Research

Pragmatic Innovations in Long-term Care was an invitational conference held in Baltimore, MD, on April 4-5, 2005 (funded by the National Institute on Aging, the Commonwealth Fund, the Retirement Research Foundation, and the Mather Institute on Aging).  The final reports from the conference are available at the above link.

The conference organizers compiled a comprehensive literature review and with their permission we have created an interactive version, updated to include recent findings and other work from the psychosocial literature. Please contact us to let us know of new work and/or other appropriate research.

The initial literature review included published research reports identified through searches of the National Library of Medicine's online database and general internet searching. More than 3,500 citations were reviewed for a final selection of 378 publications. The publications are organized in accordance with categories of a guiding conceptual framework: those relating to areas of intervention (what is being done); outcomes (why it is being done); and areas for practice-research interface. Many articles are relevant to more than one area, of course, and so these headings have been chosen for purposes of presentation and synthesis.

The are also a collection of articles that address larger themes relevant to the conference agenda of bridging the research/practice/policy gap (click on author's name for summary or abstract).

Barriers and facilitators in translating research into practice: Bradley, Schlesinger et al. (2004) describe the process of adoption of an evidence-based, multifaceted innovative program into the clinical setting. Bradley, Webster et al. (2004) discuss key aspects of rapid diffusion and adoption of evidence-based innovations in health care. Finally, Cody et al. (2002) address barriers to the use of nonpharmacological interventions in nursing homes and recommendations for overcoming such barriers. Barriers and facilitators in conducting research within nursing home settings: Maas et al. (2002) discuss the issues and challenges of ethically acceptable and rigorous research in nursing home settings. Mentes and Tripp-Reimer (2002) review both barriers and facilitators to the research process within nursing homes.

Importance of integrating research and practice: Pillemer, Suitor and Worthington (2003) argue for better integration of theory, research and intervention within gerontology to include more federal support for translational research initiatives. Stratmann et al. (1997) review a series of studies that demonstrates the
importance of research in setting a course for positive change in clinical practice. Schnelle et al. (1997) explore pressures on nursing home providers to respond to policy changes (e.g., standards of care) put in place without a realistic assessment of whether there are intervention protocols or resources available to meet the standards. Schnelle (1997) also discusses the need for applied research centers based in long-term care facilities.

Measurement and design issues: Beck (2001) discusses theoretical and methodological research issues affecting the rigor of existing studies of the care of nursing home residents with dementia and factors that limit the translatability of these findings into treatment recommendations and standards of care. Sival et al. (2000) describe how the implementation of new measurement tools as part of a research study itself affected staff reports and management of the outcome under evaluation, and recommend that prospective intervention studies include a stabilization phase for measurements prior to any planned trial. McConnell et al. (2003) focus on understanding patterns of natural change in function over one year among long-stay nursing home residents in order to better characterize natural declines.

Conference Organizers:

Philip Sloane, MD, MPH and Sheryl Zimmerman, PhD, of the Program on Aging, Disability, and Long-term Care of the Sheps Center for Health Services Research at the University of North Carolina, and Sidney Stahl, PhD, of the National Institute on Aging.  

The literature review was authored by Cynthia Port, PhD,  Philip D. Sloane, MD, MPH, and Sheryl Zimmerman, PhD.

We wish to thank Ann Gray and Quality Partners of Rhode Island for their assistance converting the document to interactive form.