Diverse Care Settings Research Articles

“It isn’t the same for everyone”: Early childhood educators’ lived experiences with cultivating social inclusion

ABSTRACT Children with disabilities are less likely than their peers without disabilities to exercise their rights to education and participation in their communities. Early childhood educators play a crucial role in ensuring that all children are included in daily activities and interactions to foster children’s wellbeing. However, educators receive minimal training on fostering social inclusion in early childhood settings. The purpose of this phenomenological study was to explore thirty-seven early childhood education professionals’ experiences and perceptions of cultivating social inclusion in the context of a training program called Building Friendships. The program involved participation in a series of training workshops aimed at fostering play and friendships in diverse and inclusive child care settings. Interviews were conducted to explore participants’ perceptions and experiences with social inclusion before and after training workshops. Educators delineated a range of issues pertaining to the quality of social inclusion, and additional training appeared to serve as a catalyst for reflection and practice changes which improved the social experiences of children with disabilities in their care. This study underscores the diverse understandings and experiences of educators with regards to social inclusion and benefits associated with providing opportunities for professional development which can promote best practices.

Latest Advancements in Transcutaneous Electrical Nerve Stimulation (TENS) and Electronic Muscle Stimulation (EMS): Revisiting an Established Therapy with New Possibilities.

Transcutaneous Electrical Nerve Stimulation (TENS) and Electronic Muscle Stimulation (EMS) are non-invasive therapies widely used for pain relief and neuromuscular adaptation. However, the clinical research supporting the efficacy of TENS in chronic pain management is limited by significant methodological flaws, including small sample sizes and inconsistent reporting of stimulation parameters. TENS modulates pain perception through various techniques, targeting specific nerve fibers and pain pathways. High-frequency TENS is effective for segmental pain control, while low-frequency TENS, reliant on endogenous opioid pathways, may be less effective in opioid-tolerant patients. Additionally, TENS may influence autonomic functions, such as micro-perfusion and sympathetic tone, further broadening its therapeutic potential. EMS, on the other hand, enhances muscle strength and neuromuscular function, particularly in rehabilitation settings, by recruiting additional muscle fibers and improving neuromuscular efficiency. To address the limitations in existing clinical applications, future advancements in TENS and EMS technologies should focus on real-time optimization of stimulation parameters, consistent therapy delivery, and improved accessibility. Integrating automated and personalized adjustments can help streamline treatment, enhance patient compliance, and overcome traditional barriers to the effective implementation of these modalities. Additionally, developing systems that enable remote monitoring and customization of therapy protocols will expand the usability of TENS and EMS in diverse care settings. Future research must focus on rigorous study designs, standardized protocols, and meaningful patient-centered outcomes to fully realize the therapeutic potential of these modalities. Innovations like NXTSTIM EcoAI™ represent a significant advancement in delivering tailored, effective, and patient-friendly pain management and rehabilitation strategies.

Care homes and primary care in England working together: A multi-method qualitative study.

In England, most long-term care for older people with complex health care needs is provided by private care homes. They rely on primary care to provide medical care and access to specialist health care services. This study explored the working relationships between care homes and primary care in one region in England to inform a theory of change for achieving improved relationships. We carried out a multi-method qualitative study using appreciative inquiry. We thematically analysed data from 33 survey responses, 15 interviews, and eight workshops with care home and primary care staff, family carers, and other community specialists to populate the theory of change. A patient and public involvement representative supported data collection, analysis, and write-up. Study participants described activities that encouraged role understanding, communication, and learning together benefitting staff, relationships, and quality of services. The lessons and experiences from the COVID-19 pandemic had shaped participants' understanding of what is required to sustain cross-sector collaboration. Key inputs included time, staff, and funding to facilitate learning how to work together effectively, as well as the capacity to adapt to diverse care settings and address the complex, individual needs of care home residents. Participants noted the few opportunities they had to share their learning and discuss best practice. The theory of change identified different dimensions of good practice, providing insight into areas for action to inform service design and practice. Ongoing organisational changes should consider what is already working well and build on these achievements to enable positive care home and primary care working relationships and so foster high quality care and equitable access to services.

