Encouraging Best Practice in Residential Aged Care Program: Final Evaluation Report

4.2 - Impact on residents

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Despite widespread adoption in health systems, it is difficult to show that use of clinical guidelines improves outcomes for patients (Bahtsevani, Uden et al. 2004; Lugtenberg, Burgers et al. 2009). Evidence that the process and structure of care have improved is typically stronger than the evidence that patient outcomes have improved (Lugtenberg, Burgers et al. 2009). This does not necessarily mean that outcomes do not improve with the implementation of evidence; it simply reflects how difficult it can be to identify improvements in outcomes and attribute those improvements to what was implemented. Consistent with this finding from the literature, there was more evidence in the EBPRAC program of improvements in resident care than there was of improvements in resident outcomes.

Based on the results of the project-level evaluations Table 13 summarises the evidence regarding changes in resident care and changes in resident outcomes for each project. The former are those changes that influence resident care in some way. Environmental changes are included because such changes can influence the experience of care for residents. Other changes range from changes in key processes such as use of end-of-life care pathways and case conferences to changes in the care delivered to residents e.g. changes in medication use and wound management. Because it is so difficult to do, no attempt has been made to separate what are effectively system changes (case conferences) from practical ‘hands on’ changes. From a project perspective what is important is that there is evidence that some changes have taken place.

Table 13 Summary of changes in practices and evidence of changes in resident outcomes

Project title	Changes in resident care (mainly processes)	Resident outcomes
NARI pain	Good evidence to indicate that pain management practices improved.	Variable outcomes with no consistent pattern of pain reduction.
UN nutrition	Many different changes in practices but no measuring of extent of change.	Mixed results for change in nutritional status.
NARI falls	Evidence of improved falls prevention activities.	Number of reported falls increased and falls-related injuries decreased.
SA dental	Some evidence of improved practices, introduction of oral health assessments.	Improved oral health with mixed results for other indicators of resident outcomes.
DATIS meds	Some evidence of improved practices.	Not evaluated.
QUT wounds	Good evidence of improved practices.	Reduction in incidence of wounds.
PW inf control	Various changes in practice, none of which were measured.	No change in resident outcomes.
MGPN pall care	Almost no evidence to indicate changes in resident care.	Not evaluated.
NEVDGP pall care	Highly variable implementation of end-of-life care pathways.	Not evaluated.
UQ pall care	Good evidence that practices improved.	Not evaluated.
UTS behav	Some evidence that practices improved.	Variable outcomes, with improvements on some measures.
HC behav	Improvements to physical environment. Practice changes not measured. Implementation of mentoring meetings.	Consistent improvement in resident outcomes.
MU behav	Improvements to the physical environment. Good evidence of improved practices.	Improved resident outcomes.

For some projects the fact that there is no measurement of the changes that have taken place does not mean that no changes took place. As was pointed out in Section 3.4 the general finding across all projects was one of lots of small changes, rather than major changes. Many of these changes are difficult to measure. A more detailed version of Table 13 is included as Appendix 16, with details of both the changes made and the outcomes achieved.

Four projects did not evaluate resident outcomes, but rather focused on evaluating changes in practices such as changes in medication use (DATIS meds project) or, in the case of the three palliative care projects, changes in the processes and systems for delivering palliative care. This was entirely appropriate and in accordance with the original funding submission for each project.

The three behaviour management projects produced the best evidence that resident outcomes improved. The pain management project in Round 1 had arguably the most comprehensive evidence that practices improved but was unable to show consistent reductions in pain. Two projects with a strong focus on prevention (oral health and wound management) were able to demonstrate improved outcomes (improved oral health and reduction in wounds).
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