3 results on '"Engels, Yvonne"'
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2. Integrating palliative care in long-term care facilities across Europe (PACE): protocol of a cluster randomized controlled trial of the ‘PACE Steps to Success’ intervention in seven countries
- Author
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Smets, Tinne, Onwuteaka-Philipsen, Bregje B. D., Miranda, Rose, Pivodic, Lara, Tanghe, Marc, van Hout, Hein, Pasman, Roeline H. R. W., Oosterveld-Vlug, Mariska, Piers, Ruth, van den Noortgate, Nele, Wichmann, Anne B., Engels, Yvonne, Vernooij-Dassen, Myrra, Hockley, Jo, Froggatt, Katherine, Payne, Sheila, Szczerbińska, Katarzyna, Kylänen, Marika, Leppäaho, Suvi, Barańska, Ilona, Gambassi, Giovanni, Pautex, Sophie, Bassal, Catherine, Deliens, Luc, van den Block, Lieve, Mammarella, Federica, Mercuri, Martina, Rossi, Paola, Segat, Ivan, Stodolska, Agata, Adang, Eddy, Andreasen, Paula, Kuitunen-Kaija, Outi, Moore, Danni Collingridge, Pac, Agnieszka, Kijowska, Violetta, ten Koppel, Maud, van der Steen, Jenny T., de Paula, Emilie Morgan, VU University medical center, General practice, Public and occupational health, APH - Aging & Later Life, APH - Quality of Care, Family Medicine and Chronic Care, Faculty of Medicine and Pharmacy, End-of-life Care Research Group, and Clinical sciences
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Alzheimer`s disease Donders Center for Medical Neuroscience [Radboudumc 1] ,Palliative care ,Quality management ,law.invention ,Study Protocol ,Indirect costs ,0302 clinical medicine ,Belgium ,Randomized controlled trial ,law ,Surveys and Questionnaires ,Health care ,Medicine and Health Sciences ,Medicine ,030212 general & internal medicine ,Cluster randomised controlled trial ,Finland ,SCALE ,Netherlands ,Medicine(all) ,Nursing home ,lcsh:RC952-1245 ,General Medicine ,3. Good health ,England ,Italy ,End-of-life care ,030220 oncology & carcinogenesis ,END ,Switzerland ,RESIDENTS ,lcsh:Special situations and conditions ,Care home ,Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18] ,03 medical and health sciences ,Nursing ,Humans ,QUALITY ,KNOWLEDGE ,VALIDITY ,Quality improvement ,Skilled Nursing Facilities ,HOMES ,business.industry ,Settore MED/09 - MEDICINA INTERNA ,ADVANCED DEMENTIA ,Long-term care ,ddc:618.97 ,Poland ,OF-LIFE CARE ,business ,Delivery of Health Care - Abstract
Background: Several studies have highlighted the need for improvement in palliative care delivered to older people long-term care facilities. However, the available evidence on how to improve palliative care in these settings is weak, especially in Europe. We describe the protocol of the PACE trial aimed to 1) evaluate the effectiveness and cost-effectiveness of the 'PACE Steps to Success' palliative care intervention for older people in long-term care facilities, and 2) assess the implementation process and identify facilitators and barriers for implementation in different countries.Methods: We will conduct a multi-facility cluster randomised controlled trial in Belgium, Finland, Italy, the Netherlands, Poland, Switzerland and England. In total, 72 facilities will be randomized to receive the 'Pace Steps to Success intervention' or to 'care as usual'. Primary outcome at resident level: quality of dying (CAD-EOLD); and at staff level: staff knowledge of palliative care (Palliative Care Survey). Secondary outcomes: resident's quality of end-of-life care, staff self-efficacy, self-perceived educational needs, and opinions on palliative care. Economic outcomes: direct costs and quality-adjusted life years (QALYs).Measurements are performed at baseline and after the intervention. For the resident-level outcomes, facilities report all deaths of residents in and outside the facilities over a previous four-month period and structured questionnaires are sent to (1) the administrator, (2) staff member most involved in care (3) treating general practitioner, and (4) a relative. For the staff-level outcomes, all staff who are working in the facilities are asked to complete a structured questionnaire. A process evaluation will run alongside the effectiveness evaluation in the intervention group using the RE-AIM framework.Discussion: The lack of high quality trials in palliative care has been recognized throughout the field of palliative care research. This cross-national cluster RCT designed to evaluate the impact of the palliative care intervention for long-term care facilities 'PACE Steps to Success' in seven countries, will provide important evidence concerning the effectiveness as well as the preconditions for optimal implementation of palliative care in nursing homes, and this within different health care systems.Trial registration: The study is registered at www.isrctn.com – ISRCTN14741671 (FP7-HEALTH-2013-INNOVATION-1 603111) Registration date: July 30, 2015.
