Team 19

Assessing Care Models Implemented in Primary Health Care for Persons with Neurocognitive Disorders

Various care models have been developed across Canada to meet the care needs and support the quality of life of the (ever-growing) number of people with Alzheimer’s disease and related dementias (AD):

  • Quebec: The Quebec Alzheimer Plan is currently in its second phase of implementation (First phase: 42 Family Medicine Groups, Second phase: all Family Medicine Groups)
  • Ontario: Initiatives developed from individual Family Health Teams (FHTs) and Local Health Integration Networks
  • New Brunswick: Initiatives developed at the clinical level

While the models are different in terms of where they occur and how they came to be, they share the same overarching goal: Timely, patient-centered, comprehensive, and continuous collaborative care for older persons with dementia.

Despite the fact that these models have shown uptake, feasibility, and are valuable to clinicians and patients alike, no systematic evaluation has been conducted. This is a problem because, in order for successful care models to spread across Canada, organizations and groups need to know the underlying conditions for success.

Filling this Gap: Research Objectives and Methods

The ROSA research program has three parts (convergent mixed methods research design), outlined below.

  1. What is the relationship between key factors and outcomes of successful management of care models?

    Quantitative cross-sectional study.

    This study is taking place in 28 primary care sites across Quebec, Ontario, and New Brunswick. We used questionnaires(1) to understand clinicians’ knowledge, attitudes, and practices about the initiatives and changes put in place, as well as organizational elements of the clinic to come up with a list of possible factors. We then reviewed anonymous medical records(2) and collected information about the quality of dementia care and dementia diagnosis rate from the patient’s point of view. Together, this information was used to make a list of key factors required for quality AD care. This list was then shared with appropriate decision makers to help improve dementia care models in the future (see objective 4).

    (1) Clinicians Questionnaires: Many factors can influence the impact of an intervention on improving the quality of care for patients with dementia, namely the attitudes, knowledge, and practices of clinicians regarding the disease and the intervention. We built, with the help of a committee of research experts and numerous clinicians across Quebec, Ontario and New Brunswick, two questionnaires that were further validated with factorial analyses. The first questionnaire has 100 questions measuring the attitudes, knowledge, and practices of physicians and nurse practitioners, while the second has 98 questions measuring attitudes, knowledge, and practices of nurses and other healthcare professionals. The questionnaires were distributed to all clinicians involved in all the sites and used these scores in our final analyses to extract what are the best practices associated with the best quality of care for dementia patients.

    (2) We measured the quality of care of patients with dementia by collecting data directly from the patients’ file, using a 10-item score validated by our team. These items include: have the patients’ cognition, functional status, psychiatric symptoms and behaviours and weight been evaluated at least once during the study period? Has their medication and their side effects been revised? If they are driving, has their ability to continue driving been evaluated? Similarly, has their caregiver’s burden been evaluated? Have homecare services, or Alzheimer society support been discussed?

  2. Describe the models, and identify the key elements clinics need for successful implementation.

    Descriptive and exploratory qualitative multiple case study.

    This study takes place in 22 of the 28 sites from the first study: 10 sites each from Quebec and Ontario, and 2 sites from New Brunswick. We are studying key documents such as job descriptions, annual reports and organizational charts and policies from each site. We are also holding semi-structured interviews with the following people from each site: one manager or administrator, three clinicians (doctor, nurse, other healthcare worker), and one patient with dementia. Finally, we are interviewing one high-level representative from the Ministry of Health in each province. These interviews will help us understand the conditions and context of the qualitative results (see objective 1), as well as reveal adaptive strategies used by local clinics to overcome any difficulties they may have encountered.

  3. Describe trends in quality of care and health service use of people who are newly-diagnosed with AD.

    For this, we are using province-wide health administrative data to describe and compare population-based trends over time. We developed indicators to measure primary care performance and health service use for persons with AD in Quebec and Ontario using the input of stakeholders within the CCNA.

    In Ontario, we will use novel statistical models to study whether new team-based primary care clinics, called Family Health Teams, have led to improve care for persons with AD.

    In Quebec, we will also measure the impact of high continuity of primary care on total and inappropriate acute hospital use in patients with dementia in Quebec.

  4. Share study results quickly with relevant partners

    Participatory integrated knowledge transfer and exchange strategy. Many individuals are affected by this research: patients and their families, caregivers, clinicians, managers, policy and decision makers. We have involved these stakeholders in the planning and execution of the project, and it is very important that we share the results of the research with them as quickly as possible to spread, set-up, and maintain these care models across Canada. This ongoing element of the program involves meetings and other dissemination activities with stakeholders in Quebec, Ontario, New Brunswick, the rest of Canada and internationally.

