Improving Healthcare Quality and Clinical Outcomes for Persons with Dementia in the Sub-Acute Hospital Through Person-Centered Care Practice

Article type: Research Article

Authors: Chenoweth, Lynn^{a; *} | Burley, Claire^a | Cook, Jacquelene^{a; b} | Cheah, Seong-Leang^c | Reyes, Patricia^{d; e} | Maiden, Genevieve^d | McGuire, Jane^d | McCade, Donna^d | Brodaty, Henry^a | Sukhapure, Mayouri^a | Harrison, Fleur^a | Williams, Anna^f

Affiliations: [a] Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry, UNSW Medicine and Health, UNSW, Sydney, Australia | [b] Department of Aged Health, Chronic Care and Rehabilitation, Concord Hospital, Sydney, Australia | [c] Research Unit, Justice Health and Forensic Mental Health Network, AGSM (G27), UNSW, Sydney, Australia | [d] War Memorial Hospital, St Vincent’s Hospital Health Network, Sydney, Australia | [e] Discipline of Medicine, UNSW Medicine and Health, UNSW, Sydney, Australia | [f] School of Nursing and Midwifery, Western Sydney University, NSW, Penrith, Australia

Correspondence: [*] Correspondence to: Professor Lynn Chenoweth, RN, PhD, Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry, UNSW Medicine and Health, Room 320 AGSM (G27), Gate 11, Botany Street, UNSW, Sydney, NSW 205, Australia. Tel.: +61 2 9385 2649; E-mail: l.chenoweth@unsw.edu.au.

Abstract: Background:Person-centered care is considered beneficial for persons with dementia. Objective:To evaluate the impact of a person-centered knowledge translation intervention on the quality of healthcare and outcomes for persons with dementia. Methods:Over nine months, sub-acute hospital nursing, allied health, and medical staff (n = 90) participated in online and/or face-to-face person-centered education and were supported by senior nursing, allied health, and medical staff champions (n = 8) to implement person-centered healthcare. The quality of healthcare service, ward climate and care delivery were evaluated pre/post study intervention. In the week following hospital admission (Time 1) and week of discharge (Time 3), agitation incidence (co-primary outcome) was assessed in participants with dementia (n = 80). Participant delirium (co-primary outcome), accidents/injuries, psychotropic medicines, length of stay, readmission and discharge destination (secondary outcomes) were compared with a retrospective group (n = 77) matched on demographics, cognition and function in activities of daily living. Results:Improvements occurred post-intervention in service quality by 17.5% (p = 0.369, phi = 0.08), ward climate by 18.1% (p = 0.291, phi = 0.08), and care quality by 50% (p = 0.000, phi = 0.37). Participant agitation did not change from Time 1 to Time 3 (p = 0.223). Relative to the retrospective group, significant reductions occurred in participant delirium (p = 0.000, phi = 0.73), incidents/injuries (p = 0.000, phi = 0.99), psychotropic medicine use (p = 0.030, phi = 0.09), and hospital readmissions within 30 days (p = 0.002, phi = 0.25), but not in discharge to home (p = 0.171). Conclusions:When person-centered healthcare knowledge is translated through staff education and practice support, persons with dementia can experience improved healthcare services and clinical outcomes, while healthcare services can benefit through reductions in unplanned service use.

Keywords: Alzheimer’s disease, clinical outcomes, healthcare quality, person-centered care champion, sub-acute hospital

DOI: 10.3233/JAD-231056

Journal: Journal of Alzheimer's Disease, vol. 98, no. 2, pp. 619-628, 2024