Capacity development in patient-oriented research: programme evaluation and impact analysis.

BACKGROUND: National and provincial funding was invested to increase the quantity and quality of patient-oriented research (POR) across Canada. Capacity development became a priority to ensure all stakeholders were prepared to engage in POR. In part, this need was met through an annual Studentship competition in the province of Alberta, providing funding to students whose research incorporated principles of POR. However, despite efforts to build capacity in the health research trainee population, little is known about the outcomes of these programmes. This evaluation study examined the outcomes of a POR capacity development programme for health research trainees. METHODS: Final impact narrative reports were submitted by the 21 Studentship programme awardees for 2015 and 2016 who represent a variety of health disciplines across three major research universities. The reports describe the programme outcomes as well as the overall impact on individual, project and professional development as POR trainees. A synthesis of structured and categorised report data was conducted, along with additional qualitative analyses as new themes emerged that were not apparent in the competency framework utilised in the programme design. RESULTS: Awardee reports detailed the impact of the Studentship programme on the key themes of increased knowledge and skill, relationship building, confidence and leadership, as well as project and career impact. The impacts felt most profoundly by the awardees were not reflective of the competencies that guided programme design. The outcomes were then re-examined using a health research capacity development framework to gain a more comprehensive view of programme impact. CONCLUSION: The Studentship programme narratives provided insight into the rarely tracked capacity development outcomes of POR research trainees. Awardee narratives indicated significant development beyond the intended competencies and suggested a need to revisit the competency framework for POR in Alberta. While competencies were useful in guiding the design of the initial programme, a more comprehensive capacity development framework was required to capture the broader impacts on trainee development. Future capacity development programmes may benefit from these early programme insights, specifically the need for more robust competencies for POR. Further exploration of evaluation methods for short-term awards and sustainability of capacity development programmes is warranted.

Understanding the Experiences of East African Immigrant Women With Gestational Diabetes Mellitus.

OBJECTIVES: East African (EA) women are a subpopulation who are at very high risk for gestational diabetes (GDM) and poor obstetric outcomes, but little is known about the care experiences of this understudied group. The objective of this study was to document the impact of a diagnosis of GDM and the perceptions of diabetes care among EA immigrant women. METHODS: Semistructured in-depth interviews were conducted with 10 EA immigrant women diagnosed with GDM in Calgary; they were recruited from community and tertiary care settings. Interviews were transcribed verbatim and analyzed using inductive thematic content analysis to explore participants' experiences when accessing and receiving care. RESULTS: EA immigrant women had varied experiences related to GDM. Thematic analysis revealed the negative impact of GDM diagnoses on women, including the burdens of self-care, fear, community influences and cultural and financial barriers. The positive impacts of the experience of diagnosis noted were primarily in the empowerment to make healthful behaviour changes. CONCLUSIONS: Study findings point to the need for more context-specific and culturally appropriate support and care. Diagnoses of GDM extended beyond the individuals affected and impacted their families culturally, psychologically and financially. Addressing the emergent themes during pregnancy is imperative to improving care providers' engagement with EA immigrant women in postpartum diabetes screening activities and beyond. The findings of this study contain elements transferable to other immigrant groups in similar socioecologic contexts.

A Survey of Rounding Practices in Canadian Adult Intensive Care Units.

OBJECTIVE: To describe rounding practices in Canadian adult Intensive Care Units (ICU) and identify opportunities for improvement. DESIGN: Mixed methods design. Cross sectional survey of Canadian Adult ICUs (n = 180) with purposefully sampled follow-up interviews (n = 7). MEASUREMENTS AND MAIN RESULTS: Medical directors representing 111 ICUs (62%) participated in the survey. Rounding practices varied across ICUs with the majority reporting the use of interprofessional rounds (81%) that employed an open (94%) and collaborative (86%) approach, occurred at the patient's bedside (82%), and started at a standard time (79%) and standard location (56%). Most participants reported that patients (83%) and family members (67%) were welcome to attend rounds. Approximately half of ICUs (48%) used tools to facilitate rounds. Interruptions during rounds were reported to be common (i.e., ≥ 1 interruption for ≥ 50% of patients) in 46% of ICUs. Four themes were identified from qualitative analysis of participant responses to open-ended survey questions and interviews: multidisciplinarity, patient and family involvement, factors influencing productivity, and teaching and learning. CONCLUSIONS: There is considerable variation in current rounding practices in Canadian medical/surgical ICUs. Opportunities exist to improve ICU rounds including ensuring the engagement of essential participants, clearly defining participant roles, establishing a standardized approach to the rounding process, minimizing interruptions, modifying the role of teaching, utilizing a structured rounding tool, and developing a metric for measuring rounding quality.

