Expansion of a Web-Based Platform to Support Caregivers in California Using CareNav

About one in five Americans is engaged in providing care to a family member. Caregivers (unpaid family members or friends) support older adults and persons with disability with a variety of conditions, including challenges in physical, cognitive, and mental health. In California, 4.5 million family caregivers are assisting individuals over the age of 18. The CA Department of Health Care Services funds 11 Caregiver Resource Centers (CRC) to support caregivers and, in 2019, provided support to expand information technology services through adoption of a statewide online assessment platform and client portal, CareNav™, to serve as a client record and referral tool. CareNav™ facilitates collection of consistent state-wide data that can inform program improvement and policy. This study evaluated the implementation process from the perspective of 35 CRC team members in guided focus group discussions. CRC staff identified several potential benefits to adopting CareNav™, including ease of client access and convenience, the ability to aggregate data to inform planning and policy, and a streamlined process for resource sharing. Challenges included customizing site-specific data needs, as well as concerns about equitable access to internet services. Ongoing evaluation will focus on validation and visualization of data, and translation of data into actionable information to improve quality and reach.

Implementation of a proactive referral tool for child healthcare professionals to encourage and facilitate parental smoking cessation in the Netherlands: a mixed-methods study

Background Recently, the parent-tailored telephone based smoking cessation counseling program ‘Smoke-free Parents’ was shown to be effective in helping parents to quit smoking. To implement this program in child healthcare settings in the Netherlands, the research team developed a proactive referral tool to refer parents to Smoke-free Parents. The aim of the present implementation study was to explore the facilitators, barriers, and suggestions for improvement in the implementation of this referral tool. Methods Child healthcare professionals (N = 68) were recruited via multiple strategies (e.g., social media, mailings, and word of mouth among healthcare professionals) and invited to complete two online (quantitative and qualitative) questionnaires and to participate in a telephone semi-structured qualitative interview between April 2017 and February 2019. In total, 65 child healthcare professionals were included in the analyses. After inductive coding, thematic analyses were performed on the qualitative data. Descriptive analyses were performed on the quantitative data. Results The data from both questionnaires and the telephone interview revealed that the majority of the child healthcare professionals (92.3 % female; average years of working as a healthcare professional: 23.0) found the Smoke-free Parents referral tool accessible and convenient to use. Yet there were several barriers that limited their use of the tool. The data revealed that one of the main barriers that healthcare professionals experienced was parental resistance to smoking cessation assistance. In addition, healthcare professionals noted that they experienced tension when motivating parents to quit smoking, as they were not the parent’s, but the child’s healthcare provider. Additionally, healthcare professionals reported being concerned about the lack of information about the costs of Smoke-free Parents, which limited professionals referring parents to the service. Conclusions Although healthcare professionals reported rather positive experiences with the Smoke-free Parents referral tool, the use of the tool was limited due to barriers. To increase the impact of the Smoke-free Parents telephone-based smoking cessation counseling program via child healthcare settings, it is important to overcome these barriers. Suggestions for improvement in the implementation of the referral tool in child healthcare settings are discussed.

Development and assessment of the usability of a web-based referral to treatment tool for persons with substance use disorders

Background Hospitalized people with unhealthy substance use should be referred to treatment. Although inpatient referral resources are often available, clinicians report that outpatient referral networks are not well-established. The purpose of this manuscript is to describe the development and usability testing of a web-based Referral to Treatment Tool (RTT © 2020 Trustees of Indiana University, all rights reserved) designed to identify treatment centers for people with unhealthy substance use. Results The RTT was conceptualized, developed, and then populated with public use and local survey data of treatment centers from 14 market ZIP codes of hospitals participating in an SBIRT implementation study. The tool underwent initial heuristic testing, followed by usability testing at three hospitals within a large healthcare system in the Midwest region of the United States. Administrative (n = 6) and provider (n = 12) users of the RTT completed a list of tasks and provided feedback through Think-Aloud Tests, the System Usability Scale, and in-person interviews. Patients (n = 4) assessed multiple versions of a take-home printout of referral sites that met their specifications and completed in-person interviews to provide feedback. Each administrative task was completed in less than 3 min, and providers took an average of 4 min and 3 s to identify appropriate referral sites for a patient and print a referral list for the patient. The mean System Usability Scale score (M = 77.22, SD = 15.57, p = 0.03) was significantly higher than the passable score of 70, indicating favorable perceptions of the usability of the RTT. Administrative and provider users felt that the RTT was useful and easy to use, but the settings and search features could be refined. Patients indicated that the printouts contained useful information and that it was helpful to include multiple referral sites on the printout. Conclusion The web-based referral tool has the potential to facilitate voluntary outpatient referral to treatment for patients with unhealthy substance use. The RTT can be customized for a variety of health care settings and patient needs. Additional revisions based on usability testing results are needed to prepare for a broader multi-site clinical evaluation. Trial Registration Not applicable.

