Using Exploratory Trials to Identify Relevant Contexts and Mechanisms in Complex Electronic Health Interventions: Evaluating the Electronic Patient-Reported Outcome Tool.

Background: Designing appropriate studies for evaluating complex interventions, such as electronic health solutions to support integrated care, remains a methodological challenge. With the many moving parts of complex interventions, it is not always clear how program activities are connected to anticipated and unanticipated outcomes. Exploratory trials can be used to uncover determinants (or mechanisms) to inform content theory that underpins complex interventions before designing a full evaluation plan.

Addressing the Evidence Gap in Stroke Rehabilitation for Complex Patients: A Preliminary Research Agenda.

Evidence suggests that a stroke occurs in isolation (no comorbid conditions) in less than 6% of patients. Multimorbidity, compounded by psychosocial issues, makes treatment and recovery for stroke increasingly complex. Recent research and health policy documents called for a better understanding of the needs of this patient population, and for the development and testing of models of care that meet their needs.

Stroke rehabilitation evidence and comorbidity: a systematic scoping review of randomized controlled trials.

Background: Most strokes occur in the context of other medical diagnoses. Currently, stroke rehabilitation evidence reviews have not synthesized or presented evidence with a focus on comorbidities and correspondingly may not align with current patient population. The purpose of this review was to determine the extent and nature of randomized controlled trial stroke rehabilitation evidence that included patients with multimorbidity.

Improving Patient Experience and Primary Care Quality for Patients With Complex Chronic Disease Using the Electronic Patient-Reported Outcomes Tool: Adopting Qualitative Methods Into a User-Centered Design Approach.

Background: Many mHealth technologies do not meet the needs of patients with complex chronic disease and disabilities (CCDDs) who are among the highest users of health systems worldwide. Furthermore, many of the development methodologies used in the creation of mHealth and eHealth technologies lack the ability to embrace users with CCDD in the specification process. This paper describes how we adopted and modified development techniques to create the electronic Patient-Reported Outcomes (ePRO) tool, a patient-centered mHealth solution to help improve primary health care for patients experiencing CCDD.

Complex health conditions and mental health training: How prepared is the frontline service provider?

How prepared are frontline service providers for dealing with mental illness in patients with multiple, complex health conditions? The aims of this study were two-fold, to gain insight into the kinds of training and education desired by frontline service providers in a healthcare setting and to compile a list of key questions for health service managers and education leaders to address based on our findings. Over 100 care providers responded to a survey. Over half of the respondents indicated no mental health training, and the majority desired increased training and support.

Stroke rehabilitation and patients with multimorbidity: a scoping review protocol.

Stroke care presents unique challenges for clinicians, as most strokes occur in the context of other medical diagnoses. An assessment of capacity for implementing "best practice" stroke care found clinicians reporting a strong need for training specific to patient/system complexity and multimorbidity. With mounting patient complexity, there is pressure to implement new models of healthcare delivery for both quality and financial sustainability.

Measuring food availability and accessibility among adolescents: Moving beyond the neighbourhood boundary.

Geographic methods have provided insight about food location availability and accessibility in understanding neighbourhood variations in health. However, quantifying exposure to food locations within a pre-defined range of an individual's residence ignores locations outside of the residential neighbourhood encountered in daily life. Global positioning system (GPS) data enables exploration of multiple contextual influences on health.

Blame, Shame, and Lack of Support: A Multilevel Study on Obesity Management.

In this research, we examined the experiences of individuals living with obesity, the perceptions of health care providers, and the role of social, institutional, and political structures in the management of obesity. We used feminist poststructuralism as the guiding methodology because it questions everyday practices that many of us take for granted. We identified three key themes across the three participant groups: blame as a devastating relation of power, tensions in obesity management and prevention, and the prevailing medical management discourse.

Life interrupted and life regained? Coping with stroke at a young age.

Stroke is a leading cause of disability across the developed world, affecting an increasing number of younger people. In this article, we seek to understand the experience of stroke as a disabling life situation among young people and the strategies that they use to recover and cope. Directed content analysis was conducted from interviews with 17 community-dwelling stroke survivors aged 55 years and younger across the United Kingdom.

Application of personalized medicine to chronic disease: a feasibility assessment.

Personalized Medicine has the potential to improve health outcomes and reduce the cost of care; however its adoption has been slow in Canada. Bridgepoint Health is a complex continuous care provider striving to reduce the burden of polypharmacy in chronic patients. The main goal of the study was to explore the feasibility of utilizing personalized medicine in the treatment of chronic complex patients as a preliminary institutional health technology assessment.

Examining the steps-per-day trajectories of cardiac rehabilitation patients: a latent class growth analysis perspective.

Purpose: Research suggests that cardiac rehabilitation (CR) patients need to engage in at least 6500 steps per day to obtain health benefits. Unfortunately, very little is known about the steps-per-day trajectories of these patients and whether the demographic, clinical, and CR program characteristics are similar for these trajectories.

Methods: Patients (n = 235) completed a questionnaire assessing demographic and clinical variables upon entry to CR and subsequently wore a pedometer for 7 days at the end of CR, and 3, 6, and 9 months after completing CR.

Clinicians' views on improving inter-organizational care transitions.

