Transforming primary care for older Canadians living with frailty Paul Stolee, PhD School of Public Health and Health Systems University of Waterloo April 2017
Outline How we got here Before CFN With CFN Where we’re going
What we were doing before CFN We were doing research We were listening to people
We were doing research The Study
Care Transitions for Patients with Hip Fracture Retrieved from: http://gtarehabnetwork.ca/downloads/report-hipfracture-nov06.pdf
We were listening to people Project… Consultations with… Types of Consultations… Funded Research Projects Health Care Providers (n=456) 34 Focus Group Sessions 127 Interviews 4 Workshops Funded Research Projects Patients and Family Caregivers 115 Interviews (n=82) Large Community Health Care Providers (n=450) Community Consultations Consultation Sessions Older Adults (n=200) (5 consultations over 4 years) >240 Individual Interviews Total ~1,156 individuals 34 Focus Group Sessions 9 workshops/consultations
“We’ve been taught, as we go along, that the doctor is always right, the doctor knows best, the doctor knows this . The doctor does not know best” ( SHARP member)
Some of our conclusions • Older patients are often not very involved in decision- making around their care • Family caregivers both have and need knowledge, but often have a limited role in care planning and decision- making • Limited use of technology • Coordination and communication between providers and services is often inadequate • Primary care could play a key role in identifying at-risk older persons and coordinating their care, but needs support for this role
Enter
Before CFN / With CFN Before CFN We developed an in-depth understanding of health system challenges for older persons With CFN We began to work on solutions for these challenges
What does the evidence say about how to engage older adults in healthcare decision-making? CFN-funded Knowledge Synthesis: the CHOICE project
How can we do “CHOICE” in practice?
CFN-funded Catalyst Grant Building on CHOICE frameworks How do the frameworks and principles identified through the CHOICE project correspond with actual experiences of engagement? What factors currently facilitate or hinder patient engagement? What resources, materials and implementation strategies (for patients, caregivers and providers) are needed to support patient engagement?
How to identify at-risk older patients in primary care? CFN-funded Frailty Implementation Grant
Frailty Implementation Grant Worked with three Ontario primary health care practices to implement and test a brief screening tool to identify at-risk older patients
Can we develop new methods of care coordination in primary care? CFN-funded Fellowship (Dr. Jacobi Elliott)
Fellowship Co-design approach for implementing a model of care coordination in primary care Two sites in Ontario (rural and urban) Screening tool, patient/caregiver engagement in decision-making, referral system with connections to community and specialist services
All of which positioned us for:
CFN Transformative Grant Proposal Proposed research initiative addresses priorities informed by prior research, consultations and literature review: Consistent screening and assessment of frailty Care coordination and system navigation Patient/caregiver engagement & shared decision-making Enabling technology support Research Question: Compared to usual care in primary care settings, does our proposed model improve health, social and economic outcomes for older Canadians living with frailty?
Five Principal Investigators Principal Investigators Dr. Paul Stolee (Proj. lead) University of Waterloo Dr. Anik Giguère Université Laval Dr. Kenneth Rockwood Dalhousie University Dr. Joanie Sims-Gould University of British Columbia Dr. Esther Suter University of Calgary
22 Co-Investigators Conestoga College Dr. Veronique Boscart McMaster University Dr. Andrew Costa University of Waterloo Dr. Jacobi Elliott University of Alberta Dr. Dorothy Forbes Alberta Health Services Dr. Heather Hanson University of Waterloo Dr. George Heckman University of Calgary Dr. Jayna Holroyd-Leduc University of Waterloo Dr. Ayse Kuspinar University of Waterloo Dr. Samantha Meyer Wilfrid Laurier University Dr. Josephine McMurray Dalhousie University Dr. Olga Theou Universite Laval Dr. Holly Witteman Dalhousie University Dr. Mohammad Hajizadeh University of Toronto Dr. Wanrudee Isaranuwatchai University of Toronto Dr. G. Ross Baker University of Waterloo Dr. Kerry Bryne University of Waterloo Dr. Catherine Burns University of Waterloo Dr. Kelly Grindrod Centre d'excellence sur le vieillissement de Québec du CHU de Québec (CEVQ) Dr. Lucille Juneau Centre d'excellence sur le vieillissement de Québec, Quebec, Centre de recherche FRQ-S du CHU de Quebec Dr. Edeltraut Kröger University of Waterloo Justine Giosa Université Laval Dr. Marie-Josée Sirois
