STANDARD EDITION OF THE INFOREHAB BULLETIN SUMMER 2013

Inside this Issue

Cover Welcome In the News Notes of Distinction Student Thesis Update

Page 1

Inside Where Are They Now? Summer Research Associate SHARP Update Recent Presentations Research Planning & Priorities

Workshop Recent Publications GWSA Seniors in Control Event WWLHIN Rehab Update

Page 2-5

Back InfoRehab London Site Update Recipe: Pineapple-Raspberry Parfaits

Page 6

Thank you for reading our summer edition bulletin. We hope that it will continue to encourage dialogue with colleagues along with the generation of new ideas!

If you would like to be included in our e-mail distribution of the bulletin or would like further information on the material presented, please contact Sheila Bodemer at sbodemer@uwaterloo.ca.

Home-based rehab for seniors improves quality of life

Waterloo Record - June 10, 2013 Paul Stolee, InfoRehab, Associate Professor, SPHHS University of Waterloo was recently interviewed about his study with University of Toronto which shows that rehabilitation services (physiotherapy and occupational therapy) in home care leads to improved function and preferred discharge for seniors with musculoskeletal disorders.

The data analysis for the study was led by Dr. Richard Cook of the Department of Statistics and Actuarial Science at University of Waterloo, and made use of the MDS-HC data from close to 100,000 Ontario home care clients.

The interview highlighted how patients involved in the study were more likely to improve in their ability to look after themselves, to perform necessary household tasks and to move around independently. They were less likely to need admission to hospital or long-term care homes. It was hoped that the Ministry of Health continues to encourage greater investment in home-based physiotherapy and occupational therapy. Full article here

Congratulations Linda on a successful thesis proposal defense! Linda's thesis topic involves exploring the experiences of health care providers who work with Alzheimer's disease and related dementia (ADRD) patients. She is using a qualitative approach involving interviews with health care providers who work with dementia patients in primary care memory clinics.

InfoRehab UW

inforehab_uw

Follow us on

Twitter and

Facebook

In the News

Jacobi was the most recent recipient of the Susan Pearce and Leslie Harwood Endowment Scholarship. This scholarship is awarded annually to a full-time graduate Applied Health Sciences student on the basis of scholastic excellence and a demonstrated interest in research related to aging and older populations. Congrats Jacobi!

Notes of Distinction: Jacobi Elliott PhD Candidate

Thesis Update: Linda Sheiban MSc Candidate

Welcome

STANDARD EDITION OF THE INFOREHAB BULLETIN SUMMER 2013

Where are they now? : Joshua Armstrong, PhD

Where are they now? : Emily Piraino, MSc

Dr. Paul Stolee and Dr. Joshua Armstrong at University of Waterloo Convocation

June 2013

From 2010-2012, Emily completed a Master’s degree in Health Studies and Gerontology at the University of Waterloo under the supervision of Dr. Paul Stolee and with the support of the InfoRehab Team. Her thesis focused on exploring barriers and facilitators to implementing the use of online networks such as TyzeTM within home care agencies to support clients and their families. This study was guided by Rogers’ Theory of Diffusion of Innovations and welcomed feedback from family caregivers, case managers, and home care providers. She also explored inclusion gaps in Randomized Controlled Trials of care transition programs for complex patients transitioning from hospital to home.

Emily is currently working for the North Bay Regional Health Centre as one of six Psychogeriatric Resource Consultants (PRCs) in the North East LHIN. She works out of Sault Ste Marie and covers the Algoma hub, which spans from Hornepayne to Elliot Lake. She has three primary roles: consultation, capacity building, and providing education based on best-practices. This past winter, her PRC group developed two new full-day workshops for care staff: PSW Champion and Geriatric Mental Health Foundations. These workshops were successfully piloted in each of the four hubs in the North East LHIN this past spring, and will be offered on an ongoing basis. These workshops focus on empowering care staff as leaders in their facilities, with a focus on using best practice assessment tools and frameworks.

Josh recently completed (February, 2013) his PhD in Aging, Health & Well-being in the School of Public Health and Health Systems at the University of Waterloo. Prior to Waterloo, Josh received a MSc in Experimental Psychology and a HBSc in Psychology (minor in biology) at Lakehead University in his home town of Thunder Bay. His doctoral research, supervised by Dr. Paul Stolee, examined rehabilitation therapy services for older adults in the Ontario Home Care System using data mining and statistical approaches in a large provincial interRAI database. His research interests include Alzheimer’s disease, frailty, quantitative methods (data mining, machine learning, and mathematical modeling), epidemiology, longevity, decision support systems, health data communication, and persuasive technology for healthy aging.

