Partners HealthCare Research Articles

The usability of virtual reality to train individuals in responding to behaviors related to dementia.

Dementia is associated with several behavioral changes globally referred to as Behavioral and Psychological Symptoms of Dementia (BPSD) of which many are recognized to be the expression of unmet needs triggered by environmental factors. BPSD are an extreme source of stress for family care partners and health care providers alike and can be the reason why people living with dementia (PLWD) are placed in long-term care homes (LTCH). The overall goal of this project was to examine whether a virtual environment that includes a virtual LTCH resident with dementia in a lifelike situation could be useful and usable for health care providers and care partners to identify potential triggers to BPSDs while being engaged emotionally with the scenario. Twenty-three health care professionals working with PLWD, 25 care partners to PLWD, 27 students in a health-related field, and 11 university/community college faculty members teaching courses relevant to gerontology tested the application which depicted a meal-time scenario. In addition to being asked about the behavioral triggers in the scene, participants were asked about the usefulness and usability of the tool for training. Presence and simulator sickness were also measured. Results suggest that participants generally felt present and emotionally engaged. They could identify the potential triggers for the observed behaviors in the virtual human with dementia as well as suggest some solutions. The majority (87% of participants) found the tool easy to use. Many participants identified the inability to interact with the virtual humans as a shortfall, and few reported mild to moderate levels of simulator sickness. As the behavioral changes associated with dementia can cause extreme stress for those interacting with PLWD, developing an effective and efficient training tool could significantly improve well-being for all involved. The investigators see the development and testing of an interactive version of this virtual environment as a next step in making this a clinically relevant training tool.

Assessing Provider Understanding of Interfacility Emergency Medical Services Transport

Background: Interfacility transfer between hospitals is an integral component of regional healthcare systems. The decisions referring providers make regarding emergency medical services (EMS) level of care and transport modality (ground versus air) can dramatically impact patient care, emergency departments' workflow, hospital length of stay, and EMS resource availability. Limited research has been done to assess understanding of interfacility transport by emergency medicine providers. 
 Methods: We developed six patient scenarios to test knowledge of level of care and mode of interfacility transfer. Seven board-certified EMS physicians determined the optimal answer to each patient scenario. We distributed a survey with the scenarios to regional healthcare partners via a database of persons who utilize or interface with interfacility transport services. We collected answers to the patient scenarios and provider characteristics (primary practice site, sex, age, specialty, years since graducation, provider degree, EMS training received). Descriptive statistics were performed and Fisher's exact tests described differences in correct answers as they varied by specialty (emergency medicine or other specialty), provider type (physician or advanced practice provider), and reported training in EMS level of care. 
 Results: Seventy-six emergency medicine providers responded, including 68 physicians and 8 advanced practice providers. The mean total score on the case scenarios was 66%, with scores ranging from 33% to 100%. The mean scores on questions testing level of care and transport modality were 67% and 70%, respectively. No significant difference was found in test scores between emergency medicine and other specialties (p=0.718) or provider level of training (p=0.799). Training in EMS level of care was correlated with higher scores on the transport modality questions (p=0.003) but not on the level of care questions (p=0.231).
 Conclusion: Variability exists in the knowledge of providers on interfacility transport throughout the state. Emergency medicine providers could benefit from education on interfacility transfer resources.

Novel and Proven Models of Public, Private, and Public-Private Partnerships in Healthcare: An Update.

Initiatives to share assets in the life science sector through dedicated partnerships had and still have a multitude of different aspects in the past few decades. The range goes from industry partners, small and big companies, in bilateral agreements with academic institutions up to large privately and publicly funded consortia. In general, the term public-private partnership (PPP) is used when at least one public (non-profit, academic, and/or government) part and one or more private for-profit partners are involved. A Public-Private Partnership is often driven by a public body, i.e. a ministry or a public agency. Their synergism has been described 10years ago (Dearing, Science 315(19):344-347, 2007; Casty and Wieman, Ther Innov Regul Sci 47(3):375-383, 2013; Stevens et al., Biotechnol Law Rep 34(4):153-165, 2015). So why view this synergism again today? It will be shown that the situation in life science has changed: novel partners acting digital, data expertise being involved on many levels and novel partnering models arising. Success and challenges will be described in this chapter.

