New projects aim to ease transitions in care

July 19, 2019

Three research teams in Alberta will test ways to improve transitions in care, thanks to new funding from the Canadian Institutes of Health Research and partner institutions.

CIHR funding supports three Alberta research teams

Story by Greg Harris

Three Alberta research projects have received federal government funding to look at ways to improve how patients transition between healthcare settings and services.

On July 19 in Edmonton, federal Health Minister Ginette Petitpas Taylor announced support for 11 projects across Canada through the Canadian Institutes of Health Research Transitions in Care program.

The total investment includes $25 million from the Government of Canada, as well as $6.3 million from partner organizations.

The three Alberta projects, which together will receive more than $3 million in funding, will address transitions in care for spinal cord patients, young adults with congenital heart disease, and critically ill patients and their family caregivers. (More below.)

Patients can experience many different types of transitions, such as moving from surgery to intensive care, from hospital back to the community, or from pediatric to adult care.

“Providing seamless transitions in care is critically important to our patients,” says Tracy Wasylak, Chief Program Officer for Strategic Clinical Networks at Alberta Health Services (AHS). “Research projects like these will help ensure Albertans receive high-quality care at every step in their health journeys, and will allow AHS to spread these best practices across the province.

“Improving transitions in care is a priority for our Strategic Clinical Networks and for AHS as a whole.”

Alberta Project summaries:

Title: CONnecting and Coordinating an Enhanced Network for TRansitions in Care (CONCENTRIC): A New Model for Spinal Cord Injury Care in Alberta

Project leads: Drs. Chester Ho and Adalberto Loyola Sanchez; principal applicants Drs. Kathy Kovacs-Burns, Jeff Bakal and Rebecca Charbonneau.

Summary: CONCENTRIC is a four-year project that will test a model for transitions in care, which will be part of a larger provincial hub-and-spokes system. The ‘hub’ sites are Calgary and Edmonton (where the SCI specialty services are) and the ‘spoke’ sites will be Lethbridge and Slave Lake, since many patients are discharged there from the hubs.

Researchers will measure the impact the new model has on patient health, experiences and well-being, as well as the use of healthcare services and associated costs. Partners in the project are from Edmonton, Calgary, Slave Lake, Lethbridge and Spinal Cord Injury Alberta.

CIHR funding: $697,421

Another $300,000 for the project comes from Friends of Glenrose (Rehabilitation Hospital), the Alberta Paraplegic Foundation, the University of Calgary Department of Clinical Neurosciences and the University of Alberta.

Title: The Impact of an Innovative eHealth Transition Intervention on Self-Management Skills among Young Adults with Congenital Heart Disease

Project lead: Dr. Andrew Mackie

Summary: The Canadian Pediatric Society and other organizations have published guidelines about how children’s hospitals should help adolescents with congenital heart disease (CHD) prepare for the move to adult healthcare, reducing the likelihood that new heart problems, which may develop in early adulthood, will be discovered too late.

Smartphone apps are widely accessible and may be helpful in providing important transition information and coping strategies to adolescents as they enter adult healthcare. The objective of this research is to determine whether a transition app is better than a nurse-led transition intervention in preparing adolescents (ages 16-17) with CHD to take on responsibility for their healthcare. The Stollery Children’s Hospital in Edmonton will be one of five sites for the project; the other four are outside Alberta.

CIHR funding: $959,384

Another $1.2 million for the project comes from the Stollery Children’s Hospital Foundation, as well as $150,000 from Alberta Innovates.

Title: Transitions in Care Bundle for Critically Ill Patients and their Family Caregivers

Project leads: Dr. Kirsten Fiest and co-leads Dr. Daniel Niven and Dr. Henry T. Stelfox

Summary: As patients from intensive care units transition to another hospital ward or home, they can encounter gaps in their care. Researchers will partner with critically ill patients and their family caregivers to co-design and evaluate an evidence-informed ‘transitions in care bundle.’ The goal is to transform transitions in care for patients recovering from critical illness by educating, empowering and engaging patients and their family caregivers as informed stewards of the care journey.

The bundle will improve health outcomes, reduce healthcare utilization and increase patient and family satisfaction with care. A community of stakeholders, including leadership from the AHS Critical Care Strategic Clinical Network and former ICU patients and families, co-developed the proposed program, which is organized across three interconnected themes of work: development, research, and implementation and evaluation.

CIHR funding: $958,100

Another $150,000 for the project comes from the University of Calgary and the Canadian Intensive Care Foundation.