A resident/family-centered, team-based quality improvement collaborative approach to comprehensive pandemic preparedness in long-term care homes

Dr. Akber Mithani’s team is one of two BC research teams being co-funded by MSFHR and the BC Ministry of Health, and supported by the BC Patient Safety & Quality Council, as part of the Implementation Science Teams – Strengthening Pandemic Preparedness in Long-Term Care Initiative led by the Canadian Foundation for Healthcare Improvement (CFHI) and the Canadian Patient Safety Institute.

Practices that show promise to improve response to the COVID-19 pandemic in long-term care homes need to be quickly implemented. These practices relate to outbreak preparation, prevention and response; COVID-19 and non-COVID-19 care; staffing; and presence of family.  

Our research team will study the experiences of long-term care teams as they conduct projects to implement promising practices to address gaps in their pandemic response. The teams will include residents, family, staff and management in six long-term care homes across Fraser Health. They will use a shared approach involving quality improvement training, engagement support, and the use of an online app to share learning between homes.

Key questions to be answered are:

  1. How can an online shared approach be used by team members within long-term care homes to improve pandemic response?
  2. How can this approach help in knowledge sharing across long-term care homes to promote best practices in pandemic response?

The lessons learned from the projects will inform strategies for pandemic response, which will be shared with other long term care homes across Fraser Health. The findings of this study will add to the efforts of 14 research teams across Canada as part of a larger initiative aiming to improve pandemic response in long-term care.

Funding Competition: CFHI-led Implementation Science Teams (IST) – Strengthening Pandemic Preparedness in Long-Term Care (LTC) Funding Opportunity

Funders: MSFHR; BC Ministry of Health

Breaking the cycle of recurrent fracture: Scaling up a secondary fracture prevention program in Fraser Health to inform spread across British Columbia

Co-leads:

  • Sonia Singh
    Fraser Health
  • Larry Funnell
    Patient partner
  • Tania Bubela
    SFU
Executive sponsor:

  • Linda Dempster
    Fraser Health

Low-trauma fractures (which occur spontaneously or following minor trauma) are a frequent consequence of osteoporosis and can lead to significant disability, and even death, for patients. One low-trauma fracture often leads to a cycle of recurrent fracture. For example, approximately 50 percent of patients who suffer a hip fracture have a history of past fracture.

In BC, the annual cost for osteoporosis-related fractures has been estimated at $269 million for hospital care, Medical Services Plan and Pharmacare alone. Despite the availability of effective treatments that reduce future fracture risk by up to 50 percent, less than 20 percent of patients suffering low trauma fractures receive such treatments in their post-fracture care. This is the osteoporosis care gap.

The evidenced-based Fracture Liaison Services (FLS) model has been adopted worldwide as the most effective model for preventing recurrent osteoporosis-related fractures in a cost-effective manner. FLS involves a dedicated coordinator who captures the patient at the point of orthopedic care for the low-trauma fracture and integrates secondary fracture prevention into the overall fracture experience. FLS coordinators link fracture patients with community family physicians to ensure sustainability and follow-through of initiated interventions to prevent another fracture.

In 2012, the Secondary Fracture Prevention Research Team in Fraser Health (FH) brought together osteoporosis and fall prevention experts to develop an FLS model that fit the context of the BC health-care environment. In 2015, the model was implemented at Peace Arch Hospital (PAH).

A controlled before and after study demonstrated a three-fold increase in appropriate fracture prevention interventions taken up by low-trauma fracture patients in the FLS group compared with a control group. FLS is now a permanent program at PAH. In this project, the team will explore how the FLS model implemented at one hospital can be successfully adapted and scaled-up to other hospital sites within FH.

Consolidated Framework for Implementation Research (CFIR) 16 will inform the team’s implementation strategy and the RE-AIM 17 model will frame the process and outcome evaluation. The key outcome is to inform an FLS implementation strategy that can be used to spread the FLS model across BC, thereby improving patients’ quality of life after low-trauma fractures and decreasing health care costs related to recurrent fracture.

Collaborative development of a dynamic electronic frailty index (eFI) for older adults living with frailty

Research co-leads:

  • Xiaowei Song
    Fraser Health

Research user co-lead:

  • Rowena Rizzotti
    Health and Technology District, Lark Group

Team members:

  • Ryan D'Arcy
    Simon Fraser University
  • Bimal Lakhani
    HealthTech Connex Inc
  • Carlo Menon
    Simon Fraser University
  • Chelsea Stunden
    Lark Group

The Canadian population over the age of 65 is expected to increase to 15 million by 2061, with 23% showing indicators of frailty. There is growing evidence that frailty is related to cognitive and physical decline; however, frailty assessments are not yet utilized effectively in community and residential settings to prevent adverse health events.

