Search

Food hypersensitivity (FHS) is a significant health issue that has extensive impacts on quality of life and mental health, causing stress, anxiety, and depression. One of the most challenging settings for managing FHS is eating food prepared outside the home (eating out) and is associated with an increased risk of accidental consumption of allergens. Citizen science may offer several advantages over conventional research methods for exploring experiences of FHS and eating out because of the personal connection that people have with the issue and the ability of the citizen science approach to provide more detailed and real-time information. In this study we piloted a co-designed FHS citizen science project to assess the extent and depth of participant engagement and motivations to participate, and the value of citizen science in FHS research. To do so, we constructed binomial and generalised linear models to predict conversion rate (from registrant to participant) and activity ratios, and we evaluated the completeness of responses. We also undertook a series of workshops and interviews, both before and after the project, with participants and project partners. A total of 121 individuals with FHS registered as citizen scientists, of which over half (52%) went on to contribute observations during the four-month data collection period. Activity ratios aligned with other citizen science projects despite the time and economic constraints upon the project regarding opportunities for eating out. We identified females, older participants (44+), and full-time employed and student participants as having higher engagement with the project. The combination of quantitative analyses and qualitative feedback indicated strong personal motivations and the importance of community in taking part. Overall, there appears good potential to utilise citizen science in food allergen research, and several practical recommendations for doing so are identified herein. [ABSTRACT FROM AUTHOR]

Background: Uptake of evidence-based care for acute myocardial infarction (AMI) is suboptimal in Tanzania, but there are currently no published interventions to improve AMI care in sub-Saharan Africa. Objectives: Co-design a quality improvement intervention for AMI care tailored to local contextual factors. Methods: An interdisciplinary design team consisting of 20 physicians, nurses, implementation scientists, and administrators met from June 2022 through August 2023. Half of the design team consisted of representatives from the target audience, emergency department physicians and nurses at a referral hospital in northern Tanzania. The design team reviewed multiple published quality improvement interventions focusing on ED-based AMI care. After selecting a multicomponent intervention to improve AMI care in Brazil (BRIDGE-ACS), the design team used the ADAPT-ITT framework to adapt the intervention to the local context. Findings: The design team audited current AMI care processes at the study hospital and reviewed qualitative data regarding barriers to care. Multiple adaptations were made to the original BRIDGE-ACS intervention to suit the local context, including re-designing the physician reminder system and adding patient educational materials. Additional feedback was sought from topical experts, including patients with AMI. Draft intervention materials were iteratively refined in response to feedback from experts and the design team. The finalized intervention, Multicomponent Intervention to Improve Myocardial Infarction Care in Tanzania (MIMIC), consisted of five core components: physician reminders, pocket cards, champions, provider training, and patient education. Conclusion: MIMIC is the first locally tailored intervention to improve AMI care in sub-Saharan Africa. Future studies will evaluate implementation outcomes and efficacy. [ABSTRACT FROM AUTHOR]

Introduction: Co-design has been cited as playing a major role in the future of effective integrated care, however, there is a lack of reporting and reflection on the methods used. Information sharing is fundamental when working in integrated care, however sharing across professions, service settings and localities can be complex. Through co-design, we seek to establish a shared understanding of information needs within a newly formed integrated care team. In doing so we aim to inform future practice in the understanding of co-design. Description: Co-design Workshop 1 (N = 24 participants, plus 6 facilitators), collected 'Current Position' understanding of service information needs. Co-design Workshop 2 (N = 18 participants, plus 6 facilitators) sought a 'Future Position' understanding, identifying solutions and next steps for establishing information-need solutions. Reflection on the co-design process was conducted to inform future co-design practices. Conclusion: Identified was a wide range of future service information needs under the themes of Culture Building, Health System Needs, and Processes. We conclude with 4 key learning points on co-designing. 1. Ensure simplicity in format. 2. Interdisciplinary co-design and co-facilitation of workshops are beneficial. 3. Planning and preparation are key. 4. Co-designing can enhance communication for service improvement. [ABSTRACT FROM AUTHOR]

Background: Uptake of evidence-based care for acute myocardial infarction (AMI) is suboptimal in Tanzania, but there are currently no published interventions to improve AMI care in sub-Saharan Africa. Objectives: Co-design a quality improvement intervention for AMI care tailored to local contextual factors. Methods: An interdisciplinary design team consisting of 20 physicians, nurses, implementation scientists, and administrators met from June 2022 through August 2023. Half of the design team consisted of representatives from the target audience, emergency department physicians and nurses at a referral hospital in northern Tanzania. The design team reviewed multiple published quality improvement interventions focusing on ED-based AMI care. After selecting a multicomponent intervention to improve AMI care in Brazil (BRIDGE-ACS), the design team used the ADAPT-ITT framework to adapt the intervention to the local context. Findings: The design team audited current AMI care processes at the study hospital and reviewed qualitative data regarding barriers to care. Multiple adaptations were made to the original BRIDGE-ACS intervention to suit the local context, including re-designing the physician reminder system and adding patient educational materials. Additional feedback was sought from topical experts, including patients with AMI. Draft intervention materials were iteratively refined in response to feedback from experts and the design team. The finalized intervention, Multicomponent Intervention to Improve Myocardial Infarction Care in Tanzania (MIMIC), consisted of five core components: physician reminders, pocket cards, champions, provider training, and patient education. Conclusion: MIMIC is the first locally tailored intervention to improve AMI care in sub-Saharan Africa. Future studies will evaluate implementation outcomes and efficacy.

Introduction: Integrated care research often fails to adequately describe co-design methods. This article outlines the process, principles and tools to co-design an integrated health and social care Hub for families experiencing adversity. Research methods: The Child and Family Hub was co-designed in four stages: (1) partnership building and stakeholder engagement, (2) formative research, (3) persona development and (4) co-design workshops and consultations. Local families, community members and intersectoral practitioners were engaged at each stage. The co-design workshops employed a human-centred design process and were evaluated using the Public and Patient Engagement Evaluation Tool (PEET). Results: 121 family participants and 80 practitioners were engaged in the Hub’s codesign. The PEET highlighted the co-design team’s satisfaction achieved by community members working alongside practitioners to generate mutual learning. Resourcing was a key challenge. Discussion: Human-centred design offered a systematic process and tools for integrating formative evidence with lived and professional experience in the Hub’s codesign. Applying community engagement principles meant that a diverse range of stakeholders were engaged across all stages of the project which built trust in and local ownership of the Hub model. Conclusion: Co-design research with families experiencing adversity should attend to language, engagement methods, team composition and resourcing decisions. [ABSTRACT FROM AUTHOR]

