Life In The Slower Lane

Here is the structured PICO analysis for the thirty-eighth article you uploaded:

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Full Title (verbatim and exact):

“International Transferability of Research Evidence in Residential Long-term Care: A Comparative Analysis of Aged Care Systems in 7 Nations”

Jain B, Cheong E, Bugeja L, Ibrahim JE

Journal of the American Medical Directors Association (2019); 20(12):1558–1565

DOI: https://doi.org/10.1016/j.jamda.2019.07.017

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Type of Article:

Cross-country comparative policy and systems analysis

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PICO Analysis:

Population:

• Not a clinical population, but rather national aged care systems in:
  • Australia, Canada, Japan, New Zealand, Switzerland, United Kingdom (England), and United States
• The study examines long-term residential aged care at the macro (policy), meso (facility), and micro (resident) levels

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Intervention (Studied Factor):

• Not a healthcare intervention but a comparative assessment of system-level and structural variables to understand:
  • Whether and to what extent aged care research findings are transferable across countries
  • How national aged care systems differ in structure, quality indicators, resident characteristics, funding, and regulatory approaches 

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Comparator:

• Australia is used as the reference system against which other countries are compared
• The article does not evaluate interventions, but assesses comparability across systems for potential research transferability

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Outcome:

1. Person-centred outcomes:

• Not directly assessed; however, resident-level variables (Table 3) include:
  • Age, gender distribution, length of stay, dementia and depression prevalence, ADL dependency levels, discharge outcomes
• Demonstrates high variability in these outcomes, which may impact the transferability of person-centred interventions 

2. Process outcomes:

• Compared meso-level variables (Table 2), such as:
  • Facility ownership (for-profit vs non-profit)
  • Staffing ratios and training levels
  • Presence of national quality indicators (e.g., interRAI or MDS use)
  • Facility size (number of beds)
• Marked differences found: e.g., the US has larger average facilities and a higher proportion of for-profit providers than Australia or Canada 

3. Health system outcomes:

• Macro-level differences (Table 1) include:
  • LTC expenditure as % of GDP (range: 0.75% to 3.5%)
  • Cost per bed per day (range: $67.70 in NZ to $293 in Switzerland)
  • Existence of dementia strategies and regulatory frameworks
• These differences may affect policy applicability, system readiness for change, and economic scalability of interventions

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Summary Conclusion:

This policy analysis study concludes that while there are broad similarities among liberal welfare states, significant differences exist across aged care systems that impact the international transferability of aged care research findings. Australia, New Zealand, and Canada were found to be the most comparable, while Japan and Switzerland were the least. Key challenges include inconsistent data definitions, missing national-level quality indicators, and variation in facility structures, staffing, and resident profiles. The authors recommend using a sociotechnical framework (macro/meso/micro) when assessing whether research findings from one country can inform policy or practice in another, rather than assuming automatic transferability.

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