Manifestations and Strategies to Deal with Politics Science Adulteration in Community Engagement Healthcare Research

Community and Public Engagement (CPE) is increasingly acknowledged as an appropriate approach in healthcare and other policy related research. However, it is also becoming clear that community engagement necessarily involves and is significantly affected by politics. This paper illuminates the manifestations of politics in community engagement research drawing examples from a community-level study that was carried out in Kasulu, a rural district in Tanzania. Specifically, the paper starts by providing some conceptual highlights on community engagement and politics, then it proceeds to show the different forms and shapes that politics can take in community-level research. Further, it argues that community engagement is by its nature a defacto victim of politics. Finally, it suggests workable strategies and tactics that could be considered by community engagement researchers to remedy scientific research from being adulterated by politics. Four strategies that were employed in our project namely creating cognitively aware communities, preparing and orienting stakeholders to engagement guidelines, the use of Community Advisory Committees, and ensuring diversity in all engagement platforms are described and exemplified. If effectively used, these measures can potentially improve the uptake and sustainability of the solutions that community-level healthcare engagement research partnerships tend to generate.

Saudi Vision 2030 and Physician’s Perception of Public-Private Partnerships in Healthcare

This research aimed to assess the existing level of awareness about PPPs among physicians’ at different levels of health care delivery system and their perception on the benefits and potential challenges in implementation of PPPs in Saudi health care system. The study collected information from a total number of 60 health professionals including consultants, specialists, residents and general practitioners who were working in public and private health facilities in Riyadh city. The analysis showed that only one-thirds of respondents had complete understanding of the features of PPPs. About 33% of them identified most of the principles of PPP, whereas 50% of them could identify at least three principles. More than 70% of respondents identified improving access to quality health care to population as one of the major benefits of PPPs. Nearly 60% of them also highlighted that focus of PPP arrangements should be for providing primary health care and emergency care to the citizen. A significant percentage of physicians’ also identified areas like specialist care, radiology services and other laboratory services as focus areas for PPP in Saudi Arabia. However, they perceived many challenges in implementing PPPs, significant of which includes lack of policy driven strategy for PPP and absence of appropriate institutional structure in managing PPPs. The study concludes that there exists a low level of awareness among physicians’ on various aspects of PPPs in health care. The study recommends the need for improving awareness about PPPs among physicians, nurses, pharmacists, laboratory technicians and allied health professionals in the Kingdom.

Using the Delphi method to develop a clinical skills assessment tool for advanced practice nurses in psychiatry and mental health

In France, advanced practice for psychiatric and mental health nurses has been developing since 2019. The acquisition of clinical skills by advanced practice nursing students requires monitoring and evaluation. This article outlines the process for creating an internship logbook. To develop and verify a tool for assessing the skills of advanced practice nursing students specializing in psychiatry and mental health during the internship stage. The Delphi method described by Hasson was used, with the aim of obtaining a consensus of over 80% of the experts consulted. A panel of ten experts, all internship tutors at partner healthcare establishments of Aix Marseille University, was consulted twice. The internship logbook was composed of 68 items. This tool is the product of a multidisciplinary process including nurses and psychiatric nurses. It can be adapted to a variety of learning environments and helps tutors track the acquisition of clinical skills during the internships, both through external and self-assessment. A new Delphi consultation will foster uptake of this tool. Advanced practice nurses in psychiatry and mental health will be included in the group of experts.

The Big Scran: building community resilience through a volunteer movement in partnership with homelessness charity, Blue Triangle, and the Health and Social Care Partnership. 