This methods paper describes a new UK-wide citizen science project, the Schools' Air Quality Monitoring for Health and Education (SAMHE) project, which is exploring indoor air quality (IAQ) in schools. Central to the project is a Web App, where school teachers and pupils can see air quality and environmental data from their classroom, learn about the significance of the data that their monitor collects, enter important contextual information to support data analysis by researchers, and are supported to do their own experiments related to air quality. School use of the SAMHE Web App is essential to the project's aims to 1) improve understanding of air quality in schools; 2) empower teachers and pupils to make informed decisions about management of their classroom environment, including ventilation; and 3) support the UK's next generation to think differently about air quality. Therefore, it is critical that the SAMHE Web App was co-designed with schools, to maximise its acceptability within schools, and to ensure that teachers and pupils engage with it. This paper describes the co-design process used within SAMHE, how co-design has helped shape the web app (including overall theme, visualisation of data, and supporting materials), and some lessons learned from the process that will be useful for future software development and citizen science projects with schools. [ABSTRACT FROM AUTHOR]

As the citizen science (CS) community flourishes, there is an opportunity to reflect on how practitioners can widen participation and work with participants as co-researchers to investigate and take action around global challenges. Through the lens of one CS case study, the X-Polli:Nation project, we report on how technologists, ecologists, and education specialists repurposed older projects by cross-pollinating ideas with children and teachers in the UK and in Italy to create Artificial Intelligence-enhanced tools appropriate for teaching sustainability in schools. Taking part in an actionable CS cycle, children learn about pollinating insects, record scientific data, create flowering habitats, and communicate their importance. Through this process, X-Polli:Nation demonstrates relevance across a number of Sustainable Development Goals (e.g., SDG 4, Quality Education; SDG 10, Reducing Inequality; and SDG 15, Life on Land), and applies the underlying SDG principle "leave no one behind." We go on to investigate if, and how, young people would like to deepen their engagement with the SDGs, and we report that taking action and communicating the importance of the SDGs were of paramount interest. The challenge of building sustainability into an already crowded curriculum can be alleviated by understanding its value, considering the audience, and adapting to new contexts. The considerable benefits include raising awareness about global sustainability issues and giving children the confidence to become passionate environmental stewards, all the while extending the life of older projects and thus making CS methods sustainable too. [ABSTRACT FROM AUTHOR]

Introduction: Co-design has been identified as a participatory method to create person-centred integrated healthcare services that align with older people’s values and lived experiences. Description: Existing guidelines on conducting co-design primarily focus on in-person methods with limited guidance on using digital methods to collect data. This gap in knowledge is particularly pertinent when co-designing with older people who can experience challenges with digital literacy and accessibility. This article uses the exemplar of a pilot site within a European co-design research project, aiming to create digital health technology to support integrated care, to describe the steps and considerations required when collaborating with older people in an online environment. Focus groups and one-to-one interviews were conducted utilising digital mediums of teleconferencing and telephone calls to engage and collaborate with older people. Discussion: Several preparatory steps are required to effectively bridge the digital divide and conduct co-design with older people including engaging gatekeepers, relationship and trust-building, assessing digital literacy levels, education and providing technological support. Conclusion: This article highlights the steps and considerations that researchers should be aware of when embarking on co-designing with older people in a digital setting. The authors describe their methods that promotes inclusivity and the empowerment of older people as equal collaborators in the research process. The co-design approach and recommendations can be applied to various research settings and wider areas of integrated care with this population.

Introduction: Co-design has been identified as a participatory method to create person-centred integrated healthcare services that align with older people’s values and lived experiences. Description: Existing guidelines on conducting co-design primarily focus on inperson methods with limited guidance on using digital methods to collect data. This gap in knowledge is particularly pertinent when co-designing with older people who can experience challenges with digital literacy and accessibility. This article uses the exemplar of a pilot site within a European co-design research project, aiming to create digital health technology to support integrated care, to describe the steps and considerations required when collaborating with older people in an online environment. Focus groups and one-to-one interviews were conducted utilising digital mediums of teleconferencing and telephone calls to engage and collaborate with older people. Discussion: Several preparatory steps are required to effectively bridge the digital divide and conduct co-design with older people including engaging gatekeepers, relationship and trust-building, assessing digital literacy levels, education and providing technological support. Conclusion: This article highlights the steps and considerations that researchers should be aware of when embarking on co-designing with older people in a digital setting. The authors describe their methods that promotes inclusivity and the empowerment of older people as equal collaborators in the research process. The co-design approach and recommendations can be applied to various research settings and wider areas of integrated care with this population. [ABSTRACT FROM AUTHOR]

Introduction: Despite the national and international policy commitment to implement integrated health systems, there is an absence of national standards that support evidence-based design, implementation, and monitoring for improvement. Health Standards Organization (HSO)’s CAN/HSO 76000:2021 –Integrated People-Centred Health Systems(IPCHS) National Standard of Canada (NSC) has been developed to help close this gap. This manuscript outlines the policy context and the process taken to develop the IPCHS standard. Description: The IPCHS standard is built around 10 design principles with detailed, action-oriented criteria and guidance for policy makers and health system partners. The IPCHS standard was co-designed with a technical committee that included balanced representation of policy makers, health system decision-makers, Indigenous leaders, providers, patients, caregivers, and academics. Additional feedback was received from a diverse audience during two public review periods and targeted consultation via interviews. This qualitative feedback, combined with the evidence reviews completed by the technical committee, informed the final content of the IPCHS standard. Discussion: The IPCHS standard was developed through a co-design process and complements existing frameworks by providing 66 detailed, action-oriented criteria, with specific guidance. The co-design process and consultations resulted in increased awareness and capacity among policy makers and health system partners. Supplementary tools are also in development to facilitate implementation and monitoring of progress and outcomes. This manuscript was developed in collaboration with technical committee members and HSO staff who led the targeted consultation and adoption of the IPCHS standard in six integrated care networks. Conclusion: Implementing integration strategies requires that we create and sustain a culture of continuous improvement and learning. Key lessons from the development process focused on the importance of co-design, embedding people-centred practices throughout the standard, formal yet iterative methodology inclusive of broad consultation, clear accountability for both policy makers and system partners, tools that support action and can be adapted to local context and level of integrated system maturity.

