Phuc Dang, Ph.D. Student, University of Victoria Madelyn P. Law, Ph.D., Brock University Laura...
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Transcript of Phuc Dang, Ph.D. Student, University of Victoria Madelyn P. Law, Ph.D., Brock University Laura...
Phuc Dang , Ph .D. S tuden t , Un i ve r s i t y o f V i c to r i aMade l yn P. Law, Ph .D. , B rock Un i ve r s i t yLaura Cousens , Ph .D. , B rock Un i ve r s i t yMiya Narush ima , Ph .D. , B rock Un i ve r s i t y
Using Network Analysis to Understand and Advance Falls Prevention Referral Pathways
Background
Falls result in negative health outcomes and have major health care cost implicationso [Public Health Agency of Canada (PHAC), 2006]
1 in 3 older adults in Canada will experience at least one fall annuallyo (Scott, Peck, & Kendall, 2004; Tinetti & Speechley, 1989)
Falls are the leading cause of hospitalization among seniors in Canadao (PHAC, 2006)
In 2004, falls accounted for $6.2 billion or 31% of Canada’s overall injury costo (SMARTRISK, 2009)
Falls Prevention Landscape
International
Prevention of Falls
Network Europe –
Network of Various
Stakeholders
National
Canadian Falls
Prevention Curriculum
Falls Prevention Initiative
Provincial
Falls and Fall Injuries Best
Practice Guideline (RNAO)
Integrated Provincial
Falls Prevention
Project (LHIN)
Niagara Region
43 Agencies (e.g., CCAC, Rehabilitation, Physical
Activity, Support Services)
Rationale
Fall Prevention Network of Niagara (FPNN) identified referral pathways between agencies as a core area to explore and make improvements
FPNN partnered with Brock University and Health Nexus to develop a network survey and network maps
Review of Literature
Foundational Research in Network
Analysis
Social networks (Valente, 2010; Scott,
1998; Borgatti, Mehra, Brass, & Labianca, 2009)Graph theory (Valente,
2010)Anthropology (Valente,
2010)
Organizational Sciences Research
Collaboration (Powell et al., 1996; Barley,
Freeman, & Hybels, 1992)
Legitimacy (Human & Provan, 2000; DiMaggio
& Powell, 1983)Partnerships (Cousens &
Slack, 1996) Linkages (MacLean,
Barnes, & Cousens, 2011)
Health Research
Collaboration and Linkages (Barnes,
MacLean, & Cousens, 2010; Provan, Harvey, &
Guernsey deZapien, 2005; Nicaise, Tulloch,
Dubois, Matanov, Priebe, & Lorant, 2012; Gregson,
Sowa, & Flynn, 2011; Fredericks, 2005)Referrals (Kwait,
Valente, & Celentano, 2001; Krauss, Meuller, &
Luke, 2001)
Varying applications of measures from network analysis
Varying methodological approaches to understanding network analysis
Research Purpose and Questions
Purpose: to understand the referral linkages that exist among falls prevention agencies in the Niagara region using a network analysis approach
Research Questions:1. What internal factors influence the level of
collaboration and integration in the network of falls prevention agencies?
2. What external factors influence the level of collaboration and integration in this case?
Methodology and Methods
Methodology and Methods
Methodology• Single case study
o (Yin, 2009)
Methods• 15 participants interviewed• Individual interviews and document analysis
o (Yin, 2009)
Data Analysis• Constant comparative approach
o (Glaser & Strauss, 1967; Corbin & Strauss, 2008)
Results
Internal Factors• (1) Health professionals initiating services,
(2) Communication strategies, (3) Formal partnerships, (4) Trust, (5) Program awareness, (6) Referral policies
External Factors• (1) Client characteristics, (2) Primary
and community care collaboration, (3) Networking, (4) Funding
Key Recommendations• (1) Electronic database, (2) Electronic
referral form, (3) Educating office staff, (4) Education days
Conclusion
Key aspect of referrals is connections between health professionals
Important to have appropriate logistics for referrals
Vital to establish rapport among health professionals
Limitations
Sampling strategyo Purposeful sampling strategy applied
Network surveyo Response rate from network survey
Research Framingo Community-based participatory research (CBPR)
could have been applied
Implications
Practice implicationso Marketing strategies to educate office staff on
programs available
o Develop a standardized referral form
o Develop an electronic database of falls prevention programs
o Utilize electronic system in primary care
o Create opportunities for face-to-face meetings
Implications – Client Feedback Loop
Future Directions
Interventional Studyo Develop electronic standardized referral form
and test its effectiveness
Theoretical Studyo Understand the role of primary care in ensuring
effective falls prevention referrals
References
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Questions