Josh is currently the successful recipient of a two-year, Alzheimer Society Research Program Postdoctoral Fellowship Award to investigate "Clinico-mathematical Approach to the Fog of Geriatrics: Application of Novel Mathematical Methods to Better Understand Health and Disease in Aging Populations". This postdoctoral research will be performed under the supervision of Dr. Arnold Mitnitski and Dr. Kenneth Rockwood at Dalhousie University (Halifax, Nova Scotia). Josh has also been appointed the Canadian Association on Gerontology Student Connection’s Vice President.

As part of the Behavioural Supports Ontario (BSO) initiative, she has been working in close collaboration with the Behavioural Support Facilitator through the local Alzheimer Society and the Clinical Behavioural Response Specialist through the local Senior’s Mental Health. One of their current projects is the creation of a tool used in long-term care homes to track BSO clients in order to identify where further support might be needed in the form of assessment, case-based education, or consultation guided by the PIECES framework. This project is currently in PDSA (plan, do, study, act) cycle. “We are also working together to build capacity with activation staff in long-term care homes to create a program that fosters meaningful activities for residents with dementia who may typically experience responsive behaviours later in the day/evening.” This program will rely heavily on a person-centred approach in order to successfully accommodate each resident’s unique needs.

“As care transitions were a major part of my work with InfoRehab, I am excited to say that I am currently a part of the Regional BSO Transitions Improvement Team in our LHIN. My affiliation with the InfoRehab team has also continued as we prepare to submit my thesis.” We are excited about Emily’s new role and continue to connect with her on related projects. All the best Emily!

STANDARD EDITION OF THE INFOREHAB BULLETIN SUMMER 2013

Seniors Helping as Research Partners (SHARP) UPDATE:

Seniors have shown initial interest in being part of this network.

We have heard from over 60 seniors who have expressed

interest in participating

In the process of submitting ethics

Hope to start official recruitment and initial focus groups in July.

Recent Presentations

Linda Sheiban, Angela Hovey, Selena Santi, Sheetal Shenoy, & Paul Stolee

While there is growing evidence of the effectiveness of home-based rehabilitation for older persons with musculoskeletal disorders, only limited information is available that describes the nature and extent of rehabilitation services provided in the home. In Ontario, hip and knee conditions affect many older adults, often resulting in the need for total joint replacement surgery. Physiotherapy is the primary treatment for clients who have undergone a joint replacement. Home care rehabilitation agencies in Ontario provide physiotherapy services in the client’s residence upon referral from a Community Care Access Centre (CCAC). We developed a profile of physiotherapy services provided by one home care rehabilitation agency to clients after a total hip or total knee replacement. The home care rehabilitation agency which provided data for this study is based in the Waterloo-Wellington Region, and delivers a wide range of home care services. Post-operative physiotherapy services include education, modalities and exercises to help improve the client’s quality of life by decreasing pain and swelling and improving mobility and range of motion. The study examined the agency’s clinical service plans for hip and knee replacement clients over the past three years of service (2009-2012), including: 1) The profile of hip and knee clients; 2) Standardized goals set and met based on care pathways developed by the CCAC in conjunction with contracted agency physiotherapists; 3) Average number of visits required to achieve the goals; and 4) Length of service provided to achieve the goals. Full presentation here

2013 Ontario Home Care Association: A Profile of Physiotherapy Service Provision for Total Hip and Knee Replacement Home Care Clients

2013 Canadian Evaluation Society: The Joy of Complexity: Evaluating Geriatric Health Systems

Paul Stolee, Jacobi Elliott, Jeanette Prorok, Heather McNeil, Katie Mairs, Linda Sheiban,& Selena Santi

There is increasing recognition that health systems are complex adaptive systems, but this is not always reflected in health system research and evaluation. Frail older patients, and the health systems which serve them, may be particularly complex. Frail older patients often have multiple, complex and interacting health and social problems and atypical disease presentations. Rockwood (1997) describes the clinical challenge of understanding this complex picture and developing a treatment plan, as the “joy of geriatrics”. Geriatric health systems are similarly complex, involving multiple health professionals, many health care settings, frequent transitions in care, and interactions between formal and informal care networks. Illustrated by several case examples, and drawing on Patton’s (2011) developmental evaluation approach, we describe how evaluation within these complex systems may both challenging and rewarding, providing opportunities for active roles in shaping programs, and for meaningful engagement of evaluators with clients and other stakeholders, including patient and citizens. Full presentation here

We are happy to have Brooke Manderson back with us for the summer. Brooke has been in Auburn Alabama, working towards her Doctor of Veterinary Medicine degree at Tuskegee University. She was formerly an InfoRehab research associate, and MSc Student with Dr. Paul Stolee. Brooke has been working with Dr. George Heckman’s on publications regarding his World Tour work. She is also disseminating the findings from the InfoRehab Transitions project, as well as working on the current care pathway for hip fracture patients in Waterloo Wellington.

