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Table 3 Project outcomes

From: Agents of change: establishing quality improvement collaboratives to improve adherence to Australian clinical guidelines for dementia care

Outcome domain

Details of measurement

Guideline adherence

 Exercise guideline adherence

Full adherence when:

a) Clinician checklist explicitly references a discussion about current physical activity levels, and;

b) Specific needs and barriers to physical activity are identified, and;

c) Treatments/strategies recommended are clinical indicated based on needs/barriers, and;

d) A written treatment plan for physical activity or exercise is provided to the person with dementia

 Occupational therapy guideline adherence

Full adherence when:

a) Home environment assessment has occurred (where applicable), and;

b) Clinician checklist explicitly references identification of primary concern/s of person with dementia and carer, and;

c) A written treatment plan to address needs of person with dementia and carer or give specific advice about suitable activities (that are tailored, of interest, and match capabilities) is provided

 Carer support guideline adherence

Full adherence when:

a) Clinician checklist explicitly references that the needs of the carer have been discussed during the consultation, and;

b) Clinician checklist explicitly references clinically indicated provision of information about programs providing respite for the carer and/or other carer support services, and;

c) A written treatment plan detailing key carer concerns and strategies to manage these is provided

Implementation

 Uptake

• Exposure: the extent to which clinicians use the materials and online training course

• Initial use: initial changes in adherence to guideline recommendations

 Sustainability

• Continued changes in adherence to guideline recommendation.

 Feasibility

• Recruitment: attraction of implementation clinicians and participating organisations

• Consent rate for people with dementia and their carers agreeing to be contacted for follow-up

• Maintenance: involvement in the program and contribution to data collection

• Withdrawals

 Acceptability

• Interviews with implementation clinicians regarding participation in the program and the acceptability of the intervention and process

• QIKAT-R tool: a three-item tool that identifies the skills and knowledge of the implementation clinicians in quality improvement (i.e. how well they can assess the need for change and identify appropriate strategies)

• NOMAD tool: a validated method of exploring why clinicians change their practice and why they do not, and this is a key aim of process evaluation.

 Fidelity

• Fidelity determined via checklists on the content of clinician-patient/carers interactions. Data captured via clinician self-report checklist and phone call surveys with patients and carers

 Penetration

• Context: information about the sites and funding models, as well as the different types of clinicians (professional background, level of seniority, and type of role).

• Reach: does the project reach a variety of different sites and people with dementia and carers

 Costs

• Calculation of costs of providing the intervention (personnel, technology, stipends, development and distribution of educational materials) and in-kind contribution required for each site estimated using a ‘bottom-up’ micro-costing approach.

• Willingness to pay questionnaire

 Impact of involvement of people with dementia and carers at all levels of the project

• Impact of involvement of people with dementia and carers on intervention quality, success

• Expectations and experiences of people with dementia and carers involved in the project

Service

 Safety

• Implementation clinicians will record any adverse events and discuss any unintended consequences

Client

 Satisfaction

• Amended version of the Patient Satisfaction Questionnaire Short-Form

 Function/QOL

• DEMQOL assesses the quality of life of clients with dementia (exercise and OT groups only)

• ZBI assesses the burden experienced by carers of people with dementia (‘carer support’ group only)

  1. Abbreviations: DEMQOL Dementia Quality of Life Questionnaire, MOOC massive open online course, NOMAD questionnaire tool based on Normalisation Process Theory, OT occupational therapy, QIKAT-R Quality Improvement Knowledge Application Tool Revised, QOL quality of life, ZBI Zarit Burden Interview