Elisabeth Rydwik

Frågeställning Rehabilitering är grundläggande för all hälso- och sjukvård, eftersom god vård och folkhälsa inte kan uppnås utan tillgång till rehabilitering (WHO). Trots detta är forskning om effekten av hemrehabilitering för att förbättra äldre personers förmåga att utföra dagliga aktiviteter (ADL) och hälsorelaterad livskvalitet (HRQL) bristfällig. Det aktuella projektet syftar till att fylla denna kunskapslucka genom att utvärdera effekterna av en strukturerad hemrehabiliteringsintervention för äldre personer, kallad Re@home. Forskningsfrågor (FF): 1. Vilken effekt har Re@home jämfört med sedvanlig rehabilitering för äldre personer avseende a) förmåga att utföra ADL, b) HRQL, c) vårdutnyttjande och d) närståendes upplevda vårdbörda? 2. Hur upplever äldre personer och deras närstående sitt deltagande i Re@home? 3. Vilka hinder och möjligheter påverkar implementeringsprocessen och utfallet av Re@home? Data och metod Detta är en randomiserad kontrollerad klusterstudie som kommer att genomföras i Stockholm, Jönköping och Luleå, vilket speglar skillnader i befolkning, stad och glesbygd samt tillvägagångssätt för att organisera hemrehabilitering. Projektet följer Medical Research C ouncils ramverk för komplexa interventioner. Interventionen baseras på flera förstudier finansierade av Forte (Dnr 2021-01791)(litteraturöversikt, fältobservationer, intervjuer, en genomförbarhetsutvärdering och en mixad metodanalys av data från förstudierna). 180 deltagare över 65 år kommer att rekryteras från 12 hemrehabiliteringsenheter (4 kluster per site). Principerna för Re@home består av innehåll (personcentrerad bedömning och aktiviteter), strategier för att engagera de äldre i en gemensam beslutsprocess, interventionens längd samt kontext, som tar hänsyn till rehabilitering i hemmiljön. Arbetsterapeuter och fysioterapeuter vid enheterna kommer att delta i utbildning och få regelbundet stöd för att säkerställa följsamhet till interventionen. Primärt utfallsmått: förmåga att utföra ADL. Sekundära utfallsmått: HRQL, tillfredsställelse med interventionen, vårdkonsumtion samt närståendes situation (FF1). Intervjuer med de äldre och deras närstående kommer att genomföras för att fånga deras upplevelser av Re@home (FF2). Hinder och möjligheter för implementeringen kommer att utvärderas med fokusgrupper och enkäter (FF3). Samhällsrelevans och nyttiggörande Rehabilitering är avgörande för att förbättra förmågan att utföra ADL samt HRQL. Därför är det viktigt att äldre personer bjuds in till gemensamt beslutsfattande under hela interventionsprocessen vilket är i linje med personcentrerad rehabilitering och integrerad vård (SOU 2019:29). Detta projekt belyser vikten av vetenskapligt baserade hemrehabiliteringsinterventioner för att förbättra vård och rehabilitering för äldre personer. Effektiv rehabilitering som minskar kostnaderna för vård och omsorg är avgörande med tanke på de demografiska utmaningarna, inklusive ett ökande antal personer över 80 år med potentiella hälsoproblem (SoU 2016:2). Detta kombineras med färre personer som arbetar och bidrar med skatter till samhället samt bristen på och svårigheterna att rekrytera personal. Detta projekt kommer att bidra till att möta dessa samhällsutmaningar, och resultaten kan implementeras för att motverka dem. Genomförande Den multiprofessionella projektgruppen består av arbetsterapeuter, fysioterapeuter, socionom, sjuksköterska och en implementeringsforskare, alla väl erfarna forskare i den design som används i detta projekt. Vi ansöker om finansiering (4,9 miljoner) för tre år med kostnader främst relaterade till forskningspersonal och att möjliggöra att personal vid rehabiliteringsenheterna kan delta, datainsamling, dataanalys samt till att presentera våra resultat. Samarbete med rehabiliteringsenheter på alla platser pågår i förstudierna och kommer att fördjupas ytterligare, vilket är avgörande för att kunna genomföra projektet.