13 Collaborators Yale Universrity Dr. Mary Tinetti University of Leeds Dr. John Young University of Newcastle Dr. Dimity Pond University of Queensland Dr. Geoff Mitchell International Foundation of Integrated Care/King's Fund Dr. Nick Goodwin University of British Columbia Dr. Patricia Rodney Hanyang University Dr. Dong Woon Han Erasmus University Rotterdam Dr. Jane Murray Cramm Waterloo Wellington CCAC Arsalan Afzal Waterloo Wellington LHIN Dr. Peter McPhedran SHARP Network Judith Carson SHARP Network Phyllis Puchyr SHARP Network Peter Puchyr
15 Knowledge Users Alberta Health Services Dr. Duncan Robertson Ontario Ministry of Health and Long-Term Care - Research, Analysis and Evaluation Branch Dr. Michael Hillmer Canadian Mental Health Association Susie Gregg Alberta Health Services Dr. Seigrid Deutschlander Cité-Limoilou area, Independent Living Program for Ederly People, Integrated University Health and Social services Centre of France Falardeau the of the Capitale Nationale MRC de Charlevoix area, Independent Living Program for Elderly People, Integrated University Health and Social services Centre Nancy Drouin of the of the Capitale Nationale Continuing Care - Edmonton Zone; Alberta Health Services Carol Anderson Regional Departments of General Practice, Integrated University Health and Social services Centre (Centres intégrés Dr. Jacque Bouchard universitaires de santé et de services sociaux) of the Capitale Nationale VHA Home HealthCare Carol Annett Canadian Foundation for Healthcare Improvement Christine Maika Canadian Home Care Association Nadine Henningsen brainXchange; Division of Geriatric Psychiatry Dr. Kenneth LeClair Health Canada Sharon Harper Alzheimer Society Ontario David Harvey Independent Living Program for ederly people Integrated University Health and Social services Centre of the of the Capitale Céline Allard Nationale
48 Partner Organizations
48 Partner Organizations • • • 248 Enterprises Canadian Society for Exercise Physiology Université Laval, Usability Testing • • Alberta Health Services, Continuing Care Dieticians of Canada (Lab)University of Waterloo, Faculty of • • Alberta Health Services, Research Priorities Independent Living Program (ILP) for Elderly Applied Health Sciences • and Implementation People University of Waterloo, School of Public • • Alberta Health Services, Seniors Health Cite-Limoilou Health and Health Systems • • Strategic Clinical Network MRC de Charlevoix Visiting Homemakers Association (VHA) • • • Alzheimer Society Ontario Université Laval, e-TUDE Waterloo-Wellington Self-Management • • Assistant Director ILP Heart and Stroke Foundation Program • • • brainXchange InVizzen Waterloo-Wellington CCAC • • • Calgary West Central Primary Care Ontario Ministry of Health and Long Term Woolwich Community Health Centre • Network Care Nova Scotia Health Authority • • • Canadian Gerontological Nurses Association Mount Forest Family Health Team Public Health Association of Canada • • • Canadian Home Care Association New Vision Family Health Team Health Canada • • • Canadian Patient Safety Institute Registered Nurses Association of Ontario Association of Ontario Health Centres • • • Canadian Society of Consulting Pharmacists Saint Elizabeth, Research Centre Community Care of Kawartha Lakes • • • Caredove Seniors Helping as Research Partners Seniors Care Network • • Centre for Hip Health and Mobility (SHARP) Network Association of Family Health Teams of • • Le Centre d’excellence sure le vieillissement Sherwood Park Primary Care Network Ontario • de Québec (Edmonton Zone) Research Institute of Aging (RIA) – Schelegel • • Canadian Foundation for Healthcare University of British Columbia, Institute for Chair • Improvement Healthy Living and Chronic Disease Primary Care Lead, Waterloo-Wellington • Canadian Institute for Health Information Prevention LHIN, Peter McPhedran
HQPs and Research Staff
Nine Study Sites Nine primary care sites across Alberta (n=2), Ontario (n=3) and Quebec (n=4) Urban and Rural
Four Interventions
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