Protocol for a program of research from the Aging, Community and Health Research Unit: Promoting optimal aging at home for older adults with multimorbidity

Maureen Markle-Reid, Jenny Ploeg, Ruta Valaitis, Wendy Duggleby, Kathryn Fisher, Kimberly Fraser, Rebecca Ganann, Lauren E Griffith, Andrea Gruneir, Carrie McAiney, Allison Williams, Maureen Markle-Reid, Jenny Ploeg, Ruta Valaitis, Wendy Duggleby, Kathryn Fisher, Kimberly Fraser, Rebecca Ganann, Lauren E Griffith, Andrea Gruneir, Carrie McAiney, Allison Williams

Abstract

Background: The goal of the Aging, Community and Health Research Unit (ACHRU) is to promote optimal aging at home for older adults with multimorbidity (≥2 chronic conditions) and to support their family/friend caregivers. This protocol paper reports the rationale and plan for this patient-oriented, cross-jurisdictional research program.

Objectives: The objectives of the ACHRU research program are (i) to codesign integrated and person-centered interventions with older adults, family/friend caregivers, and providers; (ii) to examine the feasibility of newly designed interventions; (iii) to determine the intervention effectiveness on Triple Aim outcomes: health, patient/caregiver experience, and cost; (iv) to examine intervention context and implementation barriers and facilitators; (v) to use diverse integrated knowledge translation (IKT) strategies to engage knowledge users to support scalability and sustainability of effective interventions; and (vi) to build patient-oriented research capacity.

Design: The research program was informed by the Knowledge-to-Action Framework and the Complexity Model. Six individual studies were conceptualized as integrated pieces of work. The results of the three initial descriptive studies will inform and be followed by three pragmatic randomized controlled trials. IKT and capacity building activities will be embedded in all six studies and tailored to the unique focus of each study.

Conclusions: This research program will inform the development of effective and scalable person-centered interventions that are sustainable through interagency and intersectoral partnerships with community-based agencies, policy makers, and other health and social service agencies. Implementation of these interventions has the potential to transform health-care services and systems and improve the quality of life for older adults with multimorbidity and their caregivers.

Trial registration: NCT02428387 (study 4), NCT02158741 (study 5), and NCT02209285 (study 6).

Keywords: Older adults; health interventions; home and community care; multimorbidity; pragmatic randomized controlled trial.

Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
ACHRU research program of six interlinked studies. ACHRU: Aging, Community and Health Research Unit.
Figure 2.
Figure 2.
Guiding framework for ACHRU program of research. ACHRU: Aging, Community and Health Research Unit.

