Search

BackgroundOlder adults with multimorbidity and complex care needs (CCN) are among those most likely to experience frequent care transitions between settings, particularly from hospital to home. Transition periods mark vulnerable moments in care for individuals with CCN. Poor communication and incomplete information transfer between clinicians and organizations involved in the transition from hospital to home can impede access to needed support and resources. Establishing digitally supported communication that enables person-centered care and supported self-management may offer significant advantages as we support older adults with CCN transitioning from hospital to home. ObjectiveThis protocol outlines the plan for the development, implementation, and evaluation of a Digital Bridge co-designed to support person-centered health care transitions for older adults with CCN. The Digital Bridge builds on the foundation of two validated technologies: Care Connector, designed to improve interprofessional communication in hospital, and the electronic Patient-Reported Outcomes (ePRO) tool, designed to support goal-oriented care planning and self-management in primary care settings. This project poses three overarching research questions that focus on adapting the technology to local contexts, evaluating the impact of the Digital Bridge in relation to the quadruple aim, and exploring the potential to scale and spread the technology. MethodsThe study includes two phases: workflow co-design (phase 1), followed by implementation and evaluation (phase 2). Phase 1 will include iterative co-design working groups with patients, caregivers, hospital providers, and primary care providers to develop a transition workflow that will leverage the use of Care Connector and ePRO to support communication through the transition process. Phase 2 will include implementation and evaluation of the Digital Bridge within two hospital systems in Ontario in acute and rehab settings (600 patients: 300 baseline and 300 implementation). The primary outcome measure for this study is the Care Transitions Measure–3 to assess transition quality. An embedded ethnography will be included to capture context and process data to inform the implementation assessment and development of a scale and spread strategy. An Integrated Knowledge Translation approach is taken to inform the study. An advisory group will be established to provide insight and feedback regarding the project design and implementation, leading the development of the project knowledge translation strategy and associated outputs. ResultsThis project is underway and expected to be complete by Spring 2024. ConclusionsGiven the real-world implementation of Digital Bridge, practice changes in the research sites and variable adherence to the implementation protocols are likely. Capturing and understanding these considerations through a mixed-methods approach will help identify the range of factors that may influence study results. Should a favorable evaluation suggest wide adoption of the proposed intervention, this project could lead to positive impact at patient, clinician, organizational, and health system levels. Trial RegistrationClinicalTrials.gov NCT04287192; https://clinicaltrials.gov/ct2/show/NCT04287192 International Registered Report Identifier (IRRID)PRR1-10.2196/20220

Restrictive measures imposed because of the coronavirus disease 2019 (COVID-19) pandemic have resulted in severe social, economic and health effects. Some countries have considered the use of immunity certification as a strategy to relax these measures for people who have recovered from the infection by issuing these individuals a document, commonly called an immunity passport. This document certifies them as having protective immunity against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the virus that causes COVID-19. The World Health Organization has advised against the implementation of immunity certification at present because of uncertainty about whether long-term immunity truly exists for those who have recovered from COVID-19 and concerns over the reliability of the proposed serological test method for determining immunity. Immunity certification can only be considered if scientific thresholds for assuring immunity are met, whether based on antibodies or other criteria. However, even if immunity certification became well supported by science, it has many ethical issues in terms of different restrictions on individual liberties and its implementation process. We examine the main considerations for the ethical acceptability of immunity certification to exempt individuals from restrictive measures during the COVID-19 pandemic. As well as needing to meet robust scientific criteria, the ethical acceptability of immunity certification depends on its uses and policy objectives and the measures in place to reduce potential harms, and prevent disproportionate burdens on non-certified individuals and violation of individual liberties and rights. [phrase omitted] Les restrictions imposees dans le cadre de la lutte contre la pandemie de maladie a coronavirus 2019 (COVID-19) ont eu de lourdes consequences economiques, sociales et sanitaires. Certains pays ont envisage la mise en place d'une strategie visant a alleger ces restrictions pour les individus gueris en leur octroyant un document communement appele <>. Ce document atteste qu'ils ont developpe une immunite protectrice contre le coronavirus 2 du syndrome respiratoire aigu severe (SARS-CoV-2), le virus a l'origine de la COVID-19. LOrganisation mondiale de la Sante a deconseille l'usage du certificat d'immunite pour l'instant, car l'incertitude demeure quant a l'existence reelle d'une immunite a long terme pour ceux qui se sont remis de la COVID-19. En outre, la fiabilite des tests serologiques censes determiner si l'individu est immunise n'est pas averee. Un tel certificat ne peut etre instaure que si les seuils scientifiques en matiere d'immunite sont respectes, qu'ils soient fondes sur les anticorps ou sur d'autres criteres. Neanmoins, meme si le certificat d'immunite est desormais bien accepte par la science, il s'accompagne de nombreuses questions d'ordre ethique en ce qui concerne la limitation des libertes individuelles et la mise en reuvre. Dans le present document, nous examinons les principales considerations a prendre en compte pour garantir l'acceptabilite ethique du certificat d'immunite visant a lever les mesures de restriction pour certaines personnes durant la pandemie de COVID-19. Cette acceptabilite ethique depend non seulement de son degre de conformite a des criteres scientifiques stricts, mais aussi de son usage, des objectifs politiques ainsi que des mesures mises en place pour attenuer les prejudices potentiels et eviter d'imposer une charge disproportionnee sur les individus depourvus de certificat, ou de bafouer les droits et libertes de tout un chacun. [phrase omitted] Las medidas restrictivas impuestas a causa de la pandemia de la enfermedad coronavirus de 2019 (COVID-19) han tenido graves efectos sociales, economicos y sanitarios. Algunos paises han considerado la posibilidad de utilizar la certificacion de inmunidad como estrategia para flexibilizar dichas medidas para las personas que se han recuperado de la infeccion mediante la expedicion a dichas personas de un documento, comunmente denominado pasaporte de inmunidad. Este documento certifica que han desarrollado inmunidad protectora contra el coronavirus-2 del sindrome respiratorio agudo severo (SARS-CoV-2), el virus que causa la COVID-19. La Organizacion Mundial de la Salud ha desaconsejado la aplicacion de la certificacion de la inmunidad en la actualidad debido a la incertidumbre sobre si existe realmente una inmunidad a largo plazo para quienes se han recuperado de la COVID-19 y a las preocupaciones sobre la fiabilidad del metodo de prueba serologica propuesto para determinar la inmunidad. La certificacion de la inmunidad solo puede considerarse si se cumplen los umbrales cientificos para asegurar la inmunidad, ya sea que se basen en anticuerpos o en otros criterios. Sin embargo, incluso si la certificacion de la inmunidad llegara a estar bien respaldada por la ciencia, tiene muchas cuestiones eticas en cuanto a las diferentes restricciones de las libertades individuales y su proceso de aplicacion. Examinamos las principales consideraciones sobre la aceptabilidad etica de la certificacion de la inmunidad para eximir a los individuos de las medidas restrictivas durante la pandemia de la COVID-19. Ademas de necesitar cumplir criterios cientificos solidos, la aceptabilidad etica de la certificacion de inmunidad depende de sus usos y objetivos de politica y de las medidas que se apliquen para reducir los posibles danos y evitar que se impongan cargas desproporcionadas a las personas que no cuenten con dicha certificacion y se violen las libertades y derechos individuales., Introduction Most countries have adopted restrictive public health measures to control the coronavirus disease 2019 (COVID-19) epidemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). These measures include physical distancing, [...]