Monday, November 3, 2003

This presentation is part of : Homecare Delivery

Using a Research Partnership to Advance Nursing Knowledge about an Empowering Partnership Approach to In-Home Care

Carol L. McWilliam, RN, MScN, EdD1, Catherine A. Ward-Griffin, RN, MScN, PhD1, Gena Browne, RN, PhD2, Moira Stewart, PhD3, Evelyn Vingilis, PhD4, Peter Coyte, PhD5, Mary Wilson, RN, MScN6, and Sandra Coleman, N/A7. (1) School of Nursing, University of Western Ontario, London, ON, Canada, (2) Nursing, MacMaster University, Hamilton, ON, Canada, (3) Epidemiology, University of Western Ontario, ON, Canada, (4) Psychology, University of Western Ontario, ON, Canada, (5) Health Economics, University of Toronto, Toronto, ON, Canada, (6) Ontario Ministry of Health and Long Term Care, Community Care Access Centre of Windsor-Essex, Windsor, ON, Canada, (7) Community Care Access Centre of London-Middlesex, London, ON, Canada
Learning Objective #1: Appraise the evidence on the comparative costs and outcomes of using an empowering client-driven partnership approach in providing in-home care and its implications for practice, education and future research
Learning Objective #2: Consider new opportunities for building diverse research partnerships to advance nursing knowledge of empowering client-driven partnership approaches

Objective: To evaluate the costs and outcomes of an evidence-based, client-driven partnership approach to in-home care. Design: The multi-measure quasi-experimental evaluative research compares the partnership approach to brokered service delivery. Population, Sample & Setting: In Ontario, the intervention home care program promotes empowerment, or equitable exercise of knowledge, status and authority, amongst individuals, by engaging clients(n=974), formal (n=300) and informal (n=300) care providers in relationship-building, health-oriented care partnerships, responding flexibly to clients� choices of role, and within and amongst its agencies (n=5), through empowering policies, procedures, staff education and continuous quality improvement mechanisms. A second Ontario home care program implementing the Ontario brokerage service delivery model serves as the comparison. Variables: Outcome measures include: clients� service utilization, health status, quality of life, partnering effort, empowerment and satisfaction with care; providers� perceived effectiveness, partnering effort, empowerment and job satisfaction; caregivers� burden, empowerment and satisfaction with care; organizations� average case manager caseloads and service costs/client group. Methods: Regression discontinuity analysis will be used to compare one year of pre and one year of post-intervention data. Findings: At baseline, clients� health status and quality of life were lower than reported norms, and choice in care was lower than clients desired. Clients� partnering effort was positively correlated with their quality of life (r=.59), health status (r=.38) and satisfaction with care (r=.16), but was not related to their service costs. Providers� partnering effort was positively correlated with their empowerment (r=.42) and job satisfaction (r=.39), and their empowerment, with their job satisfaction (r=.59). Mean monthly organization costs /client were $440.19 and the average case manager caseload was 136. On-going analyses of post-intervention data will be presented. Conclusions: Findings provide initial evidence of the appropriateness of the approach for improving service delivery in the home. Implications: The intervention merits global research partnerships for more extensive testing.

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