References

    1. Boyd C, Fortin M. Future of multimorbidity research: how should understanding of multimorbidity inform health system design? Public Health Rev 2010; 32: 451–474. DOI: 10.1007/BF03391611.
    1. Canadian Institutes for Health Research. Seniors and the health care system: what is the impact of multiple chronic conditions? (2011, accessed May 28, 2018).
    1. Donner G. Bringing care home: the expert group on home and community care, (2015, accessed May 28, 2018).
    1. Canadian Institutes for Health Research. Strategy for patient-oriented research-patient engagement framework, (2014, accessed May 28, 2018).
    1. Kuluski K, Peckham A, Williams P, et al. What gets in the way of person-centred care for people with multimorbidity? Lessons from Ontario, Canada. Heathc Q 2016; 19: 17–23. DOI: 10.12927/hcq.2016.24694.
    1. Keon WJ, Pepin L. Population health policy. Ontario, Canada: The Senate of Canada, 2008.
    1. Tourangeau Outcomes Research. The impact of home care nurse staffing, work environments and collaboration on patient outcomes: phase ii policy implications for Ontario. Ontario, Canada: University of Toronto, 2015.
    1. Markle-Reid M, Keller H, Browne G. Health promotion for the community-living older adult In: Fillit H, Rockwood K, Young J. (eds) Brocklehurst’s textbook of geriatric medicine and gerontology. 8th ed Philadelphia, USA: Elsevier, 2010, pp. 835–847.
    1. Canadian Foundation for Healthcare Improvement. Home is where the health is: dramatic results show shifting chronic disease care closer to home reduces hospital use, (2018, accessed May 28, 2018).
    1. Turcotte M. Family caregiving: what are the consequences? Ontario, Canada: Statistics Canada, 2013.
    1. Hollander MJ, Liu G, Chappell NL. Who cares and how much? The imputed economic contribution to the Canadian healthcare system of middle-aged and older unpaid caregivers providing care to the elderly. Heathc Q 2009; 12: 42–49.
    1. Adelman RD, Tmanova LL, Delgado D, et al. Caregiver burden: a clinical review. JAMA 2014; 311: 1052–1060. DOI: 10.1001/jama.2014.304.
    1. Roth DL, Fredman L, Haley WE. Informal caregiving and its impact on health: a reappraisal from population-based studies. Gerontologist 2015; 55: 309–319. DOI: 10.1093/geront/gnu177.
    1. Leroy L, Bayliss E, Domino M, et al. The agency for healthcare research and quality multiple chronic conditions research network: overview of research contributions and future priorities. Med Care 2014; 52 Suppl 3: S15–22. DOI: 10.1097/MLR.0000000000000095.
    1. Kuluski K, Nelson MLA, Tracy CS, et al. Experience of care as a critical component of health system performance measurement: recommendations for moving forward. Healthc Pap 2017; 17: 8–20. DOI: 10.12927/hcpap.2017.25415.
    1. Bayliss EA. Simplifying care for complex patients. Ann Fam Med 2012; 10: 3–5. DOI: 10.1370/afm.1352.
    1. Dumbreck S, Flynn A, Nairn M, et al. Drug-disease and drug-drug interactions: systematic examination of recommendations in 12 UK national clinical guidelines. BMJ 2015; 350: h949 DOI: 10.1136/bmj.h949.
    1. Tinetti ME, Fried TR, Boyd CM. Designing health care for the most common chronic condition—multimorbidity. Jama—J Am Med Assoc 2012; 307: 2493–2494. DOI: 10.1001/jama.2012.5265.
    1. Zullig LL, Whitson HE, Hastings SN, et al. A systematic review of conceptual frameworks of medical complexity and new model development. J Gen Intern Med 2016; 31: 329–337. DOI: 10.1007/s11606-015-3512-2.
    1. Cohen L, Davis R, Cantor J, et al. Reducing health care costs through prevention: working document. California, USA: Prevention Institute, 2007.
    1. Smith SM, Wallace E, O’Dowd T, et al. Interventions for improving outcomes in patients with multimorbidity in primary care and community settings. Cochrane Database Syst Rev 2016; 3: CD006560 DOI: 10.1002/14651858.CD006560.pub3.
    1. Grembowski D, Schaefer J, Johnson KE, et al. A conceptual model of the role of complexity in the care of patients with multiple chronic conditions. Med Care 2014; 52 Suppl 3: S7–S14. DOI: 10.1097/MLR.0000000000000045.
    1. Bayliss EA, Bonds DE, Boyd CM, et al. Understanding the context of health for persons with multiple chronic conditions: moving from what is the matter to what matters. Ann Fam Med 2014; 12: 260–269. DOI: 10.1370/afm.1643.