Liver Fibrosis Assessment in Chronic Liver Diseases Using Elastography: A Comprehensive Review of Vibration-Controlled Transient Elastography and Shear Wave Elastography

Chronic liver diseases (CLD) are a major global health issue, with liver fibrosis progression and cirrhosis as critical determinants of prognosis and treatment strategy. Historically, liver biopsy has been the gold standard for assessing fibrosis, but limitations such as invasiveness, variability in results, and cost have spurred the development of non-invasive tests. Elastography techniques measure liver stiffness, providing important insights into fibrosis severity across various CLDs, including hepatitis B and C and metabolic dysfunction-associated steatotic liver disease (MASLD). Ultrasound-based elastography techniques include vibration-controlled transient elastography (VCTE), point shear wave elastography, and 2D shear wave elastography. Most studies report high accuracy for diagnosing significant fibrosis and cirrhosis. While VCTE is the most widely used elastography method, each technique has strengths and limitations in different patient populations, affected by factors like alanine aminotransaminase levels, obesity, and presence of hepatic inflammation. Elastography proves valuable informations in treatment decisions for hepatitis B patients in the "gray zone" and helps identify high-risk groups requiring post-hepatitis C eradication surveillance. Recent studies emphasize the potential of elastography-based scores, such as the FibroScan-AST and AGILE scores, in improving diagnostic accuracy for patients with MASLD. However, diagnostic performance may vary by setting, requiring validation in primary care. Emerging precision medicine approaches, integrating genomics and novel biomarkers, promise to further enhance risk stratification in CLD management. Despite substantial advances, broader clinical application of elastography and related biomarkers necessitates further validation, particularly in diverse care settings, to ensure their optimal utility in routine clinical practice.

Mission and Future Plans for the ADPKD Centers of Excellence Program.

The Autosomal Dominant Polycystic Kidney Disease (ADPKD) Centers of Excellence Program, launched by the Polycystic Kidney Disease Foundation in 2022, aims to bridge the gap in specialized care for individuals with ADPKD. This program seeks to enhance the availability of specialized clinicians and simplify the process for patients seeking expert care. It is founded on three pillars: improving care for all individuals with ADPKD, educating and empowering the community, and advancing PKD research. The program draws inspiration from successful models in other diseases, such as cystic fibrosis and muscular dystrophy, which have demonstrated the effectiveness of standardized care centers in improving patient outcomes. Patient and clinician stakeholder interviews have identified key areas where a national program could make a significant impact, including the need for a core care team with defined referral processes, mentorship and shared care models, patient navigation services, and education around expert consensus and care guidelines. The program introduces two designations: "Center of Excellence" and "Partner Clinic" to accommodate diverse care settings and enhance patient access to specialists. The Partner Clinic designation ensures that patients in smaller community practices have access to specialized care through mentorship and guidance from experts at Centers of Excellence. The program also emphasizes the importance of specialized services, especially in underserved communities experiencing health disparities, to manage the complexities of ADPKD care. Patient focus groups have highlighted the need for care navigation services, centralized sources of knowledge, and access to local care. The program aims to address these needs by providing a structured framework for care coordination, enhancing patient self-advocacy, and improving overall outcomes for individuals with ADPKD.

Assessment of needs, challenges, and re-design considerations for culturally sensitive provision and delivery of palliative care supports and services for older adults who prefer to age and die in place in diverse India.

As the global older adult population continues to grow, challenges related to managing multiple chronic conditions (MCCs) or multimorbidity underscore the growing need for palliative care. Palliative care preferences and needs vary significantly based on context, location, and culture. As a result, there is a need for more clarity on what constitutes palliative care in diverse settings. Our objective was to present an international perspective on palliative care in India, a culturally diverse and large ancient Eastern middle-income country. In this narrative review article, we considered three questions when re-designing palliative care for older adults aging-in-place in India: (I) what are the needs for palliative care for persons and their families? (II) Which palliative care domains are essential in assessing improvements in the quality of life (QoL)? (III) What patient reported measures are essential considerations for palliative care? To address these questions, we provide recommendations based on the following key domains: social, behavioral, psychological, cultural, spiritual, medical, bereavement, legal, and economic. Using an established and widely reported conceptual framework on aging and health disparities, we provide how these domains map across multiple levels of influence, such as individual or family members, community, institutions, and health systems for achieving the desired QoL. For greater adoption, reach, and accessibility across diverse India, we conclude palliative care must be carefully and systematically re-designed to be culturally appropriate and community-focused, incorporating traditions, individual preferences, language(s), supports and services from educational and health institutions, community organizations and the government. In addition, national government insurance schemes such as the Ayushman Bharat Yojna can include explicit provisions for palliative care so that it is affordable to all, regardless of ability to pay. In summary, our considerations for incorporating palliative care domains to care of whole person and their families, and provision of supports of services from an array of stakeholders broadly apply to culturally diverse older adults aging in place in India and around the globe who prefer to age and die in place.