Background: Patients with complex health conditions frequently require care from multiple providers and are particularly vulnerable to poorly executed transitions from one healthcare setting to another. Poorly executed care transitions can result in negative patient outcomes (e.g.

Defining quality outcomes for complex-care patients transitioning across the continuum using a structured panel process.

Background: No standardised set of quality measures associated with transitioning complex-care patients across the various healthcare settings and home exists. In this context, a structured panel process was used to define quality measures for care transitions involving complex-care patients across healthcare settings.

Methods: A modified Delphi consensus technique based on the RAND method was used to develop measures of quality care transitions across the continuum of care.

The care delivery experience of hospitalized patients with complex chronic disease.

Objective: This study investigated what is important in care delivery from the perspective of hospital inpatients with complex chronic disease, a currently understudied population.

Participants And Setting: One-on-one semi-structured interviews were conducted with inpatients at a continuing care/rehabilitation hospital (n = 116) in Canada between February and July 2011.

Design: The study design was mixed methods and reports on patient characteristics and care delivery experiences.

Safety threats and opportunities to improve interfacility care transitions: insights from patients and family members.

Aim: To explore patients' and family members' perspectives on how safety threats are detected and managed across care transitions and strategies that improve care transitions from acute care hospitals to complex continuing care and rehabilitation health care organizations.

Background: Poorly executed care transitions can result in additional health care spending due to adverse outcomes and delays as patients wait to transfer from acute care to facilities providing different levels of care. Patients and their families play an integral role in ensuring they receive safe care, as they are the one constant in care transitions processes.

A scoping review and thematic classification of patient complexity: offering a unifying framework.

The path to improving healthcare quality for individuals with complex health conditions is complicated by a lack of common understanding of complexity. Modern medicine, together with social and environmental factors, has extended life, leading to a growing population of patients with chronic conditions. In many cases, there are social and psychological factors that impact treatment, health outcomes, and quality of life.

Advancing coordinated care in four provincial healthcare systems: evaluating a knowledge-exchange intervention.

Objectives: This research project created and evaluated a knowledge-exchange intervention designed to facilitate an increase in organizational readiness for implementing coordinated stroke care in four primarily rural provincial healthcare systems.

Intervention: Knowledge brokers were linked to networks within, across and outside the provinces to support, inform and disseminate best practice recommendations for coordinated stroke care within the provincial healthcare systems.

Findings: The intervention increased awareness and dissemination of recommendations, which stimulated the implementation of coordinated stroke care.

Physical activity and nutrition among youth in rural, suburban and urban neighbourhood types.

Objectives: Physical activity and nutrition are essential to healthy living and particularly important during youth, when growth and development are key. This study examined rates of physical activity (PA) and diet quality (DQ) among youth in grades 7 to 9 in Halifax, Nova Scotia, during the 2008/09 school year and tested differences among students in rural, urban and suburban neighbourhood types of high and low socio-economic status (SES).

Methods: Youth in grades 7 through 9 (aged 12-16; 53% male) from six schools (N=380), stratified by neighbourhood type (urban, suburban, rural) and SES, wore accelerometers for up to 7 days (mean=4.

Conservation of resources theory and research use in health systems.

Background: Health systems face challenges in using research evidence to improve policy and practice. These challenges are particularly evident in small and poorly resourced health systems, which are often in locations (in Canada and globally) with poorer health status. Although organizational resources have been acknowledged as important in understanding research use resource theories have not been a focus of knowledge translation (KT) research.

Secondary stroke prevention best practice recommendations: exploring barriers for rural family physicians.

Introduction: Patients' risk of having a second stroke can be substantially reduced by implementing best practice recommendations for secondary stroke prevention. However, evidence indicates that rural practitioners may face barriers to implementing these recommendations into their practices. This research project developed a workshop to increase practitioner awareness of the recommendations, and to identify barriers to the application of recommendations for secondary prevention of stroke in rural practices.

Creating a supportive environment for living with stroke in rural areas: two low-cost community-based interventions.

With the growing burden of chronic illness affecting aging populations, rural health systems are faced with unique challenges to support and promote health in their communities. The Yarmouth Stroke Project was a 5-year initiative aimed at improving health care services for stroke survivors in rural Nova Scotia, Canada. A needs assessment indicated a lack of support to self-manage stroke during community re-integration.

Does moving from a high-poverty to lower-poverty neighborhood improve mental health? A realist review of 'Moving to Opportunity'.

Ray Pawson's realist review method was used to analyse 22 evaluations/reviews of the Moving to Opportunity (MTO) housing intervention. MTO was a randomized controlled trial that moved families from high-poverty to low-poverty neighborhoods in five US cities between 1994 and 2006. This realist review focussed on mental health outcomes of families who moved, as well as the mechanisms through which moving influenced mental health.

Six essential roles of health promotion research centres: the Atlantic Canada experience.

Over the past 20 years, the federal government and universities across Canada have directed resources towards the development of university-based health promotion research centres. Researchers at health promotion research centres in Canada have produced peer-reviewed papers and policy documents based on their work, but no publications have emerged that focus on the specific roles of the health promotion research centres themselves. The purpose of this paper is to propose a framework, based on an in-depth examination of one centre, to help identify the unique roles of health promotion research centres and to clarify the value they add to promoting health and advancing university goals.