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Couture V, Germain N, Côté É, Lavoie L, Robitaille J, Morin M, Chouinard J, Couturier Y, Légaré F, Hardy MS, Chartier LB, Brousseau AA, Sourial N, Mercier É, Dallaire C, Fleet R, Leblanc A, Melady D, Roy D, Sinha S, Sirois MJ, Witteman HO, Émond M, Rivard J, Pelletier I, Turcotte S, Samb R, Giguère R, Abrougui L, Smith PY, Archambault PM. Transitions of care for older adults discharged home from the emergency department: an inductive thematic content analysis of patient comments. BMC Geriatr 2024; 24:8. [PMID: 38172725 PMCID: PMC10763115 DOI: 10.1186/s12877-023-04482-0] [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: 04/22/2023] [Accepted: 11/13/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE Improving care transitions for older adults can reduce emergency department (ED) visits, adverse events, and empower community autonomy. We conducted an inductive qualitative content analysis to identify themes emerging from comments to better understand ED care transitions. METHODS The LEARNING WISDOM prospective longitudinal observational cohort includes older adults (≥ 65 years) who experienced a care transition after an ED visit from both before and during COVID-19. Their comments on this transition were collected via phone interview and transcribed. We conducted an inductive qualitative content analysis with randomly selected comments until saturation. Themes that arose from comments were coded and organized into frequencies and proportions. We followed the Standards for Reporting Qualitative Research (SRQR). RESULTS Comments from 690 patients (339 pre-COVID, 351 during COVID) composed of 351 women (50.9%) and 339 men (49.1%) were analyzed. Patients were satisfied with acute emergency care, and the proportion of patients with positive acute care experiences increased with the COVID-19 pandemic. Negative patient comments were most often related to communication between health providers across the care continuum and the professionalism of personnel in the ED. Comments concerning home care became more neutral with the COVID-19 pandemic. CONCLUSION Patients were satisfied overall with acute care but reported gaps in professionalism and follow-up communication between providers. Comments may have changed in tone from positive to neutral regarding home care over the COVID-19 pandemic due to service slowdowns. Addressing these concerns may improve the quality of care transitions and provide future pandemic mitigation strategies.
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Affiliation(s)
- Vanessa Couture
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Nathalie Germain
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
- Faculty of Medicine, Université Laval, Québec, Québec Canada
| | - Émilie Côté
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Lise Lavoie
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Joanie Robitaille
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Michèle Morin
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
- Faculty of Medicine, Université Laval, Québec, Québec Canada
| | - Josée Chouinard
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Yves Couturier
- Department of Social Work, Université de Sherbrooke, Sherbrooke, Québec Canada
| | - France Légaré
- Faculty of Medicine, Université Laval, Québec, Québec Canada
- VITAM - Centre de recherche en santé durable, Québec, Québec Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Québec Canada
- Centre de recherche du CHU de Québec - Université Laval, Axe santé des populations et pratiques optimales en santé, Université Laval, Québec, Québec Canada
| | - Marie-Soleil Hardy
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Lucas B. Chartier
- Department of Emergency Medicine, University Health Network, Toronto, ON Canada
| | | | - Nadia Sourial
- Department of Health Management, Evaluation and Policy, School of Public Health, Université de Montréal, Montréal, Québec Canada
| | - Éric Mercier
- Faculty of Medicine, Université Laval, Québec, Québec Canada
- Centre de recherche du CHU de Québec - Université Laval, Axe santé des populations et pratiques optimales en santé, Université Laval, Québec, Québec Canada
| | - Clémence Dallaire
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
- Faculty of Nursing Science, Université Laval, Québec, Québec Canada
| | - Richard Fleet
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
- Faculty of Medicine, Université Laval, Québec, Québec Canada
- VITAM - Centre de recherche en santé durable, Québec, Québec Canada
| | - Annie Leblanc
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
- Faculty of Medicine, Université Laval, Québec, Québec Canada
