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Transitions of older adults between emergency departments and community care in Quebec: a case study

2025· article· en· W4414153048 on OpenAlex
Marlène Karam, Catherine Hudon, Maud‐Christine Chouinard, Loïc Vermeulen, Arnaud Duhoux

Why this work is in the frame

A frame that forgets how it found something cannot be audited. These are the routes that admitted this work.

affAt least one author lists a Canadian institution in the pinned OpenAlex snapshot.
fundA Canadian funder is recorded on the work.
aboutThe title or abstract carries a Canadian signal from the geographic lexicon.

Bibliographic record

VenueGeriatric Nursing · 2025
Typearticle
Languageen
FieldMedicine
TopicEmergency and Acute Care Studies
Canadian institutionsUniversité de MontréalUniversité de SherbrookeHEC Montréal
FundersSocial Sciences and Humanities Research Council of Canada
KeywordsPrimary careEconomic shortageTransitional carePopulation ageingOlder peopleFocus groupEmergency departmentHealth carePopulation

Abstract

fetched live from OpenAlex

• Establishing trust and continuity with older adults in the ED is challenging. • Strengthening primary care is crucial to better meet the needs of older adults. • Training efforts and mentorship are needed to support new nurse care coordinators. This study aimed to examine the care coordination processes and challenges between emergency department and primary care interdisciplinary teams, with a focus on the role of nurses in ensuring safe transitions for older adults. A case study was conducted within an Integrated Health and Social Services Centre in Quebec. Two types of data were used: documents and semi-structured interviews with 15 professionals involved in the transition. The Transitional Care Model guided the study. Several challenges were identified, namely establishing trust and continuity with older adults, balancing their wish to return home with ensuring their safety, the limited training of nurses to fulfill this role, the lack of communication across care levels, and the shortage of resources within primary care level. Given the aging population and its complex needs, it is urgent to move away from hospital-centrism and to strengthen primary care to enable older adults to age healthily in their community.

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.

Full frame distilled prediction

Teacher imitation

Not calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.

metaresearch head score (Codex)0.000
metaresearch head score (Gemma)0.000
Version: codex-gemma-dda1882f352aValidation status: machine_predicted_unvalidated
Candidate categoriesnone
Consensus categoriesnone
DomainCandidate signal: none · Consensus signal: none
Study designCandidate signal: Observational · Consensus signal: Observational
GenreCandidate signal: Empirical · Consensus signal: Empirical
Teacher disagreement score0.086
Threshold uncertainty score0.999

Codex and Gemma teacher scores by category

CategoryCodexGemma
Metaresearch0.0000.000
Meta-epidemiology (narrow)0.0000.000
Meta-epidemiology (broad)0.0000.000
Bibliometrics0.0000.001
Science and technology studies0.0000.000
Scholarly communication0.0000.000
Open science0.0000.000
Research integrity0.0000.000
Insufficient payload (model declined to judge)0.0000.000

Machine scores (provisional)

The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.

Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.

Opus teacher head0.013
GPT teacher head0.329
Teacher spread0.315 · how far apart the two teachers sit on this one work
Validation statusscore_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it