Ben View Community Resource Centre has been a leading community anchor organisation within the Greater Glasgow and Clyde Health Board Area for two decades, diligently uniting the community by co-designing and building volunteering movements to meet community needs in West Dunbartonshire, Scotland.
 In partnership with homelessness charity, Blue Triangle, and the West Dunbartonshire Health and Social Care Partnership, a new volunteering movement, entitled ‘The Big Scran’, has been created to provide essential practical support, food, heat and social interaction. In tandem, the partnership has addressed wider needs, effecting generational change for individuals and families, such as maximising income or supporting delivery of health outcomes.
 Ben View’s expertise in anticipating local needs and galvanising community resources positions them as expert. Against the backdrop of the global financial crisis and complex public health challenges facing the community, such as gender-based violence, substance misuse, youth homelessness and other population health themes, the partnership, including Blue Triangle and West Dunbartonshire HSCP are a force for good. Their approach addresses immediate needs (hunger, heat and social interaction) and affects generational change, taking a person-centred and trauma informed approach, building individual relationships, leveraging the skills, talents and local knowledge of volunteers, supporting translation of needs assessment into meaningful interventions.
 Against all the Social Determinants of Health, West Dunbartonshire fairs poorly internationally. The burden of depression, anxiety, mental illness, substance misuse, alcohol dependency, smoking and interpersonal violence are key drivers contributing to our burden of disease, more so in West Dunbartonshire. The impact of social isolation and loneliness on individual’s physical and mental wellbeing has been well documented. It increases the risk of stress, anxiety and depression and doubles the risk of dementia. 
 The Health and Social Care Partnership understands that the status quo is no longer an option and that building a resilient and compassionate community of people, is essential to tackle the complex social justice challenges facing the population. The thought leadership from this initiative builds the compassionate community by creating and co-producing a new volunteering movement, in partnership with service delivery organisations and the Health and Social Care Partnership, which carries the statutory duty for health and social care.
 The relational approach to health improvement by creating a volunteering movement of local people, supported by known and respected local organisations, builds the community resilience required during the harsh global financial crisis. The success of this initiative has been such that other communities are now launching their own ‘Big Scran’.
 ‘The Big Scran’s’ processes and assets have been created to be transferable and scalable to all communities. Other communities across Scotland are using this model and their assets and to build similar partnerships and volunteer movements in their own areas. This fits with the policy landscape in Scotland and beyond and its desire to create and connect compassionate volunteering movements across Scotland and globe. The success and impact of the Big Scran movement is informed and sustained by people’s needs. All involved, recipients and volunteers positively gain from this replicable model.

The Social Service of Health Insurance Funds? A VALUABLE partner in integrated care! There for everyone, with a focus on personal care and support!

There for everyone, with a focus on personal care and support! Who are the Social Service of the Health Insurance Companies? To be able to make use of the Belgian Social Security, every citizen must be affiliated with one of the recognized health insurance funds. This membership makes one eligible for e.g. reimbursement of medical care, benefits due to disability or pregnancy… However, the operation of a Belgian health insurance funds goes beyond these basic services. Every organization has a social service, tasked with the support of people’s request for help concerning matters of health,well-being, care such as the organization of home care, child benefits, complex social administration procedures, … Being subsidized by the Flemisch governement, these services are accessible and free for each citizen or member.Strengths of The Social Service of the Health Insurance Funds! A proactive approach
 The Social Service of each health insurance fund is committed to prevent underprotection (non-take up) and support the most vulnerable people of society. Each year they choose at least 3 target groups they approach proactively. An example of such a group is people who are hospitalized frequently and/or for a longer period of time. In these cases, the services take the initiative to contact the client and offer them some information about their services. Without obligation, the client can decide whether he/she wants to make use of the services.
 A guide, a coach, an advocate …
 The role of The Social Service changes based on what the client wants or needs. On one occasion our social workers can function as a guide in the elaborate and complex field of the available benefits and care on different governmental levels. On another, they can be a coach who empowers the client in achieving or pursuing a life goal. Based on their experiences with clients/members, the social departments have a signaling function to policymakers like the Flemish or Belgian governments.
 Multi-channel accessibility
 In order to keep up with an ever-becoming complex world and realize accessible care/support, The Social Services make use of an array of (digital) tools to (stay) connect(ed) with their client. House visits, (E-)mail, (Video) calls, swinging by the local office… there are multiple possibilities to ask/answer questions, exchange information, … The client can choose the medium he or she’s most comfortable with.
 
 A partner in health care and wellbeing
 Throughout the years The Social Services of the Health Insurance Funds have developed a great expertise in helping people with complex, multiple and/or chronic disabilities, health issues, social issues. Our social workers and occupational therapists work together, as a multidisciplinary team, to ensure a qualitive coaching and follow-up of their clients (and their needs). In order to keep providing this quality of care in the future, it has become clear that collaboration with others is necessary. That’s why the Social Services of the Health Insurance Funds have formed strong partnerships with other parties in the primary care such as (the social departments of) local governments or publicly funded wellbeing organizations.

