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Ghai S, Chassé K, Renaud MJ, Guicherd-Callin L, Bussières A, Zidarov D. Transition of care from post-acute services for the older adults in Quebec: a pilot impact evaluation. BMC Health Serv Res 2024; 24:421. [PMID: 38570840 PMCID: PMC10993552 DOI: 10.1186/s12913-024-10818-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 03/03/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Early discharge of frail older adults from post-acute care service may result in individuals' reduced functional ability to carry out activities of daily living, and social, emotional, and psychological distress. To address these shortcomings, the Montreal West Island Integrated University Health and Social Services Centre in Quebec, Canada piloted a post-acute home physiotherapy program (PAHP) to facilitate the transition of older adults from the hospital to their home. This study aimed to evaluate: (1) the implementation fidelity of the PAHP program; (2) its impact on the functional independence, physical and mental health outcomes and quality of life of older adults who underwent this program (3) its potential adverse events, and (4) to identify the physical, psychological, and mental health care needs of older adults following their discharge at home. METHODS A quasi-experimental uncontrolled design with repeated measures was conducted between April 1st, 2021 and December 31st, 2021. Implementation fidelity was assessed using three process indicators: delay between referral to and receipt of the PAHP program, frequency of PAHP interventions per week and program duration in weeks. A battery of functional outcome measures, including the Functional Independence Measure (FIM) and the Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10 scale, as well as fall incidence, emergency visits, and hospitalizations were used to assess program impact and adverse events. The Patient's Global Impression of Change (PGICS) was used to determine changes in participants' perceptions of their level of improvement/deterioration. In addition, the Camberwell Assessment of Need for the Elderly (CANE) questionnaire was administered to determine the met and unmet needs of older adults. RESULTS Twenty-four individuals (aged 60.8 to 94 years) participated in the PAHP program. Implementation fidelity was low in regards with delay between referral and receipt of the program, intensity of interventions, and total program duration. Repeated measures ANOVA revealed significant improvement in FIM scores between admission and discharge from the PAHP program and between admission and the 3-month follow-up. Participants also reported meaningful improvements in PGICS scores. However, no significant differences were observed on the physical or mental health T-scores of the PROMIS Global-10 scale, in adverse events related to the PAHP program, or in the overall unmet needs. CONCLUSION Findings from an initial sample undergoing a PAHP program suggest that despite a low implementation fidelity of the program, functional independence outcomes and patients' global impression of change have improved. Results will help develop a stakeholder-driven action plan to improve this program. A future study with a larger sample size is currently being planned to evaluate the overall impact of this program. CLINICAL TRIAL REGISTRATION Retrospectively registered NCT05915156 (22/06/2023).
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Affiliation(s)
- Shashank Ghai
- Department of Political, Historical, Religious and Cultural Studies, Karlstad University, Karlstad, Sweden.
- Centre for Societal Risk Research, Karlstad University, Karlstad, Sweden.
| | - Kathleen Chassé
- Montréal West Island Integrated University Health and Social Services Centre, Montreal, Québec, Canada
| | - Marie-Jeanne Renaud
- Montréal West Island Integrated University Health and Social Services Centre, Montreal, Québec, Canada
| | - Lilian Guicherd-Callin
- Montréal West Island Integrated University Health and Social Services Centre, Montreal, Québec, Canada
| | - André Bussières
- School of Physical and Occupational Therapy, McGill University, Montreal, Québec, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Montréal, Québec, Canada
- Departement Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Diana Zidarov
- Faculté de Médicine, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Québec, Canada
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Hudon C, Lambert M, Aubrey-Bassler K, Chouinard MC, Doucet S, Ramsden VR, Zed J, Luke A, Bisson M, Howse D, Schwarz C, Rubenstein D, Taylor J. Fostering collective leadership to improve integrated primary care: lessons learned from the PriCARE program. Arch Public Health 2024; 82:24. [PMID: 38388457 PMCID: PMC10882827 DOI: 10.1186/s13690-024-01258-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/19/2024] [Indexed: 02/24/2024] Open
Abstract
Case management (CM) is an intervention for improving integrated care for patients with complex care needs. The implementation of this complex intervention often raises opportunities for change and collective leadership has the potential to optimize the implementation. However, the application of collective leadership in real-world is not often described in the literature. This commentary highlights challenges faced during the implantation of a CM intervention in primary care for people with complex care needs, including stakeholders' buy-in and providers' willingness to change their practice, selection of the best person for the case manager position and staff turnover. Based on lessons learned from PriCARE research program, this paper encourages researchers to adopt collective leadership strategies for the implementation of complex interventions, including promoting a collaborative approach, fostering stakeholders' engagement in a trusting and fair environment, providing a high level of communication, and enhancing collective leadership attitudes and skills. The learnings from the PriCARE program may help guide researchers for implementing complex healthcare interventions.