Introduction: Despite the national and international policy commitment to implement integrated health systems, there is an absence of national standards that support evidence-based design, implementation, and monitoring for improvement. Health Standards Organization (HSO)'s CAN/HSO 76000:2021 -- Integrated People-Centred Health Systems (IPCHS) National Standard of Canada (NSC) has been developed to help close this gap. This manuscript outlines the policy context and the process taken to develop the IPCHS standard. Description: The IPCHS standard is built around 10 design principles with detailed, action-oriented criteria and guidance for policy makers and health system partners. The IPCHS standard was co-designed with a technical committee that included balanced representation of policy makers, health system decision-makers, Indigenous leaders, providers, patients, caregivers, and academics. Additional feedback was received from a diverse audience during two public review periods and targeted consultation via interviews. This qualitative feedback, combined with the evidence reviews completed by the technical committee, informed the final content of the IPCHS standard. Discussion: The IPCHS standard was developed through a co-design process and complements existing frameworks by providing 66 detailed, action-oriented criteria, with specific guidance. The co-design process and consultations resulted in increased awareness and capacity among policy makers and health system partners. Supplementary tools are also in development to facilitate implementation and monitoring of progress and outcomes. This manuscript was developed in collaboration with technical committee members and HSO staff who led the targeted consultation and adoption of the IPCHS standard in six integrated care networks. Conclusion: Implementing integration strategies requires that we create and sustain a culture of continuous improvement and learning. Key lessons from the development process focused on the importance of co-design, embedding people-centred practices throughout the standard, formal yet iterative methodology inclusive of broad consultation, clear accountability for both policy makers and system partners, tools that support action and can be adapted to local context and level of integrated system maturity. [ABSTRACT FROM AUTHOR]

Introduction: Multiple neurodevelopmental problems affect 7–8% of children and require evaluation by more than one profession, posing a challenge to care systems. Description: The local problem comprised distressed parents, diagnostic processes averaging 36 months and 28 visits with 42% of children >4 years at referral to adequate services, and no routines for patient involvement. The co-design project was developed through a series of workshops using standard quality improvement methodology, where representatives of all services, as well as parents participated. The resulting integrated care model comprises a team of professionals who evaluate the child during an average of 5.4 appointments (N = 95), taking 4.8 weeks. Parents were satisfied with the holistic service model and 70% of children were under 4 at referral (p < 0.05). While 75% of children were referred, 25% required further follow-up by the team. Discussion: The Optimus model has elements of vertical, clinical and service integration. Reasons for success included leadership support, buy-in from the different organisations, careful process management, a team co-ordinator, and insistent user involvement. Conclusion: Evaluating multiple neurodevelopmental problems in children requires an integrated care approach. The Optimus care model is a relevant showcase for how people-initiated integrated care reforms can make it into usual care.

Introduction: The implementation of people-centred care requires strategies that respond to local conditions and contexts, with the participation of local stakeholders in collaborative approaches such as co-design. Within this framework, the authors performed a literature review to identify the most implemented practices in health and social care services for co-designing digital solutions. Methods: The literature review was conducted following five steps: (i) Definition of the Keywords and their relations; (ii) Definition of the selection criteria; (iii) Search in PubMed; (iv) Selection of papers; and (v) Analysis of the selected papers. Results: 20 papers addressed to co-design health digital solutions with stakeholders were analysed in terms of the activities implemented and participants involved. Discussion: Previous studies using co-design methods for the deployment of health digital solutions employed a wide range of activities, most of them combining activities and/or mixed target groups. Conclusion: Co-design is the key to deliver people-centred care as it allows to involve stakeholders in the development of health digital solutions. Implementing one or more of the co-design methods identified in this literature review should be considered to better address the needs and specific projects and target groups.

Introduction: The Carer Support Unit (CSU) of the Central Coast Local Health District (CCLHD), NSW, Australia, developed, trialled and implemented a Carer Readiness Tool (CRT) to help carers gauge their readiness to care at home, highlight to hospital staff areas for additional support for carers, and provide evidence of carer engagement in discharge planning. Description: A rigorous co-design process was followed with carer consultation at key milestones in development of the CRT. The tool was piloted in two cancer/chronic renal disease inpatient units commencing November 2019. Discussion: The CRT was well-received by carers who appreciated the opportunity to complete the tool in their own time, not in front of the patient. Positive feedback was received from clinicians, including the breadth of the CRT’s content which contributed to better discharge planning. The need to manually incorporate a hard copy form into the electronic medical record is a limitation of the CRT. Conclusion: The CRT is context-specific and fit for purpose. During the development of the CRT, the project team focused on the face validity and usefulness of the tool. The next stage of the project will be formal evaluation of the tool to measure its impact.

Introduction: The implementation of people-centred care requires strategies that respond to local conditions and contexts, with the participation of local stakeholders in collaborative approaches such as co-design. Within this framework, the authors performed a literature review to identify the most implemented practices in health and social care services for co-designing digital solutions. Methods: The literature review was conducted following five steps: (i) Definition of the Keywords and their relations; (ii) Definition of the selection criteria; (iii) Search in PubMed; (iv) Selection of papers; and (v) Analysis of the selected papers. Results: 20 papers addressed to co-design health digital solutions with stakeholders were analysed in terms of the activities implemented and participants involved. Discussion: Previous studies using co-design methods for the deployment of health digital solutions employed a wide range of activities, most of them combining activities and/or mixed target groups. Conclusion: Co-design is the key to deliver people-centred care as it allows to involve stakeholders in the development of health digital solutions. Implementing one or more of the co-design methods identified in this literature review should be considered to better address the needs and specific projects and target groups. [ABSTRACT FROM AUTHOR]

Introduction: Multiple neurodevelopmental problems affect 7-8% of children and require evaluation by more than one profession, posing a challenge to care systems. Description: The local problem comprised distressed parents, diagnostic processes averaging 36 months and 28 visits with 42% of children >4 years at referral to adequate services, and no routines for patient involvement. The co-design project was developed through a series of workshops using standard quality improvement methodology, where representatives of all services, as well as parents participated. The resulting integrated care model comprises a team of professionals who evaluate the child during an average of 5.4 appointments (N = 95), taking 4.8 weeks. Parents were satisfied with the holistic service model and 70% of children were under 4 at referral (p < 0.05). While 75% of children were referred, 25% required further follow-up by the team. Discussion: The Optimus model has elements of vertical, clinical and service integration. Reasons for success included leadership support, buy-in from the different organisations, careful process management, a team co-ordinator, and insistent user involvement. Conclusion: Evaluating multiple neurodevelopmental problems in children requires an integrated care approach. The Optimus care model is a relevant showcase for how people-initiated integrated care reforms can make it into usual care. [ABSTRACT FROM AUTHOR]

Introduction: Increased interest in collaborative and inclusive approaches to healthcare improvement makes revisiting Elinor Ostrom’s ‘design principles’ for enabling collective management of common pool resources (CPR) in polycentric systems a timely endeavour. Theory and method: Ostrom proposed a generalisable set of eight core design principles for the efficacy of groups. To consider the utility of Ostrom’s principles for the planning, delivery, and evaluation of future health(care) improvement we retrospectively apply them to a recent co-design project. Results: Three distinct aspects of co-design were identified through consideration of the principles. These related to: (1) understanding and mapping the system (2) upholding democratic values and (3) regulating participation. Within these aspects four of Ostrom’s eight principles were inherently observed. Consideration of the remaining four principles could have enhanced the systemic impact of the co-design process. Discussion: Reconceptualising co-design through the lens of CPR offers new insights into the successful system-wide application of such approaches for the purpose of health(care) improvement. Conclusion: The eight design principles – and the relationships between them – form a heuristic that can support the planning, delivery, and evaluation of future healthcare improvement projects adopting co-design. They may help to address questions of how to scale up and embed such approaches as self-sustaining in wider systems.

