Papers by Carolyn Steele Gray
Additional file 2. Recommendations for the ePRO.
Additional file 1. Standards for Reporting Qualitative Research checklist.
BACKGROUND Although mobile health (mHealth) applications are increasingly being used to support p... more BACKGROUND Although mobile health (mHealth) applications are increasingly being used to support patients with multiple chronic conditions (multimorbidity), the majority of mHealth apps experience low interaction and eventual abandonment. To tackle this engagement issue, it is important to understand social-behavioral factors that impact patients’ usage behavior when developing a mHealth program. OBJECTIVE This study aims to explore the social and behavioral factors contributing to the patients’ usage behavior of a mHealth app called the electronic Patient Reported Outcome (ePRO). The ePRO app supports goal-oriented care delivery in interdisciplinary primary care models. METHODS A descriptive qualitative study was used to analyze interview data collected for a larger mixed-method pragmatic trial. The original 15-month trial was conducted in six primary care teams across Ontario between 2018 and 2019. For this analysis, patients were classified as long-term or short-term users based o...
Objective:Hospital redevelopment constitutes a revolutionary change that can face strong resistan... more Objective:Hospital redevelopment constitutes a revolutionary change that can face strong resistance from employees. Few studies have examined how employee readiness for change relates to adjustment outcomes typically captured in post-occupancy evaluation (POE). The relationship between organi-zational readiness and employee adjustment is examined in the context of a POE conducted during a hospital redevelopment. Background: Our study focuses on the redevelopment of a complex continuing care and rehabilitation hospital that underwent complete physical redevelopment and major shifts in operational and organizational processes. Methods: Using a pretest–posttest quasi-experimental research design, staff organizational readiness was assessed using surveys at four time periods: 6 months prior to the move (n 125), 2 months prior to the move (n 84), 3 months after the move (n 187), and 6 months after the move (n 194). Measures included organizational readiness, workplace satisfaction, psych...
The Author(s) 2014. This article is published with open access at Springerlink.com Abstract This ... more The Author(s) 2014. This article is published with open access at Springerlink.com Abstract This commentary focuses on patient-reported measures as tools to support patient-centered care for patients with multiple chronic conditions (MCCs). We argue that those using patient-reported measures in care management or evaluation of services for MCC patients should do so in recognition of the challenges involved in treating them. MCC patient care is challenging because (1) it is difficult to specify the causes of particular symptoms; (2) assessment of many important symptoms relies on subjective report; and (3) patients require care from a variety of providers. Due to the multiple domains of health affected in single individuals, and the large variation in needs, care that is holistic and individualized (i.e. patient-centered) is appropriate for MCC patients. However, due to the afore-mentioned challenges, it is important to carefully consider what this care entails and how practical cont...
BMJ Open, 2021
IntroductionOlder adults may experience challenges during the hospital to home transitions that c... more IntroductionOlder adults may experience challenges during the hospital to home transitions that could be mitigated by digital health solutions. However, to promote adoption in practice and realise benefits, there is a need to specify how digital health solutions contribute to hospital to home transitions, particularly pertinent in this era of social distancing. This rapid review will: (1) elucidate the various roles and functions that have been developed to support hospital to home transitions of care, (2) identify existing digital health solutions that support hospital to home transitions of care, (3) identify gaps and new opportunities where digital health solutions can support these roles and functions and (4) create recommendations that will inform the design and structure of future digital health interventions that support hospital to home transitions for older adults (eg, the pre-trial results of the Digital Bridge intervention; ClinicalTrials.gov Identifier: NCT04287192).Meth...
Digital health systems have an important role to play in the delivery of integrated health and so... more Digital health systems have an important role to play in the delivery of integrated health and social care services. Despite their utility, the adoption of these tools has lagged for many organizations, leading to missed opportunities for advancing integrated care. This chapter describes how digital health innovations, in particular information and communication technologies, can address three common integrated care “problems” to demonstrate how these tools can be put into practice. Practical recommendations and strategies to enable implementation are offered at the end of the chapter.
