Few studies have examined the safety risks of the annual outpatient clinic handoffthat occurs when residents either advance to a higher level of training or graduate ("year-end transfer"). A ...multifaceted intervention was designed and implemented to identify and improve followup of high-risk patients during academic year-end outpatient transfers in a psychiatry resident continuity clinic.
Departing residents identified "acute" patients, who were scheduled on a priority basis for longer appointments during the first month after the transfer. In addition, standardized written and face-to-face sign-outs occurred, incoming clinicians contacted every patient in the first week, and specialized didactics were provided.
For the three intervention years combined, the odds ratio of hospitalization for acute patients compared to nonacute patients was 9.2 (95% confidence interval CI: 2.43, 34.7; p = .001). Compared to Year 1, the proportion of acute patients seen within 31 days in Years 2 and 3 increased by 32.2% (from 64.3% to 85.0%, p < .0001). The median time-to-first visit for acute patients decreased by 42% (from 24 days in Year 1 to 14 days in Year 3, p = .001). Finally, resident perception of the quality of the handoffim-proved in all areas compared to baseline, including resident-to-resident communication (2.8 to 3.0, p = .03), accuracy of caseload lists (2.8 to 4.1,p = .003), identification of high-risk patients (2.1 to 3.7, p < .0001), and usefulness of supervision during the transition (2.7 to 4.3, p < .0001).
Categorical designation by the outgoing clinicians effectively identified patients at higher risk for hospitalization during the transition. Relatively low-cost interventions may significantly improve patient safety and resident training in not only psychiatry, but also other disciplines and specialties.
With increasing cancer survivorship has come an increased necessity to support people living with cancer (PLWC) to have a good quality of life including being physically active. Using mixed methods, ...the current study aimed to use the RE-AIM evaluation framework (Reach, Effectiveness, Adoption, Implementation and Maintenance) to determine how the football community trust delivered CARE (Cancer and Rehabilitation Exercise) intervention was able to increase participants' physical activity in order to improve their quality of life and regain physiological and psychological function. Quantitative outcome data were collected at baseline, 3 and 6 months using the Cancer Physical Activity Standard Evaluation Framework questionnaire. Semi-structured focus groups (
= 5) captured participants' (
= 40) lived experience of the reach, effectiveness, adoption, implementation, and maintenance of CARE. Questionnaire data were analysed using repeated measures ANOVAs and qualitative data were thematically analysed. Following diagnosis, CARE was successful in providing participants with a unique and accessible opportunity to become or restart physically activity, by providing a local, socially supportive, and inclusive environment. This resulted in significant increases in physical activity (
= 5.98,
= 0.009), quality of life (QoL) (
= 13.12,
= 0.000) and significant reductions in fatigue (
= 11.19,
= 0.000) over 6 months. Participants also reported becoming more active, recovering physical function, regaining independence, and enhanced psychological well-being as a result of attending CARE. Key design features of CARE were also identified across RE-AIM. CARE, a football community trust delivered physical activity intervention was successful in significantly improving participants' QoL and in regaining the physical and psychological functioning of people living with cancer. Results suggest that maintaining engagement in CARE for 6 months and beyond can support people to maintain these changes. Engaging in robust evaluations such as this can help organizations to successfully secure future funding for their programs.
It is well documented that Canadian healthcare does not fully meet the health needs of First Nations, Inuit or Métis peoples. In 1996, the Royal Commission on Aboriginal Peoples concluded that ...Indigenous peoples' healthcare needs had to be met by strategies and systems that emerged from Indigenous worldviews and cultures. In 2015, the Truth and Reconciliation Commission also called on health organizations to learn from Indigenous "knowledges" and integrate Indigenous worldviews alongside biomedicine and other western ways of knowing. These calls have not yet been met. Meanwhile, the dynamic of organizational learning from knowledges and evidence within communities is poorly understood--particularly when learning is from communities whose ways of knowing differ from those of the organization. Through an exploration of organizational and health system learning, this study will explore how organizations learn from the Indigenous communities they serve and contribute to (re-)conceptualizing the learning organization and learning health system in a way that privileges Indigenous knowledges and ways of knowing. This study will employ a two-eyed seeing literature review and embedded multiple case study. The review, based on Indigenous and western approaches to reviewing and synthesizing knowledges, will inform understanding of health system learning from different ways of knowing. The multiple case study will examine learning by three distinct government organizations in Northwest Territories, a jurisdiction in northern Canada, that have roles to support community health and wellness: TÅįchÇ« Government, Gwich'in Tribal Council, and Government of Northwest Territories. Case study data will be collected via interviews, talking circles, and document analysis. A steering group, comprising TÅįchÇ« and Gwich'in Elders and representatives from each of the three partner organizations, will guide all aspects of the project. Examining systems that create health disparities is an imperative for Canadian healthcare. In response, this study will help to identify and understand ways for organizations to learn from and respectfully apply knowledges and evidence held within Indigenous communities so that their health and wellness are supported. In this way, this study will help to guide health organizations in the listening and learning that is required to contribute to reconciliation in healthcare.