Summer Research Associate – Brooke Manderson

STANDARD EDITION OF THE INFOREHAB BULLETIN SUMMER 2013

On June 24, 2013, a planning and priorities workshop was held to develop research plans and priorities focused on the assessment and management of older adults with chronic disease. The workshop brought together health system and academic researchers to identify research questions related to system improvement priorities and potential research projects that could address these questions.

The objectives of the workshop included: 1. Sharing past research and previous consultations with seniors and

system stakeholders 2. Obtaining feedback on priority areas for improving seniors health

services 3. Capturing insights to inform new research initiatives and funding

opportunities

Roundtable and group discussions explored issues and current opportunities in three main topic areas: early identification, system navigation and inter-professional collaborative practice (IPCP). Many ideas and insights emerged from the discussion with the goal of a

coherent and integrated system for patients/users and providers.

The workshop identified opportunities for small-scale validation projects on screening tools that might be undertaken almost immediately, as well as for research plans to examine interprofessional collaborative practice, that could form the basis of one or more operating grant applications to be submitted to the Fall CIHR competition (September) or other funding opportunities.

For the workshop, we were happy to have Brooke Manderson and Justine Toscan, who both completed their MSc with InfoRehab during the same timeframe, reunited. Justine’s and Brooke’s paper, “Just another fish in the pond” was recently published. Congrats ladies!

Research Planning & Priorities Workshop

Waterloo Inn – June 24th

2013

Toscan, J., Manderson, B., Santi, S., Stolee, P. “Just another fish in the pond”: The transitional care experience of a hip fracture patient. International Journal of Integrated Care. June 2013 , Vol 13 No 26 Full article here This study has given a voice to a patient as a partner in care as well as being a recipient of care. Through the inclusion of multiple perspectives the importance of both transformative care and patient experiences for quality improvement can be realized.

Santi, S.M., Hinton, S., Berg, K., and Stolee, P. Bridging the Information Divide: Strategies for Health Information Sharing in Home Care. Canadian Journal of Nursing Research. Spring 2013, Vol. 45 No 1, 16 –35. Full article here The sharing of info across disciplines also offers advantages outside of each profession, creating a system of client-centred care that is more efficient and that ensures improved continuity for the patient.

Cook, R.J., Berg, K., Hirdes, J., Lee, K., Poss, J., Hirdes, J., Stolee, P. Rehabilitation in Home Care is Associated with Functional Improvement and Preferred Discharge. Archives of Physical Medicine and Rehabilitation. June 2013. Vol. 94 No 6, 1038-47 Full article here With increasing numbers of older adults with chronic conditions, it is essential to provide the right services at the right time in a cost-effective manner. Long-stay home care patients who receive rehab at home have improved outcomes and lower use of costly services.

Johnson, H., Forbes, D., Egan, M.Y., Elliott, J., Stolee, P., & Chesworth, B.M. Hip-Fracture Care in Rural Southwestern Ontario: An Ethnographic Study of Patient Transitions and Physiotherapy Handoffs. -Physiotherapy Care. April 2013. Epub. Full article here Inadequate handoffs compromised continuity of care, delayed progress in rehabilitation, and resulted in families’ missing information of vital importance to their caregiving role. A multi-directional exchange of information is needed between patients, families, and health care providers across care settings.

STANDARD EDITION OF THE INFOREHAB BULLETIN SUMMER 2013

Ontario is getting older and to avoid bankrupting the province’s healthcare system two decades from now, pre-emptive measures are happening to address the care seniors need today and in the future. That is the message that 200 seniors heard during the health care forum on June 4

th at Guelph’s Evergreen

Seniors Centre. Older adults came looking for answers to their health care questions.

Keynote speaker Dr. Samir Sinha - provincial lead investigator for the government’s recently released health care strategy for seniors - spoke on the strategy’s design and how to help seniors with various healthcare needs to stay in their homes with assistance from agencies in the community.

A panel of local insiders in health care for the aging also made presentations. Dr. George Heckman, geriatrician and Schlegel Research Chair in Geriatric Medicine, University of Waterloo; Ross Kirkconnell, Executive Director, Guelph Family Health Team; Cathy Sturdy-Smith, Manager, Specialized Geriatric Service, Canadian Mental Health Association; and Tricia Murray, Client Service Manager, WWCCAC.

The discussion surrounded questions on how to advocate for health care needs, and the home care services the agency offers and how to access them.

The InfoRehab team was assisting the Guelph Wellington Seniors Association (GWSA) in the planning of the event, the collection of personal experiences with the health care system of the seniors in addition to feedback regarding the event. The response to the event was very positive and there is the potential to hold a similar forum in Waterloo.

FACTS: AGING & COMPLEXITY

60%

10% of seniors with complex care challenges.