    1. Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff (Millwood) 2008; 27: 759–769. DOI: 10.1377/hlthaff.27.3.759.
    1. Public Health Agency of Canada. Heart disease in Canada: highlights from the Canadian chronic disease surveillance system, (2017, accessed May 28, 2018).
    1. World Health Organization. Cardiovascular diseases: key facts, ) (2017, accessed May 28, 2018).
    1. An integrated vascular health blueprint for Ontario. Toronto: Cardiac Care Network of Ontario, Heart and Stroke Foundation and Ontario Stroke Network, 2012.
    1. Chan AW, Tetzlaff JM, Altman DG, et al. SPIRT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med 2013; 158: 200–207. DOI: 10.7326/0003-4819-158-3-201302050-00583.
    1. Wilson T, Holt T, Greenhalgh T. Complexity science: complexity and clinical care. BMJ 2001; 323: 685–688.
    1. Schaink AK, Kuluski K, Lyons RF, et al. A scoping review and thematic classification of patient complexity: offering a unifying framework. J Comorb 2012; 2: 1–9.
    1. Northwood M, Ploeg J, Markle-Reid M, et al. Integrative review of the social determinants of health in older adults with multimorbidity. J Adv Nurs 2018; 74: 45–60. DOI: 10.1111/jan.13408.
    1. Daniel H, Bornstein SS, Kane GC, et al. Addressing social determinants to improve patient care and promote health equity: an American college of physicians position paper. Ann Intern Med 2018; 168: 577–578. DOI: 10.7326/M17-2441.
    1. Graham ID, Logan J, Harrison MB, et al. Lost in knowledge translation: time for a map? J Contin Educ Health Prof 2006; 26: 13–24. DOI: 10.1002/chp.47.
    1. Thorne S, Stephens J, Truant T. Building qualitative study design using nursing’s disciplinary epistemology. J Adv Nurs 2016; 72: 451–460. DOI: 10.1111/jan.12822.
    1. Markle-Reid MGA, Ploeg J, Fisher K, et al. Health and social service utilization costing manual. Hamilton, Ontario: McMaster University, School of Nursing, Aging, Community and Health Research Unit, 2016.
    1. Hankivsky O, Cormier R. Intersectionality: moving women’s health research and policy forward. Vancouver: Women’s Health Research Network, 2009.
    1. Ware JE, Kosinski M, Keller SD. Sf-12: how to score the sf-12 physical and mental health summary scales. Lincoln, USA: QualityMetric Inc., 1998.
    1. Self-Management Resource Center. Self-efficacy for managing chronic disease 6-item scale, (accessed May 28, 2018).
    1. Bedard M, Molloy DW, Squire L, et al. The Zarit burden interview: a new short version and screening version. Gerontologist 2001; 41: 652–657.
    1. Colin Reid R, Stajduhar KI, Chappell NL. The impact of work interferences on family caregiver outcomes. J Appl Gerontol 2010; 29: 267–289. DOI: 10.1177/0733464809339591.
    1. Curran GM, Bauer M, Mittman B, et al. Effectiveness-implementation hybrid designs combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care 2012; 50: 217–226. DOI: 10.1097/MLR.0b013e3182408812.
    1. RE-AIM. Re-aim: reach effectiveness adoption implementation maintenance, (2017, accessed November 10, 2017).
    1. Meleis A. Transitions theory: middle-range and situation specific theories in nursing research and practice. 1st ed New York, USA: Springer Publishing Company, 2010.
    1. Duggleby W, Swindle J, Peacock S. Self-administered intervention for caregivers of persons with Alzheimer’s disease. Clin Nurs Res 2014; 23: 20–35. DOI: 10.1177/1054773812474299.
    1. Browne G, Gafni A, Roberts J. Approach to the measurement of resource use and costs (working paper S06-01). Hamilton, Ontario, Canada: McMaster University, System-Linked Research Unit on Health and Social Service Utilization, 2006.
    1. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 1977; 84: 191–215.
    1. Miller WR, Rollnick S. Motivational interviewing: preparing people for change. 2nd ed New York, USA: The Guilford Press, 2002.
    1. Markle-Reid M, Ploeg J, Fisher K, et al. The Aging, Community and Health Research Unit—Community Partnership Program for older adults with type 2 diabetes and multiple chronic conditions: a feasibility study. Pilot Feasibility Stud 2016; 2: 24 DOI: 10.1186/s40814-016-0063-1.
    1. Oregon Research Institute. Summary of diabetes self-care activities (SDSCA): FAQs, (2016, accessed March 3 2017).
    1. Irwin M, Artin KHH, Oxman MN. Screening for depression in the older adult: criterion validity of the 10-item Center for Epidemiological Studies Depression Scale. Arch Intern Med 1999; 159: 1701–1704. DOI: 10.1001/archinte.159.15.1701.