Impact

By identifying the key elements for success in the studied models, we are:

  • Making improvements to the access, quality, and continuity of care for people with AD.
  • Improving the knowledge and ability of primary care clinicians to care for people with AD.
  • Further exploring specialist collaboration in AD care.
  • Looking at specific strategies for scaling-up across Canada.

View a map of ROSA’s various study sites on our Clinic Map

Preliminary Results, News and Program Updates

Executive Summary:

View the executive summary from our latest report to the Ministère du Santé et Services Sociaux du Québec (Quebec Ministry of Health).

Newsletter:

View 2016 Co-pi newsletter

Several members of our team are happy to be a part of the Canadian Academy of Health Sciences (CAHS)’s panel for the Assessment of Evidence and Best Practices for the development of a Canadian Dementia Strategy. See more here

Publication List and Media

Read a short opinion piece published by our team in The Gazette on the need for multidisciplinary teams in treating AD

Read a featured post on Nadia Sourial’s (PhD candidate) research

View our publication index

Events:

 

Quebec, Ontario and New Brunswick Stakeholder Meeting

Stakeholders from Quebec, Ontario and New Brunswick, including decision-makers, managers, researchers, and patient and caregiver representatives, were invited to a meeting in Montreal, Canada on June 16th 2017. The focus of this meeting was on the initial and ongoing results from the evaluation of the implementation of the first phase of the Quebec Alzheimer Plan. Future stakeholder meetings, with the next planned for Fall 2018, will include results from the studied initiatives in Ontario and New Brunswick.

Three major themes led the discussion:

  • Implementation Strategy
  • Interdisciplinary care (within primary care), and the role of specialty care (memory clinics)
  • Coordination with community organizations, caregivers and homecare services

View a summary of the day’s discussions. For a short opinion piece published on the outcomes of this meeting, see our ‘Media’ section.

 

ROSA International Council Roundtable

During the 21st IAGG World Congress in San Francisco, the ROSA team organized a meeting with our research colleagues from around the world working in evaluation and implementation research of Alzheimer’s plans and initiatives. We were able to catch up on the state of similar research programs internationally, and discuss common barriers and further questions for study that face the field. This international council will continue to exchange information and discuss on these topics, and will aim to culminate in a large international workshop in Canada in 2019.

Are you interested in becoming a part of the International Council?

The council meets annually, often at international conferences, to disseminate and share the latest results and personal experiences working in this field of evaluation and implementation research. For more information, please contact our KT director, Rachel Simmons at Rachel.simmons@mcgill.ca!

OUR TEAM: Canadian Team for Healthcare Services and System Improvement in Dementia Care

Primary Investigators:

 

Dr. Howard Bergman

Dr. Bergman’s work in health services research and policy has centered on aging, chronic disease, and frailty, and promoting primary medical care. In the fields of aging, chronic disease, frailty, and health services, Dr. Bergman was (from 1999-2009) co-Founder and co-Director of Solidage Research Group. From 1999-2002, he was 1 of 2 principal investigators in the development and evaluation of a randomized controlled trial – the SIPA model of integrated care for the frail elderly population. His work on integrated care for very frail older persons is recognized internationally in academic, policy, and government circles. Dr. Bergman led a group of Canadian and international investigators in the Canadian Initiative on Frailty and Ageing and continues to lead the International Database Inquiry on Frailty.

Appointed by the Quebec Minister of Health in 2007, Dr. Bergman tabled (2009) a proposal for the Quebec Alzheimer Plan (known in Quebec as the Bergman Plan) from prevention to end of life care, including the research agenda. He is now working with the Quebec Ministry of Health on implementing this plan.

Read Full Bio

 

Dr. Isabelle Vedel

Dr. Isabelle Vedel is a public health physician and an Assistant Professor in the Department of Family Medicine at McGill University. She is also an investigator at the Lady Davis Institute at Sir Mortimer B. Davis – Jewish General Hospital. She did her post-doctoral fellowship in health service research in chronic disease management (health care services organization, health management, information technology) at McGill University (2012). She has received an investigator award from the Canadian Institute of Health Research and a Dawson Scholar.

