Using Research to Improve Outcomes and Efficiencies

Transcription

1 Using Research to Improve Outcomes and Efficiencies Raquel Betini PhD(c) interrai Canada School of Public Health and Health Systems University of Waterloo Leslie Eckel PhD(c), R.S.W. Knowledge Exchange Associate interrai Canada School of Public Health and Health Systems University of Waterloo

2 Outline Background Caregiver distress - Overview Caregiver Recharge Respite program Caregiver Recharge evaluation study interrai Caregiver Screener (pilot) Method Results Not to be reprinted withot expressed permission of interrai Canada

3 3 Caregiver Distress: Overview

4 Source: Health Council of Canada, 2012

5 Source: Health Council of Canada, 2012

6 Source: Health Council of Canada, 2012

7 Source: Health Council of Canada, 2012

8 An initiative of Mississauga Halton Local Health Integration Network The CR has provided flexible hours of respite to more than 2000 informal caregivers since 2013 to improve their quality of life and avoid care recipient institutionalization Eligibility criteria: Caregiver caring for care recipient with MAPLe 4 or 5, or receiving palliative care AND Caregiver Strain Index (9 to 13) past criteria interrai Caregiver Screener current criteria

9 Caregiver Recharge Evaluation Study: A Collaboration between interrai Canada, UW and MH LHIN Not to be reprinted without expressed permission of interrai Canada

10 Caregiver Recharge evaluation study Care recipient assessments interrai CHA, RAI-HC interrai CHA, RAI-HC Discharge Summary Reports T1: Program entry T2: 6 month after entry T3: Discharge CSI and interrai Caregiver interrai Caregiver Survey Survey Caregiver assessments Not to be reprinted without expressed permission of interrai Canada

11 interrai Caregiver Screener (pilot) Why an informal caregiver screener? to identify informal caregivers at high risk of adverse outcomes Highlights of the Screener: Based on data from the CR evaluation study Sensitivity to changes Derived from a caregiver survey with 82 items within 5 domains Validation using various methods: criterion and convergent validity, survey construct evaluation

12 Significant Caregiver Items The following self-reported items representing psychological distress were identified: In the last three days, how often have you felt little interest or pleasure in the things you normally enjoy? In the last three days, how often have you been anxious, restless, or uneasy? In the last three days, how often have you been sad, depressed, or hopeless? In the last three days, how often have you felt overwhelmed by your relative/friend s illness? Not to be reprinted without expressed permission of interrai Canada

13 Response set In the last three days, how often have you been Not in the last 3 days Not in the last 3 days, but often feel that way 1 or 2 days in the last 3 days Daily in the last 3 days Not to be reprinted without expressed permission of interrai Canada

14 Risk Levels After a series of analysis, the screener scores were split into 3 groups 1) Low risk (score of 0 on Caregiver Screener) 2) Moderate risk (score of 1-4 on Caregiver Screener ) 3) High risk (score of 5-8 on Caregiver Screener) Statistical analysis were performed to evaluate the association between caregiver risk levels and caregiver characteristics

15 Results

16 % with diagnosis Diagnoses among CR program clients (care recipients) Dementia other than Alzheimer's disease Alzheimer's disease Cancer Not to be reprinted without expressed permission of interrai Canada

17 Who Are the Caregivers? Age, gender and language % Relationship with care recipient % < and < 70 > 70 age group Female English - first language < and < 70 > 70 Spouse Child Other

18 Caregiver Characteristics by Caregiver Risk of Adverse Outcomes (n=328)

19 Caregivers at Higher Risk compared to the Lowest Risk of Adverse Outcomes are 2.5x more likely to visit the doctor or nurse practitioner 4x more likely to report poor or fair health

20 Caregivers at Higher Risk compared to the Lowest Risk of Adverse Outcomes are 2.9x more likely to report that they believe that the person they are helping would be better off elsewhere 8.8 x more likely to report that on the whole my life is rarely/never/sometimes good

21 Indicators of Psychological Health 60 Low risk Moderate risk High risk 50 P< % Depression In the last 3 days, have you been easily distracted, had trouble paying attention or becoming sidetracked?

22 Pain: severity and frequency Low risk Moderate risk High risk 50 P < % Severe/Horrible/Excrutiating Every day in the last 3 days Not to be reprinted without expressed permission of interrai Canada

23 Caregiver is unable to Low risk Moderate risk 40 *P<0.05 **P< % Increase emotional support* Continue at least one day in the last 3 days** RAI HC, n= 129 Caregiver survey, n= 325

24 Poverty indicator P<0.001 % Low risk Moderate risk High risk *In the last 30 days, have you made trade-offs among purchasing: adequate food or shelter, clothing or prescribed medications, sufficient home heat or cooling, necessary health care or home care due to limited funds? Not to be reprinted without expressed permission of interrai Canada

25 Quality of Life Caregiver reported that always, or most of the time Low risk Moderate risk High risk P< % On the whole, my life is good I am hopeful about my future

26 Conclusions The caregiver screener identifies caregivers at higher risk of adverse outcomes This short screener may potentially be used to identify caregivers that have higher needs of respite and could benefit from further assessment Not to be reprinted without expressed permission of interrai Canada

27 Next steps Research paper Evaluate results of pilot implementations of the interrai Caregiver Screener: Caregiver Recharge Services HNHB CCAC pilot implementation Future implementations

28 Acknowledgements Not to be reprinted without expressed permission of interrai Canada

29 Thank you! Questions? Raquel Betini: Not to be reprinted without expressed permission of interrai Canada