Learning Wisdom
Learning Integrated Health System to Mobilize Context-Adapted Knowledge With a Wiki Platform to Improve the Transitions of Frail Seniors From Hospitals and Emergency Departments to the Community
Background: Elderly patients discharged from hospital experience fragmented care, repeated and lengthy emergency department (ED) visits, relapse into their earlier condition, and rapid cognitive and functional decline. The Acute Care for Elders (ACE) program at Mount Sinai Hospital in Toronto, Canada uses innovative strategies, such as transition coaches, to improve the care transition experiences of frail elderly patients. The ACE program reduced the lengths of hospital stay and readmission for elderly patients, increased patient satisfaction, and saved the health care system over Can $4.2 million (US $2.6 million) in 2014. In 2016, a context-adapted ACE program was implemented at one hospital in the Centre intégré de santé et de services sociaux de Chaudière-Appalaches (CISSS-CA) with a focus on improving transitions between hospitals and the community. The quality improvement project used an intervention strategy based on iterative user-centered design prototyping and a “Wiki-suite” (free web-based database containing evidence-based knowledge tools) to engage multiple stakeholders.
Objective: The objectives of this study are to (1) implement a context-adapted CISSS-CA ACE program in four hospitals in the CISSS-CA and measure its impact on patient-, caregiver-, clinical-, and hospital-level outcomes; (2) identify underlying mechanisms by which our context-adapted CISSS-CA ACE program improves care transitions for the elderly; and (3) identify underlying mechanisms by which the Wiki-suite contributes to context-adaptation and local uptake of knowledge tools.
Methods: Objective 1 will involve staggered implementation of the context-adapted CISSS-CA ACE program across the four CISSS-CA sites and interrupted time series to measure the impact on hospital-, patient-, and caregiver-level outcomes. Objectives 2 and 3 will involve a parallel mixed-methods process evaluation study to understand the mechanisms by which our context-adapted CISSS-CA ACE program improves care transitions for the elderly and by which our Wiki-suite contributes to adaptation,
implementation, and scaling up of geriatric knowledge tools.
Results: Data collection started in January 2019. As of January 2020, we enrolled 1635 patients and 529 caregivers from the four participating hospitals. Data collection is projected to be completed in January 2022. Data analysis has not yet begun. Results are expected to be published in 2022. Expected results will be presented to different key internal stakeholders to better support the effort and resources deployed in the transition of seniors. Through key interventions focused on seniors, we are expecting to increase patient satisfaction and quality of care and reduce readmission and ED revisit.
Conclusions: This study will provide evidence on effective knowledge translation strategies to adapt best practices to the local context in the transition of care for elderly people. The knowledge generated through this project will support future scale-up of the ACE program and our wiki methodology in other settings in Canada.
ClinicalTrials.gov NCT04093245
International Registered Report Identifier (IRRID): DERR1-10.2196/17363
Students’ Projects

Annie Toulouse-Fournier
Relationship between anxiety symptoms and the risk of emergency department revisits in patients 65 years and older before and during the COVID-19 pandemic: a prospective cohort study
Publications
Germain N, Jémus-Gonzalez E, Couture V, Côté É, Morin M, Toulouse-Fournier A, Bert L, Giguère R, Sinha S, Sourial N, Chartier LB, Witteman HO, Légaré F, Samb R, Turcotte S, Chandavong S, Abrougui L, Robitaille J, Archambault PM. (2024). Caregivers’ burden of care during emergency department care transitions among older adults: a mixed methods cohort study. [Submitted March 8th, 2024]. Age and Ageing.
Vanessa Couture, Nathalie Germain, Émilie Côté, Lise Lavoie, Joanie Robitaille, Michèle Morin, Josée Chouinard, Yves Couturier, France Légaré, Marie-Soleil Hardy, Lucas B Chartier, Audrey-Anne Brousseau, Nadia Sourial, Éric Mercier, Clémence Dallaire, Richard Fleet, Annie Leblanc, Don Melady, Denis Roy, Samir Sinha, Marie-Josée Sirois, Holly O Witteman, Marcel Émond, Josée Rivard, Isabelle Pelletier, Stéphane Turcotte, Rawane Samb, Raphaëlle Giguère, Lyna Abrougui, Pascal Y Smith, Patrick M Archambault, Network of Canadian Emergency Researchers. (2024). Transitions of care for older adults discharged home from the emergency department: an inductive thematic content analysis of patient comments. BMC Geriatrics. 24(1)