Citizen science is increasingly recognized as a valid research methodology by the research community and policy makers alike. In our experience, however, citizen science is sometimes used as a catchall term for activities that involve scientific and democratic innovation, resource efficiency in scientific processes, outreach, and education. We fear that this use of the term citizen science risks undermining the recognition of citizen science in academia as well as among citizen scientists and the general public in the longer term. Informed by these concerns, we report on a transdisciplinary attempt to establish quality criteria to decide in a transparent manner which citizen science projects are listed on Österreich forscht, an Austrian citizen science platform that is based on an established network of citizen scientists, academic researchers, funding institutions, and research institutions. We present 20 quality criteria and their relationship to existing literature, and describe the process by which they were formulated over a one-year period: a series of transdisciplinary exchanges, concerning what shape citizen science should take in the particular context of Austria, and the potential implications of certain quality criteria for individual disciplines and practitioners. While we realize that any demarcation process is bound to produce exclusionary effects, we argue that the bottom-up, transdisciplinary nature of our working group was a necessary step for Österreich forscht to strengthen its identity and purpose.

Introduction: Virtual Communities of Practices (vCoP) offer patients the possibility to interact and share tools and knowledge necessary for their empowerment. This paper describes the co-design process of a vCoP for the empowerment of people with ischemic heart disease (IHD). Methods: We used a modified experience-based design approach to co-design the vCoP in collaboration with people with IHD and health professionals consisting of two phases: exploratory and development phase. Data collection techniques included listening labs, workshops, and online participation. Results: Twenty-five people with IHD and ten health professionals participated. Experiences and needs for empowerment in IHD were identified in the exploratory phase allowing for the development of a Patient Journey Map. In the development phase, people with IHD prioritized needs to be addressed by the vCoP content framework in addition to content proposals. Discussion: The Patient Journey Map helped to easily visualize the empowerment needs of people with IHD and it might be transferable for the development of other people-centred interventions. The co-design process also allowed the development of training materials adapted to the priorities of people with IHD. Conclusion: A people-centred co-design process of a vCoP may facilitate the empowerment of people with IHD.

Introduction: Increased interest in collaborative and inclusive approaches to healthcare improvement makes revisiting Elinor Ostrom's 'design principles' for enabling collective management of common pool resources (CPR) in polycentric systems a timely endeavour. Theory and method: Ostrom proposed a generalisable set of eight core design principles for the efficacy of groups. To consider the utility of Ostrom's principles for the planning, delivery, and evaluation of future health(care) improvement we retrospectively apply them to a recent co-design project. Results: Three distinct aspects of co-design were identified through consideration of the principles. These related to: (1) understanding and mapping the system (2) upholding democratic values and (3) regulating participation. Within these aspects four of Ostrom's eight principles were inherently observed. Consideration of the remaining four principles could have enhanced the systemic impact of the co-design process. Discussion: Reconceptualising co-design through the lens of CPR offers new insights into the successful system-wide application of such approaches for the purpose of health(care) improvement. Conclusion: The eight design principles - and the relationships between them - form a heuristic that can support the planning, delivery, and evaluation of future healthcare improvement projects adopting co-design. They may help to address questions of how to scale up and embed such approaches as self-sustaining in wider systems. [ABSTRACT FROM AUTHOR]

Background: Effective models for complex patients in primary care require appropriate targeting, engagement of patients and caregivers, and coordination with other services (McCarthy et al., 2015). A large national project, funded by the Canadian Frailty Network, aims to co-design and implement a model in primary care that includes risk-stratification, patient engagement and care coordination techniques for older Canadians living with frailty. This presentation focuses on the process of implementing the intervention in primary care sites in Canada. Methods: Grounded in frameworks for implementation, the Consolidated Framework for Implementation Research (CFIR; Damschroder et al., 2009) and The Behaviour Change Wheel (BCW; Michie et al., 2011), researchers worked with eight primary care sites (urban and rural) in three Canadian provinces. Project implementation was completed in two phases. Pre-implementation: individual and focus group interviews with providers (n=35) and older adults (n=8) were conducted to understand current care practices and plan for implementation. Intervention was co-designed with staff and older adults. Implementation: Researchers worked with primary care sites to train staff and support implementation. Monitoring of the implementation process included Interviews with providers (n=15) and field notes. Data were analyzed using directed coding, following the CFIR and BCW. Results: A number of learnings emerged during the implementation phases. Buy-in was required from the entire team as well as management. Team members provided meaningful information to guide implementation, which contributed to a sense of ownership of the process. It was important that intervention components were tailored to the needs at each site. Ongoing and frequent discussions with the team was necessary to support successful implementation. Scheduling meetings and training sessions for staff was challenging due to the length of time away from direct patient care. Discussion/Conclusion: A new primary care model for complex patients that included risk-screening, care coordination, patient engagement and shared decision-making, was implemented in eight primary care sites. Lessons from this project will be used to guide future implementation of similar interventions in other primary care sites. Lessons learned: Implementation of a complex intervention takes time. A significant amount of time should be dedicated to the pre-implementation phase for appropriate co-development of resources. Implementation planning should be done in partnership with primary care providers to increase buy-in and older adults. Limitations: This project was only completed in team-based primary care settings. Suggestions for future research: This work was completed in team-based settings and involved non-physician roles to carry out the intervention. More work is needed to understand how this model would need to be adapted in other primary care settings. References: 1- McCarthy, D. Models of care for high-need, high-cost patients: An evidence synthesis. Commonwealth Fund Publications. 2015. 2- Damschroder, L. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci, 2009; 4(1), 50. 3- Michie, S. The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 2011;6, 42.

