bridging the gap between health promotion theory and care for chronic illness empowering for health...

Bridging the Gap between Health Promotion Theory and Care for Chronic Illness

Empowering for Health Care

Management at Home

C. L. McWilliam, MScN, EdD

The University of Western Ontario, London, Ontario, CANADA

E. Vingilis, M. Stewart, E. Vingilis, C. Ward-Griffin, J Hoch, A. Donner, UWO

G. Browne, McMaster University

P. Coyte, University of Toronto

S. Golding (PRESENTER), S. Coleman, M. Wilson, et al., CCACs of Ontario, CANADA

FUNDED BY:

The Canadian Institutes of Health Research

Purpose:

To evaluate the Costs & Outcomes

of an Empowering Partnering Approach to Chronic

Care Management at Home

(2000-2004)

Bridging the Gap between Health Promotion Theory and Care for Chronic Illness

EVIDENCE-BASED EVOLUTION OF EMPOWERING PARTNERING

RCT of “health promotion” visits achieved:

greater independence (p=.008; p=007)

greater perceived ability to manage own health (p=.014)

less desire for information (p=.021; p=.035)

greater quality of life (p=.006)

8.2 fewer days in hospital; less in-home service

PHENOMENOLOGICAL STUDYFINDINGS

The Empowering Partnering Process

Relationship-building +

Conscious Awareness

THE EMPOWERING PARTNERINGPROCESS

Building Trust & Meaning

Connecting

Caring

Mutual Knowing

Mutual Creating

Empowering Partnering:

Client-centered

Empowering of all involved, beginning with the client

Relationship-building process

Health-oriented

Strengths-based focus

Bridging the Gap between Health Promotion Theory and Care for Chronic Illness

EMPOWERMENT:equitable balance of

knowledge status authority

in the care relationship (Clark, 1989)

HEALTH:the ability to realize aspirations, satisfy needs, & respond positively to the environment; a resource for everyday living (WHO, 1986)

Bridging the Gap between Health Promotion Theory and Care for Chronic Illness

individual level: clients as care partners client choice of involvement in care mgt.

client and provider empowerment

organizational level: staff education changed care procedures empowering policies empowering language

interorganizational level: shared philosophy shared educational programming shared C.Q.I. strategy collaborative research

Bridging the Gap between Health Promotion Theory and Care for Chronic Illness

Quasi-Experimental Evaluation Research:

intervention and comparator

home care programs12-month baseline (2000-01)12-month follow-up (2002-03)

Bridging the Gap between Health Promotion Theory and Care for Chronic Illness

SAMPLE: Baseline Follow-up

N (PARTICIPATION RATE) N (PARTICIPATION RATE)

Computer Database 7200 (100%) 7200 (100%)

Clients 974 (58%) 809 (31%)

Caregivers 249 (62%) 303 (49%)

Providers 291 (59%) 288 (36%)

Bridging the Gap between Health Promotion Theory and Care for Chronic Illness

Age: 72 yrs

Gender: female 70% Education: </= secondary 75%

Income: </= $20,000 65% # Chronic Problems: 2.4

Informal Caregiver: 71%

Client Demographics:

Age: 42.5yrs

Role: case mgr 12% nurse 34% therapist 11% PSW 43% Status full time 43% part time 57%

Experience 10 yrs Qualifications </=diploma 72%

Provider Demographics

Age: 60 yrs

Gender: female 69%

Marital Status married 82%

Education post secondary 50%

Caregiver Demographics

VARIABLE: CORRELATION (Pearson’s r)

Clients’

Health Status .38

Quality of Life .59 Satisfaction with Care .16

Providers’

Job Satisfaction .39Perceived Effectiveness .36

Outcome Measures Correlated with Empowering Partnering

Government Service Cuts

Shift to Centralized Government Control

Policy & Procedure for Standardized Assessment

Mediating Variables

N (%)

Providers Trained 349 (30%)

Trained Staff Attrition 32 (2.3%)

Clients Engaged 2689 (44%)

The Progress in Implementing Intervention

Health Care Costs: No Difference

Satisfaction with Care: No Difference Positive Trend better in (I)

Health-promoting effort: No Difference

Partnering in Decision-making: No Difference Improved in both (I) and (C)

Client Outcomes: Intervention (I) vs Comparator (C)

Organization

Job Satisfaction: Almost Significant (p=.06) No Change in (I); Dropped in (C)

Job Motivation: No Difference No Change in (I); Dropped in (C)

Job characteristics: Almost Significant (p=.07) Positive Trend in (I) over time

Empowerment: No Difference Health-promoting effort: No Difference

Provider Outcomes: Intervention (I) vs Comparator (C)

Organization

Caregiver Outcomes

35.1

31.532.2

33.8

29

30

31

32

33

34

35

36

PRE POST

Mea

n C

are

Bur

den

Sco

re

Intervention Comparator

Mean Total Monthly Services Utilization Costs Over Time

Intervention vs. Comparator

Intervention Services Utilization Costs by Service Category

Conclusions:

Change takes time

The policy context may impede the intervention

Program outcomes affected by many factors

KT requires grassroots perspective transformation

Further research is needed

Bridging the Gap between Health Promotion Theory and Care for Chronic Illness