STANDARD EDITION OF THE INFOREHAB BULLETIN SPRING 2013

1

STANDARD EDITION OF THE INFOREHAB BULLETIN SPRING 2013

Follow us on Twitter and Facebook!

inforehab_uw

InfoRehab UW

Publications:

McLeod J, Stolee P, Walker J, Heckman G. Measuring Care Transition Quality for Older Patients with Musculoskeletal Disorders. Musculoskeletal Care. 2013 Jan 9. doi: 10.1002/msc.1043. (e-pub)

Presentations:

Linda Sheiban, Angela Hovey, Selena Santi, Sheetal Shenoy & Paul Stolee. OHCA 2013 Symposium: A profile of physiotherapy service provision for total hip and knee replacement home care clients. May 23rd in Mississauga, ON.

In this edition of the InfoRehab Bulletin we will be taking a look at the exciting research opportunities that lie ahead in 2013, introducing our new students, and reflecting on some of the notable contributions InfoRehab members have made to in 2012. It is an exciting new year for the InfoRehab Team as we continue to report our findings in publications and conferences, and move forward with new research opportunities and projects.

If you would like to be included in our e-mail distribution of the bulletin, would like further information on the material presented, or if you would like to see any additions to the bulletin please contact Sheila Bodemer at sbodemer@uwaterloo.ca.

Welcome!

COVER

Welcome

Recent Publications &

Upcoming Presentations

BACK

Congratulations Claire

Lafortune

Bone Healthy Recipe:

Vegetable Lentil Soup

Meet our New Students

Award winning poster: Patterns

of Multimorbidity in the Ontario

Home Care System

Dissertation Abstract: Josh

Armstrong

Patient Engagement

CAG Poster Presentations

Research Team Update:

Dorothy Forbes

“Where are they now?”:

Helen Johnson

Recent Publications & Upcoming Presentations

INSIDE

STANDARD EDITION OF THE INFOREHAB BULLETIN SPRING 2013

2

Congratulations to Josh Armstrong for his award winning poster at the 2012

Scientific Meeting of the Gerontological Society of America in San Diego.

Patterns of Multimorbidity in the Ontario Home Care System

Joshua J. Armstrong, Mu Zhu, John Hirdes, Paul Stolee

Kelsey received her Honours Bachelor of Arts with a Specialization in Psychology and a minor in Gerontology from the University of Ottawa in 2012. She is now in her first year of her MSc in the School of Public Health and Health Systems at the University of Waterloo, under the supervision of Dr. Stolee. Her passion for improving the quality of life for older adults began when she worked as an activity coordinator in a long-term care facility. Since then, she has worked three consecutive summers in long-term care as a social events coordinator and as an outreach coordinator. These experiences have inspired her to pursue further education in the field of gerontology. Her research interests include dementia, postoperative delirium, mental health, health systems, quality of care, and quality of life for older adults.

Mudi is a graduate student in the School of Public Health and Health Systems at the University of Waterloo, under the supervision of Dr. Paul Stolee and Dr. Chris Perlman. She received her Honours Bachelors of Science Degree in Health Studies from University of Toronto in 2011. Mudi's research interests include health services delivery, transitional care and the effectiveness of the health care system in improving outcomes for those with complex co-morbidities.

Kelsey Huson, MSc Candidate

Mudathira Kadu, MSc Candidate

Meet our New Students:

The Gerontological Society of America Health Sciences Section Person-in-Training Award

INTRODUCTION: Driven by the high prevalence of multiple chronic diseases, the aging population, and the rise of health care costs, there is a mounting interest in the study of multimorbidity. Multimorbidity is the coexistence of multiple chronic diseases and has been shown to be associated negative health outcomes and increased service health care utilization. The prevalence of multimorbidity in older adults has been reported to range between 55 to 98% yet little research has focused directly on developing our understanding concurrent multiple chronic diseases and the resulting common patterns. With clinical and administrative data growing rapidly through the everyday use of information systems, investigations into frequent patterns of chronic diseases can be conducted through the application of novel data mining techniques. Association rule mining (ARM) can be applied to health information from older adults to discover the prevalence of multimorbidity and the most common patterns of chronic diseases within an aging patient population. METHODS: ARM was performed using the arules package in R on clinical assessment data from long-stay (>60 days) homecare clients over the age of 65 in Ontario using the provincially mandated RAI-HC data system (N=298 262; year range = 2005-2010). RESULTS: The prevalence of multimorbidity (2 or more concurrent diseases) for those over the age of 65 was 78%. The ARM analysis resulted in identifying the top 20 2-way combinations of chronic diseases and the top 5 3-way combinations for Alzheimer’s disease, dementia not AD, and hypertension. CONCLUSIONS: Our findings illustrate that multimorbidity is prevalent in the home care population and that common patterns of chronic diseases can be identified through the application of innovative data mining techniques.

