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U of R researchers providing virtual health solutions for older adults, patients, and Indigenous communities receive more than $300K

By UAC and Johnson Shoyama Graduate School of Public Policy Posted: March 16, 2021 9:35 a.m.

U of R researchers providing virtual health solutions for older adults, patients, and Indigenous communities receive more than $300K from SHRF
U of R researchers providing virtual health solutions for older adults, patients, and Indigenous communities receive more than $300K from SHRF Photo: stock

University of Regina researchers have received $333,150 from the Saskatchewan Health Research Foundation (SHRF) to:

  • develop the CareOnDemand digital homecare ordering tool;
  • create an online self-help resource for patients who have experienced adverse events and/or institutional betrayal in healthcare; and,
  • further develop the CO-Away digital platform.

As part of its new Solutions Program, SHRF awarded their Impact and Innovation Grants to mobilize the research community and its partners to focus and coordinate on addressing timely Saskatchewan health challenges.

“This program allows for flexibility and responsiveness and keeps Saskatchewan health needs at its core,” says SHRF chief executive officer, Patrick Odnokon. “We work with our partner and stakeholders’ input and look at current trends to ensure the program remains focused on supporting our local expertise to find local solutions in areas that will have the most impact for the most people in the province.”

CareOnDemand: Engineering and Evaluating a Patient-oriented Homecare Ordering Tool to Enhance Aging in Place During the COVID Era

The COVID-19 pandemic has raised significant and long-standing concerns regarding the structure, delivery, and financing of long-term care.

In June 2020, the Canadian Institute for Health Information reported that while Canada’s COVID-19 death rate was relatively low, compared to other OECD countries, the proportion of deaths in long-term care was double the OECD average, with many observers referring to it as a “national disgrace.” 

Before the vaccination rollout across Canada, residents in long-term care facilities were twice as likely to succumb to the virus. Yet, over 30 per cent of their deaths could have been prevented if long-term facilities had the capacity to replace double and quadruple-occupancy rooms with single occupancy rooms, or better yet, if some of these patients could have been treated from home.   

"In these long-term care facilities, a significant proportion of older adults, many with underlying medical conditions, are susceptible to severe infection, and overcrowding may further increase baseline exposure risks,” says Ramona Kyabaggu, assistant professor in the Johnson Shoyama Graduate School of Public Policy (JSGS). “However, we have also known, for quite some time, that homecare is an alternative to long-term care that enables older adults to receive care at home safely and enables them to maintain independence and ties to the community while reducing costs to health systems in the order of 40-75 per cent.

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Ramona Kyabaggu, assistant professor
in the Johnson Shoyama Graduate
School of Public Policy (JSGS).
Photo by: U of R Photography

Thanks to a $50,000 Innovation Grant from SHRF, principal researcher Kyabaggu, along with Dr. Cheryl Camillo, JSGS assistant professor, and Dr. Tim Maciag, lecturer in the Faculty of Engineering, is developing a CareOnDemand application to assist older adults in navigating and ordering homecare services. The goal of the app is to improve accessibility and provide timely, efficient, high-quality, patient-centred homecare services to Saskatchewan seniors.

“Our patient-centred research explores the optimal design and application of our homecare ordering solution and the supportive health-system policies and info-structure for improved access to services, care integration, and linkage of homecare services data,” said Kyabaggu. “Ultimately, our technology-enabled homecare innovation will make it more feasible for older adults to safely age in place." 

In Saskatchewan, individuals can receive homecare through the Saskatchewan Health Authority or arrange for their support services through providers such as Eden Care Communities. Current data shows that in 2014-15, there were 7,258 homecare users in Saskatchewan, and that between 2011-12 and 2014-15 there was a 34 per cent increase in homecare use among adults aged 65 years and older. Those numbers are projected to grow exponentially.

“We believe that a community-centred, open-source, and open-data software solution will lead to greater quality-of-care and improved data-driven decision-making experiences for all stakeholders,” said Maciag. “In working with Eden Care Communities and their customers, we engage with Saskatchewan homecare customers, their families, and homecare administrators, to engineer, deploy, evaluate, and iterate the improved virtual care experiences within our community."

Alan Stephen, chief executive officer of Eden Care Communities, says his team is looking forward to collaborating on such a significant project.

“We are thrilled to be part of this exceptional research team. With this generous support from SHRF, we will be able to further develop this important component of the future of home care. We know home care is vital and this funding will position us to lead the way to better care and support in the future,” says Stephen.  

Virtual care technology, such as CareOnDemand, can help deliver both demand and supply-side improvements to address system gaps and unmet informational needs for better decision-making at the patient, provider, and systems levels.

