The Ontario CLRI catalyzes applied research and innovation to develop evidence-informed practices and enhance quality in long-term care. In partnership with colleges and universities, we conduct and support research that designs and tests innovative approaches that enhance care in long-term care. Since 2012, we have supported more than 50 clinical and education grants.
CLRI Research Projects
GeriMedRisk is an interdisciplinary telemedicine geriatric clinical pharmacology and psychiatry consultation service available to clinicians. Operating weekdays 9-5, participating clinicians can access support from a GeriMedRisk team member by calling a toll-free number or using eConsult from the Ontario Telemedicine Network (OTN) or BASE eConsult. GeriMedRisk is a not-for-profit, industry-free service.
Culture Change Evaluation Framework
A feasible and valid measurement framework has been constructed for culture change to measure high valid markers to evaluate culture change within a long-term care home. The framework is under review for potential use and application across Ontario long-term care homes.
Research to develop new evidence-based deprescribing guidelines, identify and develop tools needed to support guideline implementation by prescribers, and evaluating the impact of the use of deprescribing tools in long-term care.
Evaluating the spread of the Champlain BASE™ eConsult Service in Early Adopting Ontario Long-Term Care Homes
The Champlain BASE™ eConsult service enables primary care providers timely access to specialist expertise from over 100 specialist groups. The Champlain BASE™ eConsult service team recently established the Ontario eConsult Centre of Excellence. This collaboration with the CLRI supports the use of the service in LTC homes. This included evaluation of impact on referral/consultation workflow, patient transfers, provider, resident and caregiver satisfaction and avoided face-to-face referrals. Resident, caregiver and provider satisfaction will be measured through interviews and focus groups, and implementation success through utilization and sector data analysis (i.e. number of eConsults, reduction in transfers to acute care for non-urgent issues). The work is guided by a multi-disciplinary, multi-sectoral advisory committee with representation from persons with lived experience in long-term care and a broad range of long-term care stakeholders.
The Power of Peer Support: Reducing Social Isolation in Residential Care Settings
Collect data on the impact of using Java peer-support groups on residents’ psychosocial well-being and cognition and on staff experiences of facilitating the program, and residents’ experiences and feedback on the program itself. Collaboration with Carleton University, Java Group Programs, Bruyère Continuing Care and Riverstone Retirement Residences. Funded by Canadian Brain Health + Innovation (September 2017-August 2018).
Intelligent Mobile App and Web-Based Alerts Application to Help Detect and Prevent Falls in the LTC Setting
Field trial of acceptability and functionality of fall detection application by Remotronic Inc. that uses Artificial Intelligence, funded by Canadian Brain Health + Innovation (March 2017-June 2018).
Develop a PIP-ID App (a medication review application) to rapidly identify instances of potentially inappropriate prescribing (PIP) in LTC
Design a bilingual smart phone application using the Excel-based PIP-identification tool (developed during CLRI 1.0) that can facilitate information gathering and decision making, based on a review current practices of medication reconciliation by LTC pharmacists. Engage stakeholders to plan pilot, review and provide feedback on the prototype application.
Team Essentials: Leading Practices for Long-Term Care (Leadership Coaching Innovation)
Leadership coaching was beta-tested and translated into preliminary online tools for Team Essentials for Engaging Families in Care. The leadership coaching consisted of a series of on-site visits, pre- and post-training, with leaders of participating homes. The goals are: to ensure program fit with the home’s priorities and QIPs; to familiarize leaders with content and delivery (i.e. training + follow-up consults + staff refreshers and post-training activities); to identify and align learning with home’s targeted performance behaviours; and, to provide leaders with tools to both set the stage for teams before training and to support and monitor practice change after training.
Team Essentials: Leading Practices for Long-Term Care (eLearning and edTech Innovations)
This year saw the initiation of the development of eLearning for Team Essentials for Engaging Families in Care (targeted for completion spring 2019). A sub-section on Resident-to-Resident Events was added to Team Essentials eLearning for Coordinating Care for Responsive Behaviours. A suite of educational videos simulating the 8As of dementia were filmed to both complement Team Essentials eLearning for Coordinating Care for Responsive Behaviours and serve as a video library resource for LTCH educators. A video toolkit for educators is under development (targeted for completion summer 2018). To support staff specialty knowledge of 24 gerontological conditions, development of a web-based just-in-time learning resource was initiated for Team Essentials for Preventing Acute Deterioration and for Responding to Acute Emergencies (targeted for beta-test completion March 2019).