System Wide Governance and Leadership: A New Governance Model to Rethink How Performance is Measured; How Integrated Services are Contracted, Funded and Co-ordinated and How Outcomes and Benefits are Assessed

This workshop shares learning from the work of Midlothian Health and Social Care Partnership to develop a strategic governance and performance framework that supports person centred practice and assesses impact on outcomes for people.
 It is widely recognised that for person centred approaches to be sustained, they need to go beyond practice and be embedded within the culture, systems and processes of health and social care organisations. This poses a challenge for traditional approaches to performance management, which tend to hold services accountable for delivering on easily measurable service outputs, rather than working in the flexible and outcome focused ways required to be person centred. In this workshop we share learning from work carried out by Midlothian Health and Social Care Partnership to align strategic governance and performance systems with their commitment to person centred practice and provide space for workshop participants to explore how they could put learning into practice.
 Midlothian HSCP are responsible for delivering and commissioning integrated services and supports to a local population of about 93,000 people in Scotland. The partnership has been strongly committed to embedding person centred practice for many years and have established the ‘MidWay’ approach to having ‘Good Conversations’ and building relationships with people, where services facilitate change, rather than aim to fix it.
 The partnership recognised that their strategic governance and performance approach was not aligned with this focus on person centred practice and outcomes for people. In 2020 they commissioned Matter of Focus to work with them to develop an outcome focused performance framework underpinned by the Matter of Focus approach and software OutNav. Over the past 2.5 years the framework has been tested and refined by diverse services and teams and is now being rolled out across the partnership. 
 The Matter of Focus approach is informed by contribution analysis and evidence to action approaches and enables organisations delivering complex change that is people based to evidence contribution to desired outcomes, rather than attribution. The approach and software is being used by more than 150 organisations internationally.
 
 The workshop will be of interest to managers, leaders, researchers and policy makers looking to embed person centred practice at scale and to improve governance and performance management approaches.
 The interactive workshop will involve: 5 minutes welcome and introductions; 10 minutes table discussion; 10 minute presentation on the Matter of Focus approach; 15 minute presentation on the framework and lessons learnt from Midlothian HSCP; 10 minute table discussions; 10 minutes feedback from tables, summary of take home messages and close. 
 The audience will be engaged through focused discussion questions at the tables. Take home messages will be captured from each table by the presenters in the final feedback session.

Integrated Health and Social Care In A Woman's Shelter and Multi-Service Agency

Introduction: Evidence exists demonstrating that integrated health and social care (IHSC) can support enhanced care for highly vulnerable and marginalized population groups. One such group are homeless women. Street Haven (SH) is a multi-service women’s agency that serves homeless women who suffers from the intersection of critical health, social and financial disadvantages living in one of the poorest urban neighbourhoods in Toronto, Canada. SH provides shelter, supported housing, addictions treatment and training support services. Over the past ten years, client acuity has increased the health and social care needs of vulnerable women. The pandemic has exacerbated this. Clients have experienced chronic homelessness which is connected to trauma. They also suffer from mental illness conditions, and chronic diseases including respiratory illnesses, and gastro-intestinal illness, and diabetes. Street Haven has engaged in integrated health and social care (IHSC) to ensure that more comprehensive care can respond to the increasing client care complexity. 
 Approach: IHSC coordination with community partners have been undertaken in order to address unmet health and social care. Within the SH shelter services, partnerships with primary health care partners, hospital services and community-based crisis and mental health teams have been established. As a result, a primary care physician and psychiatrist can be accessed once weekly on site by clients. Homeless women are then attached to a physician and psychiatrist while accessing SH services. In addition, when clients experience crisis, community-based outreach mental health and crisis teams are dispatched by other organizations to SH locations. The SH addiction treatment residence services also integrate with psychiatry services with a community clinical services agency and with the community crisis team to introduce crisis and psychiatric supports for addiction service clients. Lastly, SH works with community policing to ensure that women who exhibit behaviours stemming from crisis, may have benefit of community policing services that provide SH and client with protection while offering crisis supports at the same time. They help to divert clients from hospital and correctional services.
 Results: IHSC enables SH to better meet the needs of its highly complex client base within its premises. Several benefits of the IHSC include the identification of unmet health and social care needs of our clients including psychiatric and mental health needs and management of chronic diseases and medication prescription needs; enhanced client community engagement through the referral and coordination of services with community health and social care partner agencies; minimization of crisis events on SH premise sites; and minimizing utilization of acute car and correctional services. The competencies that are absent in the organization are available due to IHSC.
 Lessons Learned: IHSC can act as a lever for women’s shelter and addiction treatment services to provide more comprehensive health and social care services. IHSC is crucial considering the austerity in government program funding in Toronto and Ontario. IHSC is another means to better serve marginalized, homeless and impoverished women to ensure that they have more equitable access to health and social care services especially where there is a gender-bias against women’s services in Toronto. 

