Faculty members in the Johnson Shoyama Graduate School of Public Policy’s (JSGS) University of Regina campus have received $200K from the Saskatchewan Health Research Foundation (SHRF) to develop the CareOnDemand digital homecare ordering tool and to further the development of the previously announced CO-Away digital platform.
“JSGS faculty are providing advanced digital solutions that health leaders and Indigenous leaders can use to make data-informed decisions that will impact residents throughout Saskatchewan,” said Dr. Loleen Berdahl (PhD), JSGS Executive Director. “Although we are now starting to see the COVID-19 vaccination rollout happening here in the province, the long-term impacts of these digital solutions extend beyond the current pandemic.”
SHRF awarded these recent grants as part of its new Solutions Program in order to mobilize the research community and its partners to focus and coordinate on addressing timely Saskatchewan health challenges. In total over $1M in funding was awarded to 14 projects led by researchers from the University of Regina, University of Saskatchewan, and Saskatchewan Polytechnic.
“This program allows for flexibility and responsiveness and keeps Saskatchewan health needs at its core,” says SHRF CEO, Patrick Odnokon. “We work with our partner and stakeholders’ input and look at current trends to ensure the program remains focused on supporting our local expertise to find local solutions in areas that will have the most impact for the most people in the province.”
CareOnDemand: Engineering and Evaluating a Patient-oriented Homecare Ordering Tool to Enhance Aging in Place During the COVID Era
The COVID-19 pandemic has raised significant and longstanding concerns regarding the structure, delivery, and financing of long-term care.
In June 2020, the Canadian Institute for Health Information reported that while Canada’s COVID-19 death rate was relatively low, compared to other OECD countries, the proportion of deaths occurring in long-term care was double the OECD average, with many observers referring to it as a “national disgrace”. Over 80% of Canadian COVID-19-related deaths were elderly patients with multiple chronic underlying conditions living in long-term care facilities. Based on current counts of total cases of COVID-19 related deaths in Canada—as reported by the Public Health Agency of Canada as of March 9, 2021—that is an estimated 17,821 people (22,276 total reported deaths).
Before the vaccination rollout across Canada, residents in long-term care facilities were twice as likely to succumb to the virus. Yet, over 30% of their deaths could have been prevented if long-term facilities had the capacity to replace double and quadruple-occupancy rooms with single occupancy rooms, or better yet, if some of these patients could have been treated from home.
"In these long-term care facilities, a significant proportion of older adults, many with underlying medical conditions, are susceptible to severe infection, and overcrowding may further increase baseline exposure risks,” says Ramona Kyabaggu, JSGS assistant professor and principal researcher on the grant. “However, we have also known, for quite some time, that homecare is an alternative to long-term care that enables older adults to receive care at home safely and enables seniors to maintain independence and ties to the community while reducing costs to health systems in the order of 40-75%.”
Joined by Dr. Cheryl Camillo (PhD), JSGS assistant professor, and Dr. Tim Maciag (PhD), lecturer, University of Regina Faculty of Engineering, the research team is developing a CareOnDemand application to assist seniors in navigating and ordering homecare services. They intend to improve accessibility and provision of timely, efficient, high-quality, patient-centered homecare services to Saskatchewan seniors.
“Our patient-centered research explores the optimal design and application of our homecare ordering solution and the supportive health system policies and info-structure for improved access to services, care integration, and linkage of homecare services data,” said Kyabaggu. “Ultimately, our technology-enabled homecare innovation will make it more feasible for older adults to safely age in place."
A 2016 report by the Saskatchewan Urban Municipalities Association stated that “it is expected that by 2038, the number of people in Saskatchewan aged 55 and over will be 666,820, or 56.8% of the population.“ This represents an increase of 247,715 people in this age cohort from 2016 census data. Those aged 80 and older will double between now and 2036, placing greater demand on the public health care system. When planned and targeted, governments can appropriately substitute home care for costly residential care services, especially long-term chronic home care.
In Saskatchewan, individuals can receive homecare through the Saskatchewan Health Authority or arrange for their support services through providers such as Eden Care Communities. The most current available information on the number of homecare users in Saskatchewan finds that there were 7,258 homecare users in 2014-15 and that there has been a positive trend in the uptake of homecare among adults aged 65 years and older, representing a 34% increase in homecare use from 2011-12 to 2014-15.
Alan Stephen, chief executive officer of Eden Care Communities, says his team is looking forward to collaborating on such a significant project.
“We are thrilled to be part of this exceptional research team. With this generous support from SHRF, we will be able to further develop this important component of the future of home care. We know home care is vital and this funding will position us to lead the way to better care and support in the future,” says Stephen.
Virtual care technology, such as CareOnDemand, can help deliver both demand and supply-side improvements to address system gaps and unmet informational needs for better decision-making at the patient, provider, and systems levels.
“We believe that a community-centred, open-source, and open-data software solution will lead to greater quality-of-care and improved data-driven decision-making experiences for all stakeholders,” said Maciag. “In working with Eden Care Communities and their customers, we engage with Saskatchewan homecare customers, their families, and homecare administrators, to engineer, deploy, evaluate, and iterate the improved virtual care experiences within our community."
At the patient-level, research has shown that despite the “digital divide”, many older adults have integrated technology into their daily lives to improve access to routine health and social care, especially during the COVID-19 pandemic. For providers, more than half of home care workers want more control over their employment, including improved autonomy, transparency and remote team management, and greater connection between home care workers and patients. An effective person-centered virtual care system can meet the needs of patients and providers, while also providing information for management, policy, and programmatic decision-making.
Thanks to an investment of $50,000 from SHRF, over the next year, Kyabaggu, Camillo, and Maciag will work with older adults using homecare services, frontline homecare workers, families of homecare users, and the Eden Care Communities’ management team on the conceptual design of the CareOnDemand application. During this time, they will also test and modify the tool to reflect user feedback.
CO-Away: Advancing virtual care using human-centered artificial intelligence
Dr. Tarun Katapally, a patient-oriented research leader and JSGS associate professor on the U of R campus, and Dr. Kelly Skinner, assistant professor at the School of Public Health and Health Systems at the University of Waterloo, have secured $150,000 to develop virtual care services as part of the CO-Away platform. The funding will allow the researchers to address access gaps that were identified during community engagement with Île-à-la-Crosse decision-makers. By focusing predominantly on human-centered artificial intelligence, the goal of this SHRF Impact Grant is to provide remote communities the advanced data analytics necessary to tackle existing and emerging health crises, while prioritizing data sovereignty. This funding is in addition to a previously announced investment by Mitacs for the development of the digital infrastructure, and it will help researchers move the project into phase two.
“Although CO-Away has been developed to respond rapidly to the COVID-19 pandemic, the digital infrastructure can be used for emerging or existing health crises,” said Katapally. “For instance, the platform already has features that address the indirect effects of COVID-19 pandemic, which exacerbate existing inequities – food insecurity and inaccessible public services. The community has also indicated that mental health, substance misuse, and domestic violence are key concerns, which they would like to address in a post-pandemic period.”
Katapally believes that the data provided through the CO-Away platform’s decision-making dashboard will provide Indigenous leaders with the necessary information to not only assist with immediate concerns related to the pandemic but also with their long-term self-governance.