complex chronic disease, patient experience, homecare, long-term care, rural health, aging, family caregiving, health services research, health policy
I’m focusing on a neglected, high cost population through an established a program of research on complex chronic disease and patient experience. Across industrialized countries a small proportion of people consume the most health care resources. These people tend to be characterized by multi-morbidities and have ongoing, and heavy, care needs. While people with complex chronic conditions use all parts of the health care system (e.g., primary care, acute care, homecare, long-term care and rehabilitation settings) they tend to cluster in some settings. In Ontario, Complex Continuing Care / Rehabilitation is one such setting that provides post-acute care to people with heavy, ongoing care needs in preparation to return home. I’m using this setting to recruit patients, families and clinicians to better understand their experience and care needs. My research shows that the care delivery experience of these patients tend to be poor, and rates of re-hospitalisations and emergency services use are high following discharge. What happens once discharged from hospital is unclear and the extent to which hospital and emergency services use could be avoided is unknown. This gap is what my current program of research moving forward seeks to fill.
I conducted policy relevant applied health services research with homecare providers and administrators across the province of Ontario during the Aging at Home Strategy. The goal was to help community partners understand the composition of their wait lists for long-term care (LTC) and assess feasibility for care in the community (based on the needs of clients and costs). As a product of the research partnership, the organizations were able to determine the resources required to support aging at home and target resources more effectively. In Northwestern Ontario alone, 100+ people were removed from the LTC wait list and received care in the community.
Serving as the foundation for my current program of work was the Bridgepoint Study a mixed methods study that I led during my Postdoctoral Fellowship. The characteristics, care experiences and needs of a medically complex, hospital based, patient population were measured. The findings from the study were used to guide the development of a Quality Improvement Plan and Three Year Strategic Plan for the hospital and presented locally, nationally and internationally.
Additional Recent Publications
Kuluski K, Bensimon CM, Alvaro C, Schaink A, Lyons, RF Tobias R. Life Interrupted: A qualitative exploration of the impact of complex chronic disease on the daily lives of patients receiving complex continuing care. Illness, Crisis & Loss 2014, 22(2): 127-144.
Schaink AK, Kuluski K, Lyons RF, Fortin M, Jadad A, Upshur RE, et al. A scoping review and thematic classification of patient complexity: Offering a unifying framework. Journal of Comorbidity. 2012;2(1):1-9.