IntroductionIntegrated community healthcare Hubs may offer a ‘one stop shop’ for service users with complex health and social needs, and more efficiently use service resources. Various policy ...imperatives exist to implement Hub models of care, however, there is a dearth of research specifically evaluating Hubs targeted at families experiencing adversity. To contribute to building this evidence, we propose to co-design, test and evaluate integrated Hub models of care in two Australian community health services in low socioeconomic areas that serve families experiencing adversity: Wyndham Vale in Victoria and Marrickville in New South Wales.Methods and analysisThis multisite convergent mixed-methods study will run over three phases to (1) develop the initial Hub programme theory through formative research; (2) test and, then, (3) refine the Hub theory using empirical data. Phase 1 involves co-design of each Hub with caregivers, community members and practitioners. Phase 2 uses caregiver and Hub practitioner surveys at baseline, and 6 and 12 months after Hub implementation, and in-depth interviews at 12 months. Two stakeholder groups will be recruited: caregivers (n=100–200 per site) and Hub practitioners (n=20–30 per site). The intervention is a co-located Hub providing health, social, legal and community services with no comparator. The primary outcomes are caregiver-reported: (i) identification of, (ii) interventions received and/or (iii) referrals received for adversity from Hub practitioners. The study also assesses child, caregiver, practitioner and system outcomes including mental health, parenting, quality of life, care experience and service linkages. Primary and secondary outcomes will be assessed by examining change in proportions/means from baseline to 6 months, from 6 to 12 months and from baseline to 12 months. Service linkages will be analysed using social network analysis. Costs of Hub implementation and a health economics analysis of unmet need will be conducted. Thematic analysis will be employed to analyse qualitative data.Ethics and disseminationRoyal Children’s Hospital and Sydney Local Health District ethics committees have approved the study (HREC/62866/RCHM-2020). Participants and stakeholders will receive results through meetings, presentations and publications.Trial registration numberISRCTN55495932.
This study investigated the physical activity experiences of people living with and beyond cancer (PLWBC) during the COVID-19 pandemic. Participants attended the cancer and rehabilitation exercise ...(CARE) programme delivered by a football community trust. Staff (
= 2) and participants (
= 9) attended semi-structured interviews investigating the PA participation and experiences of attending/delivering different modes of CARE, including exercise classes delivered outdoors and delivered online. Interviews also investigated participant aspirations for returning to CARE sessions delivered in person indoors. The findings show that the COVID-19 pandemic and government restrictions impacted on PA participation, yet exercise sessions provided via CARE offered participants an important opportunity to arrest their inactivity, keep active and maintain their fitness and functionality. Barriers to participation of CARE online included access to IT infrastructure, internet connectivity and IT skills and comfort using IT. Regarding CARE outdoors, the weather, range of equipment, variety of exercises and the lack of toilets and seats were barriers. In the different CARE modes, the skills of delivery staff who were sensitive to the needs of participants, social support, and the need for participants to maintain good mental and social health were important facilitators for engagement and are considerations for programme delivery. CARE helped PLWBC to keep physically active.
Older adults (OA) represent a core priority group for physical activity and Public Health policy. As a result, significant interest is placed on how to optimise adherence to interventions promoting ...these approaches. Extra Time (ET) is an example of a national programme of physical activity interventions delivered in professional football clubs for OA aged 55+ years. This paper aims to examine the outcomes from ET, and unpick the processes by which these outcomes were achieved.
This paper represents a secondary analysis of data collected during the evaluation of ET. From the 985 OA reached by ET, n=486 adopted the programme and completed post-intervention surveys (typically 12 weeks). We also draw on interview data with 18 ET participants, and 7 staff who delivered the programme. Data were subject to thematic analysis to generate overarching and sub themes.
