Evaluating an Innovative Model of Interdisciplinary and Interagency Primary Care for Homebound Seniors
Notice bibliographique
Résumé
Background: Expanding on evidence-based models for home-based primary care, the Eastern York Region North Durham Ontario Health Team (Canada) launched the Seniors Home Support program in June 2021 to improve access to primary care for homebound seniors. Success of this program is in its patient-centered design, which has fueled the integration of geriatric and palliative care within a primary care service for a seamless patient experience across the continuum of care. Frail homebound seniors face a myriad of challenges to accessing traditional office-based primary care due to cognitive, physical, or social factors. Frailty, coupled with trends in increasing lifespans and chronic diseases, puts homebound seniors among the highest users of acute medical services and highly vulnerable to receiving fragmented care across health care settings. The Seniors Home Support program is a sustainable model of care that improves health care delivery and the patient and caregiver experience through one integrated team of primary care providers, nursing, allied health, and paramedics working across health sectors. Method: Using the quadruple aim, we evaluated the impact of an integrated primary care program on patient and caregiver experiences, provider satisfaction, health outcomes, and health system costs. Patient and caregiver engagement was imperative to ensure that results are meaningful. We elected using the Older Adult Experience Survey, a validated, evidence-informed tool created with older adult and caregiver co-design for specialized geriatric services. Prior to administration of this tool, we conducted informal consultations with caregivers to ensure suitability for the SHS population. Patient, caregiver, and provider surveys were administered between Aug to Dec 2023. Health outcomes were examined by estimating the number of hospital avoidance events that occurred since program inception. An extensive review of urgent care data using a standardized process and coding scheme developed by primary care and emergency care clinicians informed this process. We corroborated results of urgent care data with patient and caregiver experiences using the survey to ask if the program helped to avoid unnecessary hospital visits. Cost savings were calculated accordingly. Results and discussion: A preliminary scan reveals the following emerging themes: Responsiveness is a necessary outcome measure and highly correlates with patient and caregiver satisfaction Integrated home-based primary care prevents unnecessary hospital visits and reduces acute care service use Timely communication is pertinent to overall team functioning and positively reflected in patient, caregiver, and provider experiences This evaluation process has also highlighted key learnings such as how the quadruple aim framework can readily inform process improvement, and how continuous engagement strategies with partners (clinicians and leadership) can ensure a sustainable interagency program. Detailed analysis is planned for Jan 2024.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,023 | 0,031 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,003 | 0,002 |
| Communication savante | 0,005 | 0,004 |
| Science ouverte | 0,003 | 0,006 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,009 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».