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Affiliation(s)
- Catherine Hudon
- Département de Médecine de Famille et de Médecine D'urgence, Université de Sherbrooke, 12e Avenue Nord, Sherbrooke, QC, 3001, Canada.
| | - Mireille Lambert
- Département de Médecine de Famille et de Médecine D'urgence, Université de Sherbrooke, 12e Avenue Nord, Sherbrooke, QC, 3001, Canada
| | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University, Room 426, 4th Floor Janeway Hostel, Health Sciences Centre, 300 Prince Philip Dr, Saint John, NL, Canada
| | - Maud-Christine Chouinard
- Faculté des Sciences Infirmières, Université de Montréal, 2375, Chemin de la Côte-Ste-Catherine, Montréal, QC, Canada
| | - Shelley Doucet
- Department of Nursing and Health Sciences, University of New Brunswick, 100 Tucker Park Road, Saint John, NB, Canada
| | - Vivian R Ramsden
- Department of Academic Family Medicine, University of Saskatchewan, 3311 Fairlight Drive, Saskatoon, SK, Canada
| | - Joanna Zed
- Department of Family Medicine, Dalhousie University, 1465 Brenton Street, Halifax, NS, Canada
| | - Alison Luke
- Department of Nursing and Health Sciences, University of New Brunswick, 100 Tucker Park Road, Saint John, NB, Canada
| | - Mathieu Bisson
- Département de Médecine de Famille et de Médecine D'urgence, Université de Sherbrooke, 12e Avenue Nord, Sherbrooke, QC, 3001, Canada
| | - Dana Howse
- Primary Healthcare Research Unit, Memorial University, Room 426, 4th Floor Janeway Hostel, Health Sciences Centre, 300 Prince Philip Dr, Saint John, NL, Canada
| | - Charlotte Schwarz
- Department of Nursing and Health Sciences, University of New Brunswick, 100 Tucker Park Road, Saint John, NB, Canada
| | - Donna Rubenstein
- Department of Family Medicine, Dalhousie University, 1465 Brenton Street, Halifax, NS, Canada
| | - Jennifer Taylor
- Department of Nursing and Health Sciences, University of New Brunswick, 100 Tucker Park Road, Saint John, NB, Canada
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Nadolny S, Bruland D, Grunwald M, Gröndahl A, Grammatico J, Richter MT, Grebe C, Latteck ÄD. Case management and care expertise as a prevention approach for adults with intellectual disabilities (FaPP-MgB): study protocol for a randomized-controlled trial. Trials 2023; 24:136. [PMID: 36814350 PMCID: PMC9946867 DOI: 10.1186/s13063-023-07155-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/10/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Adults with intellectual disabilities have a higher prevalence of unhealthy eating habits, stress, low levels of mobility, and comparable drug consumption as the general population. Consequently, they suffer from several chronic diseases earlier and more often, but there are fewer prevention and health promotion services including this population. The goal of this study is to determine if an advanced practice nursing approach in the community with home visits is an effective way to improve the health status of adults with intellectual disabilities. METHODS We will conduct a randomized-controlled trial with waiting list design in Hamburg, Germany. Inclusion criteria are diagnosis ICD F70-F79 and exclusion criteria are care level > 3 according to the German Social Code XI or being at the end-of-life. Participants will be block randomized. The intervention consists of advanced practice nurses performing case management, social space analysis, prevention planning, and counseling through four outreach home visits on nutrition, mobility, addiction, and stress. Comparison is usual care. The primary outcome is health status (WHODAS) after 12 months. Secondary outcomes are health-related quality of life (EQ-5D) and resilience (RS-11) after 6 and 12 months. The calculated sample size is 256 with an estimated dropout of 30%. Raters and analysts will be blinded. Analysis will be performed using ANCOVAs. DISCUSSION By providing case management and utilizing their nursing expertise, advanced practice nurses will provide valuable input and guidance on prevention and health promotion for people with intellectual disabilities. They will close the gap between health and social care, which is prominent in Germany, through cooperation between the existing care sectors. The findings will be disseminated in peer-reviewed journals and presented at national and international conferences. TRIAL REGISTRATION German Clinical Trials Register, DRKS00028771 , registered 4 July 2022, Universal Trial Number: U1111-1277-0595.