    1. Lowe B, Decker O, Muller S, et al. Validation and standardization of the generalized anxiety disorder screener (GAD-7) in the general population. Med Care 2008; 46: 266–274.
    1. Thornton M, Travis SS. Analysis of the reliability of the modified caregiver strain index. J Gerontol B-Psychol 2003; 58: S127–S132. DOI: 10.1093/geronb/58.2.S127.
    1. Peters DH, Adam T, Alonge O, et al. Implementation research: what it is and how to do it. Bmj-Brit Med J 2013. November 20; 347:f6753.
    1. Damschroder LJ, Aron DC, Keith RE, et al. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci 2009; 4: 50 2009 DOI: 10.1186/1748-5908-4-50.
    1. Saleebey D. The strengths perspective in social work practice. 3rd ed Ontario, Canada: Allyn and Bacon, 2002.
    1. Markle-Reid M, Orridge C, Weir R, et al. Interprofessional stroke rehabilitation for stroke survivors using home care. Can J Neurol Sci 2011; 38: 317–334. DOI: 10.1017/S0317167100011537.
    1. Kania J, Kramer M. Collective impact. Stanford Social Innovation Review 2011; Winter: 36–41.
    1. Craig P, Dieppe P, Macintyre S, et al. Developing and evaluating complex interventions: the new Medical Research Council guidance. Brit Med J 2008; 337: a1655 DOI: ARTN a165510.1136/bmj.a1655.
    1. Zwarenstein M, Treweek S, Gagnier JJ, et al. Improving the reporting of pragmatic trials: an extension of the CONSORT statement. Brit Med J 2008; 337: a2390 DOI: ARTN a239010.1136/bmj.a2390.
    1. Loudon K, Treweek S, Sullivan F, et al. The PRECIS-2 tool: designing trials that are fit for purpose. Bmj—Brit Med J 2015; 350: h2147 DOI: 10.1136/bmj.h2147.
    1. Hahn OM, Schilsky RL. Randomized controlled trials and comparative effectiveness research. J Clin Oncol 2012; 30: 4194–4201. DOI: 10.1200/Jco.2012.42.2352.
    1. Fiore LD, Lavori PW. Integrating randomized comparative effectiveness research with patient care. New Engl J Med 2016; 374: 2152–2158. DOI: 10.1056/NEJMra1510057.
    1. Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med 2014; 12: 573–576. DOI: 10.1370/afm.1713.
    1. Nilsen P. Making sense of implementation theories, models and frameworks. Implement Sci 2015; 10: 53 DOI: ARTN 53 10.1186/s13012-015-0242-0.
    1. May C, Finch T. Implementing, embedding, and integrating practices: an outline of normalization process theory. Sociology 2009; 43: 535–554. DOI: 10.1177/0038038509103208.
    1. Canadian Institutes for Health Research. Guide to knowledge translation planning at CIHR: integrated and end-of-grant approaches, (2012, accessed May 28, 2018).
    1. McLean RK, Graham ID, Bosompra K, et al. Understanding the performance and impact of public knowledge translation funding interventions: protocol for an evaluation of Canadian institutes of health research knowledge translation funding programs. Implement Sci 2012; 7: 57 DOI: 10.1186/1748-5908-7-57.
    1. Patton MQ. Developmental evaluation: applying complexity concepts to enhance innovation and use. New York, USA: Guilford Press, 2010.
    1. Smith SM WE, O’Dowd T, Fortin M. Interventions for improving outcomes in patients with multimorbidity in primary care and community settings. Cochrane Db Syst Rev 2016; 3: CD006560 DOI: 10.1002/14651858.CD006560.pub3.
    1. Markle-Reid M, Browne G, Gafni A. Nurse-led health promotion interventions improve quality of life in frail older home care clients: lessons learned from three randomized trials in Ontario, Canada. J Eval Clin Pract 2013; 19: 118–131. DOI: 10.1111/j.1365-2753.2011.01782.x.
    1. Markle-Reid M, McAiney C, Forbes D, et al. An interprofessional nurse-led mental health promotion intervention for older home care clients with depressive symptoms. BMC Geriatr 2014; 14: 62 DOI: 10.1186/1471-2318-14-62.
    1. Markle-Reid M, Browne G, Gafni A, et al. The effects and costs of a multifactorial and interdisciplinary team approach to falls prevention for older home care clients ‘at risk’ for falling: a randomized controlled trial. Can J Aging 2010; 29: 139–161. DOI: 10.1017/S0714980809990377.
    1. Markle-Reid M, Weir R, Browne G, et al. Health promotion for frail older home care clients. J Adv Nurs 2006; 54: 381–395. DOI: 10.1111/j.1365-2648.2006.03817.x.

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