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 questions The overall aim is to develop models that support older adults´ participation in everyday activities that engage and lead to well-being where welfare technology is used to reduce the need for primary- and homecare.The needs of older adults at risk/ with frailty and significant others participating in interventions using digital technologies and what is needed for successful implementation will be studied together with the older adults, significant others, informal carer and staff.Research questions Can a prevention program using technology supporting engaging activities in everyday life reduce risk or maintain/delay the level of frailty in older adults? (project A)How can a prevention program that use technology support “Good quality, local health care “for frail older adults become a self-evident and integrated way of working as an addition to physical care within primary healthcare? (project A)Can a specialized homecare service (Reablement) using technology support older adults’ participation and engagement in everyday life while living at home? (project B)What are the needs of informal carer who provide support to older adults living with frailty at home? (project A-D)What are the systemic factors for and how can co-creation methods contribute to successful implementation of an intervention using technology directed towards older adults to improve primary care and homecare services? (project A-E)                                                                                                                                                                Data and method The interdisciplinary program is based on tested interventions using digital technology with positive effects in the context of older adult’s home. Five projects with qualitative and quantitative methods are planned. A digital platform will be used to compare data. With analyses from projects A-D, a model describing effects of implementation that can change and implement new interventions and working approaches using will be developed (project E).Relevance and utilisation In Europe, more than 1/3 of older adults &lt

75 years live with frailty that causes functional limitations with an impact on well-being of many older adults thats lead to high costs for tax-funded care.The home is an important arena and with an increase of older adults new working models are needed. The result will generate knowledge about how to use digital solutions for preventive efforts, more efficient primary- and homecare that enable participation in everyday life of older adults and support for relatives and staff.Plan for project realisation A close collaboration between staff in Region Stockholm/Uppsala, City of Stockholm, Huddinge municipality and researchers at Karolinska Institutet, Royal Institute of Technology and Uppsala University that will work closely to a reference group of older adults, significant others, and stakeholders.

Home rehabilitation for older people is widely implemented, but research on the content and the effectiveness of the rehabilitation interventions used in practice are scarce and we lack of knowledge of how home-rehabilitation units collaborate with social- and health care services. The aim is to evaluate the state of home rehabilitation in relation to scientific evidence and the effectiveness on older persons’ well-being, participation and ability in daily activities as well as the older persons satisfaction with the interventions, the collaboration between social service- and health care providers, and level of service utilization. The design is based on the realist evaluation method, where a defined program theory is used as a base for the evaluation. The main characteristic is to identify context, mechanism and outcomes of the target process. The project will be conducted in Jönköping, Luleå and Stockholm which reflects different parts of the country in relation to size and care organisations. During phase 1, a program theory is established through systematic searches of scientific and grey literature

extracting data, analyzes and synthesizing will be conducted and discussed during four workshops. During phase 2, the context and mechanisms of impact is explored at home-rehabilitation units at the three sites, through observations of interaction between staff and patients, patient record auditing, and focus groups and interviews. During phase 3, the effectiveness of home rehabilitation will be evaluated by patient record auditing, register data, questionnaires and interviews and will be analyzed in relation to the described program theory. An overarching analysis of what, for whom and under which circumstances that home rehabilitation leads to change will be conducted with data from all three phases using mixed methods. The results of identified mechanisms and relevant context factors will be related to the outcomes of effectiveness to identify outcome patterns.

Older adults make up approximately 20% of the Swedish population. The ongoing demographic development, with an ageing population and a continuously larger proportion of older adults, leads to continuously increasing demand for appropriate and efficient geriatric care. One particularly critical moment in the continuum of care for older adults is the transition between different responsible authorities, between regional and municipal care.The project consists of four phases and the aims are (I) to map and assess the situation in terms of health, care activities and resource use after discharge, (II) analyse associations with care-transition outcomes, (III) based on phase I-II, generate viable ideas for addressing and improving the situation, and (IV) implement new and improved ways of working as well as perform a post-implementation evaluation of effects (IV). The design of the study is closed cohorts based on registry data (phases I-II) together with an experience-based co-design (phase III), implementation and evaluation (phase IV).The data set leveraged in phases I-II consists of patient records from geriatric care, health care utilization data for six months after discharge extracted from the Stockholm Regional Healthcare Data Warehouse, socioeconomic data from Statistics Sweden, and data from the National Board of Health and Welfare on social services and death cause. In phase III, an experience-based co-design approach will be leveraged to develop a new model for the coordination of care, where the synthesised knowledge from phases I-II will be used as a base. In phase IV, the co-designed new model of coordination of care will be implemented. To be able to draw adequate conclusion from the outcome analyses, data on the process of implementation will be collected, and frequency of readmission will be the primary outcome measure to evaluate the effect of new ways of working. Costs of readmission will be computed before and after implementation.