Of the 486 participants, the majority 95%, (n= 462) were White British and 59.7% (n=290) were female. Most adopters (65.4%/n=318) had not participated in previous interventions in the host clubs. Social interaction was the most frequently reported benefit of participation (77.2%, n=375). While the reach of the club badge was important in letting people know about the programme, further work enhanced adoption and satisfaction. These factors included (i) listening to participants, (ii) delivering a flexible age-appropriate programme of diverse physical and social activities, (iii) offering activities which satisfy energy drives and needs for learning and (iv) extensive opportunities for social engagement.
Findings emerging from this study indicate that physical activity and health interventions delivered through professional football clubs can be effective for engaging OA.
Increasingly the health impacts of physical inactivity are being distinguished from those of sedentary behavior. Nevertheless, deleterious health prognoses occur when these behaviors combine, making ...it a Public Health priority to establish the numbers and salient identifying factors of people who live with this injurious combination.
Using an observational between-subjects design, a nonprobability sample of 22,836 participants provided data on total daily activity. A 2-step hierarchical cluster analysis identified the optimal number of clusters and the subset of distinguishing variables. Univariate analyses assessed significant cluster differences.
High levels of sitting clustered with low physical activity. The Ambulatory & Active cluster (n = 6254) sat for 2.5 to 5 h·d(-1) and were highly active. They were significantly younger, included a greater proportion of males and reported low Indices of Multiple Deprivation compared with other clusters. Conversely, the Sedentary & Low Active cluster (n = 6286) achieved ≤60 MET·min·wk(-1) of physical activity and sat for ≥8 h·d(-1). They were the oldest cluster, housed the largest proportion of females and reported moderate Indices of Multiple Deprivation.
Public Health systems may benefit from developing policy and interventions that do more to limit sedentary behavior and encourage light intensity activity in its place.
The purpose of this study was to examine whether an innovative, inclusive and integrated 12-week exercise, behaviour change and nutrition advice-based weight management programme could significantly ...improve the cardiovascular risk factors of overweight and obese men and women over the age of 35. One hundred and ninety-four men and 98 women (mean age = 52.28 ± 9.74 and 51.19 ± 9.04) attending a community-based intervention delivered by Notts County Football in the Community over one year, took part in the study. Height (m), weight (kg), fitness (meters covered during a 6 min walk) and waist circumference (cm) were measured at weeks 1 and 12 as part of the intervention. Changes in body weight, waist circumference and fitness for men and women were measured by a 2-way repeated measures ANOVA, with significance set to p < 0.05.Weight, waist circumference and fitness significantly improved over time in both men (4.96 kg, 6.29 cm, 70.22 m; p < 0.05) and women (4.26 kg, 5.90 cm, 35.29 m; p < 0.05). The results demonstrated that the FITC lead weight loss intervention was successful in significantly improving cardiovascular risk factors in both men and women. In particular, the weight loss reductions achieved were comparable to those seen in similar, more costly men-only programmes. This is the first study to demonstrate the efficacy of such an intervention in an inclusive, mixed gender programme and more specifically, in women.
It has been suggested that football and communities are inextricably linked. Healthy lifestyles are an important component in maintaining the sustainability of local communities, not least, because a ...convincing evidence base supports the holistic benefits that can be derived from health-enhancing behaviours, such as regular physical activity. As such, efforts to promote health improvement through sport and physical activity include those interventions delivered in professional sporting settings. Johnman and colleagues (Johnman and Mackie, 'The Beautiful Game') have heralded sports clubs as important venues for the delivery of health improvement interventions for a range of groups across local communities. This includes health improvement activities delivered in professional football club community schemes. While exemplary practice shows how health improvement programmes can be implemented and evaluated, our experience and engagement with professional football club community schemes supports the notion that more needs to be undertaken to help clubs develop monitoring and evaluation strategies in order to assess the impact of their health improvement programmes. In our short communication, we share our plans for helping two professional football clubs develop their monitoring and evaluation strategies for their community health promotion programmes. Potential outcomes emerging from this process are twofold. (1) To help club community schemes in-build and sustain monitoring and evaluation practices within their future health improvement provision. (2) To use the impact and process outcomes emerging from programme evaluations, to successfully secure the necessary resources to sustain future health improvement activities for their local communities. Outcomes emerging from this study will be of interest to football clubs and evaluators alike, as they seek to develop evaluation strategies for their health improvement programmes.
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