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- 2018
3. Improving palliative care in selected settings in England using quality indicators: a realist evaluation
- Author
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Iliffe, Steve, Davies, Nathan, Manthorpe, Jill, Crome, Peter, Ahmedzai, Sam H, Vernooij-Dassen, Myrra, and Engels, Yvonne
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Male ,Alzheimer`s disease Donders Center for Medical Neuroscience [Radboudumc 1] ,Evidence-based practice ,Quality management ,Palliative care ,Referral ,Health Services for the Aged ,media_common.quotation_subject ,Best practice ,Care homes ,Quality indicators ,Patient Care Planning ,Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18] ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Electronic Health Records ,Humans ,Medicine ,Quality (business) ,030212 general & internal medicine ,Patient Comfort ,Quality improvement ,Quality Indicators, Health Care ,Quality of Health Care ,Cancer ,media_common ,Medicine(all) ,Terminal Care ,business.industry ,030503 health policy & services ,Medical record ,Hospices ,General Medicine ,Primary care ,3. Good health ,Hospitalization ,England ,Evidence-Based Practice ,Female ,Dementia ,0305 other medical science ,business ,Realist evaluation ,End-of-life care ,Research Article - Abstract
Background There is a gap between readily available evidence of best practice and its use in everyday palliative care. The IMPACT study evaluated the potential of facilitated use of Quality Indicators as tools to improve palliative care in different settings in England. Methods 1) Modelling palliative care services and selecting a set of Quality Indicators to form the core of an intervention, 2) Case studies of intervention using the Quality Indicator set supported by an expert in service change in selected settings (general practice, community palliative care teams, care homes, hospital wards, in-patient hospices) with a before-and-after evaluation, and 3) realist evaluation of processes and outcomes across settings. Participants in each setting were supported to identify no more than three Quality Indicators to work on over an eight-month period in 2013/2014. Results General practices could not be recruited to the study. Care homes were recruited but not retained. Hospital wards were recruited and retained, and using the Quality Indicator (QI) set achieved some of their desired changes. Hospices and community palliative care teams were able to use the QI set to achieve almost all their desired changes, and develop plans for quality improvements. Improvements included: increasing the utility of electronic medical records, writing a manual for end of life care, establishing working relationships with a hospice; standardising information transfer between settings, holding regular multi-disciplinary team meetings, exploration of family carers’ views and experiences; developing referral criteria, and improvement of information transfer at patient discharge to home or to hospital. Realist evaluation suggested that: 1) uptake and use of QIs are determined by organisational orientation towards continuous improvement; 2) the perceived value of a QI package was not powerful enough for GPs and care homes to commit to or sustain involvement; 3) the QI set may have been to narrow in focus, or more specialist than generalist; and 4) the greater the settings’ ‘top-down’ engagement with this change project, the more problematic was its implementation. Conclusions Whilst use of QIs may facilitate improvements in specialist palliative care services, different QI sets may be needed for generalist care settings. Electronic supplementary material The online version of this article (doi:10.1186/s12904-016-0144-1) contains supplementary material, which is available to authorized users.
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