Introduction: Over the past two decades, Australia’s child population has grown by 12%, yet fewer children are seen by General Practitioners (GP) (Freed, 2011) and more present to emergency departments (Freed, 2015) and hospital outpatient clinics for relatively simple conditions that could be managed in primary care. We therefore aimed to co-develop and pilot an innovative, integrated GP-paediatrician care model and test its feasibility and acceptability to GPs, families and paediatricians, across 5 Victorian (Australia) general practices. Theory/Methods: GP and paediatrician co-design of an integrated care model comprising: weekly GP-paediatrician co-consulting sessions and monthly hour-long case discussions at each practice led by GPs and facilitated by a paediatrician, and email/telephone support to GPs by paediatricians. Paediatricians recorded data on numbers of children and types of cases seen in co-consults and number and topics and number of attendees in the case discussions. We extracted data on quality of GP care for common conditions and pre/post referral patterns of GPs via GHRANITE electronic medical record data extraction software. GP and paediatrician satisfaction with model of care and family satisfaction with GP care for their child were collected via surveys. Results: After 9 months of implementation, 447 children were seen in co-consults and 27 case discussion sessions were conducted with 206 attendees. GPs report high satisfaction with the model and changes in their knowledge and confidence with paediatric care. GPs referred 9% fewer children to hospital and families reported improved confidence in thier GP's care (complete confidence from 78% to 94%) and increased first preference for followup care with a GP (65.4% to 82.8%). Discussion: A novel, integrated model of care between GPs, paediatricians and families is feasible and acceptable to GPs, general practice staff, paediatricians and families. Challenges include ensuring accurate and complete data on GP referral patterns, payment for the co-consulting sessions, and clear communication to practice staff and parents about the role of the paediatrician as a co-consultant with the GP rather than a stand-alone specialist care provider. Conclusions: Developing and embedding a GP-paediatrician model of integrated care in Australia’s primary health care system is feasible and acceptable. Pilot data suggest that the model improves GP confidence to manage paediatric care, streamlines specialist care for child developmental/behavioural problems and may reduce referrals to hospital outpatient clinics and emergency departments. Lessons learned: Intervention design must involve paediatricians, GPs, practice managers and practice administrative staff from the outset. Mutual expectations and clear roles and responsibilities of GPs and paediatricians in co-consultations must be established. Careful attention to messaging to families about the nature of co-consultations will avoid families seeking a paediatrician without a GP. Limitations: pilot study Future research: controlled trial to test the costs and effectiveness of this model in improving GP quality of care for common paediatric health conditions, reducing referrals to outpatient specialist clinics and emergency departments, improving GP confidence in paediatric care, and family satisfaction with primary care for their child.

Background: Integrated Care in Australia has mostly been implemented as micro-level initiatives rather than systemically, which has challenged its sustainability [1]. South Eastern Sydney Local Health District (SESLHD) and the Central and Eastern Sydney Primary Health Network (CESPHN) have sought to scale the benefits of existing micro-level strategies, such as inter-disciplinary coordination, coordination, and person-centred care, in order to increase population-level impacts and enhance sustainability. The focus of their joint Integrated Care Strategy has shifted towards implementation of meso- and macro-level integrated care programs [2]. This paper presents an overview of the evolution, implementation and evaluation of this novel program. About the IC Program: The centrepiece of the revamped Strategy is three interlinked programs, based on Bodenheimer’s 10 building blocks [3]: 1) General Practice 2020:a quality improvement activity in general practice involving practice teams. 2) Care Coordination: a model of service involving Clinical Nurse Consultants and a social worker. 3) Talking Wellbeing:a co-produced salutogenic initiative based in general practice. Th objectives of these programs are to: Strengthen partnerships and integration. Support general practice to transition towards a person-centred medical neighbourhood (PCMN) model. Establish a sustainable, localised care coordination model. Build connections and experiences that enhance individual and collective wellbeing. The PCMN model is an Australian federal government initiative, similar to the health care home concept [4]. Desired outcomes of the PCMN are aligned with the quadruple aim [5]. Evaluation: The three programs will be evaluated at: (i) consumer, (ii) provider, and (iii) service levels. The overall analytic approach is informed by Normalisation Process Theory [6], with emphasis on the impact, acceptability, feasibility, sustainability, and scalability of the Strategy. Data will be collected at 6, 12 and 18 months points following implementation. Implications for Integrated Care: Lessons learnt from the evolution and and implementation of the three programs that make up the Strategy will have relevant to integrated care in other settings. References: 1- Angus L and Valentijn PP (2018). From micro to macro: assessing implementation of integrated care in Australia. Australian Journal of Primary Health. 24;59-65. 2- Stewart G, Bradd P, Bruce T, et al (2017). Integrated care in practice – the South Eastern Sydney experience. Journal of Integrated Care. Vol.25;No.1:49-60. 3- Bodenheimer T, Ghorob A, Willard-Grace R and Grumbach K (2014). The 10 building blocks of high-performing primary care. Annals of Family Medicine. Vol.12;No.2;166-171. 4- Grant R and Greene D (2012). The Health Care Home Model: Primary Health Care Meeting Public Health Goals. American Journal of Public Health. Vol.102;No.6:1096-1103. 5- Bodenheimer T and Sinsky C (2014). From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Annals of Family Medicine. Vol.12;No.6;573-576. 6- May CR, et al (2018). Using Normalization Process Theory in feasibility studies and process evaluations of complex healthcare interventions: a systematic review. Implementation Science. 13(1):80.

Introduction: Health apps are dynamic, versatile, illustrative tools that allow patient empowerment, healthy habits improvement, health data monitoring/storage, diagnosis and direct health provision. The initiatives that attempt to define their evaluation, account incomplete aspects. The objective of the AQuAS-UOC mHealth research group is to develop a tool for a comprehensive evaluation of mHealth interventions - in general and for overweight and obesity in particular-, considering the expertise of developers, health professionals, health technology assessment agencies and users/patients. Theory/Methods: During 2015, initial workshops were undertaken with mHealth experts to assess the necessity of developing an evaluation tool and classifying apps according to their risk. Focus groups were also conducted with users, health professionals and technicians to explore mHealth evaluation needs. A literature search is allowing the identification of mHealth evaluation initiatives and establishing an initial pool of criteria for their evaluation. Next steps include the agreement of a) those criteria and domains to be included in the tool through a Delphi technique, and b) the format of the tool through focus groups/workshops. Results: Initial workshops and focus groups led to a publication of a theoretical framework for mHealth assessment in which, ideally, a chosen set of domains and subdomains should address the appropriate use of each mhealth solution, develop expedited and conclusive methods to evaluate them, assess mHealth solution risk and inform stakeholders of relevant results. For the content to be included in a general tool and for a more specific one (targeted to weight management apps), 95 and 114 criteria were listed respectively and grouped in 10 domains: app purpose, privacy/security, clinical evidence, intervention content, user experience, usability, interoperability, costs, organizational impact, and legal/ethical issues. Mixed methods (data tracking, validated and ad-hoc questionnaires and qualitative research) are used to asses them. Final tool will be developed once qualitative research (focus groups with different stakeholders) will be conducted. Discussion: A high number (unmanageable in practice) of criteria for mHealth assessment were identified; Delphi techniques, focus groups and workshops with professionals, app developers and technicians from health assessment agencies should help to prioritize, reduce and define the tool. Conclusions: The tool must support the process of evaluating mHealth solutions and help key agents to make informed decisions when developing, integrating, selecting, recommending, implementing or adopting mHealth solutions. The tool will help identifying those solutions that provide value to patients, health professionals and health system. Lessons learned: - An agreed content and format of the tool can maximized its use. - mHealth evaluation should be in constant adaptation to changes in standards and find an equilibrium between its development and implementation. Limitations: - Initial workshops and literature search was done at an international level, however, qualitative techniques (Delphi and focus groups) are being done with Spaniards professionals and end-users. - High heterogeneity among mhealth assessment tools; most instruments used are not yet validated. - The constant and rapid development of new mHealth solutions demands a continuous update and review of the assessment tool. Suggestions for future research: The developed tool should be piloted on existing mHealth initiatives

