Patrick Archambault: Supporting the creation of a LEARNing INteGrated health system to mobilize context-adapted knowledge with a Wiki platform to Improve the transitions of frail Seniors from hospitals and emergency Departments to the cOMmunity: the LEARNING WISDOM project

Introduction: Older patients discharged from hospital currently experience fragmented care, repeated and lengthy Emergency Department (ED) visits, relapse into their earlier condition, and rapid cognitive and functional decline. The Acute Care for Elders (ACE) program at Mount Sinai Hospital in Toronto, Canada uses innovative strategies such as transition coaches, follow-up calls and patient self-care guides to improve the care transition experiences of the frail elderly patients from hospitals to the community. The ACE program reduced lengths of hospital stay and readmissions for elderly patients, increased patient satisfaction, and saved the healthcare system over $6 million in 2014.

In 2016, a context-adapted ACE program was implemented at one hospital in the Centre intégré en santé et en services sociaux de Chaudière-Appalaches (CISSS-CA), a large integrated healthcare organization in Quebec, with a focus on improving transitions between hospital and the community for the elderly. This previous quality improvement project used an intervention strategy based on iterative user-centered design prototyping and a “Wiki-suite” (a free online database containing evidence-based knowledge tools in all areas of healthcare) to engage multiple stakeholders. Within this one-year project, we developed an ACE intervention adapted to the context of the CISSS-CA with the support of the Mount Sinai Hospital, the Canadian Foundation for Healthcare Improvement (CFHI) and the Canadian Frailty Network (CFN). The goal of the current study is to implement and measure the impact of this context-adapted CISSS-CA ACE program for elderly care transitions in four hospital sites within the CISSS-CA, using the Wiki-suite.

Objectives: 1) Implement a context-adapted CISSS-CA ACE program in four hospitals in the CISSS-CA and measure its impact on patient, caregiver, clinical and hospital-level outcomes; 2) Identify underlying mechanisms by which our context-adapted program improves care transitions for the elderly; 3) Identify underlying mechanisms by which the Wiki-suite contributes to context-adaptation and local uptake of knowledge tools.

Methods: 1- Staggered implementation of the context-adapted CISSS-CA ACE program across the four CISSS-CA sites; interrupted time series to measure the impact on hospital, patient, and caregiver-level outcomes. 2 and 3- Parallel mixed-methods process evaluation study to understand the mechanisms by which our context-adapted program improves care transitions for the elderly and by which our Wiki-suite contributes to adaptation, implementation and scaling up of geriatric knowledge tools.

Results: This study was funded by the Canadian Institutes for Health Research in May 2017. The project was approved by the CISSS-CA ethics committee in May 2018. Data collection started in January 2019. As of January 2020, we enrolled 1500 patients and 500 caregivers from the four participating hospitals. Data collection is projected to be completed in January 2022. Data analysis has just begun.

Impact on EM: This study will provide evidence on effective knowledge translation (KT) strategies to adapt best practices to local context in transition of care for the elderly. It will contribute to adapting geriatric knowledge to local contexts. The knowledge generated through this project will support future scale-up of the ACE program and our wiki methodology to other settings in Canada.