Rapid advancements in frailty assessment have demonstrated that deficits accumulation can predict health and function over time, and when used properly, can predict the need for institutionalization. The goal of this research is to enhance multi-disciplinary partnerships and stakeholder collaboration to create evidence. This will inform a knowledge translation plan for developing a dynamic electronic frailty index that can monitor frailty indicators within the community environment, continuously and dynamically.

Over the 12-month funding cycle, we will convene and collaborate with multi-disciplinary (researchers, research users, caregivers, seniors) stakeholders over five co-designed engagement activities, informed by ecological principles. The workshops will:

  • Identify the resources available to monitor frailty progression.
  • Identify the people, systems, and structures available and ready to monitor deficits accumulation.
  • Use the data collected to create an evidence-based knowledge translation plan that can inform decision making for developing a dynamic electronic frailty index that continuously and dynamically monitors frailty in the community setting.

Qualitative data will be thematically coded and analyzed. Knowledge translation and dissemination strategies will follow the Ageing Framework by the World Health Organization to ensure best-practices.

Breaking the cycle of recurrent fracture: Scaling up a fracture prevention program in British Columbia

Co-leads:

  • Sonia Singh
    Fraser Health
  • Larry Funnell
    Patient partner
  • Tania Bubela
    SFU
Executive sponsor:

  • Teresa O’Callaghan
    Fraser Health

Low-trauma fractures (fractures that occur spontaneously or following minor trauma) are a frequent consequence of osteoporosis, leading to significant disability and even death for patients.

One low-trauma fracture often leads to a cycle of recurrent fracture. For example, half of patients who suffer a hip fracture have a history of past fracture. In BC, the cost for osteoporosis-related fractures has been estimated at $269 million for hospitals, the medical services plan, and Pharmacare alone.

Despite the availability of effective treatments that reduce future fracture risk by up to 50%, fewer than 20% of patients suffering low trauma fractures receive such treatments in their post-fracture care. This is the osteoporosis care gap.

The evidenced-based Fracture Liaison Services (FLS) model has been recognized and adopted worldwide as the most effective model for preventing recurrent osteoporosis-related fractures in a cost-effective manner. FLS involves a dedicated coordinator who “captures” the patient at the point of orthopedic care for the low-trauma fracture and seamlessly integrates secondary fracture prevention into the overall fracture experience. FLS coordinators link up with community family physicians to ensure sustainability and follow-through of the initiated interventions to prevent further fractures.

In 2012, the Secondary Fracture Prevention Research Team at Fraser Health brought together osteoporosis and fall prevention experts locally, nationally and internationally, to develop an FLS model that fit the context of the BC health care environment. In 2014, the model was implemented at Peace Arch Hospital (PAH) in BC. A controlled before and after study demonstrated a three-fold increase in appropriate fracture prevention interventions received by low trauma fracture patients in the FLS group compared to a control group. FLS is now a permanent program at PAH.

This project will explore how the FLS model implemented at one hospital in BC can be successfully adapted and scaled-up to other hospital sites within BC. The Consolidated Framework for Implementation Research will inform the implementation strategy and the RE-AIM model will frame the process and outcome evaluation. The key outcome will be to inform an FLS implementation strategy that can be used to scale up to other hospital sites across BC, improving patient quality of life after low trauma fractures and decreasing health care costs related to recurrent fractures.

Advance Care Planning Evaluation in Hospitalized Elderly Patients

The primary purpose of this study is to evaluate Advance Care Planning (ACP) to determine from the patient and families’ perspectives, the prevalence of ACP, satisfaction with end of life (EOL) communication and decision-making, and to enable local or regional teams to develop and implement specific action plans aimed at increasing the quality and quantity of ACP efforts specifically, and the overall quality of EOL care in general.

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Why are so many patients dissatisfied with knee replacement surgery? Exploring variations of the patient experience

The purpose of this research is to determine why such high numbers of patients – up to 1 in 5 – who undergo knee replacement surgery are dissatisfied with the outcomes of their surgery. Total Knee Arthroplasty (TKA), is the most requested joint replacement surgery in Canada, and will continue to increase in response to the needs of an aging population.   A greater understanding of the variations in patient outcomes, and the factors that contribute to the dissatisfaction rate, will inform surgical program planning and help to standardize procedures and services to achieve better outcomes.

Continue reading “Why are so many patients dissatisfied with knee replacement surgery? Exploring variations of the patient experience”