Ageing well in place: EET as an answer to the need for integrated care and support

Background: Older people prefer to stay as long as possible in their own home and environment. However, as people age, they are typically confronted with age-related declines on different domains; often leading to multidimensional (physical, psychological, social and environmental) frailty, which is associated with an increased vulnerability to adverse health outcomes and a decrease in wellbeing. In order to age well at home, one must shift from the (often) current fragmented, supply-driven support to a more integrated and multidisciplinary demand-driven support that focuses on the wants and needs of older people and their caregivers.
 The Elder Expertise Team in Tienen (Belgium): Currently, as also mentioned by our stakeholders of informal caregivers, there is insufficient continuity and coherence between the different disciplines involved in the support and care at various echelons. This often leads to non-transparency, not only for older frail people but also for their informal and formal caregivers. As a result, the problems are not recognized, nor treated in time, leading to a threatening of the autonomy, participation in society, health and wellbeing and often leading to an admission into a residential care facility.
 To address this need, in Tienen, the “Elderly Expertise Team (EET)” was established in 2019 with the objective of enabling frail elderly people to live at home for as long and as qualitatively as possible by offering the most appropriate care and support. The EET has a multidisciplinary, cross-sector and cross-organizational composition, using a network-oriented approach. In order to give an answer to multidimensional frailty, besides healthcare partners also partners from welfare are part of the EET.
 The EET serves as a “single point of entry” which coordinates care and support across a network of different care and support providers. The EET uses a stepped-care approach: (1) one starts with giving (general) advice by phone, (2) if there is a need for additional case-specific support an assessment and/or screening is done, leading to case-specific tailored advice and a short-term treatment of up to 5 sessions is provided; (3) if necessary, a referral to more specialized care is done. Besides the care for older persons and their caregivers, the EET also provides coaching, trainings and intervisions for formal caregivers. This all results in better and integrated care and support, leading to reduced admissions to residential care and a better wellbeing for the older person and his/her context.
 Future: Currently, the EET works mainly at the intervention level. However, in the future a more population-based approach using risk-profiles for multidimensional frailty and doing pro-active home visits might also lead to a better casefinding and prevention of frailty. Moreover, as the focus is now on clinical and service integration, the EET recognizes the need for functional integration by means of shared electronic patient records.

Community and healthcare team partnership addressing financial worries as a barrier to health

Background: A ground-breaking collaborative project called Reducing the Impact of Financial Strain, intentionally built a foundation through trust, shared purpose, and co-design, to support complex, inter-related health and social issues and system transformation.
 Who is it for? A diverse group of community stakeholders had a common goal of financial wellbeing as a determinant of health for the community. Primary care teams also worked together with communities to create services that respond to the needs of patients with financial strain.
 Who did you involve and engage with? In Alberta, Canada four participating rural community multi-sectoral teams worked with their Primary Care Networks to reduce financial strain as a barrier to health using co-design tools such as patient journey mapping, personas, asset mapping, simulations and collaborative decision making. The multi-sectoral community teams were supported with training, funding, collaborative learning conversations, community engagement tools, evidence-based strategies, and evaluation from provincial and regional partners including Alberta Health Services and Alberta Medical Association. Local health promotion and primary care leads supported multisectoral, interdisciplinary teams to co-create financial well-being goals and actions. Multi-sectoral partners included primary care, health and social organizations, municipalities, faith groups, indigenous communities, police, mental health, businesses, nonprofit groups, community agencies and community members.
 What did you do? Primary care teams brought empathy and financial well-bring into health care conversations by asking patients a question– ‘do you ever have difficulty making ends meet at the end of the month’? By understanding experiences of people living with financial strain, their mindsets shifted and interactions with patients became more meaningful. With the community, they mapped and connected patients to the assets. Some teams hosted an intense and transformational poverty simulation exercise.
 What results did you get? 623 patients were screened for financial strain, targeting select populations. About 30% screened positive, and 80% of this group accepted a referral for financial assistance, mental health, medication assistance, and social isolation. Most clinic team members embraced the need to talk about financial strain, and agreed that screening for financial strain is important, relevant to practice, and easily implemented.
 What impact did you have? Collectively, communities implemented 60 local initiatives inspired by evidence-based strategies in the Building Financial Well-being Toolkit, such as technology lending programs, transportation vouchers, system navigation, communities of practice, networking between clinic and community, and financial strain screening and interventions embedded into primary care practice.
 What is the learning for the international audience? Key learning that teams highlighted included: expand the health team into community, access deep wisdom of community and partners, look for ways to give power to communities and collaborate and co-design innovation solutions with diverse stakeholders.
 What are the next steps? Other health care and community partners have been inspired by the stories and discoveries shared at https://financialwellness.healthiertogether.ca/ website. A movement towards an integrated health-creating system has been started as primary care teams realize the unrecognized opportunity of collaborating with diverse partners. Primary care teams across the province are beginning to co-design solutions to complex social challenges.

