Adaptation of the quality of care from the patient’s perspective (QPP) instrument for persons with dementia

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Ann Karin Helgesen


Background: Despite the fact that dementia care is one of the most rapidly growing areas in healthcare, relatively little is known about the experiences of persons with dementia in relation to quality of care. The Quality of care from the Patient’s Perspective (QPP) instrument has previously been adapted for use in different healthcare settings. The aim of this study was to adapt the QPP for use by persons with dementia. Methods: The study was conducted in special care units (SCUs) in Norway. An exploratory factor analysis using principal axis factoring with oblique rotation was performed for psychometric evaluation. Internal consistency was assessed by Cronbach’s alpha. Results: The result show that it was possible to assess how persons with dementia living in  SCUs in nursing homes evaluate the care when using an adapted version of the QPP. The QPP questionnaire specifically for dementia care (QPP-DC) consists of 23 items representing seven factors with an eigenvalue ≥ 1.0. The reliability coefficients were acceptable for most factors. Conclusions: QPP-DC provides a meaningful tool for quality improvements of care in special care units by detecting areas of importance for the persons with dementia. In that way the care could be more person centered. Nevertheless, research is needed to further validate and test the QPP-DC questionnaire.  

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WHO 2015. The epidemiology and impact of dementia current state and future trends. Accessed 1.February 2018.

Prince M, Bryce R, Albanese E, Wimo A, Ribeiro W, Ferri CP. (2013). The global prevalence of dementia: A systematic review and metaanalysis. Alzheimers Dement. 9:63-75.

Winblad B, Amouyel P, Andrieu S, Ballard C, Brayne C, Brodaty H, ... Zetterberg H. (2016). Defeating Alzheimer's disease and other dementias: A priority for European science and society. Lancet Neurol. doi: 10.1016/S1474-4422(16)00062-4.

van Baalen A, Vingerhoets Ad JJM, Sixma HJ & de Lange J. (2011). How to evaluate quality of care from the perspective of people with dementia: an overview of the literature. Dementia. 10:112–37.

Helgesen AK. Patient participation in everyday life in special care units for persons with dementia. (2013). Faculty of Social and Life Sciences, Karlstad University Studies. (Doctoral dissertation).

Halek M, Dichter M.N, Quasdorf T, Riesner C, Bartholomeyczik S. (2013). The effects of dementia care mapping on nursing home residents’ quality of life and staff attitudes: design of the quasi-experimental study Leben-QD II. BMC Geriatrics. 13:1.

Schmidt, S. G., Dichter, M. N., Bartholomeyczik, S., & Hasselhorn, H. M. (2014). The satisfaction with the quality of dementia care and the health, burnout and work ability of nurses: A longitudinal analysis of 50 German nursing homes. Geriatric Nursing. 35(1), 42-46.

Abrahamson K, Clark D, Perkins A, Arling G. (2012). Does cognitive impairment influence quality of life among nursing home residents? Gerontologist. 52:632-640.

Mozley CG, Huxley P, Sutcliffe C, Bagley H, Burns A, Challis D, Cordingley L. (1999). ‘Not knowing where I am doesn't mean I don't know what I like’: cognitive impairment and quality of life responses in elderly people. International Journal of Geriatric Psychiatry. 14:776-783.

Conradsson M, Rosendahl E, Littbrand H, Gustafson Y, Olofsson B, Lövheim H. (2013). Usefulness of the Geriatric Depression Scale 15-item version among very old people with and without cognitive impairment. Aging & Mental Health. 17:638-645.

Brod M, Stewart AL, Sands L, Walton P. (1999). Conceptualization and measurement of quality of life in dementia: the dementia quality of life instrument (DQoL). Gerontologist. 39:25-35.

Logsdon R, Gibbons LE, McCurry SM, Teri L. (2002). Assessing quality of life in older adults with cognitive impairment. Psychosomatic Medicine. 64:510-19.

Perales J, Cosco TD, Stephan BC, Haro JM, Brayne C. (2013). Health-related quality-of-life instruments for Alzheimer's disease and mixed dementia. International Psychogeriatrics. 25:691-706.

Bowling A, Rowe G, Adams S, Sands P, Samsi K, Crane M, ... Manthorpe J. (2015). Quality of life in dementia: a systematically conducted narrative review of dementia-specific measurement scales. Aging & Mental Health. 19:13-31.'

Grøndahl VA, Fagerli LB. (2016) Care quality in nursing homes: a cluster analysis. International Journal of Health Care Quality Assurance. 30: 25-36.

Tolson D, Rolland Y, Andrieu S, Aquino J. P, Beard J, Benetos A, ... Franco A. (2011). International Association of Gerontology and Geriatrics: A global agenda for clinical research and quality of care in nursing homes. Journal of the American Medical Directors Association. ;12:184-189.

