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