Over the next year, Kyabaggu, Camillo, and Maciag will work with older adults using homecare services, frontline homecare workers, families of homecare users, and the Eden Care Communities’ management team on the conceptual design of the CareOnDemand application. During this time, they will also test and modify the tool to reflect user feedback.

Help for People Who Have Been Hurt by Healthcare: Creating and Evaluating an Online Resource  

Many reports indicate that approximately seven per cent of healthcare patients have experienced one or more adverse medical events. Studies using more inclusive definitions, including how patients define harm, report that around 50-80 per cent of patients have experienced some kind of harm in healthcare. Previous studies have found that 70-90 per cent of patients reporting adverse events indicate that these events caused psychological harm. Adding to this, experiencing institutional betrayal – which is where an institution either causes or fails to prevent harm – in healthcare is associated with psychological symptoms above and beyond those symptoms associated with adverse events.

Armed with this data, psychology professor Dr. Bridget Klest began researching the healthcare experiences of people with trauma histories as part of a 2014 SHRF Establishment Grant.

“Patients told me stories not only about how prior trauma impacted their healthcare, but also of being traumatized within healthcare,” says Klest.

This led her to delve into the role that healthcare institutions played in contributing to healthcare harm, and used the term “institutional betrayal” when discussing this phenomenon.

“That term resonated deeply with patients,” says Klest. “Over and over, patients and their family members, people with lived experience of harm and betrayal in healthcare, asked me where to go for help to deal with the aftermath of these events.”

However, the kind of support patients wanted did not exist.

“Their stories were moving, deeply personal, sometimes heartbreaking, and spoke to the heart of healthcare. They left me with a strong desire to help, and that’s the impetus for this research project,” says Klest, who received a $133,150 SHRF Impact Grant for her project to develop an online self-help resource for patients who have experienced adverse events and/or institutional betrayal in healthcare.

“First my team will develop a web-based resource that will provide patients with support for their well-being. Using an existing clinical psychology protocol called Acceptance and Commitment Therapy (ACT), we will adapt it to the experience and context of institutional betrayal in healthcare,” says Klest. 

ACT is a behavioral intervention that can be delivered in an online, self-help format. It teaches people how to manage thoughts and feelings that are barriers to valued action while also providing patients with useful information and resources. 

“ACT is focused on empowerment and choice – helping people take action in a way that makes sense to them, and is aligned with their own values. In this context, taking action might include self-care, connecting with friends, family, and/or community, re-engaging with healthcare, or making a formal complaint,” says Klest. 

In the next phase of the project her team will launch the site, then recruit Saskatchewan residents to use the resource, asking them to complete two sets of questionnaires – once prior to using the online resources, and then after they’ve used it to evaluate its effectiveness. 

“Our goal is to create a digital resource that will empower patients, and improve their well-being,” explains Klest. “And, because it’s online, the site will be available to anyone with an internet connection, which includes approximately 95 per cent of Saskatchewan households.”

Klest says their resource also has the potential to improve Saskatchewan residents’ engagement with healthcare, and their physical and mental health.

Scaling-up and advancing virtual care using human-centered artificial intelligence

Dr. Tarun Katapally, a patient-oriented research leader and JSGS associate professor, along with Dr. Kelly Skinner, assistant professor at the School of Public Health and Health Systems at the University of Waterloo, have secured $150,000 to develop virtual care services as part of the scale-up of Katapally’s Digital Epidemiology and Population Health Laboratory’s digital health platform. The funding will allow the researchers to address access gaps that were identified during community engagement with decision-makers in Île-à-la-Crosse, Saskatchewan.  

By focusing predominantly on human-centered artificial intelligence, the goal of this SHRF Impact Grant is to provide remote communities the advanced data analytics necessary to tackle existing and emerging health crises, while prioritizing data sovereignty. This funding is in addition to a previously announced investment by Mitacs for the development of the digital infrastructure, and it will help researchers move the project into phase two.

“Although the inception of this digital platform was to rapidly respond to the COVID-19 pandemic, the digital infrastructure can be used for emerging or existing health crises,” said Katapally. “For instance, the platform already has features that address the indirect effects of COVID-19 pandemic, which exacerbate existing inequities – food insecurity and inaccessible public services. The community has also indicated that mental health, substance misuse, and domestic violence are key concerns, which they would like to address in a post-pandemic period.”

Katapally says the data provided through the platform’s decision-making dashboard will provide Indigenous leaders with the necessary information to not only assist with immediate concerns related to the pandemic but also with their long-term self-governance.