Beerens HC, Sutcliffe C, Renom-Guiteras A, Soto ME, Suhonen R, Zabalegui A, ….(2014). Right Time Place Care Consortium. Quality of life and quality of care for people with dementia receiving long term institutional care or professional home care: the European RightTimePlaceCare study. Journal of the American Medical Directors Association. 15:54-61.

Wilde B, Starrin B, Larsson G, Larsson M. (1993). Quality of care from a patient perspective: a grounded theory study. Scandinavian Journal of Caring Science. 7:113-120.

Wilde B, Larsson G, Larsson M, Starrin B. (1994). Quality of care: development of a patient-centred questionnaire based on a grounded theory model. Scandinavian Journal of Caring Science. 8:39-48.

Wilde-Larsson B, Larsson G. (2002). Development of a short form of the Quality from the patient’s perspective (QPP) questionnaire. Journal of Clinical Nursing. 11:681-687.

Larsson G, Wilde Larsson B. (2003). Quality Improvement Measures based on Patient Data: Some Psychometric Issues. International Journal of Nursing Practice. 9: 294-299.

Wilde‐Larsson B, Larsson G, Kvist, L.J, Sandin‐Bojö A.K. (2010). Womens’ opinions on intrapartal care: development of a theory‐based questionnaire. Journal of Clinical Nursing. 19:1748-1760.

Holter H, Sandin-Bojö A. K, Gejervall A. L, Wikland M, Wilde-Larsson B, Bergh C. (2014). Quality of care in an IVF programme from a patient's perspective: development of a validated instrument. Human Reproduction. 29:534-547.

Kirchhoff J. W, Andersen K. L. (2015). Uformell omsorg til pasienter i hjemmesykepleien. Sykepleien Forskning. 10

Sandsdalen T, Rystedt I, Grøndahl VA, Hov R, Høye S, Wilde-Larsson B. (2015). Patients’ perceptions of palliative care: adaptation of the Quality form the patient’s perspective instrument for use in palliative care, and description of patients’ perceptions of care received. BMC Palliative Care. Doi 10.1186/s12904-015-0049-4.

Grøndahl VA, Karlsson I, Hall-Lord ML, Appelgren J, Wilde-Larsson B. (2011). Quality of care from patients’ perspective – impact of the combination of person-related and external objective care conditions. Journal of Clinical Nursing. 20:2540-2551.

Larsson G, Wilde-Larsson B. (2001). Quality of care and service as perceived by adults with developmental disabilities, their parents and primary caregivers. Mental Retardation. 39:249-258.

Folstein MF, Folstein SE, McHugh PR. (1975). ‘Mini-Mental State’: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research. 12:189-198.

Strobel C, Engedal K. (2008). MMSE-NR. Norsk Revidert Mini Mental Status Evaluering. Revidert og utvidet manual. Oslo. Nasjonalt kompetansesenter for aldring og helse. [Norwegian].

Field A. Discovering statistics using SPSS. (2014). London: SAGE Publications; 2013.

Hair JFJ, Black WC, Babin BJ, Anderson RE. Multivariate data analysis. A global

perspective 7th.. San Francisco: Pearson.

Polit D. F, Beck C.T. (2017). Nursing Research: generating and assessing evidence for nursing practice. Philadelphia: Wolters Kluwer.

Bruvik F.K, Ulstein I.D, Ranhoff A.H, Engedal K. (2012). The quality of life of people with dementia and their family carers. Dementia and geriatric cognitive disorders. 34:7-14.

Digby R, Lee S, Williams A. (2016) Interviewing people with dementia in hospital: recommendations for researchers. Journal of Clinical Nursing. 25:1156-1165.

McKeown J, Clarke A, Ingleton C, Repper J. (2010). Actively involving people with dementia in qualitative research. Journal of Clinical Nursing. 19:1935-1943.

van Campen C, Sixma H, Friele R.D, Kerssens J.J, Peters L. (1995). Quality of care and patient satisfaction: a review of measuring instruments. Medical Care Research and Review. 52:109-133.

Train G.H, Nurock S.A, Manela, M, Kitchen G, Livingston G.A. (2005). A qualitative study of the experiences of long-term care for residents with dementia, their relatives and staff. Aging & Mental Health. 9:119-128.

Kirkevold Ø, Engedal K. The quality of care in Norwegian nursing homes. (2006). Scandinavian Journal of Caring Sciences. 20:177-183.

Nakrem S, Vinsnes A.G, Harkless G.E, Paulsen B, Seim A. (2013). Ambiguities: residents’ experience of ‘nursing home’ as my home. International Journal of Older People Nursing. 8:216-225.

Drageset J, Kirkevold M. Espehaug B. (2011). Loneliness and social support among nursing home residents without cognitive impairment: A questionnaire survey. International Journal of Nursing Studies. 48:611–619.

Pitkala K.H. (2016). Loneliness in Nursing Homes. Journal of the American Medical Directors Association.