Current and future challenges of decision-making support for people living with dementia in diverse long-term care settings in Japan

Current and future challenges of decision-making support for people living with dementia in diverse long-term care settings in Japan

Identifying Gaps and Barriers in Alzheimer's Disease and Related Dementia Research and Management in Low- and Middle-Income Countries: A Survey of Health Professionals and Researchers.

The significant increase in Alzheimer's disease and related dementia prevalence is a global health crisis, acutely impacting low- and lower-middle and upper-middle-income countries (LLMICs/UMICs). The objective of this study is to identify key barriers and gaps in dementia care and research in LLMICs and UMICs. We conducted an international, cross-sectional survey among clinicians and healthcare professionals (n = 249 in 34 countries) across LLMICs and UMICs, exploring patient demographics, use of clinical diagnosis, dementia evaluation, screening/evaluation tools, and care and treatment. Significant disparities were found in diagnostic practices, access to assessments, and access to care. On average, clinicians in LLMICs saw more patients, had less time for evaluations, lower use of formal screening and tools, and less access to biomarkers. They were also under-resourced compared to UMICs. The findings provide insights for policymakers, healthcare organizations, and researchers to address the complex challenges associated with dementia care in diverse settings. Addressing these challenges requires a multipronged approach involving local, national, and international stakeholders.

Factors Impacting Intent to Share Multigenic Cancer Testing Results in a Community Hospital Setting.

Multi-gene, multi-cancer, hereditary cancer risk screenings may be useful in cancer prevention and treatment, not only for cancer patients but also for patients' family members. If genetic cancer screening is to have the widest possible benefit, it must be extended into diverse cancer care settings that serve diverse patient communities, providing cancer patients and their relatives with individualized cancer risk evaluations. Little research, to date, has examined the impact of extending multigenic cancer screening into diverse settings. Without empirical data characterizing the support needs of cancer patients and their family members, we may not adequately satisfy the needs of all patients and risk exacerbating existing disparities in cancer care and outcomes. We examined patient perspectives on the sharing of genetic results with at-risk family members by surveying a racially diverse sample of cancer patients receiving a multi-gene, multi-cancer risk screen in a community hospital setting. In a survey of 230 cancer patients, we found that intent to share results with family members was high but varied across family member types. More respondents planned to disclose results to at least one sister (82.5%) compared to at least one brother (73.1%). Over one-fourth of participants (27.4%) were either uncertain about sharing or intended to withhold their genomic screening results from at least one at-risk family member eligible for cascade testing. Participants were more likely to withhold their results from a sibling than from a child. Furthermore, intent to share across all family member types was lower if probands failed to identify at least one benefit to sharing. Understanding factors associated with decisions to share results with at-risk relatives in diverse patient populations can help clinicians support cascade genetic cancer screenings in diverse communities and settings.

Early Palliative Care in the Emergency Department: A Concept Clarification.

: Healthcare advances have contributed to patients living longer with chronic illnesses and diseases with uncertain trajectories impacting quality of life (QOL). Palliative care (PC) is no longer only for dying oncology patients as many healthcare practitioners have adopted the PC concept in diverse care settings and the timing of PC implementation remains ambiguous. There is a need to develop an operational definition of early palliative care (EPC) by clarifying the phenomenon and bridging concepts with empirical data to develop and test possible interventions before integrating EPC into emergency care (EC). : Norris' concept clarification method was used as the philosophical framework to define, analyze, and clarify EPC. An electronic search of literature from 2000-2024, using CINAHL, PubMed, APA PsychINFO, and Psychology and Behavioral Sciences Collection databases and search terms "early palliative care" AND "emergency care" NOT "animals", and NOT "pediatrics" were screened for eligible articles. : Of the 826 articles identified; 22 articles were retained for review. Attributes included timing, palliative, and EC; antecedents included symptom burden, access to care, and cognitive awareness; consequences included QOL and resource utilization; an empirical referent used to screen patients is the highly accurate surprise question "Would I be surprised if this patient died within a year?" : Clarifying the concept of EPC leading to an operational definition will advance the development of interventions that support the implementation of EPC in ED clinical practice.

