Setting the balance of care for older adults at risk of hospitalization and delayed discharge: A mixed-methods research protocol.

Introduction: Delayed hospital discharge is a persistent care quality issue experienced across health systems worldwide and remains a priority area to be addressed in Canada. Often associated with a decrease in services while waiting to leave the hospital, delayed discharge from hospital can lead to increased frailty, physical and cognitive decline, and caregiver burnout. Optimizing availability of and timely access to community-based health and social care are avenues that could reduce initial admissions to the hospital and length of hospital stay, and facilitate hospital discharges.

Characteristics and Trajectory of Older Adults Supported by a Patient Navigator Program in a Hospital Setting: A Cohort Observational Study.

To improve transitions in care, a new patient navigation (PN) program was introduced to support older adults with complex care needs transition from hospital to home. The patient navigator is a community social worker embedded in the hospital's care teams. A cohort observational design was used to conduct the study by analysing the patient navigator's clinical notes and hospital's administrative data to describe the characteristics of patients, scope of the patient navigator's activities, and patient outcomes.

Exploring and prioritizing content to include in a medication self-management toolkit for persons with spinal cord injury/dysfunction: A concept mapping approach.

Background: Adults with spinal cord injury/dysfunction (SCI/D) face challenges with medications they take to manage their secondary conditions (e.g., pain, urinary tract infections, autonomic dysreflexia).

COVID-19 and Mortality in the Spinal Cord Injury Population: Examining the Impact of Sex, Mental Health, and Injury Etiology.

Background/objective: The purpose of this study was to investigate the impact of the COVID-19 pandemic on mortality rates in a community-dwelling spinal cord injury (SCI) population in Ontario.

Methods: Using health administrative databases, monthly mortality rates were evaluated pre-pandemic, during the pandemic, and post-pandemic from March 2014 to May 2024. Data were stratified by sex, injury etiology, and mental health status.

A new patient navigation model of care to support older adults in transitions of care: Key considerations for implementation for policy-makers and health system leaders.

A Patient Navigation (PN) model of care was introduced in a large metropolitan hospital in Ontario (Canada) to support transitions in care for older adults in 2019. The patient navigator is a community social worker or "community transitional lead" embedded in the hospital's in care teams to assist with discharge planning and provide follow-up care to older adults, their families, and/or care partners for up to 90 days. Initially, the PN program supported acute care patients and has since expanded in the Emergency Department and Reactivation Care Centre.

What happened to the patients? Care trajectories for persons with a delayed hospital discharge during wave 1 of COVID-19 in Ontario, Canada; a population-based retrospective cohort study.

During the initial wave of coronavirus disease of 2019 (COVID-19), patients were rapidly discharged from acute hospitals in anticipation of an expected influx of patients with COVID-19. Patients that were no longer receiving acute medical care but were waiting for their next destination (i.e.

COVID-19 Vaccine Uptake among People with Spinal Cord Injury and Dysfunction in Ontario, Canada: A Population-Based Retrospective Cohort Study.

Persons with disabilities experience numerous barriers to healthcare access including vaccine accessibility. The purpose of this study was to determine COVID-19 vaccine uptake in the spinal cord injury and disease (SCI/D) population of Ontario and identify potential factors influencing C OVID-19 vaccine uptake. This was a retrospective closed-cohort study using administrative health data on individuals with SCI/D of traumatic and non-traumatic causes to examine the monthly number of COVID-19 vaccine doses received between December 2020 and December 2023.

Lung cancer survival by immigrant status: a population-based retrospective cohort study in Ontario, Canada.

Background: Lung cancer is one of the most common cancers and causes of cancer death in Canada. Some previous literature suggests that socioeconomic inequalities in lung cancer screening, treatment and survival may exist. The objective of this study was to compare overall survival for immigrants versus long-term residents of Ontario, Canada among patients diagnosed with lung cancer.

Identifying and prioritizing recommendations to optimize transitions across the care journey for hip fractures: Results from a mixed-methods concept mapping study.

Background: Individuals who experience a hip fracture have numerous care transitions. Improving the transition process is important for ensuring quality care; however, little is known about the priorities of different key interest groups. Our aim was to gather recommendations from these groups regarding care transitions for hip fracture.

An Examination of Utilization Rates Over Time of Nerve and Tendon Transfers in Canada to Improve Upper Limb Function in Cervical Spinal Cord Injury.

Upper limb function loss in cervical spinal cord injury (SCI) contributes to substantial disability, and negatively impacts quality of life. Nerve transfer and tendon transfer surgery can provide improved upper limb function. This study assessed the utilization of nerve and tendon transfer surgery for individuals with tetraplegia in Canada.

Patterns of inpatient acute care and emergency department utilization within one year post-initial amputation among individuals with dysvascular major lower extremity amputation in Ontario, Canada: A population-based retrospective cohort study.