- VITAM - Centre de recherche en santé durable, Québec, Québec Canada
| | - Don Melady
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada
- Schwartz-Reisman Emergency Medicine Institute, Mount Sinai Hospital, Toronto, ON Canada
| | - Denis Roy
- Commissaire à la santé et au bien-être (CSBE), Québec, Québec Canada
| | - Samir Sinha
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Department of Medicine, Sinai Health System and University Health Network, Toronto, ON Canada
| | - Marie-Josée Sirois
- Faculty of Medicine, Université Laval, Québec, Québec Canada
- Département de réadaptation, Faculté de médecine, Université Laval, Québec, Québec Canada
| | - Holly O. Witteman
- Faculty of Medicine, Université Laval, Québec, Québec Canada
- VITAM - Centre de recherche en santé durable, Québec, Québec Canada
| | - Marcel Émond
- Faculty of Medicine, Université Laval, Québec, Québec Canada
- VITAM - Centre de recherche en santé durable, Québec, Québec Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Québec Canada
| | - Josée Rivard
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Isabelle Pelletier
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Stéphane Turcotte
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Rawane Samb
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Raphaëlle Giguère
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
- Faculty of Science and Engineering, Université Laval, Québec, Québec Canada
| | - Lyna Abrougui
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
- Faculty of Science and Engineering, Université Laval, Québec, Québec Canada
| | - Pascal Y. Smith
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Patrick M. Archambault
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
- Faculty of Medicine, Université Laval, Québec, Québec Canada
- VITAM - Centre de recherche en santé durable, Québec, Québec Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Québec Canada
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Ghandour EK, Leblond S, Binette S, Rivard J, Joanisse J, Carreau L, Bert L, Boutier V, Fortin JP, Denis JL, Sinha S, Archambault P. Implementation of the Acute Care for Elders Strategy to Improve the Quality of Care Transitions in Quebec and Ontario: a Retrospective Multiple Case Study. Can Geriatr J 2023; 26:444-477. [PMID: 38045881 PMCID: PMC10684303 DOI: 10.5770/cgj.26.679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Background In 2016, two Canadian hospitals participated in a quality improvement (QI) program, the International Acute Care for Elders (ACE) Collaborative, and sought to adapt and implement a transition coach intervention (TCI). Both hospitals were challenged to provide optimal continuity of care for an increasing number of older adults. The two hospitals received initial funding, coaching, educational materials, and tools to adapt the TCI to their local contexts, but the QI project teams achieved different results. We aimed to compare the implementation of the ACE TCI in these two Canadian hospitals to identify the factors influencing the adaptation of the intervention to the local contexts and to understand their different results. Methods We conducted a retrospective multiple case study, including documentary analysis, 21 semi-structured individual interviews, and two focus groups. We performed thematic analysis using a hybrid inductive-deductive approach. Results Both hospitals met initial organizational goals to varying degrees. Our qualitative analysis highlighted certain factors that were critical to the effective implementation and achievement of the QI project goals: the magnitude of changes and adaptations to the initial intervention; the organizational approaches to the QI project implementation, management, and monitoring; the organizational context; the change management strategies; the ongoing health system reform and organizational restructuring. Our study also identified other key factors for successful care transition QI projects: minimal adaptation to the original evidence-based intervention; use of a collaborative, bottom-up approach; use of a theoretical model to support sustainability; support from clinical and organizational leadership; a strong organizational culture for QI; access to timely quality measures; financial support; use of a knowledge management platform; and involvement of an integrated research team and expert guidance. Conclusion Many of the lessons learned and strategies identified from our analysis will help clinicians, managers, and policymakers better address the issues and challenges of adapting evidence-based innovations in care transitions for older adults to local contexts.