Concept mapping brainstorming results for improving care transitions for adults with hip fracture in Ontario, Canada

Introduction: Individuals who have experienced a hip fracture often undergo numerous transitions in care between providers and sectors. These transitions are a time of vulnerability with the potential for poor health outcomes and experiences, yet there are limited recommendations on how to improve this care journey for adults with hip fracture.
 Target Audience: The target audience for our study include decision-makers and providers with a hip fracture portfolio, as well as patients who have experienced a hip fracture and their unpaid caregivers. 
 Who was involved: This study included patient and caregiver partners. They were involved in the grant application, study participant recruitment, data collection, and final data analysis. This study also included healthcare provider and decision-maker partners who supported participant recruitment and will be knowledge users. 
 Aims and Methods: The aim of this study was to create a list of actionable recommendations to improve care transitions for individuals with hip fracture from the perspectives of patients, caregivers, providers, and decision-makers. We used a mixed methods concept mapping approach, to gather perspectives from these key stakeholders in Ontario, Canada. Here, we report on the results of the first phase of the concept mapping study. Participants created a list of statements that they felt would improve care transitions for individuals who had experienced a hip fracture. The statements were analyzed inductively and grouped thematically. 
 Results: Thirty-two individuals participated in the brainstorming phase of this study (2 patients, 5 caregivers, 21 providers, 4 decision-makers). They created 887 statements that were condensed by the research team into 72 final statements. The final statements were grouped into seven main themes and were divided into four domains for care transition improvement. The first is the patient-related domain, which encompassed two themes: self-management and self-management-support, and rehabilitation therapy and activities. The second domain is provider-related and includes: healthcare provider skills and communication and trust. The third domain includes two system-related themes: continuity of care and health system efficiencies. The last domain relates to care processes with one theme: transition planning and follow up care. 
 Learnings for the international audience: Previous literature on improving care transitions has had focused primarily on the transfer of information between care providers with little emphasis on the caregiver/patient role. Our results, however, highlight the importance of meaningful patient and caregiver engagement, with active involvement in all aspects of care including the transition process. Further, many statements created by our participants included policies, assessments, and care specific to individuals with hip fracture and cognitive impairment/delirium, emphasizing this as an important area for consideration when aiming to improve care transitions. 
 Next Steps: The next phases of concept mapping will be conducted, which will include statement sorting and rating (importance and priority). A final concept mapping session will be held integrating the qualitative and quantitative data and an opportunity to reflect on the findings with key stakeholders. Statements that are rated highly importance and priority will inform actionable recommendations to improve care transitions for hip fracture.

RESPONDING TO THE HEALTH CARE ENVIRONMENT: DEVELOPMENT OF CBO NETWORKS TO ADDRESS SOCIAL DETERMINANTS OF HEALTH

Abstract AAAs, with their wide array of community partnerships and ability to respond to local needs and context, are an important connection between social and health care. Recent research describes the impact of AAA services and partnerships on population health, and AAAs are increasingly contracting with health care systems and payers to provide a variety of supportive services that enable older adults to live at home and in the community. To better meet the needs of health care partners, and to maximize their service reach and impact, AAAs and other community-based organizations (CBOs) are increasingly forming networks to contract with health care entities. Data from the 2021 CBO-Health Care Contracting Survey shows that 44 percent of AAAs are part of a network that provides contracted services to health care entities, but little is known about how these networks are formed and sustained. Findings from a new qualitative study on CBO networks, which consisted of 23 semi-structured interviews with network leads (also known as community hubs) and member organizations, describe how AAAs and other CBOs are developing networks and contracting with health care entities. This session will share findings from the qualitative study to describe the opportunities and ongoing challenges of network participation. Networks allow CBOs to serve more people and contract with health care partners to provide integrated care, but ongoing challenges include lack of data infrastructure and financial viability for members that may have fewer clients to serve. This session will also discuss the policy implications of these findings.