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Affiliation(s)
- Stephan Nadolny
- Institute for Educational and Health-Care Research in the Health Sector, Bielefeld University of Applied Sciences, Interaktion 1, 33619, Bielefeld, Germany. .,Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle, Germany.
| | - Dirk Bruland
- grid.434083.80000 0000 9174 6422Institute for Educational and Health-Care Research in the Health Sector, Bielefeld University of Applied Sciences, Interaktion 1, 33619 Bielefeld, Germany
| | - Marie Grunwald
- grid.434083.80000 0000 9174 6422Institute for Educational and Health-Care Research in the Health Sector, Bielefeld University of Applied Sciences, Interaktion 1, 33619 Bielefeld, Germany ,grid.434095.f0000 0001 1864 9826Institute for Management and Technology, Osnabrück University of Applied Sciences, Kaiserstraße 10C, 49809 Lingen, Germany
| | - Annika Gröndahl
- grid.434083.80000 0000 9174 6422Institute for Educational and Health-Care Research in the Health Sector, Bielefeld University of Applied Sciences, Interaktion 1, 33619 Bielefeld, Germany
| | - Jessica Grammatico
- grid.434083.80000 0000 9174 6422Institute for Educational and Health-Care Research in the Health Sector, Bielefeld University of Applied Sciences, Interaktion 1, 33619 Bielefeld, Germany
| | - Miriam Tariba Richter
- grid.11500.350000 0000 8919 8412Competence Center for Health, Hamburg University of Applied Sciences, Alexanderstraße 1, 20099 Hamburg, Germany
| | - Christian Grebe
- grid.434083.80000 0000 9174 6422Institute for Educational and Health-Care Research in the Health Sector, Bielefeld University of Applied Sciences, Interaktion 1, 33619 Bielefeld, Germany
| | - Änne-Dörte Latteck
- grid.434083.80000 0000 9174 6422Institute for Educational and Health-Care Research in the Health Sector, Bielefeld University of Applied Sciences, Interaktion 1, 33619 Bielefeld, Germany
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A Model for Examining Family Health History Awareness: Rethinking How to Increase Its Interfamilial and Clinical Utility and Transmission. Prof Case Manag 2022; 28:45-52. [DOI: 10.1097/ncm.0000000000000621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Elias L, Maiden G, Manger J, Reyes P. Teaming up for more comprehensive care: case study of the Geriatric flying squad and emergency responders (Ambulance, Police, Fire and Rescue). JOURNAL OF INTEGRATED CARE 2021. [DOI: 10.1108/jica-05-2021-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this paper is to describe the development, implementation and initial evaluation of the Geriatric Flying Squad's reciprocal referral pathways with emergency responders including New South Wales Ambulance, Police and Fire and Rescue. These innovative pathways and model of care were developed to improve access to multidisciplinary services for vulnerable community dwelling frail older people with the intent of improving health and quality of life outcomes by providing an alternative to hospital admission.Design/methodology/approachThis is a case study describing the review of the Geriatric Flying Squad's referral database and quality improvement initiative to streamline referrals amongst the various emergency responders in the local health district. The implementation and initial evaluation of the project through online survey are further described.FindingsSustainable cross-sector collaboration can be achieved through building reciprocal pathways between an existing rapid response geriatric outreach service and emergency responders including Ambulance, Police, Fire and Rescue. Historically, emergency services would have transferred this group to the emergency department. These pathways exemplify person-centred care, underpinned by a multidisciplinary, rapid response team, providing an alternative referral pathway for first responders, with the aim of improving whole of health outcomes for frail older people.Practical implicationsEnablers of these pathways include a single point of contact for agencies, extended hours to support referral pathways, education to increase capacity and awareness, comprehensive and timely comprehensive assessment and ongoing case management where required and contemporaneous cross-sector collaboration to meet the medical and psychosocial needs of the client.Originality/valueThe Geriatric Flying Squad reciprocal pathways are a unique model of care with a multi-agency approach to addressing frail older people's whole of health needs.
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