STANDARD EDITION OF THE INFOREHAB BULLETIN SPRING 2013

3

In February 2013, a CIHR Planning Grant proposal was submitted to assist with network development and implementation; the results of this funding opportunity will be announced in June. The aims of the proposed network will be to: 1) obtain ongoing input from seniors on research directions, as well as feedback on research findings; 2) connect seniors in Waterloo region with research opportunities; and 3) offer seniors ongoing learning opportunities to help them strengthen skills and learn more about relevant health care topics and resources. The network will initially focus on seniors living in Waterloo-Wellington and South West LHIN; we hope to expand the catchment area to include seniors from across Ontario as the network continues to develop. The SHARP network will be housed at the University of Waterloo under the supervision of Dr. Paul Stolee, who along with his dedicated research team, will strive to engage seniors in mutually beneficial collaborative relationships.

BACKGROUND: Rehabilitation therapies are effective for older persons in home-based settings, and have the potential to save money for the health system, while also improving the quality of life for older adults who may otherwise be hospitalized or institutionalized. Although there is evidence that home-based rehabilitation can improve functional outcomes in older adults, research has shown that many older home care clients do not receive the rehabilitation services they need. Despite the home care sector’s increasing importance within Ontario’s health care system, we have a limited understanding of the population that currently utilizes these services and how these services are allocated in the province. This dissertation project aims to enhance the understanding of this domain using a large provincial data repository of home care client information (RAI-HC information system). METHODS: Using the Andersen-Newman Framework to guide this research from a conceptual standpoint, and combining it with the CRoss Industry Standard Process for Data Mining (CRISP-DM) as an organizational framework, this dissertation focuses on examining data collected on older long-stay home care clients. Prior to the data mining modeling procedures, knowledge of the rehabilitation services in home care was developed through a series of semi-structured interviews with key informants. The results of this qualitative study were then used to inform quantitative analyses that included creating rehabilitation service user profiles using the K-means clustering algorithm, and the development of predictive models of rehabilitation service provision using a Random forest algorithm and multilevel models. RESULTS: Older home care clients who receive occupational therapy and physiotherapy in the Ontario Home Care System form a complex and heterogeneous client population. These services are often provided to clients following an acute event, yet many older adults who could benefit from therapy services for functional improvement and maintenance are not provided services due to limited resources. K-means clustering analyses resulted in the creation of seven profiles of rehab service users illustrating the multidimensional diversity of the service user population. Predictive models were able to identify client characteristics that are commonly associated with service provision. These models confirmed the large amount of regional variation found across the province and highlighted the differences between factors that lead to occupational therapy and physiotherapy service provision. CONCLUSIONS: Using multiple methods to systematically examine rehabilitation services for long-stay clients, new insights into the current user population and the client characteristics related to service provision were obtained. Future research activities should focus on ways to use the regularly collected standardized data to identify older long-stay home care clients who would benefit most from the rehabilitation therapy services provided by the provincial home care system.

Joshua J. Armstrong

Doctoral Dissertation Abstract

Rehabilitation Therapy Services For Older Long–Stay Clients in the Ontario Home Care System

Introducing our Patient Engagement Network:

Source: Armstrong, J. (2013). Rehabilitation Therapy Services for Older Long-Stay Clients in the Ontario Home Care System. Unpublished Doctoral Dissertation. University of Waterloo.

STANDARD EDITION OF THE INFOREHAB BULLETIN SPRING 2013

4

2012 Canadian Association of Gerontology Poster Presentation:

STANDARD EDITION OF THE INFOREHAB BULLETIN SPRING 2013

5

2012 Canadian Association of Gerontology Poster Presentation:

STANDARD EDITION OF THE INFOREHAB BULLETIN SPRING 2013

6

Helen is a registered Physiotherapist with experience in all sectors of the health care system including acute care, rehabilitation, and community care, with management experience in specialized geriatric services. In 2009-11 Helen completed a Masters’ degree in Health and Rehabilitation Science, Health and Aging at Western University in collaboration with the InfoRehab Team at University of Waterloo. Her research study, which focused on the experience of patients with hip fracture through their care transitions across the rehabilitation continuum of care, provided the ideal background for stepping into her new role as Rehabilitation Network Lead with the Erie St. Clair Local Health Integration Network (ESC LHIN). Last year, the ESC LHIN began a project to review the current state of rehabilitation services in the region, to envision a more ideal future state to meet the needs of residents, and to develop a strategy and action plan for system improvement. The final report was released in September 2012.