6% 50% of seniors with less complex care needs.

of Ontario's collective health care spending is spent on

of provincial health care spending is used by

WWLHIN Rehab Project: An Update by Emmi Perkins

In the Rehabilitative Care Review that was completed in 2011/12, the Rehabilitation Services Review Committee recommended that the Rehabilitative Care System in Waterloo-Wellington Local Health Integration Network (WWLHIN) be re-organized around four condition-specific “Streams of Care” (Stroke/Neurology, Musculoskeletal, Cardio-pulmonary, Frail Elderly/ Medically Complex) in order to enhance the delivery of best practices and the allocation of health human resources.

Each Stream is being supported by a “Lead Organization” whose mandate will be to develop, implement and oversee the on-going monitoring and evaluation of evidence-based clinical care pathways within their respective stream and across the continuum of ‘Rehabilitative Care’ (i.e. from acute care to the community). The system will be supported by standardized assessment and communication tools and practices across the continuum of care, specialized case management for high needs patients, centralized intake for in-patient services, and improved integration with community services and primary care. Opportunities for efficiencies (i.e. transitioning patients to the lowest resource intensity setting required to meet their needs, provision of care by alternative providers, estimated lengths of stay, and innovative models of service delivery) will be embedded into clinical care pathways, where appropriate.

The Musculoskeletal (MSK) Stream of Care is being led by Cambridge Memorial Hospital. The MSK Stream Steering Committee has been working since September 2012 to develop integrated, cross-continuum, evidence-based care paths for patients with a Total Joint Arthroplasty and for those with a Fractured Hip. These care paths will be introduced in August and September 2013. InfoRehab will be involved in reviewing and providing feedback on the possible care pathways in consultation with the WWLHIN.

Additionally, an Integrated Orthopedic Capacity plan was submitted by WWLHIN to the Ministry of Health in February 2013 and work is underway to address the opportunities identified in that plan.

Guelph Wellington Senior’s

Association hosts MY Healthcare:

Seniors in Control

FOR MORE INFORMATION

The Waterloo Record – Meet Health Needs of Seniors

The Guelph Mercury – Healthcare System Changing to Meet Seniors’ Needs

STANDARD EDITION OF THE INFOREHAB BULLETIN SUMMER 2013

InfoRehab: London Site Updates

This recipe was borrowed from: http://www.eatingwell.com/recipes/crunchy_pear_celery_salad.html

PREPARATION

1. Soak celery in a bowl of ice water for 15 minutes. Drain and pat dry. Cut into 1/2-inch pieces.

2. Whisk vinegar, honey and salt in a large bowl until blended. Add pears; gently stir to coat.

Add the celery, cheese and pecans; stir to combine. Season with pepper. Divide the lettuce

leaves among 6 plates and top with a portion of salad. Serve at room temperature or chilled.

Make Ahead Tip: Prepare salad without pecans up to 2 hours ahead. Stir in pecans just

before serving.

Tip: To toast chopped pecans, cook in a small dry skillet over medium-low heat, stirring

constantly, until fragrant and lightly browned, 2 to 4 minutes.

3.

Nutrition Information

215 calories

13g fat

20mg cholesterol

20g carbohydrates

5g protein

4g fiber

240 mg sodium

219 mg potassium

15% daily value of calcium

INGREDIENTS

4 stalks celery, trimmed and cut in half crosswise

2 tablespoons cider, pear, raspberry or other fruit vinegar

2 tablespoons honey

1/4 teaspoon salt

2 ripe pears, preferably red Bartlett or Anjou, diced

1 cup finely diced white Cheddar cheese

1/2 cup chopped pecans, toasted (see Tip)

Freshly ground pepper, to taste

6 large leaves of lettuce

Bone Healthy Recipe: Crunchy Pear & Celery Salad

A quick and delicious healthy recipe for summer!

Serves: 6 (1 cup each) Active Time: 25 minutes

Enhancing MSK rehabilitation through better use of health information

This research is funded by the Canadian Institutes of

Health Research

Dr. Bert Chesworth, Physical Therapy, University of Western Ontario

In the InfoRehab Fall 2012 Bulletin, the London site reported on its use of storyboards at its Transitional Care Knowledge Exchange Day held earlier in the year. One key suggestion from that event was to pursue the development of a transitional care checklist. To that end, a pilot study to trial a prototype transitional care checklist is nearing the end of its planning stages.

The study will roll out in September 2013 with our local collaborators at Strathroy Middlesex General Hospital (SMGH) and the Southwest Community Care Access Centre (CCAC). Upon admission to acute care, a referral to the CCAC Care Coordinator will be generated for patients screened positively as a "Complex Discharge" by the South West Community Care Access Centre Complex Discharge Screening Tool. Clinicians in acute care will complete the transitional care checklist each day a patient remains in the acute care setting. The modified Care Transitions Measure (CTM®) will be completed by patients or their substitute decision-maker after transition home. The results of this study will be used to evaluate implementation and to improve the checklist before it is used on a larger scale.