University of Alberta

Project 1 - "Building Context - An Organizational Monitoring Program in Long Term Care"

Objectives 

Project 1 was designed to monitor and explore the role of the work environment (i.e., organizational context) on knowledge translation (use of best practices) and the subsequent effect of knowledge translation on resident and provider outcomes in 36 residential long term care facilities in the Canadian Prairie Provinces. 

The TREC Data Collection Process 

TREC data collection involves three sources:

Facilty and Unit Profile Data

Information about the facility itself (e.g., staffing type and levels, age of facility, policies, and educational opportunities) and unit level data (e.g., staffing, resident turnover) are collected through short structured interviews with site administrators and unit care managers.

The TREC Survey

This survey is a suite of instruments designed to measure organizational context and its effects on the use of best practices.  The TREC Survey and asks questions on the work environment, use of research, information sharing activities and processes, health and well-being, and frequency of instances of aggressive behaviours in the workplace. It has variations for each of the following groups: healthcare aides, nurses (registered nurses and licensed practical nurses), physicians, allied care professionals, education/practice specialists, and managers.

Based on pilot work, the survey was administered in one of two ways:

  • Regulated staff (registered nurses and licensed practical nurses], physicians, allied health care providers, education/practice specialists, and managers) completed the survey online at a time and place that works for them.
  • Health care aides completed the survey in a computer assisted personal interview format (called CAPI) with the study team reading the questions and entering the responses directly into the database on a laptop computer.

Nooro Online Research ( www.nooro.com ) worked with the TREC team to develop six versions of the survey. The five online versions for the regulated staff are accessed through a unique URL and password over an secure, encrypted connection.

Nooro developed a unique solution that allowed TREC staff to enter responses during the CAPI interview into a virtual server located on a laptop. When they returned to the office they were able to access the Internet and upload the data over a secure connection before returning to the filed to conduct more interviews. This solution enabled us to work around the fact that many Nursing Homes accessible internet connections. 

RAI – MDS 2.0

Resident outcomes are derived from data routinely collected with the Resident Assessment Instrument/ Minimum Data Set – Version 2.0 (RAI-MDS 2.0). The RAI-MDS 2.0 is an international system for capturing essential information about the health, physical, mental, and functional status of continuing and long-term care facility residents.

The full assessment, used on admission and annually, includes sections from basic demographics information to health problems and functional status. A less extensive quarterly assessment is used to examine changes in resident status.

The RAI-MDS 2.0 is used in long-term care facilities across the Prairie Provinces. There is an extensive literature base to support use of this tool. The following RAI-MDS 2.0 indicators were proposed as outcomes in the project 1 analyses:

  • Pain management
  • Falls and fractures
  • Problem behavior management
  • Health Status Index - a composite measure of health related quality of life

RAI – MDS 2.0 data was requested on a yearly basis from the appropriate data custodian.

Survey Sample

In the TREC study two nursing home samples were proposed for a combined sample of 36 sites:

31 urban facilities drawn from the three provinces

5 rural facilities in Saskatchewan

The following table outlines the number of regions and sites.

Province
Region
Number of Sites
Alberta
Capital Health Region
6
 
Calgary Health Region
8
 
East Central Health
2
 
subtotal
16
Saskatchewan
Saskatoon Health Region
4
 
Regina Qu’Appelle Health Region
3
 
Rural Sample
5
 
subtotal
12
Manitoba
Winnipeg Health Region
8
 
subtotal
8
Total Number of Sites:
36

Milestones

Facility and Unit Profiles completed by June 2010

TREC Wave 1 survey data collection completed by July 15, 2009

TREC Wave 2 survey data collection completed by June 30, 2010

RAI/MDS 2.0 data from 36 facilities currently available

Data analysis and manuscript preparation in progress. Announcements of papers accepted for publication will be available as they occur in the "News" feature of this website.