Systematic implementation and evaluation of an app-based community platform for assessing pain in long-term care facilities

Abstract

Pain is under-assessed and under-addressed among older adults living in long-term care (LTC) facilities. The Pain Assessment Checklist for Seniors with Limited Ability to Communicate-II (PACSLAC-II) is a validated assessment tool for health professionals to assess pain in residents with dementia. A tablet app, based on the PACSLAC-II, has been shown to have clinical utility. This study involved the systematic implementation and evaluation of a new community platform that works in conjunction with an updated PACSLAC-II app. The community platform is comprised of (a) a quality indicator (QI) feature, which allows health care professionals to view and share their unit QI scores (e.g., frequency of resident assessments) with other units; and (b) a resource community portal (CP) feature aimed at facilitating user interaction and continuing education. The objectives of this study were to (1) evaluate whether pain Qis (e.g., frequency and timeliness of pain management interventions) improved with the use of the app (and each feature) compared to the LTC unit’s regular pain assessment practices; (2) evaluate the impact of the use of the PACSLAC-II app and each of the new features on health care professionals’ self-reported stress and burnout levels, and; (3) obtain the perspectives of health care professionals on the app and its specific features through semi-structured interviews. Based on the job-demand resource model, it was anticipated that LTC units assigned to use the app and both features would see the most gains in QI scores, reduced staff stress, and staff satisfaction with the app. This would be followed by units that were assigned to the app with only one feature, and lastly by units that had access to the basic app with no additional features. For the purposes of hypothesis testing, a minimum of 25% improvement in QI scores was considered to reflect meaningful change. This study employed a mixed methods multiple-baseline design across several LTC facilities. Eleven LTC facilities participated in this study and were randomly assigned to one of five conditions (App only, App + QI, App + CP, App + QI + CP, App + CP + QI). Complementing the unit data, 34 health care professionals completed self-report questionnaires and 32 participated in semi-structured interviews. QI data revealed improvements in QI scores compared to baseline regardless of experimental condition. Contrary to hypotheses, however, regression analyses showed that demographic data and utilization of the associated websites did not predict stress and burnout scores. Thematic analysis of staff interviews showed that a majority of participants expressed a preference for using the app as opposed to a paper version of the PACSLAC-II due to reasons such as the app’s ability to provide useful information (i.e., resident pain graphs), increased data security, as well as its user-friendly interface and increased convenience. The overall increase in QI scores observed in the implementation period suggests that the utilization of the PACSLAC-II may be effective and feasible in improving pain assessment practices in LTC facilities. At the same time, QI gains were not maintained during a follow up period, likely related to unusually high competing demands on staff due to the COVID-19 pandemic. Nonetheless, the results of this study strongly support benefits of using the app version of the PACSLAC-II, although use of the extra features were not shown to confer additional advantages to frontline staff. As pointed out by some participants, the QI feature might prove more useful for facility administrators monitoring overall facility performance than to frontline nursing staff.