School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
SE Research Centre, SE Health, Markham, Ontario, Canada.
BMJ Open. 2022 Aug 11;12(8):e060339. doi: 10.1136/bmjopen-2021-060339.
The COVID-19 pandemic exacerbated existing challenges within the Canadian healthcare system and reinforced the need for long-term care (LTC) reform to prioritise building an integrated continuum of services to meet the needs of older adults. Almost all Canadians want to live, age and receive care at home, yet funding for home and community-based care and support services is limited and integration with primary care and specialised geriatric services is sparse. Optimisation of existing home and community care services would equip the healthcare system to proactively meet the needs of older Canadians and enhance capacity within the hospital and residential care sectors to facilitate access and reduce wait times for those whose needs are best served in these settings. The aim of this study is to design a model of long-term 'life care' at home (LTlifeC model) to sustainably meet the needs of a greater number of community-dwelling older adults.
An explanatory sequential mixed methods design will be applied across three phases. In the quantitative phase, secondary data analysis will be applied to historical Ontario Home Care data to develop unique groupings of patient needs according to known predictors of residential LTC home admission, and to define unique patient vignettes using dominant care needs. In the qualitative phase, a modified eDelphi process and focus groups will engage community-based clinicians, older adults and family caregivers in the development of needs-based home care packages. The third phase involves triangulation to determine initial model feasibility.
This study has received ethics clearance from the University of Waterloo Research Ethics Board (ORE #42182). Results of this study will be disseminated through peer-reviewed publications and local, national and international conferences. Other forms of knowledge mobilisation will include webinars, policy briefs and lay summaries to elicit support for implementation and pilot testing phases.
COVID-19 大流行加剧了加拿大医疗保健系统中现有的挑战，并强调需要进行长期护理 (LTC) 改革，以优先建立一个综合的服务连续体，以满足老年人的需求。几乎所有加拿大人都希望在家中生活、衰老和接受护理，但用于家庭和社区护理以及支持服务的资金有限，并且与初级保健和专门的老年病服务的整合也很少。优化现有的家庭和社区护理服务将使医疗保健系统能够主动满足加拿大老年人的需求，并增强医院和住宿护理部门的能力，以促进那些在这些环境中需求得到最好满足的人的获得，并减少等待时间。本研究的目的是设计一种长期的家庭 "生活护理"（LTlifeC 模式）模型，以可持续地满足更多社区居住的老年人的需求。
将应用解释性顺序混合方法设计，跨越三个阶段。在定量阶段，将对安大略省家庭护理的历史数据进行二次数据分析，根据已知的居住长期护理院入院预测因素，对患者需求进行独特的分组，并使用主要护理需求定义独特的患者情况。在定性阶段，将采用修改后的 eDelphi 流程和焦点小组，让社区临床医生、老年人和家庭照顾者参与制定基于需求的家庭护理包。第三阶段涉及三角测量，以确定初始模型的可行性。
这项研究已经获得滑铁卢大学研究伦理委员会的伦理批准（ORE #42182）。本研究的结果将通过同行评议的出版物以及地方、国家和国际会议进行传播。其他形式的知识转化将包括网络研讨会、政策简报和通俗易懂的摘要，以征求对实施和试点测试阶段的支持。