The report identified nine strategic goals, with an initial focus on three key priority patient populations, which makes up the highest percentage of rehabilitation service utilization: patients with stroke and hip fracture, as well as geriatric patients. The initial emphasis will be on the identification and implementation of best practices for these top three clinical conditions across the care continuum, along with efforts to facilitate the appropriate utilization of inpatient rehabilitation beds, and improve access to funded outpatient and community-based rehabilitation services. Other goals include developing a collaborative senior’s fall prevention strategy and improving chronic disease self-management with residents and family caregivers across programs. Helen was a co-leader in the ESC LHIN Rehabilitation Strategic Planning Project, and has been hired as the new ESC LHIN’s Rehabilitation Network Lead to facilitate the ongoing development, planning and implementation of initiatives in the strategic plan.

My clinical practice has been primarily community nursing in rural and urban settings in Ontario, Saskatchewan and Alberta. On completion of my graduate studies at the Faculty of Nursing, University of Alberta, I began my academic career at the University of Saskatchewan, followed by The University of Western Ontario and recently returned to the University of Alberta. I have taught community nursing, research, and systematic review undergraduate and graduate courses. My community nursing experiences drive my program of research which focuses on supporting persons with dementia and their care partners in rural and urban Canada. I am currently conducting a CIHR/ASC funded project that is exploring rural home care providers, persons with dementia and their care partners' co-creation of evidence-informed decision-making related to dementia care. We are also exploring the influence of the context of northern home care centres in knowledge translation to front-line home care providers. In addition, I have examined the influence of gender on social support among home care clients using interRAI data and continue to conduct Cochrane Reviews on exercise and light therapy in managing the symptoms of dementia.

In 2008, Dr. Paul Stolee invited me to participate on a research grant titled, Enhancing Home Care Rehabilitation Through Better Use of Health Information and the following year to participate in an Emerging Team titled, InfoRehab: Enhancing MSK Rehabilitation Through Better Use of Health Information. Both projects were funded by CIHR. My affiliation with InfoRehab has continued as we explore collaborative possibilities to examine InfoLinCS: Informed and Linked Care for Seniors in primary health care settings in Alberta and Ontario.

Dorothy Forbes PhD, RN

Helen Johnson, BSc P.T., MSc

An Update from Dorothy Forbes at the University of Alberta

An Update from Helen Johnson at the Erie St. Clair LHIN

STANDARD EDITION OF THE INFOREHAB BULLETIN SPRING 2013

7

Claire Lafortune, a former co-op student who will be returning in January 2014, is the recipient of the CIHR Undergraduate Studentship in Mobility, Musculoskeletal Health and Arthritis. Claire will be returning to work on her project Unasked questions: The perspective of hip fracture patients on clinical assessments during her final co-op term. This project will be supervised by Dr. Paul Stolee and Dr. Mary Egan. We wish her success on this project!

Serves: 4 Preparation time: 30 1 tablespoon olive oil 1 small chopped onion ½ cup carrots, diced ½ cup celery, diced 1 clove garlic, chopped ½ can (15 ounces) whole peeled

crushed tomatoes 1 can brown lentils, drained 1 bay leaf 4 cups low sodium vegetable broth Salt and pepper, to taste ¼ cup chopped mixed fresh thyme,

rosemary, and parsley 1 bunch (½ pound) fresh kale,

stemmed and chopped 1 tablespoon cider vinegar

Ingredients

1. In a large soup pot / stock pot, heat the olive oil. Add the onion, carrot, and celery and cook for 5 minutes. Add the garlic and continue cooking, stirring occasionally, for 5 minutes.

2. Stir in the tomatoes and cook for another 2 minutes. Add the lentils, bay leaf, stock, salt, and pepper.

3. Bring the content to a boil, and simmer for 10 minutes, stirring occasionally. Add more water during cooking if

the soup seems to be too thick.

4. Add the herbs, kale, and vinegar. Stir well. Bring to a boil again, lower the heat, and re-cover the pan. Continue cooking for another 15 minutes or until the kale is tender. Remove bay leaf and serve.

Per serving:

147 calories

173 mg calcium

7 g protein

67 mg magnesium

Nutrition

Information

Directions

This recipe was borrowed from: http://www.bidmc.org/YourHealth/BIDMCInteractive/HealthyIs/BoneHealthyRecipes.aspx

Enhancing MSK rehabilitation through better use of health information

This research is funded by the Canadian Institutes of

Health Research

Bone Healthy Recipe: Vegetable Lentil Soup

Congratulations Claire Lafortune!