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Affiliation(s)
- El Kebir Ghandour
- Institut national d'excellence en santé et en services sociaux (INESSS), Québec, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux-SASSS du CISSS de Chaudière-Appalaches, Lévis, QC, Canada
| | - Sara Leblond
- Hôpital Montfort, Ottawa, ON, Canada
- Institut du Savoir Montfort, Ottawa, ON, Canada
| | - Sébastien Binette
- VITAM-Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, QC, Canada
| | - Josée Rivard
- Centre intégré de santé et de services sociaux de la Montérégie-Centre, Greenfield Park, QC, Canada
| | - John Joanisse
- Hôpital Montfort, Ottawa, ON, Canada
- Institut du Savoir Montfort, Ottawa, ON, Canada
| | | | - Laetitia Bert
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux-SASSS du CISSS de Chaudière-Appalaches, Lévis, QC, Canada
- Université Laval, Québec, QC, Canada
| | - Véronique Boutier
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux-SASSS du CISSS de Chaudière-Appalaches, Lévis, QC, Canada
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Jean-Paul Fortin
- VITAM-Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, QC, Canada
- Université Laval, Québec, QC, Canada
| | - Jean-Louis Denis
- Département de gestion, d'évaluation et de politique de santé (DGEPS), École de santé publique-Université de Montréal, Montréal, QC, Canada
| | - Samir Sinha
- Sinai Health, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Department of Institute of Health Policy and Management, University of Toronto, Toronto, ON, Canada
- Division of Geriatric Medicine and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Patrick Archambault
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux-SASSS du CISSS de Chaudière-Appalaches, Lévis, QC, Canada
- Institut du Savoir Montfort, Ottawa, ON, Canada
- VITAM-Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, QC, Canada
- Université Laval, Québec, QC, Canada
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
- Department of Anesthesiology and Intensive Care Medicine, Université Laval, Québec, QC, Canada
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Fritsche G, Schoonenboom N, Van der Kroon H, Douma CE, Van der Dussen J, Verlaan M, Cloosterman B, Heems M, Nepal A, Toor EJ, de Rooij A, van Stralen KJ, Lucke JA. The effect of regional transmural agreements on the information transfer of frail older patients. BMC Geriatr 2023; 23:787. [PMID: 38030983 PMCID: PMC10688100 DOI: 10.1186/s12877-023-04519-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 11/25/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Frail older patients are at risk for many complications when admitted to the hospital. Multidisciplinary regional transmural agreements (RTA) in which guidelines were set concerning the information transfer of frail older patients might improve outcomes. We aim to investigate the effect of implementation of the RTA on the completeness of the information transfer of frail older patients when admitted to and discharged from the hospital. METHODS This is a retrospective cohort study in which we collected data from 400 randomly selected hospitalized frail older patients (70+) before the implementation of the RTA, January through March 2021, and after, October through December 2021. The cohort was split up into four groups, which determined what correspondence would be checked (referral letter by General Practitioner (GP) and three groups of 'hospital letters': ED letter upon admittance, clinical discharge letter to the elderly care physician and clinical discharge letter to the GP. We assessed for mention of frailty, a medication list and mention of resuscitation orders. RESULTS In the period before implementation the mean age of patients was 82.6 years (SD 7.4) and 101 were female (50.5%), after implementation mean age was 82.3 (SD 6.9) and 112 were female (56.0%). Frailty was mentioned in hospital letters in 12.7% before and 15.3% after implementation (p = 0.09). More GP referral letters were present after implementation (32.0% vs. 54.0%, p = 0.03), however frailty was mentioned only in 12.5% before and 7.4% after (p = 0.58). There was a good handover of medication lists from the hospital (89.3% before, 94% after, p = 0.20) and even better from the GP (93.8% before, 100% after, p = 0.19). Resuscitation orders were mentioned in 59.3% of letters from the hospital before implementation and 57.3% after (p = 0.77), which is higher than in the referral letters (18.8% before and 22.2% after (p = 0.91). DISCUSSION The implementation of RTA improved the number of GP referral letters present; however, it did not lead to other significant improvements in communication between the hospital and the GP's. Frailty and resuscitation orders are still frequently not mentioned in the reports. After a successful reimplementation, the improvements of outcomes could be investigated.
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Affiliation(s)
- G Fritsche
- Department of Emergency Medicine, Spaarne Gasthuis, Boerhaavelaan 22, Haarlem, 2035 RC, The Netherlands
| | - N Schoonenboom
- Department of Neurology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - H Van der Kroon
- Department of Geriatrics, Spaarne Gasthuis, Haarlem, The Netherlands
| | - C E Douma
- Department of Internal Medicine, Spaarne Gasthuis, Haarlem, The Netherlands
| | | | - Mne Verlaan
- General Practitioner, Haarlem, The Netherlands
| | | | - M Heems
- Elderly Care Physician, Amstelring, Hoofddorp, The Netherlands
| | - A Nepal
- Elderly Care Physician, Zorgbalans, Haarlem, The Netherlands
| | - E J Toor
- Transmural Coordinating Centre, Spaarne Gasthuis, Haarlem, The Netherlands
| | - A de Rooij
- Transmural Coordinating Centre, Spaarne Gasthuis, Haarlem, The Netherlands
| | - K J van Stralen
- Spaarne Gasthuis Academy, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - J A Lucke
- Department of Emergency Medicine, Spaarne Gasthuis, Boerhaavelaan 22, Haarlem, 2035 RC, The Netherlands.