Dr. Isabelle Vedel’s research interests are mainly in health care organization and primary health care services for persons with multiple chronic diseases and older patients. Her research work focuses on health services research in chronic disease management, particularly Alzheimer’s or related disorders.

Read Full Bio

Co-Investigators:

Erin Strumpf

McGill University

View Bio

Sarah Pakzad

University of Moncton

View Bio

Paula Rochon

University of Toronto

View Bio

Susan Bronskill

Institute for Clinical Evaluative Sciences

View Bio

Carrie McAiney

McMaster University

View Bio

Tibor Schuster

McGill University

View Bio

Yves Couturier

Université de Sherbrooke

View Bio

Pam Jarrett

Dalhousie University

View Bio

Investigators and Collaborators:

 

Michele Aubin

U Laval, QC

Roxane Borges da Silva

U de Montreal, QC

Edeltraut Kroger

U Laval, QC

Danielle St-Laurent

INSPQ, QC

Valerie Emond

INSPQ, QC

Paul-Emile Bourque

U of Moncton, NB

Andrea Gruneir

ICES, ON

Frank Molnar

U of Ottawa, ON

Geoff Anderson

ICES, ON

Machelle Wilchesky

McGill, QC

Vladimir Khanassov

McGill, QC

Sharon Kaasalainen

McMaster U, ON

Dominique Gagnon

UQAT, QC

Charo Rodriguez

McGill U, QC

Pamela Baxter

McMaster U, ON

Sherry Dupuis

U of Waterloo, ON

Liette Lapointe

McGill U, QC

Jennifer Ingram

Trent U, ON

Dallas Seitz

Queen’s U, ON

Linda Lee

McMaster U, ON

Jeannie Haggerty

McGill U, QC

Andre Tourigny

INSPQ, QC

Janusz Kaczorowski

U de Montreal, QC

Guillaume Ruel

INSPQ, QC

Martin Fortin

U de Sherbrooke, QC

Christian Bocti

U de Sherbrooke, QC

Nicole Dubuc

U de Sherbrooke, QC

Judy Baird

McMaster U, ON

Susan Baptiste

McMaster U, ON

Michel Grignon

McMaster U, ON

Chris Patterson

McMaster U, ON

Gary Naglie

U of Toronto, ON

Jean-Louis Denis

ENAP, QC

Lise Lamothe

U de Montreal, QC

Ann MacAulay

McGill U, QC

Jalila Jbilou

Moncton U, NB

Ainsley Moore

McMaster U, ON

Bryn Robinson

MSSU, NB

Heather Bursey

GNB, NB

Research Associates (McGill University):

 

Genevieve Arsenault-Lapierre

Research Coordinator

Rachel Simmons

Director of Knowledge Transfer

Lucie Vaillancourt

Research Nurse

Marine Hardouin

Research Assistant

Mélanie LeBerre

Research Assistant

Rebecca Rupp

Administrative Coordinator

Deena Hunsbarger

Research Coordinator, McMaster University

Stacey Hawkins

Research Coordinator, Senior Care Network

Students:

 

Nadia Sourial

Biostatistician and PhD student, McGill University

Claire Godard-Sebillotte

MD, MSc, PhD student, McGill University

Ahmed Bakry

BSc, McGill University

Maude-Émilie Pépin

MSc,Université de Sherbrooke

Maxime Guillette

BSc, Université de Sherbrooke

Nathalie Dame

BSc, Université de Sherbrooke

Frantz Siméon

MSc, Université de Sherbrooke

Noémie Nicol-Clavet

BSc, Université de Sherbrooke

Jessie Caron-Audet

MSc, Université de Sherbrooke

Allison Gemmill

Undergraduate Student, McMaster University

Charmaine Holland

Undergraduate Student, McMaster University

Maxime Guillette

MSc, McGill University

Noémie Nicol-Clavet

BSc, Université de Sherbrooke

Martin Yang

BSc, McGill University

Matthew Hacker Teper

BSc, McGill University

Miguel Trottier

Undergraduate Student, McGill University

Anshuman Saksena

Undergraduate Student, McGill University

Ovidiu Tatar

MSc, McGill University

Deniz Cetin-Sahin

MSc, McGill University

Mylène Michaud

MSc, University of Moncton

Véronique Savoie

MSc, University of Moncton

Valérie Thériault

BSc, University of Moncton

The following page is authored by members of Team 19 of the Canadian Consortium on Neurodegeneration in Aging. Any questions regarding the content can be directed to: rachel.simmons@mail.mcgill.ca