Online Post-Graduate Interprofessional Certificate in Complex and Long-Term Care (eCampusOntario Grant)
The purpose is to increase the reach of Team Essentials: Leading Practices for LTC across the province. In partnership with George Brown College (lead) and Ryerson University, this fully online Certificate program is being developed with a focus on preparing post-graduate healthcare providers to work interprofessionally with clients and families who require complex and long-term care within institutions or in the home. In addition to online, courses, learners complete a capstone field placement within their local community as well as 2 virtual learning placement courses that integrate case-based learning, simulation, serious game principles and social learning spaces. (Grant completion: June 2018; First intake anticipated spring 2019).
Alleviating the Clinical Placement Crisis: Virtual Learning Environments for Next Generation Dementia Caregivers
In response to the brevity and shrinking supply of clinical placements in aging and dementia care, this solution will optimize a software-based Virtual Learning Environment, blended with healthcare student internships and clinical placements in a long-term care teaching home. The proposed mixed-methods research study extends the development and evaluation of the software platform customized for the eCampusOntario grant (above). Through problem-solving a series of increasingly challenging virtual client cases within a feedback and rewards system, the Virtual Learning Environment will standardize, tailor and augment student exposure to a comprehensive range and greater volume of complex, atypical and infrequent dementia care situations (e.g., dementia types + multiple comorbidities, polypharmacy, alcoholism, MAID, cannabis, sexuality). An RCP2 grant application submitted to the Centre for Aging + Brain Health Innovation in collaboration with Ryerson University and George Brown College was not selected for funding.
Family Engagement Study (Canadian Institutes of Health Research Grant)
Led by Dr. L. Cranley at the University of Toronto, the purpose of this study is to develop, implement and evaluate a shared decision-making intervention to engage LTC residents, their primary care partner and the interdisciplinary care team in a collaborative approach to care decisions. This grant application was ranked first by the Social Dimensions in Aging Committee. Team Essentials for Engaging Families in Care will be a core part of the intervention in combination with team huddles. (July 2018 – December 2019)
SOS! A Gamified App to Improve Early Detection of Acute Deterioration Associated with Unnecessary Emergency Hospitalization in the Frail Elderly
This mobile learning app enables continuing education for participants of Team Essentials for Preventing Acute Deterioration and for Responding to Acute Emergencies by providing practice with instant feedback on application of knowledge and best practices to over 35 scenarios focused on the care of frail elderly at risk of acute deterioration. This project transitions a previously developed and tested beta-version of a product into a commercially available product. Managers and educators will be able to monitor learning outcomes to address learning needs. Based on beta-test feedback, the SOS Gamified Learning App feedback and rewards system as well as reporting functions were improved through program coding. Recommendations for a business model and go-to-market strategy and the associated eLearning for Team Essentials for Preventing Acute Deterioration were formally developed by an expert strategic consultancy. A sustainability plan will be developed in fiscal year 2018-19.SPARK Grant from the Centre for Aging + Brain Health Innovation.
Sensory Observation System Checklist App to Improve Communication, Observation and Assessment in the Face of Acute Deterioration in the Elderly: From Prototype into the Hands of Clinicians and Informal Caregivers
This project digitalizes the pocket cards for Team Essentials for Preventing Acute Deterioration, Responding to Acute Emergencies and Coordinating Care for Responsive Behaviours into an App to support knowledge-to-practice and implementation in the practice setting. This App provides a complete and precise checklist of systems related to body functions and the environment to support healthcare workers in recognizing and responding in a timely way when working with the frail elderly. Two versions were developed for healthcare providers and for informal caregivers. Major program coding and beta-testing were completed. Recommendations for a business model and go-to-market strategy and the associated eLearning for Team Essentials for Preventing Acute Deterioration were formally developed by an expert strategic consultancy. A sustainability plan will be developed in fiscal year 2018-19. Supported by a grant from the Centre for Aging + Brain Health Innovation.
Virtual Reality Dementia Simulations and App
Building on a proof of concept pilot, this project explored the use of virtual reality as a scalable educational tool to deliver dementia simulations to enhance caregiver empathy and skills. Applications and synergies with other collaborators were explored to advance the work and to secure additional funding. An RCP2 grant application submitted to the Centre for Aging + Brain Health Innovation for a cross-realities platform in collaboration with Baycrest Academic Education, Digital Generals, Hospital for Sick Children and George Brown College was not selected for funding.
Tailored Education for Diverse Healthcare Professionals (MOHLTC Academic Health Science Centre Alternative Funding Plan Grant)
This project developed and evaluated a novel approach to continuing education in geriatric mental health using customized, or “bespoke”, education modules. Members of interprofessional healthcare teams as well as across settings (e.g., LTC, community, hospital) may have very different learning needs. Evaluation focused on learning outcomes and increased uptake of quality improvement tools in the clinical setting.
Research articles on a range of topics
Over the years, the Ontario CLRI teams produced many peer reviewed articles on a range of topics. A bibliography of these are in preparation and will be posted on the CLRI website.