THE AGING NETWORK AS A CATALYST FOR COMMUNITY GERONTOLOGY AND APPLIED RESEARCH

Abstract The Older Americans Act (OAA) established Area Agencies on Aging (AAAs) fifty years ago as local community-based organizations responsible for planning, coordinating, funding, and delivering nutrition and other supportive services which allow older adults to remain living in their homes and communities. Local control and decision-making, mandated by the OAA, has allowed AAAs to adapt to the evolving needs and demands of their communities The centrality of their role was never more apparent than during the COVID-19 pandemic. As national and societal circumstances have resulted in increased social isolation, housing insecurity, and public health concerns for older adults, AAAs have adapted and expanded beyond traditional OAA services to address the social and health needs of an increasingly diverse older adult population. The Community Gerontology framework provides a useful structure to understand the evolution and impact of AAAs and the broader Aging Network on the health of older adults. Using data from the 2022 National Survey of AAAs and a new qualitative study on Community Care Hubs, academic and Aging Network-based researchers will illustrate the many partnerships and pathways of mutual influence between AAAs and the micro and macro levels to describe how Aging Network services are expanding provision of services for health care partners, public health initiatives, and new housing and homelessness services and partnerships to address emerging needs. The symposium will conclude with an illustration of how applied researchers and Aging Network organizations partnered on research-informed practice to innovate and strengthen services for at-risk older adults.

ON THE FRONTLINES: TRAINING A DEMENTIA CAREGIVING WORKFORCE IN CALIFORNIA

Abstract Direct care workers who provide in-home care – such as caregivers hired by consumers of California’s Medicaid-funded In-Home Supportive Services (IHSS) program – are well positioned to observe changes in their consumer’s cognition, health, or behaviors. This proximity to consumers better allows for reporting to healthcare partners, which may reduce risk of emergency department visits, hospitalizations, and other adverse outcomes that are disproportionately high among people living with Alzheimer’s disease and related dementias (ADRD). Despite their vital role in supporting people living with ADRD, IHSS caregivers receive minimal formal training for their unique position. To address this training gap, the IHSS+ ADRD Training Project is a five-year effort funded by the California Department of Public Health to train 720 IHSS caregivers in Alameda and Los Angeles counties, with classes in English, Spanish, Cantonese, and Mandarin. To date, 582 IHSS caregivers have been trained. Using a pre-posttest design, our preliminary findings indicate statistically significant increases in dementia knowledge and self-efficacy that could bolster caregiver’s skills. These results also reveal that IHSS caregivers value training opportunities to better support their consumers. Correlations between caregiver training outcomes and healthcare utilization patterns of their consumers were further examined by evaluating administrative data before and after the training. The results need to be further understood in the context of COVID-19 and the ADRD illness trajectory. Implications include expanding long-term funding for multi-week training programs, which aligns with the California Master Plan for Aging’s goal to support and create one million high-quality caregiving jobs by 2030.

Patient outcomes in longitudinal observational studies (POLOS) of rheumatoid arthritis: Determining the OMERACT core domain set

ObjectiveTo define and select rheumatoid arthritis (RA)-specific core domain set for Longitudinal Observational Studies (LOS) within the Outcome Measures in Rheumatology (OMERACT) framework. MethodsA three-round online Delphi exercise, including patient research partners (PRPs) and other community partners in healthcare, was conducted. Domains scored 7–9 (i.e., critically important to include) by ≥ 70 % of participants in both groups were included. Items were consolidated in a subsequent dedicated meeting. ResultsNineteen domains scored ≥ 70 % consensus in both groups. The focus group refined these into a list of twelve domains. ConclusionThe achieved consensus will inform the next steps of developing the core domain set for LOS in RA.

Evaluating the Feasibility of a Novel Firearm Injury Prevention Program for Pre-adolescent Children Through Health Care and Community-Based Partnerships: The Future Healers Program Pilot Study.