International Journal of Integrated Care, 2019
Social Science & Medicine, 2018
Complex adaptive systems (CAS) theory views healthcare as numerous sub-systems characterized by d... more Complex adaptive systems (CAS) theory views healthcare as numerous sub-systems characterized by diverse agents that interact, self-organize, and continuously adapt. We apply this complexity science perspective to examine the extent to which CAS theory is a useful lens for designing and implementing health policies. We present the case of Health Links, a "low rules" policy intervention in Ontario, Canada aimed at stimulating the development of voluntary networks of health and social organizations to improve care coordination for the most frequent users of the healthcare system. Our sample consisted of stakeholders from regional governance bodies and organizations partnering in Health Links. Qualitative interview data were coded using the key complexity concepts of sensemaking, self-organization, interconnections, coevolution, and emergence. We found that the complexity-compatible policy design successfully stimulated local dynamics of flexibility, experimentation, and learning and that important mediating factors include leadership, readiness, relationship-building, role clarity, communication, and resources. However, we saw tensions between preferences for flexibility and standardization. Desirable developments occurred only in some settings and failed to flow upward to higher levels, resulting in a piecemeal and patchy landscape. Attention needs to be paid not only to local dynamics and processes, but also to regional and provincial levels to ensure that learning flows to the top and informs decision-making. We conclude that implementation of complexity-compatible policies needs a balance between flexibility and consistency and the right leadership to coordinate the two. Complexity-compatible policy for integrated healthcare is more than simply 'letting a thousand flowers bloom'.
International Journal of Integrated Care, 2017
International Journal of Health Policy and Management, 2022
Marten’s et al’s paper "Integration or Fragmentation of Health Care? Examining Policies and ... more Marten’s et al’s paper "Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study", offers an in-depth examination of integrated care policy efforts in Belgium. A key finding in this case study was that political fragmentation proved too great an obstacle for integration efforts. In this commentary, I draw on the organizational behaviour and integrated care literatures to suggest how meso-level mechanisms related to sensemaking, distributive leadership, and evaluation could help overcome policy (or macro) level challenges like those experienced in Belgium. The commentary also suggests we need to consider and address both the process and normative challenges in these transformation efforts.
Healthcare Policy, 2014
This paper focuses on accountability for the home and community care (HCC) sector in Ontario. The... more This paper focuses on accountability for the home and community care (HCC) sector in Ontario. The many different service delivery approaches, funding methods and types of organizations delivering HCC services make this sector highly heterogeneous. Findings from a document analysis and environmental scan suggest that organizations delivering HCC services face multiple accountability requirements from a wide array of stakeholders. Government stakeholders tend to rely on regulatory and expenditure instruments to hold organizations to account for service delivery. Semi-structured key informant interview respondents reported that the expenditure-based accountability tools being used carried a number of unintended consequences, both positive and negative. These include an increased organizational focus on quality, shifting care time away from clients (particularly problematic for small agencies), dissuading innovation, and reliance on performance indicators that do not adequately support ...
BMC Medical Informatics and Decision Making
Background Digital health technologies can support primary care delivery, but clinical uptake in ... more Background Digital health technologies can support primary care delivery, but clinical uptake in primary care is limited. This study explores enablers and barriers experienced by primary care providers when adopting new digital health technologies, using the example of the electronic Patient Reported Outcome (ePRO) tool; a mobile application and web portal designed to support goal-oriented care. To better understand implementation drivers and barriers primary care providers’ usage behaviours are compared to their perspectives on ePRO utility and fit to support care for patients with complex care needs. Methods This qualitative sub-analysis was part of a larger trial evaluating the use of the ePRO tool in primary care. Qualitative interviews were conducted with providers at the midpoint (i.e. 4.5–6 months after ePRO implementation) and end-point (i.e. 9–12 months after ePRO implementation) of the trial. Interviews explored providers’ experiences and perceptions of integrating the too...
