Study protocol for a hospital-to-home transitional care intervention for older adults with multiple chronic conditions and depressive symptoms: a pragmatic effectiveness-implementation trial

Background: Patient “engagement” in health research broadly refers to including people with lived experience in the research process. Although previous reviews have systematically summarized approaches to engaging older adults and their caregivers in health research, there is currently little guidance on how to meaningfully engage older adults with multimorbidity as research partners. Objectives: This paper describes the lessons learned from a patient-oriented research program, the Aging, Community and Health Research Unit (ACHRU), on how to engage older adults with multimorbidity as research partners. Over the past 7-years, over 40 older adults from across Canada have been involved in 17 ACHRU projects as patient research partners. Methods: We developed this list of lessons learned through iterative consensus building with ACHRU researchers and patient partners. We then met to collectively identify and summarize the reported successes, challenges and lessons learned from the experience of engaging older adults with multimorbidity as research partners. Results: ACHRU researchers reported engaging older adult partners across many phases of the research process. Five challenges and lessons learned were identified: 1) actively finding patient partners who reflect the diversity of older adults with multimorbidity, 2) developing strong working relationships with patient partners, 3) providing education and support for both patient partners and researchers, 4) using flexible approaches for engaging patients, and 5) securing adequate resources to enable meaningful engagement. Conclusion: The lessons learned through this work may provide guidance to researchers on how to facilitate meaningful engagement of this vulnerable and understudied subgroup in the patient engagement literature.

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“…Further details on patient engagement within ACHRU 22 and 1 of the 17 projects has been published elsewhere. 22 , 35 , 36 …”

Section: Resultsmentioning

confidence: 99%

Engagement of older adults with multimorbidity as patient research partners: Lessons from a patient-oriented research program

Markle‐Reid

Ganann

Ploeg

et al. 2021

Journal of Multimorbidity and Comorbidity

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“…Pragmatic features included the recruitment of participants representative of the population presenting in the hospital setting, the flexible delivery of the intervention by Registered Nurses (RNs) from the setting, the use of patient-relevant outcomes (e.g., quality of life, patient experience), and the use of intention-to-treat analysis. Details of the study design and outcome measures are reported in the published study protocol [71]. The methods, results, and flow of participants through the study are presented here according to the CONSORT statement for pragmatic randomized controlled trials [70].…”

Section: Methodsmentioning

confidence: 99%

“…Details regarding the CAST intervention are described in the published study protocol [71]. The intervention was developed using the Medical Research Council Framework for developing complex interventions, which highlights the importance of theoretical and empirical evidence [75].…”

Section: Interventionmentioning

confidence: 99%

“…Details regarding outcome measures are described in the study protocol [71]. Outcomes were assessed at baseline and at the 6-month and 12-month follow-up through interviewer-administered questionnaires during a structured in-home interview.…”

Section: Outcomes and Measuresmentioning

confidence: 99%

“…The finding that there was no statistically significant difference between groups in perperson health service use costs may not be due to similar cost of the two interventions, but due to a lack of power (small sample size). We invested significant resources and implemented numerous strategies to encourage recruitment that are outlined in detail in the study protocol [71]. However, the results highlight the continued need to identify, test and implement innovative methods to enhance recruitment of this population.…”

Section: Plos Onementioning

confidence: 99%

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Effectiveness of a nurse-led hospital-to-home transitional care intervention for older adults with multimorbidity and depressive symptoms: A pragmatic randomized controlled trial

et al. 2021

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Objective To evaluate the effectiveness of a nurse-led hospital-to-home transitional care intervention versus usual care on mental functioning (primary outcome), physical functioning, depressive symptoms, anxiety, perceived social support, patient experience, and health service use costs in older adults with multimorbidity (≥ 2 comorbidities) and depressive symptoms. Design and setting Pragmatic multi-site randomized controlled trial conducted in three communities in Ontario, Canada. Participants were allocated into two groups of intervention and usual care (control). Participants 127 older adults (≥ 65 years) discharged from hospital to the community with multimorbidity and depressive symptoms. Intervention This evidence-based, patient-centred intervention consisted of individually tailored care delivery by a Registered Nurse comprising in-home visits, telephone follow-up and system navigation support over 6-months. Outcome measures The primary outcome was the change in mental functioning, from baseline to 6-months. Secondary outcomes were the change in physical functioning, depressive symptoms, anxiety, perceived social support, patient experience, and health service use cost, from baseline to 6-months. Intention-to-treat analysis was performed using ANCOVA modeling. Results Of 127 enrolled participants (63-intervention, 64-control), 85% had six or more chronic conditions. 28 participants were lost to follow-up, leaving 99 (47 -intervention, 52-control) participants for the complete case analysis. No significant group differences were seen for the baseline to six-month change in mental functioning or other secondary outcomes. Older adults in the intervention group reported receiving more information about health and social services (p = 0.03) compared with the usual care group. Conclusions Although no significant group differences were seen for the primary or secondary outcomes, the intervention resulted in improvements in one aspect of patient experience (information about health and social services). The study sample fell below the target sample (enrolled 127, targeted 216), which can account for the non-significant findings. Further research on the impact of the intervention and factors that contribute to the results is recommended. Trial registration clinicaltrials.gov Identifier: NCT03157999.

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Nurse‐led care management models for patients with multimorbidity in hospital settings: A scoping review

Gonçalves

Mendes

Caldeira

et al. 2022

J Nursing Management

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Aim The aim of this scoping review is to map the nurse‐led care management models for patients with multimorbidity in hospital settings. Background Patients with multimorbidity in hospital, due their complexity, benefit a nurse‐led care management model. This care management model allows for better identification of patients' needs and a person‐centred approach. Evaluation This review followed the JBI methodology for scoping reviews. The search included the international databases Web of Science, CINAHL, MEDLINE, Nursing & Allied Health Collection and grey literature. A total of 21 articles were included in the final content analysis. Key issues Three categories of nurse‐led care management models emerged from the data, namely, nurse‐led programs, case management and nurse facilitator models. The interventions focused on training, discharge support, follow‐up, health promotion and patient‐centred care. Conclusion The centrality of the patient is a common characteristic of nurse‐led care models, namely, the acquisition of disease self‐management skills, preparation for hospital discharge and continuity of care in the community. Implications for nursing management Nurse‐led care management models can empower patients to manage their chronic conditions more effectively. Adapting these care management models in hospital settings will be a challenge for nurse managers. Scoping review protocol The full protocol used can be accessed at doi:.

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Study protocol for a hospital-to-home transitional care intervention for older adults with multiple chronic conditions and depressive symptoms: a pragmatic effectiveness-implementation trial

Cited by 14 publications

References 66 publications

Engagement of older adults with multimorbidity as patient research partners: Lessons from a patient-oriented research program

Engagement of older adults with multimorbidity as patient research partners: Lessons from a patient-oriented research program

Effectiveness of a nurse-led hospital-to-home transitional care intervention for older adults with multimorbidity and depressive symptoms: A pragmatic randomized controlled trial

Nurse‐led care management models for patients with multimorbidity in hospital settings: A scoping review

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