Implementing a new model in primary care for older canadians living with frailty

Seven lessons from the field: Research on transformation of health systems for older adults

“…We largely draw on our experiences from three research programs: (1) a Canadian Institutes of Health Research (CIHR)-funded investigation of challenges related to health information sharing and care coordination for older patients, especially during transitions in care 12 ; (2) a study of the policy, regulatory, and health system challenges associated with health technology innovation and adoption, funded by the AGE-WELL (Aging Gracefully Across Environments using Technology to Support Wellness, Engagement, and Long Life; www.agewell-nce.ca) Network of Centres of Excellence (NCE) 17 ; and (3) ongoing research on the enhancement of primary care for older adults, funded by the Canadian Frailty Network NCE (www.cfn-nce.ca), including work on how to support patient and caregiver involvement in healthcare decision-making, [18][19][20] as well as on risk screening and care coordination. 15,21 Research-related challenges for health system transformation…”

“…At the level of individual programs and teams, staff members who are partners in a research project may be reassigned to other positions or leave the organization, with new staff coming in who are unfamiliar with the project and who may wish to see the project go in a different direction (or abandoned). 21 Some research designs, such as cluster randomized trials 24 or stepped wedge designs, 25 allow for the possibility of comparative settings or systems to serve as a kind of control group. Pragmatic trials, 26 with their emphasis on implementation in usual practice settings with fewer exclusion criteria for research subjects, offer some hope of greater generalizability.…”