Exploring the Influence of Family Dynamics on Death Attitude among Elderly People: A Comparative Study of Chitwan and Jhapa District, Nepalrict, Nepal

This research examines the impact of living arrangements on death attitudes among elderly individuals in Nepal's Chitwan and Jhapa districts. A cross-sectional survey of 127 participants (79 in elder homes, 48 in their own homes) was conducted and analyzed using SPSS v.20. Significant differences in death attitudes were found based on living arrangements. Elder home residents showed greater acceptance of quick death, less fear, and viewed death more as relief from pain. They preferred dying in religious places, while those in their own homes preferred passing at home. Belief in reincarnation was higher among those living independently. The study reveals that living environments significantly influence elderly individuals' death attitudes, with elder home residents exhibiting more acceptance towards death. These findings suggest a need for tailored end-of-life care and support services that consider living arrangements and cultural contexts, contributing to the discourse on geriatric care in diverse settings.

Group Reminiscence Therapy for Dementia to Improve Well-Being and Reduce Behavioral Symptoms.

The global increase in dementia cases highlights the urgent need for effective treatment and care strategies. The aim of this study was to evaluate the effects of group reminiscence therapy on cognitive function, subjective well-being, and behavioral and psychological symptoms of dementia (BPSD) in older adults with moderate to severe dementia. A pre-post comparative design was used, with 49 participants receiving eight group reminiscence therapy sessions over 4 weeks. Baseline, one-week, and one-month postintervention assessments were conducted using the Hasegawa Dementia Scale-Revised (HDS-R), the Neuropsychiatric Inventory-Nursing Home Version (NPI-NH), and the Philadelphia Geriatric Center Morale Scale (PGC Morale Scale). The results showed no significant improvement in HDS-R scores, but significant improvements in PGC Morale Scale (p = 0.0417) and NPI-NH scores (p = 0.00226), indicating improved well-being and reduced BPSD. These findings suggest that group reminiscence therapy is effective in improving BPSD. Future research should focus on extending the duration of the intervention, including different populations, and combining group reminiscence therapy with other therapeutic approaches to fully determine its long-term benefits and mechanisms. Research on its cost-effectiveness and cultural applicability could further validate and improve the use of group reminiscence therapy in diverse care settings.

Nursing strategies for enhancing calm in older Arabs with dementia: integrating Snoezelen methods, aromatherapy, and personal items to reduce agitation

BackgroundAgitation significantly impacts Arab elders with dementia. Multisensory stimulation, such as Snoezelen, shows promise but lacks exploration in Arab contexts. ObjectiveEvaluate a culturally adapted multisensory intervention—combining Snoezelen, aromatherapy, and personal items—on agitation in Arab elders with dementia. MethodsA quasi-experimental design assessed 31 patients receiving the intervention against 31 controls. Agitation, quality of life, and neuropsychiatric symptoms were measured using the Cohen-Mansfield Agitation Inventory (CMAI) and the Neuropsychiatric Inventory (NPI). ResultsThe intervention group exhibited notable reductions in CMAI scores for aggression and agitation behaviors (p < 0.001) and improvements in quality of life and NPI scores for agitation/aggression and depression/dysphoria (p < 0.001). ConclusionThis culturally tailored multisensory approach effectively reduced agitation and improved well-being in Arab dementia patients. The findings advocate for further research and suggest such interventions can be beneficial in culturally diverse dementia care settings. Trial registrationClinicalTrials.gov, ID NCT06216275

S96 - The Pharmacist-Integrated Medication Treatment for Opioid Use Disorder (PrIMO) Model: Operationalizing an Effective Clinical Care Model to Assess Feasibility in Diverse Care Settings

S96 - The Pharmacist-Integrated Medication Treatment for Opioid Use Disorder (PrIMO) Model: Operationalizing an Effective Clinical Care Model to Assess Feasibility in Diverse Care Settings

New chronic inflammatory demyelinating polyneuropathy/Guillain-Barré syndrome guidelines - impact on clinical practise.