Introduction: Lower extremity amputation (LEA) is a life altering procedure, with significant negative impacts to patients, care partners, and the overall health system. There are gaps in knowledge with respect to patterns of healthcare utilization following LEA due to dysvascular etiology.

Objective: To examine inpatient acute and emergency department (ED) healthcare utilization among an incident cohort of individuals with major dysvascular LEA 1 year post-initial amputation; and to identify factors associated with acute care readmissions and ED visits.

From Crisis to Opportunity: A Qualitative Study on Rehabilitation Therapists' Experiences and Post-Pandemic Perspectives.

Rehabilitation therapists (RTs) have developed substantial mental health problems since the pandemic. Our study aimed to understand the experience of COVID-19 on occupational therapists and physiotherapists practicing in Canada, how the pandemic may have affected care delivery, and to identify new learnings articulated by RTs. A qualitative descriptive study design guided data collection through one-on-one interviews, dyadic interviews, and focus groups.

"I think we did the best that we could in the space:" A qualitative study exploring individuals' experiences with three unconventional environments for patients with a delayed hospital discharge.

Background: Given growing hospital capacity pressures, persistent delayed discharges, and ongoing efforts to improve patient flow, the use of unconventional environments (newly created or repurposed areas for patient care) is becoming increasingly common. Despite this, little is known about individuals' experiences in providing or receiving care in these environments.

Objectives: The objectives of this study were to: (1) describe the characteristics of three unconventional environments used to care for patients experiencing a delayed discharge, and (2) explore individuals' experiences with the three unconventional environments.

The impact of the COVID-19 virus and pandemic on healthcare utilization, access, delivery, experiences, and outcomes in the spinal cord injuries/dysfunction population: A scoping review study.

Background: Individuals with spinal cord injuries or disease (SCI/D) require frequent healthcare services. The COVID-19 pandemic may have impacted healthcare. Furthermore, due to secondary health conditions and comorbidities persons with SCI/D are at increased risk of experiencing severe symptoms or outcomes if infected with the COVID-19 virus.

Understanding transitions in care for persons with limb loss: a qualitative study exploring health care providers' perspectives.

Purpose: To explore health care providers' (HCP) experiences related to transitions in care from inpatient rehabilitation to the community for patients with limb loss.

Materials And Methods: A qualitative study was conducted using semi-structured interviews. Participants were eligible if they were HCPs currently working in amputation rehabilitation at a rehabilitation hospital in Ontario, Canada, with at least 1-year experience in this setting, and could speak and understand English.

Experiences and Outcomes of Using e-Prescribing for Opioids: Rapid Scoping Review.

Background: e-Prescribing is designed to assist in facilitating safe and appropriate prescriptions for patients. Currently, it is unknown to what extent e-prescribing for opioids influences experiences and outcomes. To address this gap, a rapid scoping review was conducted.

Non-adherence to COPD medications and its association with adverse events: A longitudinal population based cohort study of older adults.

Objective: To determine the association between non-adherence to long term chronic obstructive pulmonary disease (COPD) medications and COPD related emergency department (ED) visits and hospitalizations in patients with incident COPD, utilizing time varying measures of adherence as well as accounting for time-varying confounding impacted by prior adherence.

Study Design And Setting: We conducted a population-based retrospective cohort study between 2007-2017 among individuals aged 66 years and older with incident COPD using multiple linked administrative health databases from the province of Ontario, Canada. Adherence to COPD medications was measured using time varying proportion of days covered based on insurance claims for medications dispensed at community pharmacies.

Corruption risks in health procurement during the COVID-19 pandemic and anti-corruption, transparency and accountability (ACTA) mechanisms to reduce these risks: a rapid review.

Background: Health systems are often susceptible to corruption risks. Corruption within health systems has been found to negatively affect the efficacy, safety, and, significantly, equitable distribution of health products. Enforcing effective anti-corruption mechanisms is important to reduce the risks of corruption but requires first an understanding of the ways in which corruption manifests.

Use of administrative claims data in observational studies of antirheumatic medication effects on pregnancy outcomes: a scoping review protocol.

Objective: The primary objective of this review is to examine which disease-modifying antirheumatic drugs (DMARDs) and biologics used to treat pregnant individuals with rheumatic conditions have been reported in observational studies using population-based health administrative data. The secondary objective is to describe which adverse pregnancy outcomes (both maternal and neonatal) have been reported, their definitions, and corresponding diagnostic and/or procedural codes.

Introduction: Pregnant individuals are typically excluded from drug trials due to unknown potential risks to both the pregnant person and fetus, leaving most antirheumatic drugs understudied for use in pregnancy.

Quality of life following non-dysvascular lower limb amputation is contextualized through occupations: a qualitative study.

Purpose: To understand how persons with non-dysvascular lower limb amputation (LLA) use occupations to contextualize their quality of life (QoL).

Methods: A qualitative study using an interpretative description approach was conducted. Analysis of the interviews was guided by an occupational perspective, which considers the day-to-day activities that are important to an individual.