Introduction: In Australia, the Queensland Child Protection Commission of Inquiry¹ highlighted that children and young people entering ‘Out-of-home care’ (OOHC) are under-immunised, experience higher prevalence of developmental delays, poor oral health, higher rates of mental health problems and substance misuse compared to those not in care. In an Australian context OOHC is ‘the care of children aged 0 –17 yearswho are unable to live with their primary caregivers. It involves the placement of a child with alternate caregivers on a short- or long-term basis’². Short description of practice change implemented: As Queensland’s largest city, with a population of approximately 2.4 million, metropolitan Brisbane has an estimated 925 children and young people (0 -17yrs) who at any one time live in OOHC. Improving health outcomes for these children and young people was identified as a priority by the Queensland Department of Child Safety Youth and Women (DCSY&W). Children’s Health Queensland Hospital and Health Service (CHQ) has partnered with the DCSY&W – Brisbane Region, and the Brisbane Aboriginal and Torres Strait Islander Community Health Service (ATSICHS) to co-design and implement an integrated interagency approach to improving the health and wellbeing outcomes of this vulnerable population. Aim and theory of change: The Navigate your Health (NYH) initiative is a ‘health navigator’ model designed to provide this population with improved access to health and developmental assessments, primary, secondary and tertiary health care and other social services to address and/or support identified health and social care needs. Through a process of co-design, the program is leading sustainable system-wide change by developing and implementing processes and pathways that mitigate the risks associated with single person or single agency solutions. Targeted population and stakeholders: The targeted population are all children and young people who enter OOHC during the two-year pilot period, and a proportion of children and young people already in OOHC. The major stakeholders are the DCSY&W, and the Brisbane ATSICHS, GPs, other health providers within the Brisbane region catchment. Timeline: The pilot program is running over a two-year period from January 2018 – January 2020. Highlights (innovation, Impact and outcomes): As of August 2018, over 250 children and young people have been referred to the program with 32% of referrals for Aboriginal and Torres Strait Islander children. Intensive case management has been required for 36% of referrals. Comprehensive health and development profiles have been completed for 75% of referrals. Sustainability: This project is a proof of concept for a replicable and sustainable model of service delivery that can be scaled to meet the unique local needs of other jurisdictions across Queensland. Transferability: Navigate your Health can be adapted to other jurisdictions. Conclusions, discussion and lessons learned: Early impact evaluation has indicated a number of significant improvements in both individual health outcomes in addition to system reform through enhanced service integration and collaboration. References: 1- State of Queensland, Queensland Child Protection Commission of Inquiry 2013. 2- Australian Government, Department of Human Services, 2007.

People-centred and evidence-based standards focused on system integration are quintessential to improving the quality of people’s care experiences and health outcomes. For example, by 2020, chronic conditions will account for almost three-quarters of all deaths worldwide. Individuals with chronic conditions require long-term, complex health and social services supports that optimize collaboration and coordination between care professionals and sectors. Integrated care means seamless care that is delivered and supported by a team of providers, that meets peoples’ needs over their lifetime. HSO’s Integrated People-Centred Health and Social Services (IPCHSS) standard is a co-designed, evidence-based tool that equips decision-makers with criteria and resources for planning, implementing and assessing the coordination of services and supports across the continuums of care. Health and social service decision makers around the world are challenged to design and deliver solutions that are sustainable and ensure accountabilities. This involves ensuring that appropriate, coordinated and comprehensive care is delivered based on priority high-need populations; and that resources are allocated in an equitable and ethical manner. Building the confidence of patients and families, that assures care is safe and of the highest quality, entails promoting a shared culture of people-centred care. Anchored on people-centered principles, HSO’s IPCHSS standard can be used by jurisdictions to engage and empower people, providers and communities; strengthen governance and accountability; and coordinate services within and across sectors to create an enabling and integrated environment. The IPCHSS standard is targeted to jurisdictions, including health and social ministries, administrators or authorities, who are accountable for funding, planning, coordinating, delivering and/or evaluating health and social services in their local communities. The standard will benefit people and populations with chronic conditions, noncommunicable diseases, mental health needs and multi-morbidities; and others whose care pathways require touch-points with providers from across the continuum of care. Applying co-design principles, processes and techniques to the IPCHSS standard allowed for a person-centered approach to identifying integrated care problems and solutions. The Technical Committee (TC), composed of experts including patients and caregivers (3), policy makers (4), providers (3), subject matter experts (4) and advisors (2), brought a rich diversity of values, approaches and experiences that surfaced lessons of knowledge power-sharing and valuable participatory design. Targeted stakeholder consultations, involving interviews with over thirty ministries, administrations, authorities, providers, patients and caregivers reinforced that integration is context driven and requires strength in the relationships, resources and priority alignment across health and social service ecosystems. The co-design process has been fundamental to ensuring the IPCHSS standard is transferable to the local context of health and social systems around the world. A movement towards integration can only be realized through engaging, mobilizing, inspiring, and empowering people, families, providers and communities. HSO’s co-design principles and processes were necessary to ensure that the IPCHSS standard is: 1) reflective of the expertise, experience and voice of those impacted and those who influence integrated care; and 2) responsive to the needs and priorities of the decision makers who are accountable to delivering quality care and supports to their communities.

