A survey of infection control among community home care service providers

PURPOSE: This study aimed to explore the current situation of infection control by community home care providers. METHODS: We investigated an area managed by one of 6 municipal social welfare offices in Fukushima. Two questionnaires were sent to all home care agencies providing home help services, visiting bathing care and visit-nursing: one to the 82 chiefs of the agencies (response rate of 90.2%) and the other to 1024 health care workers working for them (57.2%). The questionnaire covered health checkups of employees, maintenance and management of devices, infection control education and manuals, and hand hygiene. RESULTS: 1. Medical checkups were organized once a year or more at 94.6% of the agencies and employee participation of once a year or more was 87.6%. 2. Regarding the management of health care devices, personnel were assigned and a registration system was introduced at 43.2% and 20.8% of the agencies, respectively. Most agencies (94.6%) provided disposable gloves and 82.6% of the employees used them when handling body fluids or excretions. However, not many agencies provided hand-washing equipment (43.2%) and paper towels (39.2%). 3. Infection control educational programs were organized at 40.3% of the agencies and attended by 30.2% of the employees. Among the agencies without such programs, 76.2% gave employees' time constraint as a reason for not giving training. On the other hand, 78.5% of non-attendants of the program answered that they were not given a chance to participate. 4. Infection control manuals were available at 68.9% of the agencies, but only 69.4% of their employees were aware of them and only 44.3% utilized them. Agencies were aware of the situation and only 42.9% answered that their manuals were fully utilized. Among the agencies currently without manuals, 47.8% are developing manuals. 5. When and how to wash hands and how to use towels in home care settings were specified in 73.0%, 78.4% and 35.1% of the agencies, respectively. As high as 92.0% of employees washed their hands after caring for clients and 74.6% after handling body fluids or excretions, but 52.2% did so before caring. It was noted that although 82.7% of the employees washed their hands with water and soap (and antiseptic agents), only 7.5% used paper towels to dry their hands. CONCLUSION: The chiefs of home care providers should be required to develop and implement better infection control strategies with the support of local governmental agencies.     

A randomized trial of opinion leader endorsement in a survey of orthopaedic surgeons: effect on primary response rates

BACKGROUND: Opinion leaders have been shown to have significant influence on the practice of health professionals and patient outcomes. METHODS: Using focus groups, key informants, and sampling to redundancy techniques, we developed a questionnaire of surgeons' preferences in the treatment of tibial shaft fractures. Twenty-two well-respected and widely known orthopaedic traumatologists endorsed the questionnaire. We randomized 395 surgeon members of the Orthopaedic Trauma Association to receive either a questionnaire that included a letter informing them of the opinion leaders' endorsement, or a questionnaire without the endorsement. RESULTS: Surgeons who received the letter of endorsement had a significantly lower response rate at 2, 4, and 8 weeks. The absolute difference in response rates was 7.8% (4.6% versus 12.4%, P < 0.05) at 2 weeks, 13.1% at 4 weeks (28.6% versus 41.7% P < 0.02), and 12.3% at 8 weeks (47.5% versus 59.8% P = 0.02). CONCLUSIONS: The addition of a letter listing expert surgeons who endorse the survey lead to significantly lower primary response rates. Those interested in influencing physician responses cannot always assume a positive effect from endorsement by opinion leaders     

A survey of skin disease among patients in an Australian nursing home

Although the number of nursing homes is increasing in Australia, few studies have investigated the dermatologic condition of their patients. To address this issue, we conducted one of the first skin disease investigations of nursing home residents in Queensland, Australia. METHODS: Our predominant data source was the attending physicians' medical reports, which are updated monthly following their physical examination of each patient. Specialist podiatrists' monthly progress notes were also used as were daily nursing reports. RESULTS: Just over half the patients (54.4%) had at least one skin disease registered among their medical records. Xerosis (dry skin) was the most common affliction, affecting 29.5% of the patients, followed by onychomycosis (tinea unguium) at 22.5% and dermatitis (8.9%). Skin cancer was recorded in 4.9%, while excoriation (3.1%) and unspecified keratosis (2.2%) were slightly less common. Being bedridden was identified as a risk factor for both xerosis (OR 3.9, 95% CI 1.8-8.7) and onychomycosis (OR 18.0, 95% Cl 7.5-49.0). CONCLUSION: Overall, our research suggests that skin diseases are reasonably common among Australian nursing home patients. The presence of certain dermatologic conditions differed from other reports.     

A randomized trial of the impact of certified mail on response rate to a physician survey, and a cost-effectiveness analysis

This study's goals were to (a) determine whether sending a survey by certified mail results in a higher response rate from physicians compared to sending by first-class mail and (b) evaluate the cost-effectiveness of this method. The study sample was 409 physicians who were nonrespondents to two previous mailings of a medical specialty society survey. Eligible physicians were designated at random to receive a final mailing either by U.S. Postal Service certified mail including a return-receipt postcard or by first-class mail. There was a higher response rate from the certified mail group compared with the first-class mail group (41.3% versus 24.8%; relative risk = 1.66, 95% Confidence interval 1.25, 2.21). A cost-effectiveness analysis showed that the cost per respondent was higher using certified mail versus first-class mail in the third mailing ($2.77 versus $2.34). Thus, use of certified mail is effective in increasing survey response but more costly.     

