COMMUNITY CARE, DIGITAL HEALTH, ESHIFT, OLDER ADULTS
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Research Summary

Research Topic:

In response to the needs of older adults at the end-of-life and challenges in recruitment and retention of healthcare providers in home care in the South West Community CareAccess Centre, a new and innovative model of home care, eShift, has been developed. eShift connects unregulated care providers (technicians) providing home care to a remotely-situated Directing Registered Nurse (DRN),through a smart phone application using real-time communication and documentation technology. The DRN monitors and directs appropriate, safe, and effective care provided in collaboration with the technician in real-time,enhancing quality of care delivery for older adults and their family caregivers.

Findings:

  • Deceased patients were 52% male and 48% female patients; the average age of all patients was 79 years (range 77-83 years of age); with most patients living in an urban location. 
  • Patients’ primary caregivers were mostly their spouse/partner followed by adult children; approximately 1/3 of patients did not have a primary caregiver in the home. 
  • All of the patients who chose home or hospice but died in hospital were hospitalized at least once in their last month of life whereas about 1/3 of patients who died in their place of choice were hospitalized in their last month of life. 
  • There was a significant difference between the two groups with respect to the presence of shortness of breath (SOB). A greater percentage of patients who died in hospital but indicated a preference to die at home or in hospice experienced SOB compared to patients who died in their place of choice.
  • Reasons for patient hospitalization in the last 30 days of life were significantly different among the two cohorts: Over-extended and overwhelmed caregivers and/or aspects of the patient’s medical condition contributed to hospitalizations among patients who chose home or hospice but died in hospital whereas medical aspects of patients’ condition were more prevalent in contributing to hospitalizations among patients who died in their place of choice. 
  • Evidence of caregiver education pertaining to the end of life and signs and symptoms of imminent death, were statistically significant between the two groups: a greater percentage of caregivers of patients who died in their place of choice were reported as receiving end of life education. This finding reinforces the opportunity for enhanced provider in-service on clear, concise communication and the importance of ongoing caregiver education pertaining to symptom control and end of life care.

This project is supported by a team of researchers & led by co-principal investigators: 

Lorie Donelle, RN, PhD, Associate Professor, Arthur Labatt Family School of Nursing and School of Health Studies, Western University. ldonelle@uwo.ca 

Sandra Regan, RN, PhD, Associate Professor, Arthur Labatt Family School of Nursing, Western University. sregan4@uwo.ca e

Suggested Citation:

Donelle, L., Regan, S. (2017, May). E-shift, an innovative home care model: Chart review of eshift patients. Arthur Labatt Family School of Nursing.

Team/Advisors

Lorie Donelle

Dr. Lorie Donelle

Associate professor and research chair, Arthur Labatt Family School of Nursing, Western University
Lorie Donelle was inspired to launch Health in All Data from her research across health literacy, equity, and digital health.
She is an Associate Professor at Western University in the Arthur Labatt Family School of Nursing and a Scientist with the Lawson Health Research Institute in London Ontario and is an inaugural member of Fellows of the Canadian Academy of Nursing (FCAN). She holds an endowed research chair – the Arthur Labatt Family Chair in Nursing focused on digital health.  Dr. Donelle’s research addresses health promotion specific to issues of health & digital health literacy(s), social justice, and digital health.  Her research investigates technology-enabled models of healthcare and the relationships between health information technologies and client/clinician health practices. Dr. Donelle contributes to International and national advisory committees for health literacy and digital health. 
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Dr. Sandra Regan, RN

Deputy Registrar and Executive Director of Education, Policy, and Practice, British Columbia College of Nurses and Midwives
Sandra is the Deputy Registrar and Executive Director of Education, Policy, and Practice at the British Columbia College of Nurses and Midwives.
Sandra’s work focuses on education program review, practice support and consultation, health policy, and research.