Keeping Long-Term Care Patients Out of Hospital During Acute Medical Illness: Proposal for Common Elements of an Integrated Healthcare Delivery System for Long-Term Care.

Integration of acute and palliative care services for long-term care (LTC) residents reduces the morbidity and mortality associated with avoidable hospitalizations while contributing to healthcare system sustainability. This paper explores patient, provider and system factors contributing to potentially avoidable emergency room visits from LTC homes, based on our clinical and quality improvement work in the Greater Toronto Area and Calgary, as well as reviews the existing literature. Commonalities are used to identify key elements for developing an integrated healthcare delivery system to manage acute medical changes in LTC residents and minimize the need for in-patient hospitalization.

Referral to health and social services for intimate partner violence in health care settings: a realist scoping review.

Efficient and coordinated health care responses to intimate partner violence (IPV) are essential, given that health care settings are a major entry point for abused women who seek professional services. However, there is a lack of evidence on how IPV referrals are effectively made within health care settings. In order to help program planners and providers across sectors to address the complex and chronic issue of IPV, a greater understanding of the post-IPV identification referral process is essential. A scoping review of the evidence on IPV referral programs and processes in health care settings was undertaken to provide an overview of the state of evidence and identify pertinent gaps in existing research. The scoping review identified 13 evaluative studies and 6 qualitative, primarily nonevaluative studies that examined IPV referral programs and processes. Evaluative studies involved a variety of designs and IPV referral outcomes. Rich descriptions of barriers and facilitators to seeking referrals by victims and making referrals by health care providers emerged from the evaluative and qualitative studies, but were explored more in depth in the qualitative studies. This scoping review provides guidance on what is currently known about IPV referral programs in health care settings and provides a starting point for further research on effectiveness of referral processes.