Bridging the Gap between Health Promotion Theory and Care for Chronic Illness Empowering for Health Care Management at Home C. L. McWilliam, MScN, EdD The University of Western Ontario, London, Ontario, CANADA E. Vingilis, M. Stewart, E. Vingilis, C. Ward-Griffin, J Hoch, A. Donner, UWO G. Browne, McMaster University P. Coyte, University of Toronto S. Golding (PRESENTER), S. Coleman, M. Wilson, et al., CCACs of Ontario, CANADA FUNDED BY: The Canadian Institutes of Health Research

Purpose: To evaluate the Costs & Outcomes of an Empowering Partnering Approach to Chronic Care Management at Home ( ) Bridging the Gap between Health Promotion Theory and Care for Chronic Illness

EVIDENCE-BASED EVOLUTION OF EMPOWERING PARTNERING RCT of “health promotion” visits achieved:  greater independence (p=.008; p=007)  greater perceived ability to manage own health (p=.014)  less desire for information (p=.021; p=.035)  greater quality of life (p=.006)  8.2 fewer days in hospital; less in-home service

PHENOMENOLOGICAL STUDY FINDINGS The Empowering Partnering Process Relationship-building +  Conscious Awareness

THE EMPOWERING PARTNERING PROCESS  Building Trust & Meaning  Connecting  Caring  Mutual Knowing  Mutual Creating

Empowering Partnering:  Client-centered  Empowering of all involved, beginning with the client  Relationship-building process  Health-oriented  Strengths-based focus Bridging the Gap between Health Promotion Theory and Care for Chronic Illness

EMPOWERMENT: equitable balance of  knowledge  status  authority in the care relationship (Clark, 1989) HEALTH: the ability to realize aspirations, satisfy needs, & respond positively to the environment; a resource for everyday living (WHO, 1986) Bridging the Gap between Health Promotion Theory and Care for Chronic Illness

individual level: clients as care partners client choice of involvement in care mgt. client and provider empowerment organizational level: staff education changed care procedures empowering policies empowering language interorganizational level: shared philosophy shared educational programming shared C.Q.I. strategy collaborative research Bridging the Gap between Health Promotion Theory and Care for Chronic Illness

Quasi-Experimental Evaluation Research:  intervention and comparator home care programs  12-month baseline ( )  12-month follow-up ( ) Bridging the Gap between Health Promotion Theory and Care for Chronic Illness

SAMPLE: Baseline Follow-up N (PARTICIPATION RATE) N (PARTICIPATION RATE) Computer Database 7200 (100%) 7200 (100%) Clients 974 (58%) 809 (31%) Caregivers 249 (62%) 303 (49%) Providers 291 (59%) 288 (36%) Bridging the Gap between Health Promotion Theory and Care for Chronic Illness

Age: 72 yrs Gender: female 70% Education: </= secondary 75% Income: </= $20,000 65% # Chronic Problems: 2.4 Informal Caregiver: 71% Client Demographics:

Age: 42.5yrs Role: case mgr 12% nurse 34% therapist 11% PSW 43% Status full time 43% part time 57% Experience 10 yrs Qualifications </=diploma 72% Provider Demographics

Age: 60 yrs Gender: female 69% Marital Status married 82% Education post secondary 50% Caregiver Demographics

VARIABLE: CORRELATION (Pearson’s r) Clients’ Health Status.38 Quality of Life.59 Satisfaction with Care.16 Providers’ Job Satisfaction.39 Perceived Effectiveness.36 Outcome Measures Correlated with Empowering Partnering

 Government Service Cuts  Shift to Centralized Government Control  Policy & Procedure for Standardized Assessment Mediating Variables

N (%) Providers Trained 349 (30%) Trained Staff Attrition 32 (2.3%) Clients Engaged 2689 (44%) The Progress in Implementing Intervention

Health Care Costs: No Difference Satisfaction with Care: No Difference Positive Trend better in (I) Health-promoting effort: No Difference Partnering in Decision-making: No Difference Improved in both (I) and (C) Client Outcomes: Intervention (I) vs Comparator (C) Organization

Job Satisfaction: Almost Significant (p=.06) No Change in (I); Dropped in (C) Job Motivation: No Difference No Change in (I); Dropped in (C) Job characteristics: Almost Significant (p=.07) Positive Trend in (I) over time Empowerment: No Difference Health-promoting effort: No Difference Provider Outcomes: Intervention (I) vs Comparator (C) Organization

Caregiver Outcomes

Mean Total Monthly Services Utilization Costs Over Time Intervention vs. Comparator Intervention Services Utilization Costs by Service Category

Conclusions:  Change takes time  The policy context may impede the intervention  Program outcomes affected by many factors  KT requires grassroots perspective transformation  Further research is needed Bridging the Gap between Health Promotion Theory and Care for Chronic Illness