The EMPATHIC project is developing a personalised Virtual Coach to help healthy elderly people to extend and maintain their quality of life, through the promotion of healthy habits and behaviour. The virtual coach methodology is based on a practical and “future orientated” model, focus on the user goals. Basically, the virtual agent is guiding the user through different stages and intermediate goals. Those “easy to reach” intermediate goals will allow the user to reach a more ambitious ones. The Empathic Virtual Coach (VC) is being designed to run on tablets, smartphones, PCs, laptops, or even on a large-screen TV. Our ambitions is to easily adapt the solution to the user’s home and to avoid unfamiliar gadgets or devices. Moreover, The VC communication is through a simple and natural conversation (non-intrusive technologies). The Empathic-VC development is based on an end-user driven design, involving healthy seniors from the first phase up to the last prototype. In order to achieve a real co-design, we are involving 180 participants distributed in three different countries (Norway, Spain and France). The target population refers to people between 65 and 79 years old healthy with no relevant chronic diseases. In addition, we will target a set of people with depressive symptoms. The VC development consider 3 main field studies carried out from 2018 to 2020. The field studies are defined as: 1) Approach validation by user 2) Early prototype 3) mature prototype. Every participant will be involved in each field study (from design to prototype). Currently we are implementing the approach validation based on a Wizard of OZ (WOZ) approach. Basically, for this first step the tools used are: 1) Well-being questionnaires, 2) WOZ interaction and 3) Ad-hoc user acceptance questionnaire. The selected Well-being questionnaires are the Geriatric Depression Scale- 30 items and the World Health Organization Quality of Life -26 items. Both questionnaires are validated on the 3 considered countries. The WOZ setup includes a screen showing an avatar. The avatar interacts with the participant mainly through speech. Importantly, the conversation/feedback provided by the avatar is controlled by a human (i.e. the wizard). A key fact is that participants must not be aware of this human control. They must believe that they are interacting with a machine (principle idea of the WOZ method). However, the Wizard is not freely controlling the output. We have stablished a protocol and dialog structure in order to test all the features that we are aiming to developed. The initial protocol, which is common for the 3 countries will evolved depending on the participant interaction. The wizard is adapting the dialog structure based on interactions. Finally, the consortium has developed a user acceptance questionnaire in order to evaluate: the willingness to interact, the pragmatism of the solution, the interaction experience, the attractiveness of the solution and the potential applications. All the user input gathered from the WOZ studies will be adapted and implemented on the early VC prototype. Thus integrating the end-user opinion within the solution design.

Because of the Schaffhausen population’s needs regarding more flexibility of authorities, an augmented importance of online services and increases in (cyber) security awareness, the e-government committee (eGov-Kernteam) of the Canton of Schaffhausen decided to pilot the electronic identity 'Schaffhauser eID+' to ultimately allow for efficient and effective Smart Government processes.* The aim of this practice article is to show how the Canton of Schaffhausen adopted a co-design approach to introduce its electronic identity and to set out key findings regarding the introduction of a technology-based public service innovation. Based on the strategic approach of a ‘testing laboratory’, co-design methodology was used through conducting usability tests and semi-structured interviews with selected individuals. The optimization suggestions collected were subsequently evaluated and reintegrated. Furthermore, the collected data were used to analyze the acceptance of the 'Schaffhauser eID+'. This piloting procedure in cooperation with citizens unites several advantages: modest budgets, rapid and more targeted product changes and, in the sense of co-design, positive spillovers with regard to acceptance and legitimacy. In reference to Smart Government and to ensure ongoing civic participation, the co-design approach should also be considered in the further development of any E-ID or Smart Government project.

Introduction: This presentation will report on the journey taken in the Australian Capital Territory (ACT) towards development of an integrated regional plan for mental health and suicide prevention. Description of Policy Context and Objective: Despite some apparent natural advantages (limited size and population), mental health care in the ACT is more fractured than integrated. Our health system is under enormous pressure and currently subject to formal, independent inquiry. Our mental health services are fragmented, too often leaving people to fall into the gaps between services. Yet the ACT has the second highest expenditure on mental health services per capita in Australia. To address this situation, the Capital Primary Health Network and the ACT Health Department have invited the community to contribute to a process of co-designed reform. This has involved consumers and carers, as well as public and private health professionals from primary, secondary and tertiary services. It has also engaged people from outside of health in a broader conceptualisation of change in relation to the social determinants of health: housing, education, employment, community services, the police, prison services and others. Target Population: The entire Canberra community, as well as the broader region. Highlights (innovation, impact and outcomes): Our method began with identification of key archetypal case studies which account for around 80% of all mental health business in the ACT. We invited the Canberra community and experts to test these case studies. We asked people what would fundamentally shift the trajectory of these typical consumer journeys towards better outcomes? Responses came at different levels; some were immediate and practical short-term ideas for service improvement; others were longer term and more complex solutions to enhance integrated care – for example to shift from fee for service models of financing to other models. The level of public engagement in thinking about the future of mental health in the ACT is unprecedented. Working groups have been established, public consultation has occurred, and online feedback has been secured. A new plan is emerging from this work. But the future is uncertain. Federal and Territory governments seem to support separateness rather than integration. There are competing policy and funding paradigms – individual choice vs population-based rationing. Staff under pressure working in public services struggle to engage in processes of reform. Perspectives on priorities differ considerably between stakeholders. Comments on Transferability: The experiences of the ACT tell a story of universal interest about local change and reform. Conclusions (key findings, discussion and lessons learned): Even in a small place, where key stakeholders know each well, integration is by no means obvious or straightforward. Policy reforms must be supported by sustained effort to drive the culture of integration. With consumers and their families at the centre of this integration, care must be taken to nurture inter-disciplinary recognition and respect. This is the wellspring of genuine integration. Without this, a rich country like Australia risks wasting resources and leaving people vulnerable to poor care.

Despite a plethora of initiatives and investment, growing demand has continued to outstrip ability to respond to needs in North West London (NWL); whilst cuts in social services have left many people who are medically fit to go home, stranded in hospital beds which are needed to treat new patients. NWL exemplifies these challenges, with 2.3 million patients and over £4 billion spent annually, split across 8 local authorities, 8 clinical commissioning groups, 10 hospitals and multiple local providers. NWL has a well-established history of joint-working, but many services still operate in silos, with duplication, gaps and inefficiencies meaning that patients receive a poorer quality of service than they deserve. Separate commissioning of services has resulted in a complex system of incompatible processes and pathways between local authorities and across hospital sites. [ABSTRACT FROM AUTHOR]

In North West London, health and social care leaders decided to design a system of integrated care with the aim of improving the quality of care and supporting people to maintain independence and participation in their community. Patients and carers, known as 'lay partners,' were to be equal partners in co-production of the system. Lay partners were recruited by sending a role profile to health, social care and voluntary organisations and requesting nominations. They formed a Lay Partners Advisory Group from which pairs were allocated to system design workstreams, such as which population to focus on, financial flow, information technology and governance. A larger and more diverse Lay Partners Forum provided feedback on the emerging plans. A key outcome of this approach was the development of an integration toolkit co-designed with lay partners. Lay partners provided challenge, encouraged innovation, improved communication, and held the actions of other partners to account to ensure the vision and aims of the emerging integrated care system were met. Key lessons from the North West London experience for effective co-production include: recruiting patients and carers with experience of strategic work; commitment to the vision; willingness to challenge and to listen; strong connections within the community being served; and enough time to do the work. Including lay partners in co-design from the start, and at every level, was important. Agreeing the principles of working together, providing support and continuously recruiting lay representatives to represent their communities are keys to effective co-production. [ABSTRACT FROM AUTHOR]

