Suchergebnisse

Background: In recognition of the limitations of technology-led standards for practitioner implementation of electronic care records, the Professional Record Standards Body for health and social care (PRSB) was established in the UK in 2013. The remit of PRSB is to develop and assure standards for the content and structure of records across all care sectors, based upon professionally-led and patient-guided requirements as endorsed by the professional bodies of the constituent health and social care disciplines. This new initiative is a very different approach from previous national information projects and faces challenges including organizational culture, operational procurement requirements and the logistics of collaborative design. Objective: This paper describes the progress of PRSB and the practical issues it faces to achieve deep stakeholder engagement and widespread adoption of its standards and guidance. The goal is to offer a sustainable approach that builds on the strengths of work to date, learns from past experience of what works and what fails, and draws upon theoretical models of transformational change. Methods: We conceptualize the PRSB strategy in terms of organizational change frameworks, evaluate it against models of success factors in health information technology and employ Normalization Process Theory (NPT) to articulate the activity stages required for realization of its goals. Results: We present an NPT model of how PRSB standards can become embedded in routine practice for care practitioners, patients/citizens, government agencies and information technology providers. We suggest some critical success factors for cultural change, moving the supplier market and sustaining a genuine co-design approach. Conclusions: It is abundantly clear that interoperability involves far more than just technology. Improving information sharing between care practitioners and with patients and citizens requires the innovative professionally-led and patient-guided approach that PRSB has pioneered. It is necessary to formally evaluate the impacts of implementation, both to build a compelling evidence base and to generate a virtuous cycle of iterative maintenance and general adoption.

Abstract Background Aims of the present study are the following: 1. to describe the rationale and methodology of the Services and Health for Elderly in Long TERm care (SHELTER) study, a project funded by the European Union, aimed at implementing the interRAI instrument for Long Term Care Facilities (interRAI LTCF) as a tool to assess and gather uniform information about nursing home (NH) residents across different health systems in European countries; 2. to present the results about the test-retest and inter-rater reliability of the interRAI LTCF instrument translated into the languages of participating countries; 3 to illustrate the characteristics of NH residents at study entry. Methods A 12 months prospective cohort study was conducted in 57 NH in 7 EU countries (Czech Republic, England, Finland, France, Germany, Italy, The Netherlands) and 1 non EU country (Israel). Weighted kappa coefficients were used to evaluate the reliability of interRAI LTCF items. Results Mean age of 4156 residents entering the study was 83.4 ± 9.4 years, 73% were female. ADL disability and cognitive impairment was observed in 81.3% and 68.0% of residents, respectively. Clinical complexity of residents was confirmed by a high prevalence of behavioral symptoms (27.5% of residents), falls (18.6%), pressure ulcers (10.4%), pain (36.0%) and urinary incontinence (73.5%). Overall, 197 of the 198 the items tested met or exceeded standard cut-offs for acceptable test-retest and inter-rater reliability after translation into the target languages. Conclusion The interRAI LTCF appears to be a reliable instrument. It enables the creation of databases that can be used to govern the provision of long-term care across different health systems in Europe, to answer relevant research and policy questions and to compare characteristics of NH residents across countries, languages and cultures.