Grant: Embedded Clinician Researcher Salary Award - Central Canada

Elderly patients discharged from emergency departments are often repeatedly readmitted, lose functioning capacity, and increase caregivers' burden of care. Care becomes fragmented, discontinuous, and costly. In addition, Quebec's Bill 10 has merged healthcare institutions but has not yet integrated their information, human resources or care management systems, resulting in further fragmentation of care. However, using proven (evidence-based) strategies can improve transition for the elderly. The Acute Care for Elders Program at Mount Sinai applied innovative strategies (interventions) which reduced lengths of hospital stay, reduced readmissions, increased patient satisfaction, and saved over $6 million in 2014. Strategies included providing transition coaches, follow-up calls and using discharge order sets and patient self-care guides (knowledge tools). Successful programs often remain an exception, however, because technical challenges and different organizational cultures make adapting them to other contexts difficult. Our WikiTrauma open-source collaborative database and Wiki 101 training program are designed so that a program can be adapted by the people affected (knowledge users) and then applied (implemented) locally. The "Wiki-suite" was successfully used in adapting trauma care, and now managers and clinicians want to apply it to geriatrics. This proposal will use the Wiki-suite to adapt and apply the Acute Care for Elders Program, specifically its care transitions component, in four hospitals in the Chaudières-Appalaches region (CISSS CA) of Quebec. We will assess the impact of using the Wiki-suite to adapt and apply the ACE Program by asking managers, clinicians and patients about its effects on patient empowerment, health outcomes, and costs. We will also explore how the Wiki-suite works in terms of behavior and organizational change to gain insight into using it to adapt any successful program to any local context (scale up).