Grant: Operating Grant: Transitions in Care - Evaluation Grants

Community-dwelling frail older adults are frequently hospitalized. Most are poorly prepared to return to the community which often results in emergency department visits, hospital re-admission, and transfer to a nursing home. 'Subacute care' is a type of hospital care designed to reduce these poor outcomes. Once a patient no longer needs regular hospital care, they are transferred from an acute to a subacute hospital bed, and provided with rehab care (e.g., to improve their strength and coping skills) until they are ready to return home. While several groups have implemented this process, subacute care has never been properly evaluated. As a result, we don't really know if it works, what providers and patients think of it, and how it could be improved. In 2018, Winnipeg Health Region planners converted 90 acute care hospital beds to subacute beds. A team of expert researchers has partnered with planners in charge in this process and with patients who have been through it, to study how it is working. We will first use large healthcare datasets to measure how subacute beds were used (e.g., how long patients had to wait to get into them), if they were cared for safely while in these beds, and if this process reduced later healthcare use (fewer hospital re-admissions, etc.). We will then review patient medical charts to see what kind of subacute care they got and if this could have been better. Lastly, we will interview hospital providers and past patients to get their perspective on how well subacute care works. Providers will be asked about the benefits and challenges of subacute care, and what they need to make it work better. Patients will be asked similar questions to see if the care they received met their needs. Our team will assess all of this information to evaluate subacute care, to see if some patients benefit more than others, and to determine how it could be improved. Our unique methods can also be used to assess how other areas of healthcare are working.