Patient-Centred Innovations for Persons With Multimorbidity - Quebec

The aim of Patient-Centred Innovations for Persons With Multimorbidity (PACE in MM) study is to reorient the health care system from a single disease focus to a multimorbidity focus; centre on not only disease but also the patient in context; and realign the health care system from separate silos to coordinated collaborations in care. PACE in MM will propose multifaceted innovations in Chronic Disease Prevention and Management (CDPM) that will be grounded in current realities (i.e. Chronic Care Models including Self-Management Programs), that are linked to Primary Care (PC) reform efforts. The study will build on this firm foundation, will design and test promising innovations and will achieve transformation by creating structures to sustain relationships among researchers, decision-makers, practitioners, and patients. The Team will conduct inter-jurisdictional comparisons and is mainly a Quebec (QC) - Ontario (ON) collaboration with participation from 3 other provinces: British Columbia (BC); Manitoba (MB); and Nova Scotia (NS). The Team's objectives are: 1) to identify factors responsible for success or failure of current CDPM programs linked to the PC reform, by conducting a realist synthesis of their quantitative and qualitative evaluations; 2) to transform consenting CDPM programs identified in Objective 1, by aligning them to promising interventions on patient-centred care for multimorbidity patients, and to test these new innovations' in at least two jurisdictions and compare among jurisdictions; and 3) to foster the scaling-up of innovations informed by Objective 1 and tested/proven in Objective 2, and to conduct research on different approaches to scaling-up. This registration for Clinical Trials only pertains to Objective 2 of the study.

Sex

All

Minimum age

18 Years

Maximum age

80 Years

PATIENTS (Studies 2.1 \& 2.2):

Inclusion Criteria:

* 3+ Chronic Conditions
* 18 to 80 years of age
* Eligible for DIMAC02 intervention

Exclusion Criteria:

* Unable to reasonably respond to questionnaires or provide informed consent (ie. cognitive impairment or language barrier)
* Deemed by provider to be too fragile

CAREGIVERS (Study 2.1):

* Close family member (wife/husband, parent, son/daughter, brother/sister) and/or caregiver to a patient that has received DIMAC02 intervention (first component)
* Sharing time with the patient (before, during and after the intervention)
* French speaking

DECISION-MAKERS (Study 2.1):

* FMG Physician-Manager, FMG Coordinators, Decision-Makers/Managers
* Involved/Familiar with DIMAC02 program

DIMAC02 INTERDISCIPLINARY team (Study 2.1):

* Nurse, Nutritionist, Kinesiologist, Social Worker, Psychologist
* Has delivered DIMAC02 intervention to at least one patient

REFERRAL PROFESSIONALS (Study 2.1):

\- Family physician or nurse/nurse practitioner

• BACKGROUNDBest A, Greenhalgh T, Lewis S, Saul JE, Carroll S, Bitz J. Large-system transformation in health care: a realist review. Milbank Q. 2012 Sep;90(3):421-56. doi: 10.1111/j.1468-0009.2012.00670.x. PMID 22985277
• BACKGROUNDPawson R, Tilley N. Realistic evaluation. London: Sage, 1997
• BACKGROUNDPatton MQ. Qualitative research & evaluation. 3rd ed. Thousand Oaks, CA: Sage Publication. 2002
• BACKGROUNDCrabtree BF, Miller WL. Doing Qualitative Research. Thousand Oaks, CA: Sage Publications Inc. 1999.
• BACKGROUNDMoher D, Hopewell S, Schulz KF, Montori V, Gotzsche PC, Devereaux PJ, Elbourne D, Egger M, Altman DG; Consolidated Standards of Reporting Trials Group. CONSORT 2010 Explanation and Elaboration: Updated guidelines for reporting parallel group randomised trials. J Clin Epidemiol. 2010 Aug;63(8):e1-37. doi: 10.1016/j.jclinepi.2010.03.004. Epub 2010 Mar 25. PMID 20346624
• BACKGROUNDPoitras ME, Fortin M, Hudon C, Haggerty J, Almirall J. Validation of the disease burden morbidity assessment by self-report in a French-speaking population. BMC Health Serv Res. 2012 Feb 14;12:35. doi: 10.1186/1472-6963-12-35. PMID 22333434
• BACKGROUNDStewart M, Brown JB, Donner A, McWhinney IR, Oates J, Weston WW, Jordan J. The impact of patient-centered care on outcomes. J Fam Pract. 2000 Sep;49(9):796-804. PMID 11032203
• BACKGROUNDStewart M, Brown JB, Hammerton J, Donner A, Gavin A, Holliday RL, Whelan T, Leslie K, Cohen I, Weston W, Freeman T. Improving communication between doctors and breast cancer patients. Ann Fam Med. 2007 Sep-Oct;5(5):387-94. doi: 10.1370/afm.721. PMID 17893379
• BACKGROUNDStewart M, et al., The patient perception of patient-centeredness questionnaire (PPPC). Working Paper Series #04-1, April 2004.