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Archambault P, Turcotte S, Smith PY, Said Abasse K, Paquet C, Côté A, Gomez D, Khechine H, Gagnon MP, Tremblay M, Elazhary N, Légaré F. Intention to Use Wiki-Based Knowledge Tools: Survey of Quebec Emergency Health Professionals. JMIR Med Inform 2021; 9:e24649. [PMID: 34142977 PMCID: PMC8277401 DOI: 10.2196/24649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/16/2021] [Accepted: 05/07/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Clinical decision support systems are information technologies that assist clinicians in making better decisions. Their adoption has been limited because their content is difficult to adapt to local contexts and slow to adapt to emerging evidence. Collaborative writing applications such as wikis have the potential to increase access to existing and emerging evidence-based knowledge at the point of care, standardize emergency clinical decision making, and quickly adapt this knowledge to local contexts. However, little is known about the factors influencing health professionals' use of wiki-based knowledge tools. OBJECTIVE This study aims to measure emergency physicians' (EPs) and other acute care health professionals' (ACHPs) intentions to use wiki-based knowledge tools in trauma care and identify determinants of this intention that can be used in future theory-based interventions for promoting the use of wiki-based knowledge tools in trauma care. METHODS In total, 266 EPs and 907 ACHPs (nurses, respiratory therapists, and pharmacists) from 12 Quebec trauma centers were asked to answer a survey based on the theory of planned behavior (TPB). The TPB constructs were measured using a 7-point Likert scale. Descriptive statistics and Pearson correlations between the TPB constructs and intention were calculated. Multiple linear regression analysis was conducted to identify the salient beliefs. RESULTS Among the eligible participants, 57.1% (152/266) of EPs and 31.9% (290/907) of ACHPs completed the questionnaire. For EPs, we found that attitude, perceived behavioral control (PBC), and subjective norm (SN) were significant determinants of the intention to use wiki-based knowledge tools and explained 62% of its variance. None of the sociodemographic variables were related to EPs' intentions to use wiki-based knowledge tools. The regression model identified two normative beliefs ("approval by physicians" and "approval by patients") and two behavioral beliefs ("refreshes my memory" and "reduces errors"). For ACHPs, attitude, PBC, SN, and two sociodemographic variables (profession and the previous personal use of a wiki) were significantly related to the intention to use wiki-based knowledge tools and explained 60% of the variance in behavioral intention. The final regression model for ACHPs included two normative beliefs ("approval by the hospital trauma team" and "people less comfortable with information technology"), one control belief ("time constraints"), and one behavioral belief ("access to evidence"). CONCLUSIONS The intentions of EPs and ACHPs to use wiki-based knowledge tools to promote best practices in trauma care can be predicted in part by attitude, SN, and PBC. We also identified salient beliefs that future theory-based interventions should promote for the use of wiki-based knowledge tools in trauma care. These interventions will address the barriers to using wiki-based knowledge tools, find ways to ensure the quality of their content, foster contributions, and support the exploration of wiki-based knowledge tools as potential effective knowledge translation tools in trauma care.
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Affiliation(s)
- Patrick Archambault
- Département de médecine d'urgence, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Université Laval, Québec, QC, Canada
| | - Stéphane Turcotte
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Pascal Y Smith
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Kassim Said Abasse
- Département de management, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
| | - Catherine Paquet
- Département de marketing, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
| | - André Côté
- Département de management, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
| | - Dario Gomez
- Département de systèmes d'information organisationnels, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
| | - Hager Khechine
- Département de systèmes d'information organisationnels, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
| | - Marie-Pierre Gagnon
- VITAM - Centre de recherche en santé durable, Université Laval, Québec, QC, Canada
- Faculté des sciences infirmières, Université Laval, Québec, QC, Canada
| | - Melissa Tremblay
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Nicolas Elazhary
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Université Laval, Québec, QC, Canada
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