The Cognitive-Communication Checklist for Acquired Brain Injury: A Means of Identifying, Recording, and Tracking Communication Impairments

Purpose The communication service needs of individuals with acquired brain injuries (ABIs) are frequently overlooked, leading to delays, denials, or premature discharge from communication interventions. This is particularly true for those with subtle cognitive-communication deficits, which may not be apparent until sufficiently challenged at work, in school, or in the community. The purpose of this study was to evaluate a referral tool that could promote understanding of the broad range of communication impairments that occur following ABI and lead to improved identification and referral. Method This study evaluated the Cognitive-Communication Checklist for Acquired Brain Injury (CCCABI) through a survey. The CCCABI is a referral tool that summarizes 45 communication difficulties in 10 areas of cognitive-communication functioning. One hundred sixteen speech-language pathologists, 34 multidisciplinary referral sources, and 41 individuals with lived experience of brain injury were surveyed to evaluate the utility of this referral tool. Results The need for such a referral tool was endorsed by 96% of speech-language pathology respondents, 91% of multidisciplinary respondents, and 100% of respondents with lived experience of brain injury. Responses supported the CCCABI as a clear, comprehensive, and accessible tool for education and identification of the communication impairments that can occur after ABI. Conclusion The CCCABI is a means of increasing understanding of communication service needs following ABI in a manner that is accessible to individuals, families, program designers, funding sources, administrators, and multidisciplinary referral sources.

PP20 Paramedic identification and referral of patients in the last year of life: a stakeholder interview study

BackgroundPatients are approaching End of Life when they are likely to die within the next 12 months. Quality in End of Life Care is variable and identifying patients in the End of Life phase is challenging, particularly in those people with diagnoses other than cancer. Many patients accessing the ambulance service are in the last year of their lives and the role of ambulance services in recognising patients approaching the end of their lives is often overlooked. Patients who are End of Life should be offered advanced care planning.Research QuestionWhat are stakeholders’ views on a paramedic screening and referral intervention aimed at improving care planning in patients in the last year of life?MethodsA qualitative study using semi-structured telephone interviews conducted with 17 stakeholders to investigate stakeholders’ views on:the utility of a paramedic screening and referral toolthe likely impact of a paramedic screening and referral toolPreliminary ResultsAll staff groups:Increasing advanced care planning would be advantageous for patientsPatients with non-malignant conditions are not readily recognised as End of Life.Paramedics should use the Gold Standards Framework Proactive Identification Guidance to identify patients in the last year of life.The proposed intervention has the potential to reduce unnecessary hospital admissions and unnecessary resuscitation.Specific staff groups:GPs: Concerns about additional workload.GPs: The intervention is useful for patients who may ‘fall under the radar’.GPs and ED doctors: Concerns about the need for paramedics to have sensitive communication skills.Paramedics and GPs: A dedicated End of Life lead or team would be advantageous.ConclusionsThe introduction of an end of life screening and referral tool into paramedic practice is a welcome intervention and will have a positive impact on patients at the end of life. GPs expressed concern about capacity to manage referrals.