There is no diagnostic biomarker that can reliably detect Guillain-Barré syndrome (GBS) or chronic inflammatory demyelinating polyneuropathy (CIDP). Diagnosis relies upon integrating key clinical characteristics and relevant supportive data. Consequently, misdiagnosis and delayed diagnosis are common. Diagnostic criteria have proven valuable resources to improve diagnosis, but are underutilized during routine clinical care. In 2021, the EAN/PNS CIDP criteria was published, and were followed by the EAN/PNS GBS criteria in 2023. Both guidelines utilized GRADE methodology to formulate evidence-based recommendations that are intended to be used by adult and paediatric clinicians across diverse care settings to optimize diagnostic accuracy and improve patient outcomes during routine clinical care. The EAN/PNS GBS and CIDP criteria detail specific clinical, electrophysiological, and laboratory features that raise diagnostic confidence, and call attention to diagnostic mimics. The sensitivity of EAN/PNS and other modern criteria to detect GBS and CIDP is high, but utilization during clinical practice is low. Complexity is one factor limiting widespread application. Strategies are needed to optimize criteria adoption during routine clinical care such that GBS and CIDP diagnosis can be achieved with greater speed and accuracy.

‘It was horrible to watch, horrible to be a part of’: Midwives’ perspectives of obstetric violence

BackgroundObstetric violence, including unconsented interventions, coercion and disrespect, violates human rights; impacting the physical and psychosocial health of women. The perspective and experience of midwives related to obstetric violence have been explored in low and middle-income countries, with limited research into the experience of midwives in high income nations. AimTo explore Australian midwives’ perspectives of obstetric violence. MethodsThematic analysis of qualitative in-depth interviews with 15 midwives experienced in supporting women during birth. Critical feminist theory underpinned each stage of the research. FindingsInterviews with 15 Australian midwives from diverse care settings were analysed thematically. Four key themes were developed from the data: ‘the operationalisation of obstetric violence’, ‘the impact of obstetric violence’ ‘the historical and situational context’ and ‘hope for the future’. Midwives considered entrenched patriarchal structures and gender inequity as fundamental to the occurrence of obstetric violence. This societal scaffold is intensified within health care systems where power imbalances facilitate maternal mistreatment through coercion and grooming women for compliance in the antenatal period. Fragmented care models expose women to mistreatment with continuity models being protective only to a point. Midwives experience their own trauma, as a result of what they have witnessed, and due to the lack of support they receive when advocating for women. ConclusionsObstetric violence occurs in Australian maternity systems with unconsented interventions, overmedicalisation, coercion, and disrespect observed by midwives. Care-related trauma impacts on the mental health of midwives, raising workforce concerns for policy makers, consumer advocates and professional bodies.

Continuous palliative sedation until death: a qualitative study of palliative care clinicians' experiences.

The practice of continuous palliative sedation until death is the subject of much medical and ethical debate, which is reflected in the inconsistency that persists in the literature regarding the definition and indications of palliative sedation. This study aims to gain a better understanding of palliative care clinicians' experiences with continuous palliative sedation. We conducted a qualitative study based on focus group discussions. We conducted six focus groups with a total of 28 palliative care clinicians (i.e., 15 nurses, 12 physicians, and 1 end-of-life doula) from diverse care settings across Canada, where assisted dying has recently been legalized. An interpretative phenomenological analysis was used to consolidate the data into six key themes: responding to suffering; grappling with uncertainty; adapting care to ensure ongoing quality; grounding clinical practice in ethics; combining medical expertise, relational tact, and reflexivity; and offering an alternative to assisted death. Interaction with the patient's family, uncertainty about the patient's prognosis, the concurrent practice of assisted dying, and the treatment of existential suffering influence the quality of sedation and indicate a lack of clear palliative care guidelines. Nevertheless, clinicians exhibit a reflective and adaptive capacity that can facilitate good practice.

Psychosocial Distress Screening Among Interprofessional Palliative Care Teams: A Narrative Review

With increased need for palliative care and limited staffing resources, non-social workers are increasingly responsible for screening for urgent psychosocial distress. The National Consensus Project guidelines call for all palliative care team members to be competent in screening across domains. Yet, in contrast to an abundance of evidence-informed tools for palliative social work assessments, standardization for interprofessional psychosocial screening is lacking. This lack of standardized practice may lead to harmful disparities in care delivery. The purpose of this narrative review is to examine current literature on evidence-informed practices for psychosocial screening within palliative care. Google Scholar, a university Summon library search engine, and prominent palliative care journals were searched using the same phrases to locate articles for inclusion. Each article was reviewed and synthesized across common themes. Although an abundance of validated screening tools exists for outpatient oncology-specific settings, there is minimal guidance on psychosocial screening tools intended for specialty palliative care. The most oft-cited tools have been met with concern for validity across diverse palliative care populations and settings. Additional research is needed to operationalize and measure brief psychosocial screening tools that can be validated for use by interprofessional palliative care teams, a stepping-stone for increased equity in palliative care practice.