Firearm violence is an American public health crisis that negatively impacts children and disproportionately affects Black youth. Few firearm injury prevention programs have been described in pre-adolescent children. The Future Healers Program is a novel collaboration constructed via partnership between the medical school, trauma center, academic surgery department, and local non-profit community organization. Our study sought to evaluate if (1) partnering with community organizations facilitated recruitment of children with prior exposure to firearm violence and (2) the health care community was a potential trusted partner appropriate for program delivery. Children aged 4-13 were recruited to join the program via news outlets and social media and in partnership with a local non-profit organization. Of the children and parents participating in the program, 48% (44/92) and 59% (38/64), respectively, completed an IRB-approved survey study. Pearson's chi-square, percentages, and 95% confidence intervals evaluated differences between children and caregivers on sociodemographic characteristics, firearm exposure (FE), firearm violence exposure (FVE), and perception of health care. Participant's residence was geocoded in relationship to incidents of firearm injury (2008-2021) in the same region. Caregivers (95%) and children (84%) reported substantial exposure to firearm violence and resided in areas with frequent firearm injury incidents. Notably, 82% of caregivers and 66% of children reported having a family member injured by gunfire. A high percentage of caregivers (79%) and children (91%) self-reported trust in the health care system. Partnerships between community organizations and health care systems can develop prevention programs that effectively recruit and engage pre-adolescent children impacted by firearm violence.

Partnerships in health care: Delivering a just-in-time professional development intervention as an effective crisis response

Partnership between a government health department, a tertiary education provider and healthcare professionals is effective in providing professional development in response to a crisis in the form of just-in-time education. In 2020 and 2021, this type of partnership supported nurses and nurse educators in clinical settings when resources were stretched. The partnership fostered the provision of evidence-based practice. As a result of this partnership, nurse participants of a massive open online course demonstrated improved knowledge and confidence when caring for patients presenting with COVID-19.

Государственно-частное партнерство в системе здравоохранения Хабаровского края

Relevance The tasks set for the healthcare system require the attraction of significant resources, primarily financial ones. Public-private partnership (hereinafter referred to as PPP) can become an effective tool for solving some of the tasks set, attract investments and become a serious inductor in the implementation of infrastructure projects, the construction of modern medical organizations. Some forms of PPP may make it possible to raise additional funds for the provision of medical care and the expansion of paid medical services. All this requires a more detailed scientific study of the forms of interaction between PPPs in the healthcare sector. Purpose and objectives of the study The purpose of the study is to increase the effectiveness of interaction between the state and business in the health care of Khabarovsk Krai by developing a set of measures using public-private partnership tools. The objectives of the study included the study of publications and the legal framework, the structure of financing in the system of compulsory health insurance, the study of the level of awareness and willingness to involve healthcare organizers of medical organizations in Khabarovsk Krai in PPP processes, as well as the study of infrastructure facilities subordinate to the Ministry of Health of Khabarovsk Krai. Materials and methods The study used data from open sources, including regulatory legal acts, publications and articles on PPP issues, studied open data from the territorial fund of compulsory medical insurance of Khabarovsk Krai, data from the unified state register of real estate. Also, a survey of health care organizers was conducted using a questionnaire specially designed for the study. Results A classification of public-private partnerships in healthcare has been developed, and the main forms of interaction have been identified. It was determined that from 2020 to 2022, funding for non-state medical organizations increased by 15 %: from 1.001.741.1 thousand rubles to 1.151.886.0 thousand rubles. There is a predominance of funding, including in 2022, of organizations of the Russian Railways system (627.552.0 thousand rubles), as well as organizations providing hemodialysis services (195.913.0 thousand rubles) and radiation diagnostics (219. 265.0 thousand rubles) PPP forms are actively used to solve social problems under the “Older Generation” program, funding for ophthalmology has been significantly increased, the dynamics compared to 2020 is +1975 %. According to the results of a survey of healthcare organizers, 2/3 of the respondents see development prospects, 44 % consider outsourcing to be the most promising, 26 % – concession agreements, 92 % indicate an insufficient level of awareness on PPP issues, 90 % expressed their willingness to take part in educational events. In total, the subordinate organizations of the Ministry of Health of Khabarovsk Krai have 1.369 premises and buildings, 419 (30.1 %) of them are used to provide the main function of medical organizations, and 950 are auxiliary. 187 (44.6 %) out of 419 have over 80 % wear and tear, need either reconstruction, major repairs, or are subject to demolition and construction of new facilities. Conclusion The results of the study allow us to fix the main parameters of the healthcare industry, determine ways for further improvement, and develop a set of measures for the development of public-private partnerships in healthcare. It is necessary to conduct an in-depth scientific study of PPP with the involvement of economists, specialists in the field of state and municipal administration, healthcare organizers, undergraduates and graduate students. A comprehensive comprehensive study will significantly increase the effectiveness of measures to develop public-private partnerships in Khabarovsk Krai.