When patients are unprepared to manage their care and recovery after discharge from hospital, they may not know the warning signs that indicate their health conditions are worsening. A new study led by York University Professor Mary Fox will investigate how best to support health-care providers in implementing a service called Warning Signs Intervention for patients in rural communities.
Mary Fox
Fox, an associate professor in the School of Nursing, Faculty of Health, was awarded a one-year Canadian Institutes of Health Research (CIHR) Transitions in Care Best & Wise Practices grant of $100,000 to undertake the research. She will work on this project with a team of key stakeholders from rural communities in Ontario and national researchers with expertise in rural health, aging, intervention research and implementation science.
When there is a lack of preparation, some patients may wait too long to seek medical help, causing their health conditions to worsen. Other patients may visit the emergency room unnecessarily. For patients in rural communities, who usually do not live close to medical services, knowing the signs that their health conditions are worsening and what to do about them is especially important.
In Fox’s prior research, older rural patients and their families indicated that their most pressing unmet need is how to detect and respond to signs of worsening health conditions, and a health-care service called the Warning Signs Intervention would help meet this need.
The service was designed specifically to prepare patients to detect and respond to the warning signs of worsening health conditions. Patients who received the intervention had more knowledge and confidence in managing changes in their health conditions at home, and had fewer emergency room visits and hospital readmissions than patients who did not receive the intervention.
However, it is not yet clear how best to support health-care providers in implementing the service in rural communities.
“Nowhere is this need more urgent than in rural Ontario, where patients have more emergency department visits and hospital readmissions in the first 30 days following hospitalization than urban patients,” said Fox. “These trends highlight the need to address inadequacies in rural transitional care and resolve rural-urban inequities in its delivery.”
In this study, Fox and her team will invite health-care providers to fill out a survey about the intervention and participate in focus groups to discuss the barriers and facilitators to providing the intervention in rural communities.
The team will then review the findings and, using a systematic process, design an implementation plan to support health-care providers in delivering the intervention, with fidelity, in rural communities. The plan is also expected to improve older patients’ and families’ abilities to manage warning signs at home after hospital discharge, while reducing emergency room visits, hospital readmissions and the cost of care in Ontario’s health-care system.
“The study will provide high-quality evidence for researchers, health-care providers and policy-makers to inform new, innovative transitional care research, practices, and policies for older people and their families in rural communities,” said Fox.
The evidence will be used to guide Fox’s future research testing the effectiveness of the implementation plan in rural communities.