The use of patient reported outcome measures in oncology clinical practice across Australia and New Zealand.

While there is increasing evidence on the benefits of PROMs in cancer care, the extent of routine collection and use of PROMs in clinical cancer practice across Australia and New Zealand (ANZ) is unknown. This study examined the prevalence and characteristics of PROMs use in routine clinical cancer care in ANZ. An online survey was designed and disseminated via professional societies and organisations using a snowball sampling approach to clinical and health administration professionals managing cancer care in ANZ. A poster advertising the study was also circulated on professional social media networks via LinkedIn and Twitter inviting health professionals from ANZ to participate if they were using or intending to use PROMs in clinical cancer practice. Responders opted into the survey via the survey link. From 132 survey views, 91(response rate, 69%) respondents from 56 clinical practices across ANZ agreed to participate in the survey, and of these 55 (n = 55/91, 60%) respondents reported collecting PROMs within their clinical practice. The majority of the respondents were from the State of New South Wales in Australia (n = 21/55, 38%), hospital (n = 35/55, 64%), and a public setting (n = 46/55, 83%). PROMs were collected in all cancer types (n = 21/36, 58%), in all stages of the disease (n = 31/36, 86%), in an adult population (n = 33/36, 92%), applied in English (n = 33/36, 92%), and used to facilitate communication with other reasons (27/36, 75%). A geospatial map analysis provided insights into the variation in PROMs uptake between the two countries and in certain jurisdictions within Australia. This study also highlights the limited resources for PROMs implementation, and a lack of systematic priority driven approach. PROM use across Australia and New Zealand seems variable and occurring predominantly in larger metropolitan centres with limited standardisation of approach and implementation. A greater focus on equitable adoption of PROMs in diverse cancer care settings is urgently needed.

Comprehensive Standardized Assessment for Information Continuity: What Does the Workforce Need

Introduction: Older adults living with frailty and multimorbidity interact with multiple care providers across different health settings increasing the risk for fragmented care and information discontinuity. Information discontinuity results in workforce inefficiencies and adverse health events, including duplication of assessment and diagnostics, medication errors and increased health service use. Standardized assessments potentiate integrated care by communicating consistent measures of health information between health care sectors and providers. InterRAI assessments facilitate integration through promoting a common language and aligning successive assessments across the care continuum.&#x0D; Description: We used a pragmatic case example of a theoretical medically-complex older adult to illustrate effective use of interRAI standardized assessments throughout the health care journey. The interRAI suite of instruments spans across the age continuum, from pediatrics to geriatrics, and is designed to be used across diverse care settings, including community services, primary care, home care, long-term care, acute care, inpatient and community mental health, and palliative services. The case example represents one patient’s assessment findings, derived from standardized assessment instruments, such as the contact assessment, home care assessment and long-term care facility assessment. Automated and embedded risk algorithms are generated as outputs from the assessment, acting as decision support tools to inform care planning for clinical, functional, and social support needs. Process schematics depict potential workflows, where instruments can guide care strategies and facilitate the flow of information between the care team members.&#x0D; Discussion: Integrating elements such as using a common language, standardized assessment items, and embedded decision support algorithms, can support effective communication and collaboration in the care of older adults between clinical settings. Risk algorithms and scales support real-time identification of care issues, with standardized assessment items allowing for changes in health status to be easily recognized. Operationalizing a suite of standardized assessment instruments across the health system offers advantages for the individual including improved continuity of care, as well as for organizations and the system through use of a consistent measurement of health metrics between health providers and sectors, and evaluating health system performance. Successful adoption of comprehensive assessment tools to support integration requires training, stakeholder engagement and time to embed work and care processes into practice.&#x0D; Conclusion: Standardized language and algorithms used in interRAI comprehensive assessments can increase capacity for integration and continuity of care across the full spectrum of health sectors and settings. Findings from this pragmatic case example demonstrate real-world application and utility of standardized assessments to support an integrated workforce.