A "Realist Review" approach to e-health: the case of type 2 diabetes in youth.

As e-health technology becomes more ubiquitous in our health and health care environments, a flexible, robust understanding of what works and under what circumstances is needed. Traditional meta-analyses tell us how frequently a technology has worked for previous populations, but not why. Realist Reviews can contribute to understanding why interventions work and by extension how results of past studies can be applied to emerging health challenges. The utility of such a method is considered in e-health interventions to address the serious growing challenge of Type 2 diabetes and metabolic syndrome in young people.

Analysis of the suitability of 'video-visits' for palliative home care: implications for practice.

We conducted a retrospective chart review to estimate the extent to which palliative home care visits could be carried out using videophones and to explore factors that might inform the eligibility criteria for video-visits. Four hundred palliative home care health records of deceased clients from 2002 were randomly selected from the Health Records Office in one Canadian health region. One visit was randomly selected from each of these health records. Three hundred and fifty-four visits were coded, and based on professional nursing judgment, the coder estimated whether video-visits could have been carried out. Approximately 43% of the visits were considered appropriate for video-visits. The results suggest that four factors may inform eligibility and decisions about a client's suitability for video-visits: diagnosis (cancer versus non-cancer), low Edmonton Symptom Assessment System (ESAS) score, no care-giver present, number and types of interventions required. Patients with a cancer diagnosis were more likely to be suitable for video-visits, which suggests that disease trajectory, rather than diagnosis of 'palliative', may be more influential in determining the care required and appropriateness of videophone use.

Moving research into practice: A decision framework for integrating home telehealth into chronic illness care.

Home telehealth is an effective alternative for some aspects of traditional care in chronic illnesses such as diabetes, congestive heart failure and asthma. However, in spite of evidence to support use of home telehealth technologies, they have not been adopted as predicted. A significant challenge for decision-makers is applying results from multiple small studies to the care of large numbers of clients in a health region. Aside from the technology, this complex decision must also include expected client outcomes, variations in nursing resources and their deployment in service delivery. This paper presents research evidence supporting the effectiveness of home telehealth for diabetes care, with attention to the range of technologies and outcome measures reported. It also discusses implications of a recently released national study on "Homecare Indicators" that reported resource allocation and outcomes in home care. The burden of illness, evidence of technology effectiveness and proposed home care outcome indicators are considered together in a decision framework to demonstrate an approach for decision-makers and practitioners to transfer home telehealth research into practice. The resulting decision framework is applied to diabetes care within one large health region in Canada to illustrate its utility as a research transfer strategy.

Stakeholder readiness for telehomecare: implications for implementation.

Numerous pilot studies have demonstrated that telehomecare technology may improve client outcomes through timely intervention and health crises prevention, thereby reducing return visits to hospitals and physician offices. Although the potential of telehomecare to increase access to services and improve quality of care and health outcomes is recognized, expectations for its widespread adoption have not been realized. Factors affecting diffusion of innovations include, among other things, perceptions of the technology, organizational characteristics, and communication. These require further exploration for telehealth applications because evidence alone will not automatically produce large-scale conversions in practice. This 12-month study was designed to assess the readiness of clients, health care professionals, and organizations to adopt telehomecare services for adult diabetic clients within the Calgary Health Region. A qualitative approach was used to collect data through focus groups with clients and home care nurses along with interviews with family physicians and key informants responsible for planning and resource allocation in diabetic homecare and telehealth programs. The transcripts of these interviews were analyzed for themes, which were categorized with respect to their effect on quality of care (including structure, process or outcome of care), including those related to the individual client, the health care provider, and the organization as a whole. The study findings identified differences in stakeholder conceptions of the technology, including common themes among clients, providers, and organizations. Implications of study results for developing a strategy to incorporate telehomecare into routine community care are discussed.