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Understanding Determinants of Outcomes in Complex Continuing Care

Study Overview

A central challenge in Complex Continuing Care (CCC) facilities, also known as chronic care, is the delivery of high quality patient care that results in best patient outcomes. Despite the growth in literature on relationships between patient outcomes and nursing-related organizational factors, little research has examined the effects of nursing care on patient or organizational outcomes in CCC.

The Hospital Report initiative in Ontario has highlighted CCC outcomes. However, description of outcome performance alone, such as found in the Hospital Report, is insufficient to improve outcomes. Outcome improvement can best be facilitated through management of determinants of those outcomes. In this study, we describe selected structures and processes of care in CCC as well as evaluated the effects these structures and processes have on outcomes for stroke patients cared for in CCC facilities. The transitional care patient population is the focus of this research and in particular, patients recovering from stroke. These patients constitute a large proportion of the CCC transitional care patients (i.e., patients who no longer require acute care but have needs too intensive for community care).

Study Purpose

The primary purpose of this study was to evaluate the effects that CCC structures and processes of care have on three transitional care stroke patient outcomes:

  1. location of discharge;
  2. length of stay; and
  3. patient satisfaction with care.

Six categories of CCC structures and processes of care were evaluated for their effects on patient outcomes: (i) patient characteristics; (ii) staff characteristics; (iii) work environment characteristics; (iv) staff responses to the work environment; (v) nurse staffing; and (vi) therapeutic interventions provided by staff. Secondary study purposes included examining CCC patient characteristics, work environments experienced by CCC multidisciplinary staff, and staff responses to these work environments.

Research Team

This study was conducted by a team of researchers: Ann Tourangeau, Katherine McGilton, and Walter Wodchis from the University of Toronto and  Gary Teare from the Health Quality Council.

This study commenced in November 2004 and was funded by the CIHR in partnership with the Ontario Ministry of Health and Long-term Care.

This study is now complete.

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