From Knowledge to Action (K2A): Developing interventions to improve older adult care transitions between nursing homes and emergency wards (NH⇄EW)

Knowlegde to action (K2A) is financed by the Research Council of Norway (RCN), as a Collaborative and Knowledge-building Project. K2A proposes an international (Norway and Canada) multidisciplinary research in where the researchers cooperate with healthcare planners, providers and patients who have agreed to collaborate to improve older adult care transitions between nursing homes (NH) and emergency wards (EW). Our primary objective is to develop and field test best-practice and contextualized interventions to improve care transitions between Nursing Homes and Emergency Wards (NH<->EW) and to develop an evidence-based model to guide practices related to the care transfers. While these interventions apply directly to Norwegian residents, the knowledge gained will have significant international implications, stemming from our nuanced and context sensitive research approach.

Our team will employ a mixed-methods approach first to engage with various providers, planners and patients to understand the nature of problematic NHEW transitions from their various perspectives (WP1), second to quantify using registry data the various patterns and costs associated with transitional care (WP2), and using this collective knowledge, third to collaborate with stakeholders to plan and pilot test interventions that align with daily care

routines and hence have strong sustainment and scale potential (WP3). Researchers internationally state that about half of all NH<->EW transitions are potentially unwarranted and/or problematic, and place residents at increasing risk without significantly improving their clinical course. Strategies to improve these transitions are urgently needed for the most medically complex and frailest segment of our population, most of whom cannot advocate for themselves.

Creating and sustaining these strategies requires teams with the collective skills to develop, conduct and evaluate meaningful change solutions, in ways that facilitate their sustainment and scale.

The primary objective is to develop, implement and field test best-practice and contextualized interventions to improve older adult care transitions between Nursing Homes and Emergency Wards (NH<->EW).

The secondary objectives are:

1. To define problematic nursing home (NH) emergency ward (EW) transitions, to identify potential solutions, and to report on definitions of intervention success.

2. Define the ‘what’ (prevalence), ‘who’ (patient characteristics), ‘when’ (system factors) and ‘where’ (geography, time) of various NH<->EW transitions, and, to calculate the potential cost reductions associated with improving NH<->EW care.

3. Employ the WP 1 and 2 findings for developing and testing evidence-based and contextualized interventions.