Psychometric properties of the full and short version Nursing Home Survey on Patient Safety Culture (NHSOPSC) instrument: a cross-sectional study assessing patient safety culture in Norwegian homecare services.

OBJECTIVES: Measure patient safety culture in homecare services; test the psychometric properties of the Nursing Home Survey on Patient Safety Culture (NHSOPSC) instrument; and propose a short-version Homecare Services Survey on Patient Safety Culture instrument for use in homecare services. DESIGN: Cross-sectional survey with psychometric testing. SETTING: Twenty-seven publicly funded homecare units in eight municipalities (six counties) in Norway. PARTICIPANTS: Five-hundred and forty health personnel working in homecare services. INTERVENTIONS: Not applicable. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary: Patient safety culture assessed using the NHSOPSC instrument. Secondary: Overall perception of service users' safety, service safety and overall care. METHODS: Psychometric testing of the NHSOPSC instrument using factor analysis and optimal test assembly with generalised partial credit model to develop a short-version instrument proposal. RESULTS: Most healthcare personnel rated patient safety culture in homecare services positively. A 19-item short-version instrument for assessing patient safety culture had high internal consistency, and was considered to have sufficient concurrent and convergent validity. It explained a greater proportion of variance (59%) than the full version (50%). Short-version factors included safety improvement actions, teamwork, information flow and management support. CONCLUSION: This study provides a first proposal for a short-version Homecare Services Survey on Patient Safety Culture instrument to assess patient safety culture within homecare services. It needs further improvement, but provides a starting point for developing an improved valid and reliable short-version instrument as part of assessment of patient safety and quality improvement processes.

The Evidence Base for an Ideal Care Pathway for Frail Multimorbid Elderly: Combined Scoping and Systematic Intervention Review.

BACKGROUND: There is a call for bold and innovative action to transform the current care systems to meet the needs of an increasing population of frail multimorbid elderly. International health organizations propose complex transformations toward digitally supported (1) Person-centered, (2) Integrated, and (3) Proactive care (Digi-PIP care). However, uncertainty regarding both the design and effects of such care transformations remain. Previous reviews have found favorable but unstable impacts of each key element, but the maturity and synergies of the combination of elements are unexplored. OBJECTIVE: This study aimed to describe how the literature on whole system complex transformations directed at frail multimorbid elderly reflects (1) operationalization of intervention, (2) maturity, (3) evaluation methodology, and (4) effect on outcomes. METHODS: We performed a systematic health service and electronic health literature review of care transformations targeting frail multimorbid elderly. Papers including (1) Person-centered, integrated, and proactive (PIP) care; (2) at least 1 digital support element; and (3) an effect evaluation of patient health and/ or cost outcomes were eligible. We used a previously published ideal for the quality of care to structure descriptions of each intervention. In a secondary deductive-inductive analysis, we collated the descriptions to create an outline of the generic elements of a Digi-PIP care model. The authors then reviewed each intervention regarding the presence of critical elements, study design quality, and intervention effects. RESULTS: Out of 927 potentially eligible papers, 10 papers fulfilled the inclusion criteria. All interventions idealized Person-centered care, but only one intervention made what mattered to the person visible in the care plan. Care coordinators responsible for a whole-person care plan, shared electronically in some instances, was the primary integrated care strategy. Digitally supported risk stratification and management were the main proactive strategies. No intervention included workflow optimization, monitoring of care delivery, or patient-reported outcomes. All interventions had gaps in the chain of care that threatened desired outcomes. After evaluation of study quality, 4 studies remained. They included outcome analyses on patient satisfaction, quality of life, function, disease process quality, health care utilization, mortality, and staff burnout. Only 2 of 24 analyses showed significant effects. CONCLUSIONS: Despite a strong common-sense belief that the Digi-PIP ingredients are key to sustainable care in the face of the silver tsunami, research has failed to produce evidence for this. We found that interventions reflect a reductionist paradigm, which forces care workers into standardized narrowly focused interventions for complex problems. There is a paucity of studies that meet complex needs with digitally supported flexible and adaptive teamwork. We predict that consistent results from care transformations for frail multimorbid elderly hinges on an individual care pathway, which reflects a synergetic PIP approach enabled by digital support.

Wearable and Mobile Technology for Safe and Active Living.

The study explores how mobile safety alarms can be utilized for ambient assisted living (AAL), and provides elderly safety, autonomy, independence and mobility. The aim is to generate knowledge on usage, usability and technical requirements to harvest the potential benefits of using wearable and mobile technologies in care for safe and active living. The study is based on real life pilots in three Norwegian municipalities with 71 users, their caregivers and relatives. Pilot users wore the mobile safety alarm while performing their daily activities - indoor and outdoor. The study shows increased safety to users, their relatives and caregivers and increased activity and mobility indicating improved social and physical health. Further development of wearables and mobile technologies is requested to meet user needs, and the inclusion of relatives imposes new challenges in terms of privacy. Mobile safety alarms represent a huge potential for efficiency and innovation in integrated care, but new tools are required for efficient collaboration and operation for large-scale implementations.

A User Study: Keyboard and Applications to Simplify Smartphone Adoption for Seniors.

The aim of the user study was to evaluate how the developed assistive physical keyboard, the Ezi-PAD, and integrated senior friendly applications, can encourage non-smartphone seniors to start using the smartphone and enable senior smartphone users to continue using a smartphone in spite of increasing motoric or visual impairment. A number of seniors with different experience and impairment, aged 64 to 86, were equipped with a smartphone and an Ezi-PAD assembly. After basic training, their use of the smartphone was monitored for up to 2 months. Five out of nine participants used the system for 2 months, and found the Ezi-PAD easy to use. The senior friendly applications gave extra utilitarian value to the phone.