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Background: Failure to sustain knowledge translation (KT) interventions impacts patients and health systems, diminishing confidence in future implementation. Sustaining KT interventions used to implement chronic disease management (CDM) interventions is of critical importance given the proportion of older adults with chronic diseases and their need for ongoing care. Our objectives are to (1) complete a systematic review and network meta-analysis of the effectiveness and cost-effectiveness of sustainability of KT interventions that target CDM for end-users including older patients, clinicians, public health officials, health services managers and policy-makers on health care outcomes beyond 1 year after implementation or the termination of initial project funding and (2) use the results of this review to complete an economic analysis of the interventions identified to be effective., Methods: For objective 1, comprehensive searches of relevant electronic databases (e.g. MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials), websites of health care provider organisations and funding agencies will be conducted. We will include randomised controlled trials (RCTs) examining the impact of a KT intervention targeting CDM in adults aged 65 years and older. To examine cost, economic studies (e.g. cost, cost-effectiveness analyses) will be included. Our primary outcome will be the sustainability of the delivery of the KT intervention beyond 1 year after implementation or termination of study funding. Secondary outcomes will include behaviour changes at the level of the patient (e.g. symptom management) and clinician (e.g. physician test ordering) and health system (e.g. cost, hospital admissions). Article screening, data abstraction and risk of bias assessment will be completed independently by two reviewers. Using established methods, if the assumption of transitivity is valid and the evidence forms a connected network, Bayesian random-effects pairwise and network meta-analysis will be conducted. For objective 2, we will build a decision analytic model comparing effective interventions to estimate an incremental cost-effectiveness ratio., Discussion: Our results will inform knowledge users (e.g. patients, clinicians, policy-makers) regarding the sustainability of KT interventions for CDM. Dissemination plan of our results will be tailored to end-users and include passive (e.g. publications, website posting) and interactive (e.g. knowledge exchange events with stakeholders) strategies., Systematic Review Registration: PROSPERO CRD42018084810.

Purpose: To evaluate the feasibility of an integrated cluster care and supportive housing model., Primary Practice Setting(s): Community shelters., Methodology and Sample: The Inner City Access Program (ICAP) is a new service delivery model employed by the Toronto Central Community Care Access Centre, which combines supportive housing services and health care for homeless, underhoused, and marginalized populations using the shelter system. We evaluated the effectiveness of the ICAP in facilitating access to health services, supporting goal-setting, and promoting interprofessional case management. Client interviews examined care goals, goal achievement, and satisfaction; staff interviews determined client-centeredness of staff-identified care goals/planning; document reviews were conducted to obtain service utilization and process data., Results: Twenty clients received service during a 15-month period before implementation. This increased to 147 clients during a 16-month period post-implementation at a 60% reduction in cost/client. Results indicated that regular interdisciplinary team meetings promoted greater service delivery efficiency; greater client satisfaction was associated with goal achievement (p < .01); and a trend toward greater perceived goal achievement (as reported separately by clients and staff) and client satisfaction when staff- and client-stated goals were more closely aligned., Implications for Case Management Practice: The ICAP proved an efficient and cost-effective model in engaging marginalized populations. There was a trend toward greater client satisfaction when clients perceived success related to "education, employment, activities, and programs" goals.