Who gets referred for knee or hip replacement? A theoretical model of the potential impact of evidence-based referral thresholds using data from a retrospective review of clinic records from an English musculoskeletal referral hub

ObjectivesTo estimate the relationship between patient characteristics and referral decisions made by musculoskeletal hubs, and to assess the possible impact of an evidence-based referral tool.DesignRetrospective analysis of medical records and decision tree model evaluating policy changes using local and national data.SettingOne musculoskeletal interface clinic (hub) in England.Participants922 adults aged ≥50 years referred by general practitioners with symptoms of knee or hip osteoarthritis.InterventionsWe assessed the current frequency and determinants of referrals from one hub and the change in referrals that would occur at this centre and nationally if evidence-based thresholds for referral (Oxford Knee and Hip Scores, OKS/OHS) were introduced.Main outcome measureOKS/OHS, referrals for surgical assessment, referrals for arthroplasty, costs and quality-adjusted life years.ResultsOf 110 patients with knee symptoms attending face-to-face hub consultations, 49 (45%) were referred for surgical assessment; the mean OKS for these 49 patients was 18 (range: 1–41). Of 101 hip patients, 36 (36%) were referred for surgical assessment (mean OHS: 21, range: 5–44). No patients referred for surgical assessment were above previously reported economic thresholds for OKS (43) or OHS (45). Setting thresholds of OKS ≤31 and OHS ≤35 might have resulted in an additional 22 knee referrals and 26 hip referrals in our cohort. Extrapolating hub results across England suggests a possible increase in referrals nationally, of around 13 000 additional knee replacements and 4500 additional hip replacements each year.ConclusionsMusculoskeletal hubs currently consider OKS/OHS and other factors when making decisions about referral to secondary care for joint replacement. Those referred typically have low OHS/OKS, and introducing evidence-based OKS/OHS thresholds would prevent few inappropriate (high-functioning, low-pain) referrals. However, our findings suggest that some patients not currently referred could benefit from arthroplasty based on OKS/OHS. More research is required to explore other important patient characteristics currently influencing hub decisions.

Development of a stop light tool using the bellarmine norton assessment tool (BNAT) for physical therapy referral.

e19067 Background: Individuals with cancer experience fatigue, pain and decline in function. The Bellarmine Norton Assessment Tool (BNAT) was developed to give an objective measure identifying a person’s overall functional ability through a variety of physical assessments focused on mobility and strength. The purpose of this study was to develop a referral tool to provide health care professionals an easy determinant for physical therapy referrals. The referral tool was designed as a Red, Yellow, Green light for easy interpretation and use. Methods: The BNAT is composed of 1 self-reported physical activity question and 4 objective tests: 2-Minute Step Test (2MST); 30-Second Sit-to-Stand; Timed Arm Curl; and Timed Up and Go. A previously collected data set of BNAT scores was utilized to develop the referral tool with the poorest performance corresponding to Red and the best corresponding to Green. Three variations of normative scaling examined optimal distribution for classification. The first model averaged normative data of 70-74 age group of healthy individuals. No participants in our study achieved 50% of population norms. Therefore, the Green light represented 35% of the normative values, the Yellow light ranged from 15-34% and the Red light identified < 15%. A second model used frequency histograms for each BNAT elements. Groupings were made based on the natural break of the data to depict the Red, Yellow or Green light. A third approach combined normative and frequency distribution for each element as compared to the respective BNAT scores. The outcome assigned BNAT score of 1 and 2 to Red light, 3 to Yellow light and 4 and 5 to Green light. Except for the 2MST, these models were similar for the cutoff between color categories. The third model best fit the study population with respect to the individual’s total BNAT score. Results: Of the 161 subjects, 47 subjects (29%) fell into the Red category, 81 (50%) into Yellow and 33 (21%) into Green. Using this scaling system for the total BNAT score, 13 score combinations result in Red light, 6 scores for Yellow light and 6 scores for Green light. Regardless of the model, most individuals were assigned a Yellow light. Conclusions: The literature is void of functional cut off scores and normative distributive data for the oncology population. We defined a referral tool with scaling based off normative scores and functional assessments that reflect the distribution of oncology patients. The third model may be used as a simple referral tool among multiple health care professionals aiding in a referral for physical therapy.