatives: Collaboration along the integrated care continuum; continence care; improved mobility; access to food and hydration and improved patient information. These priority areas and the responding quality improvement initiatives are discussed in relation to patient-centred outcomes for enhanced care delivery for frail older people in an acute hospital setting.ConclusionsThe co-design approach to quality improvement places patient-centred outcomes such as dignity, identity, respectful communication as well as independence as key drivers for implementation. Enhanced inter-personal communication was consistently emphasised by the co-design team and much of the quality improvement initiatives target more effective, respectful and clear communication between healthcare personnel and patients. Measurement and evaluation of these patient-centred outcomes, while challenging, should be prioritised in the implementation of quality improvement initiatives. Adequate resourcing and administrative commitment pose the greatest challenges to the sustainability of the interventions developed along the SAFE pathways. The inclusion of organisational leadership in the co-design and implementation teams is a critical factor in the success of interventions targeting service delivery and quality improvement.

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Undertaking a Collaborative Rapid Realist Review to Investigate What Works in the Successful Implementation of a Frail Older Person’s Pathway

Cited by 23 publications

References 30 publications

Primary care interventions to address physical frailty among community-dwelling adults aged 60 years or older: A meta-analysis

Primary care interventions to address physical frailty among community-dwelling adults aged 60 years or older: A meta-analysis

New Ways of Working? A Rapid Exploration of Emerging Evidence Regarding the Care of Older People during COVID19

Enabling public, patient and practitioner involvement in co-designing frailty pathways in the acute care setting

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