Nathalie Germain, Annie Toulouse-Fournier, Rawane Samb, Émilie Côté, Vanessa Couture, Stéphane Turcotte, Michèle Morin, Yves Couturier, Lucas B Chartier, Nadia Sourial, Samir Sinha, Don Melady, Marie-Soleil Hardy, Richard Fleet, France Légaré, Denis Roy, Holly O Witteman, Éric Mercier, Josée Chouinard, Josée Rivard, Marie-Josée Sirois, Joanie Robitaille, Patrick M Archambault, LEARNING WISDOM investigators, Network of Canadian Emergency Researchers. (2024) Emergency department revisits at thirty days are modestly explained by caregiver burden: a prospective cohort study. MedRxiv
Ariane Plaisance, Julien Turgeon, Lucas Gomes Souza, France Légaré CQ, Stéphane Turcotte, Nathalie Germain, Tommy Jean, Maude Dionne, Félix Antoine Fortier, Patrick Plante, Diane Tapp, Véronique Gélinas, Emmanuelle Bélanger, Mark H Ebell, Christian Chabot, Tom van de Belt, Alexis F Turgeon, Patrick M Archambault. (2024). Exploring the impact of a context-adapted decision aid and online training about shared decision making about goals of care with elderly patients in the intensive care unit: a mixed-methods study. MedRxiv
Nathalie Germain, Rawane Samb, Émilie Côté, Annie Toulouse-Fournier, Joanie Robitaille, Stéphane Turcotte, Michèle Morin, Martyne Audet, Laetitia Bert, Josée Rivard, Audrey-Anne Brousseau, Lucas B Chartier, Nadia Sourial, France Légaré, Holly O Witteman, Clémence Dallaire, Chantal Kroon, Patrick M Archambault, LEARNING WISDOM Investigators, Network of Canadian Emergency Researchers. (2024). Impact of a geriatric emergency management nurse on thirty-day emergency department revisits: a retrospective propensity score matched case-control study. MedRxiv
El Kebir Ghandour, Sara Leblond, Sébastien Binette, Josée Rivard, John Joanisse, Louise Carreau, Laetitia Bert, Véronique Boutier, Jean-Paul Fortin, Jean-Louis Denis, Samir Sinha, Patrick Archambault. (2023). Implementation of the Acute Care for Elders Strategy to Improve the Quality of Care Transitions in Quebec and Ontario: a Retrospective Multiple Case Study. Canadian Geriatrics Journal. 26(4)
Archambault P M, Rivard J, Smith P Y, Sinha S, Morin M, LeBlanc A, Couturier Y, Ghandour E K, Denis J-L, Melady D, Paré D, Chouinard J, Kroon C, Huot-Lavoie M, Bert L, Witteman H, Brousseau A-A, Sirois M-J, Émond M, Fleet R, Chandavong S, Légaré F, Pelletier I, Dallaire C. (2020). Protocol for the LEARNING WISDOM mixed-methods implementation study. JMIR Research Protocols. 9(8): 1-16.
Bert, L. ; Rho, A. ; Bergeron, F. ; Côté-Boileau, É. ; Denis, J.-L. ; Maher, L. ; Archambault, P. (2021). Analysis of the National Health Service Institute for Innovation and Improvement Sustainability Model: A Scoping Review Protocol. OSF. online: 1-13.http://dx.doi.org/10.17605/OSF.IO/D2QXK
Présentation: Bert L., Bergeron F., Côté-Boileau E.; Denis J.-L.; Archambault P. (2022). Revue de littérature portant sur un outil de pérennisation: le NHS Sustainability Model. Symposium virtuel « B̂atir ensemble le système de santé apprenant du Québec », organisé par l’Unité de soutien au système de santé apprenant (SSA) Québec, Québec, Canada: https://www.youtube.com/watch?v=Doj3KH_-Oj0&ab_channel=Unit%C3%A9desoutienSSAQu%C3%A9bec
Présentation: Bert L. (2021). Diminuer le retour à l’urgence des aînés : étude des interactions entre professionnels pour pérenniser les pratiques exemplaires dans le contexte d’un système de santé apprenant. Journée annuelle 2021 du Réseau-1 Québec, Québec, Canada
Présentation: Laetitia Bert, Frédéric Bergeron, Elizabeth Côté-Boileau, Jean-Louis Denis, Patrick Michel Archambault.(2021). Analyse du National Health Service Institute for Innovation and Improvement Sustainability Model: un examen de la portée. Journées scientifiques étudiantes et de développement de carrière de VITAM, Québec, Canada
Affiche: Bert L., Bergeron F., Côté-Boileau É., Denis J.-L., Archambault P. (2021). Analysis of the National Health Service Institute for Innovation and Improvement Sustainability Model: A Scoping Review. 49th NAPCRG Annual Meeting, Leawood, États-Unis d’Amérique
Présentation: Bert L. (2021). Diminuer le retour à l’urgence des aînés : étude des interactions entre professionnels pour pérenniser les pratiques exemplaires dans le contexte d’un système de santé apprenant. Journée scientifique du Centre de recherche du CISSS de Chaudière-Appalaches, Lévis, Canada
Présentation: Bert L. (2021). Diminuer le retour à l’urgence des aîné.e.s : étude des interactions entre professionnel.le.s pour pérenniser les pratiques exemplaires dans le contexte d’un système de santé apprenant. Journées scientifiques étudiantes et de développement de carrière de VITAM, Québec, Canada
Présentation: Bert L. (2021). Présentation de la thèse : Diminuer le retour à l’urgence des aînés : étude des interactions entre professionnels pour pérenniser les pratiques exemplaires dans le contexte d’un système de santé apprenant.Dans le cadre de la remise de la bourse “nouveaux étudiants de 3e cycle 2020” du Centre de recherche du CISSS de Chaudière-Appalaches., Lévis, Canada