Maria Flink

Research problem and specific questionsCoordination of healthcare activities is of particular importance for older people in need of geriatric care as they often have multiple conditions and health related needs, requiring  care from several providers. The overall aim of this research project is to introduce and evaluate a person-centered care transition model that is currently being developed through co-creation with end-users to improve the coordination of care after discharge from geriatric inpatient care. The project is divided in three phases with the following research questions: (1) is the new care transition model feasible in a local setting? (2) is the care transition model effective when evaluated in a cluster randomized-controlled trial (RCT)? (3) what are the prerequisites for implementation and how do patients, next of kin and staff experience the care transitions process?Data and methodPhase I is a feasibility study where the new model will be evaluated in terms of fidelity, applicability and acceptability using focus groups, individual interviews and questionnaires. We will also evaluate the model’s preliminary effect on total costs after discharge, their distribution between payers, and rate of readmission using register data. In phase II and III a refined model (based on the results from the feasibility study) will be introduced and evaluated with an effect and process evaluation using the same type of methods as in phase I. The primary outcome in the cluster RCT will be total costs.Societal relevance and utilizationThis proposal targets the societal challenge of providing coordinated services between social services and healthcare to an aging population in a fragmented system. If coordination of care between different responsible providers of health and social care is improved, it may have significant positive impact for the older adults, involved staff, and the society. This project takes an overarching approach and evaluates costs across the health and social care system.Plan for project realizationFOU nu (asset manager) has a close collaboration with the geriatric departments in the region, the primary care centres and units within the municipalities as well as with patient representative organizations that we are collaborating with in the ongoing project. This, as well as ongoing collaborations with other R&D-units within the region, gives us an excellent possibility to ensure that the project is realized as described.

Research problem and specific questionsWorldwide, welfare societies strive to overcome fragmentation of services through increased integration. Despite this, evidence and support is lacking to guide local actors in social services and primary care on how to co-create integration with and for end users, such as older people. The aim is to, together with local actors and older people, develop and evaluate a research-based toolbox to integrate services for older people in need of both social services and primary care.What support do local actors need to co-create, test and monitor improvements of integrated services?What content, structure and design are needed in a toolbox to support local actors in co-creating, testing, and monitoring integrated services?What is the feasibility, perceived value, and impact of the toolbox?Data and methodThis participatory action research project comprises of three work packages (WP). In WP 1, we will use a participatory, longitudinal multiple case study design including four cases to explore actors’ need of support. In WP 2, we will use a Delphi-study design and participatory methods to develop the toolbox. In WP 3, we will use an observational case study design to evaluate feasibility, value, and impact. Data will be generated through structured and semi-structured observations, focus group and individual interviews, and surveys. Data will be analyzed with qualitative and quantitative methods.Societal relevance and utilisationA welfare society reform is launched in Sweden to integrate services and meet the needs of an aging population. However, the task of developing, implementing, and evaluating integrated services is a complex challenge that requires collaborative approaches, involving multiple stakeholders and end users. Yet, this task has been delegated primarily to local actors with limited decision-making mandates and possibilities to involve end users. The toolbox will support local actors with practical tools to co-create integrated services with and for older people.Plan for project realisationThe project will be conducted in collaboration between five Research and Development Units in Stockholm with partnering stakeholders in social services, primary care, and pensioner organizations. Costs for stakeholders’ involvement are included in the budget.

The purpose is to evaluate the effects of a self-management fall prevention program for people with multiple sclerosis (PwMS): Is the program effective in reducing number of falls in PwMS at 6- and 12-months? What contextual factors, mechanisms of impact and implementation aspects can likely explain the effects of the program? What is the cost effectiveness of the program at 12 months? The project is carried out by our interdisciplinary team including a person with MS. The team is experienced in fall prevention, self-management, and randomized control trials (RCT) with both qualitative and quantitative methods including health economic evaluations. The program is evaluated in a RCT regarding effect, process, and cost-effectiveness, with start spring 2024 and end of data collection in fall 2025. Recruited are 208 PwMS, ambulatory and non-ambulatory. Primary effect outcome is fall incidence. For process evaluation, interviews with a strategic sample of intervention PwMS and quantitative data from the program platform are used. For cost-effectiveness analysis, quantitative data is collected from program participants and national databases. Falls among PwMS are very common and associated with injuries, fear of falling, low health-related quality of life and high socioeconomic costs, due to the many injurious falls. There are very few self-management fall prevention programs

only our has been developed using a co-design process with PwMS and healthcare professionals.

Research problem and specific questionsFalls among people with multiple sclerosis (PwMS) are common and lead to fear of falling, injuries, impaired health and high societal costs. Fall prevention interventions should focus on development of self-management skills and include non-ambulatory PwMS. We have, in a co-design process, developed a digital group based self-management fall prevention program. The aim is to evaluate this program. Research questions: 1) Is the fall prevention program effective in reducing number of falls in PwMS at 6- and 12-months post-intervention? 2) What contextual factors, mechanisms of impact and implementation aspects can likely explain the effects of the intervention? 3) How do PwMS experience their fall prevention behaviours and strategies in daily life at 6- and 12-months post-intervention?Data and methodThe program is evaluated in a randomized control trial regarding effect and process by quantitative and qualitative methods, in line with recommendation for complex interventions. Recruited are 208 PwMS, ambulatory and non-ambulatory, who are randomised to intervention or control. Number of falls are monitored from allocation until 12-months post-intervention via SMS dispatches. Primary effect outcome is fall incidence. Secondary outcomes include fall prevention behaviours, fear of falling, fall-related self-efficacy, physical activity, participation in daily activities, and impact of MS on health. Semi-structured interviews with a strategic selection of intervention PwMS and quantitative data from the program platform are used for process evaluation.Societal relevance and utilizationThe program contributes to reduce inequalities in care and rehabilitation for PwMS as the digital format gives PwMS living in communities without specialized MS-centres the opportunity to participate. The program’s focus on development of self-management skills contributes to increase social participation in PwMS, and if number of falls are reduced to decrease costs for the individual and the society.Plan for project realizationThe project is carried out by our interdisciplinary research group with expertise in quantitative and qualitative methods and MS. A PhD student will be recruited. Four trained group leaders will deliver the intervention during year 2024. Data are collected before randomization and immediately after and 6- and 12-months post-intervention. Costs are associated with project personnel (PhD student and researchers).