A randomized controlled trial of home telecare

We have established a randomized controlled trial of home telecare. The intervention aims to address a growing problem in the National Health Service (NHS), that is, high admission rates of patients with exacerbations of chronic obstructive pulmonary disease (COPD). Equipment procurement for the trial has been difficult, as no single supplier was able to meet the project s full requirements. The fact that the service is provided by existing clinical NHS staff has advantages when considering the generalizability of the results within the NHS. However, there are also disadvantages, since existing staff have little research experience. Considerable time has been required to help staff familiarize themselves with the equipment and become comfortable with its use. This has posed a barrier to the implementation of the service.     

An advance letter did not increase the response rates in a telephone survey: a randomized trial

ObjectiveTo test the impact of an advance letter on response and cooperation rates in a nationwide telephone survey, given previous inconsistent results.Study Design and SettingWithin the context of a larger telephone survey, 1,000 Australian households were randomly selected to take part in this trial. Half were randomly allocated to receive an advance letter, whereas the remainder did not receive any advance communication. Response and cooperation rates were compared between the two groups.ResultsA total of 244 interviews were completed, 134 of which were with households that had been sent an advance letter. Intention-to-treat analysis revealed no significant difference in response between those who had received a letter and those who had not (26.8% vs. 22.0%, respectively). In addition, there was no significant difference between the groups in terms of either cooperation (78.4% vs. 79.7%) or response rate (56.3% vs. 57.9%), and no clear differences emerged in terms of the demographic characteristics of the two groups.ConclusionAn advance letter was not seen to be effective in increasing response or cooperation rates in a nationwide telephone survey. Researchers should consider alternative methods of increasing participation in telephone surveys.     

Variations in hospitalization rates among nursing home residents: the role of discretionary hospitalizations

OBJECTIVE: To examine variations in hospitalization rates among nursing home residents associated with discretionary hospitalization practices. DATA SOURCES: Quarterly Medicaid case-mix reimbursement data from the state of Massachusetts served as the core data source for this study, which was linked with data from the Medicare Provider Analysis and Review file (MEDPAR) to specify hospitalization status, nursing facility attribute data from the state of Massachusetts to specify facility-level organizational and structural attributes, and data from the Area Resource File (ARF) to specify area market-level attributes. Data spans three years (1991-1993) to produce a longitudinal analytical file containing 72,319 person-quarter-level observations. STUDY DESIGN: Two-step, multivariate logistic regression models were estimated for highly discretionary hospitalizations versus those containing less discretion, and low discretionary hospitalizations versus those containing greater amounts of physician discretion. PRINCIPAL FINDINGS: Findings indicate that facility case-mix levels and area hospital bed supply levels contribute to variations in hospitalization rates among nursing home residents. Highly discretionary hospitalizations appear to be most sensitive to patient diagnoses best described as chronic, ambulatory care sensitive conditions. CONCLUSIONS: Findings suggest that defining hospitalizations simply in terms of whether an event occurs versus otherwise may obscure valuable information regarding the contribution of various risk factors to highly discretionary versus low discretionary hospitalization rates.     

Labour-saving strategies to maintain survey response rates: a randomised trial

To evaluate response-aiding strategies feasible in large surveys, we randomly allocated general practitioners (GPs) to one of four intervention groups: Group 1 received 'exhaustive' telephone prompts by a medical peer in advance of a questionnaire; Group 2, inclusion of an embossed pen with the questionnaire; Group 3, an advance letter prompt; and Group 4, a 'single attempt' advance telephone prompt by a non-medical research assistant. Follow-up procedures were identical. Response rates by group were not significantly different overall (χ²4.59, df=3, p=0.20) although advance prompts by a medical peer were significantly more effective than other strategies for male GPs. The difference in overall response rates between males (63%) and females (74%) was significant (χ²=15.40, df=1, p<0.01). No other response bias was evident. Our demonstration of a significant interaction between respondent sex and response-aiding strategy invites further research.     

Effects of characteristics of the survey instrument on response rates to a mail survey of community hospitals.

