Implementation of the Acute Care for Elders Strategy to Improve the Quality of Care Transitions in Quebec and Ontario: a Retrospective Multiple Case Study

Authors

  • El Kebir Ghandour Institut national d'excellence en santé et en services sociaux (INESSS); SASSS du CISSS de Chaudière-Appalaches
  • Sara Leblond Hôpital Montfort; Institut du Savoir Montfort
  • Sébastien Binette Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale
  • Josée Rivard Centre intégré de santé et de services sociaux de la Montérégie-Centre
  • John Joanisse Hôpital Montfort; Institut du Savoir Montfort https://orcid.org/0000-0001-7471-5621
  • Louise Carreau Hôpital Montfort
  • Laetitia Bert SASSS du CISSS de Chaudière-Appalaches; Université Laval https://orcid.org/0000-0002-5743-5131
  • Véronique Boutier SASSS du CISSS de Chaudière-Appalaches; Centre intégré de santé et de services sociaux de Chaudière-Appalaches
  • Jean-Paul Fortin Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale; Université Laval https://orcid.org/0000-0002-4107-9937
  • Jean-Louis Denis Université de Montréal
  • Samir Sinha Sinai Health; University of Toronto; Johns Hopkins University
  • Patrick Archambault SASSS du CISSS de Chaudière-Appalaches; Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale; Université Laval https://orcid.org/0000-0002-5090-6439

DOI:

https://doi.org/10.5770/cgj.26.679

Keywords:

care transition, frailty, older adults, transition coach, implementation evaluation, multiple case study, quality improvement collaborative

Abstract

Background

In 2016, two Canadian hospitals participated in a quality improvement (QI) program, the International Acute Care for Elders (ACE) Collaborative, and sought to adapt and implement a transition coach intervention (TCI). Both hospitals were challenged to provide optimal continuity of care for an increasing number of older adults. The two hospitals received initial funding, coaching, educational materials, and tools to adapt the TCI to their local contexts, but the QI pro-ject teams achieved different results. We aimed to compare the implementation of the ACE TCI in these two Canadian hospitals to identify the factors influencing the adaptation of the intervention to the local contexts and to understand their different results.

Methods

We conducted a retrospective multiple case study, including documentary analysis, 21 semi-structured individual interviews, and two focus groups. We performed thematic analysis using a hybrid inductive-deductive approach.

Results

Both hospitals met initial organizational goals to varying degrees. Our qualitative analysis highlighted certain factors that were critical to the effective implementation and achievement of the QI project goals: the magnitude of changes and adaptations to the initial intervention; the organizational approaches to the QI project implementation, management, and monitoring; the organizational context; the change management strategies; the ongoing health system reform and organizational restructuring. Our study also identified other key factors for successful care transition QI projects: minimal adaptation to the original evidence-based intervention; use of a collaborative, bottom-up approach; use of a theoretical model to support sustainability; support from clinical and organizational leadership; a strong organizational culture for QI; access to timely quality measures; financial support; use of a knowledge management platform; and involvement of an integrated research team and expert guidance.

Conclusion

Many of the lessons learned and strategies identified from our analysis will help clinicians, managers, and policymakers better address the issues and challenges of adapting evidence-based innovations in care transitions for older adults to local contexts.

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Published

2023-12-01

How to Cite

1.
Ghandour EK, Leblond S, Binette S, Rivard J, Joanisse J, Carreau L, Bert L, Boutier V, Fortin J-P, Jean-Louis Denis, Sinha S, Archambault P. Implementation of the Acute Care for Elders Strategy to Improve the Quality of Care Transitions in Quebec and Ontario: a Retrospective Multiple Case Study. Can Geriatr J [Internet]. 2023 Dec. 1 [cited 2024 Feb. 25];26(4):444-77. Available from: https://cgjonline.ca/index.php/cgj/article/view/679

Issue

Section

Original Research