BACKGROUND Digital health technologies have been proposed to support hospital to home transitions... more BACKGROUND Digital health technologies have been proposed to support hospital to home transitions for older adults. The COVID-19 pandemic and associated physical distancing guidelines propelled a shift to digital health technologies. However, the characteristics of older adults who participated in digital health interventions to support hospital to home transitions remain unclear. This information is needed to assess whether current digital health technologies are generalizable to the needs of broader older adult populations. OBJECTIVE We conducted a rapid review of the existing literature to: i) identify the characteristics of the populations targeted by studies testing the implementation of digital health interventions that are designed to support hospital to home transitions, ii) identify the characteristics of the samples included within studies testing digital health interventions used to support hospital to home transitions, and iii) create recommendations for enhancing the di...
International Journal of Integrated Care
International Journal of Integrated Care
This research seeks to identify what accountability frameworks were in place for the home and com... more This research seeks to identify what accountability frameworks were in place for the home and community care sector in the Canadian province of Ontario, how home and community care agencies in Ontario responded to accountability demands attached to government service funding (specifically through Community Care Access Centre (CCAC) contracts and Local Health Integration Network (LHIN) Multi-Service Accountability Agreements (MSAAs) and what, if any, effect accountability frameworks had on service
In the early 1990s Canada was in a recession and the government of Saskatchewan felt the pressure... more In the early 1990s Canada was in a recession and the government of Saskatchewan felt the pressure of a growing deficit. In 1992, the provincial government decided to reduce the health care budget by 3.3%. The following year, the government undertook regionalization of health care services through the Health Districts Act, with a focus on promoting preventative health care rather than solely treatment-based care. The budget cuts resulted in the closure of 52 rural hospitals, leading to a public outcry. Evaluations of the reform were not able to show a definite detrimental effect on health outcomes in the corresponding communities. Community members expressed increased caregiver burden, travel costs and travel time to the next nearest hospital, and potential inequalities in access to care. When undertaking reform, it is important that government consider the voices of local communities in the decision-making process. Au début des années 90, le Canada était en récession et, en Saskatchewan, le déficit budgétaire posait un problème pressant au gouvernement provincial. Celui-ci décida de réduire le budget de la santé de 3,3% en 1992. L'année suivante, le gouvernement mit en place une régionalisation des services de santé fondée sur la Loi sur les Districts de Santé, avec comme objectif de favoriser la prévention par rapport aux soins purement curatifs. 52 hôpitaux ruraux durent fermer à cause des coupes budgétaires, entraînant une réaction de rejet de la part du public. Les évaluations de la réforme n'ont pas pu établir avec certitude une détérioration de la santé dans les communautés concernées. Les habitants des communautés concernées ont exprimé une charge accrue pour les aidants, des coûts et temps de transports plus élevés pour se rendre à l'hôpital le plus proche, et d'éventuelles inégalités d'accès aux soins. Les voix des populations concernées devraient être écoutées lors de la prise de décision sur de telles réformes.
Canadian Family Physician Médecin de famille canadien, 2021
It is 2021. The imperative to move health care services outside of hospitals is evident. Before t... more It is 2021. The imperative to move health care services outside of hospitals is evident. Before the coronavirus disease 2019 (COVID-19) pandemic, Canadian media had switched its tune from “shorter surgical times” to demanding the end of “hallway medicine.” During the COVID-19 pandemic, the message is to keep patients safe at home and out of high-risk settings. With a greater focus on care received outside of the hospital, there is growing emphasis on the role played by communitybased care sectors and, in particular, family medicine. However, confusion remains around this sector, including terminology and the role it plays in keeping patients healthy in their communities. Clarity around terminology is essential to guide health system reform both in Canada and globally, and to ensure health system actors are using a single vocabulary. In this article, we clarify the distinctions between primary health care (PHC), primary care, and family medicine and highlight how family medicine is a...
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Papers by Carolyn Steele Gray