A 4-factor, 16-cell experimental design was used to investigate the relationship between response rates of community hospitals to a survey conducted by the American Hospital Association (AHA) and 4 characteristics of the survey instrument, each varied dichotomously: the perceived length of the questionnaire, the order of questions, the orientation of the appeal made in the cover letter, and the presence or absence of a promise to share the results of the study with respondents. Response rate variations between the various cells were examined and multiple logistic regression was used to analyze the significance of the association between response rates and each of the four survey instrument variables while controlling for the effect of the others. At the same time, control was also maintained for the effects of five institutional characteristics of hospitals which a previous study had shown to have a significant relationship to response: bed size, location within or outside a standard metropolitan statistical area, AHA membership status, type of ownership, and form of control. The perceived length of the questionnaire and the order of questions were found to have a significant effect on response rates, but the orientation of the cover letter and a promise to share the results of the study with the respondents were found to be insignificant.     

Questionnaire color and response rates to mailed surveys. A randomized trial and a meta-analysis

The authors conducted a randomized trial in Geneva, Switzerland, to assess whether response rates to a mailed survey could be increased by printing the questionnaire on green paper. The authors also conducted a meta-analysis of 10 experimental studies that tested the effect of colored questionnaires on response rates. The randomized trial showed no effect (relative risk of responding [RR] = 1.00). The meta-analysis showed that mailing questionnaires on pink paper increased response rates by 12% (RR = 1.12, 95% confidence interval = 1.01 to 1.25, p = 0.04). Other colors had no statistically significant effect (blue: RR = 1.03, p = 0.49; green: RR = 1.02, p = 0.23; yellow: RR = 0.96, p = 0.30). Overall, using colored instead of white paper had no effect (RR = 1.02, p = 0.17). Thus, printing questionnaires on colored paper does not substantially increase response rates in surveys, except for pink paper.     

A comparison of response rate and time according to the survey methods used: A randomized controlled trial

The purpose of this study was to evaluate the effects of recorded and standard deliveries, and stamped and franked return envelopes in a postal survey of Korean–Vietnam veterans. Nine hundred veterans were randomly divided into four subgroups. A randomized controlled trial was conducted for two mailing strategies. The 52 study subjects to whom mail was undeliverable and 36 additional study subjects found not to be residing at the listed addresses were excluded from the study. The 699 (86%) surveys were returned within 39 business days after the first mailing. The response rate for the recorded delivery (88%) was significantly higher than that of the standard delivery (82%)(p = 0.03), and the response rate of the stamped return envelops (88%) was higher than that of the franked return envelops (85%)(p = 0.27). The replies for the recorded and standard deliveries arrived an average of 10.2 and 9.9 business days, respectively, after the first mailing (p = 0.60). The average times of the responses for the stamped and franked return envelopes were 9.8 and 10.4 business days, respectively (p = 0.25). Recorded deliveries significantly increased the response rate compared to standard deliveries, and stamped return envelops slightly increased the response rate a little compared to franked return envelops. The timing of response of recorded deliveries was similar to that of standard deliveries but the volume of response of recorded deliveries was higher than that of standard deliveries.This revised was published online in April 2005. In the previous version the article category was missing.     

A randomized controlled trial of home telerehabilitation for post-knee arthroplasty

We compared the effectiveness of home telerehabilitation with conventional rehabilitation following knee replacement surgery (total knee arthroplasty, TKA). Forty-eight patients (mean age 66 years) who received TKA were recruited prior to discharge from hospital after surgery and were randomly assigned to telerehabilitation or usual care. Telerehabilitation sessions (16 per participant over two months) were conducted by trained physiotherapists using videoconferencing to the patient's home via an Internet connection (512 kbit/s upload speed). Disability and function were measured using standardized outcome measures in face-to-face evaluations at three times (prior to and at the end of treatment, and four months after the end of treatment). Clinical outcomes improved significantly for all subjects in both groups between endpoints. Some variables showed larger improvements in the usual care group two months post-discharge from therapy than in the telerehabilitation group. Home telerehabilitation is at least as effective as usual care, and has the potential to increase access to therapy in areas with high speed Internet services.     

Numbering questionnaires had no impact on the response rate and only a slight influence on the response content of a patient safety culture survey: a randomized trial

Objectives

In self-completed surveys, anonymous questionnaires are sometimes numbered so as to avoid sending reminders to initial nonrespondents. This number may be perceived as a threat to confidentiality by some respondents, which may reduce the response rate, or cause social desirability bias. In this study, we evaluated whether using nonnumbered vs. numbered questionnaires influenced the response rate and the response content.

Study Design and Setting

During a patient safety culture survey, we randomized participants into two groups: one received an anonymous nonnumbered questionnaire and the other a numbered questionnaire. We compared the survey response rates and distributions of the responses for the 42-questionnaire items across the two groups.

Results

Response rates were similar in the two groups (nonnumbered, 75.2%; numbered, 72.8%; difference, 2.4%; P = 0.28). Five of the 42 questions had statistically significant differences in distributions, but these differences were small. Unexpectedly, in all five instances, the patient safety culture ratings were more favorable in the nonnumbered group.

Conclusion

Numbering of mailed questionnaires had no impact on the response rate. Numbering influenced significantly the response content of several items, but these differences were small and ran against the hypothesis of social desirability bias.