Introduction: Delivering more integrated care has long been a priority in England. Both care quality and cost effectiveness have been seen to require effective collaboration between local government and the NHS. Despite repeated national programmes and some localised progress, success has never been universalised. The recent Coalition Government launched several initiatives to enable integrated care to 'become the standard model for everyone with health and care needs' (Hunt and Lamb 2013). Among these initiatives was the establishment of 'integration pioneers' in the 'most ambitious and visionary areas' to 'help to get the ball rolling' and share 'every lesson learned'. In return, central government promised support to remove national barriers to integration. The Whole Systems Integrated Care (WSIC) programme in North West London (NWL) was the largest pioneer in terms of population (2.4million) and partners (31 agencies). This paper reports on an initial evaluation conducted by its authors between January 2014 and May 2015. Theory/Methods: A primarily qualitative evaluation with a strong formative element was commissioned to provide ongoing feedback and independent assessments of: - How WSIC was designed; - Stakeholder involvement; - Early implementation of pilot schemes; - How far WSIC appeared on track to meet its objectives. Data were collected through documentary analysis, non-participant observation, 73 interviews, workshops, a focus group, and two web-based surveys. The interviews and focus group were recorded, transcribed and analysed using NVivo. Emerging findings were fed back in round table sessions to help structure reflections on progress. Results: - WSIC built on lessons identified by an earlier evaluation in NWL (Curry et al 2013). It was ambitious and well resourced from funds pooled by the eight CCGs: £14.9m over the first two years of which most (£7.9m) was spent on management consultancy to address barriers to integration and lead a co-design. - A programme team developed a timetabled process for integrated care to become 'business as usual' from April 2015. A key principle was to save time and resources by addressing problems once rather than in each of eight local areas. - The initial co-design phase was completed largely on time. However, the programme was more than a year behind schedule when our evaluation ended and had yet to deliver significant service change. Only two of eight early adopter projects had begun operations by April 2015. - By late April 2015, the WSIC programme was seen to be approaching a 'tipping point'. Changes in the programme's leadership created concerns about its strategic management capacity and the need to demonstrate its ability to deliver change was considered increasingly urgent. Discussion: - A complex mix of enablers and barriers with local and national origins was considered responsible for the relative success of the design stage and the much slower progress subsequently. Co-design, inclusivity (especially of lay partners), an openness to learning, a clear, timetabled route map, together with roles of the programme management team and its resources were seen as valuable enablers. - However, the transition from planning to implementation and roll out of Early Adopters proved more difficult than anticipated. While some of the barriers could be addressed locally, others ultimately required action by central government. Among the former, the programme struggled to find the balance between, for example: collective leadership and local autonomy; integrated commissioning and integrated provision; NHS leadership and local authority engagement; local variation and programme-wide consistency; investment in design and support for ongoing implementation and change. - Managing such tensions is integral to such a programme and requires capabilities in systems leadership. NHS leaders have relatively little training or experience in managing systems as opposed to organisations.(Timmins, 2015). - National barriers slowing progress included difficulties in: securing data-sharing and information governance; developing payment and accountability systems aligned with integrated care objectives; enabling local government to be more equal partners especially when their finances were cut more heavily than the NHS; maintaining acute provider viability while reducing hospital admissions; balancing completion and collaboration. - Many of these barriers were identified before the Pioneer initiative but, despite the national commitment to remove them, little progress has yet been made. Conclusion: The distinction between local and national barriers and facilitators is an analytical one. In practice, they are interdependent. The NWL case shows the importance of developing effective local systems leadership capabilities within a national framework structured to support such leadership. It also highlights the need to ensure integration barriers are removed during the design stage and that the transition from design to delivery is planned and supported. [ABSTRACT FROM AUTHOR]

Introduction: (comprising context and problem statement) Partners Advancing Transitions in Healthcare (PATH), funded by The Change Foundation, is a community partnership of patients, family caregivers, health and community care providers, and a technology company, making local process changes to improve healthcare transition experiences. Care transition miscues result in poor patient experiences, sub-optimal outcomes and inefficient use of health resources. PATH partners collectively identified four issues contributing to miscues: 1) care transitions are provider-, not person-, centered, 2) critical health and personal information often does not transition with patients, 3) seniors are not intrinsically valued, not provided opportunities for having their needs addressed, 4) community and providers lack knowledge about the aging process and available supports. The partners collectively designed interventions for these issues. Experience based co-design (EBCD) and person centered care (PCC) are embedded into all PATH processes. PATH's goal is to make measurable improvement in care transition experiences. The improvements are driven by patients' needs and experiences, powered by a unique partnership, and grounded in EBCD. Description of practice change implemented: Phase 1: Analyze patients', caregivers', and providers' stories to understand care transition challenges and use stories to inform co-design team work. Phase 2: Teams of patients, caregivers and providers co-design process changes:1) internet portal with resources and information allowing creation of personal "Aging Well" plans. 2) mobile technology, allowing a person to: present their unique health/life story and needs to care providers, exchange messages with providers, perform self-monitoring, and maintain electronic record of health history and information. Phase 3: Pilot Phase 2 changes: 250 patients and 95 health care providers test the mobile technology at each health care encounter. Measures include experiences, outcomes, and impact. Aim and theory of change: Demonstrate to stakeholders, leaders, policy makers that improvement work in a community coalition, with patients and caregivers as equal partners, will improve care transition experiences. Targeted population and stakeholders: Seniors (over 65) with > 1 chronic health condition in Northumberland, Ontario, population 60,000. Timeline: Start up: 8/2012-11/2012 Phase 1: 11/2012-4/2013 Phase 2: 4/2013-4/2014 Phase 3: 4/2014-3/2015 Highlights (innovation, impact and outcomes) - Mobile technology, co-designed by seniors and health system providers, is a valuable tool to plan, inform and improve care transitions; - Care delivery is now focused on individual needs of people receiving services; - Local patients and caregivers worked as equal partners with health and community service providers to collectively re-design care transitions; - Internet based Aging Well Planning and community resources for seniors; - Established community norm of patient and caregivers engaging as equal partners in improvement projects outside of PATH; - Demonstrated the impact of seniors and caregivers as equal partners in all phases of PATH; - Value of cross-sector improvement initiatives demonstrated. Conclusions (comprising key findings) - People over 65 embrace mobile technology, particularly as a way to present themselves to the health care system. - Providers embrace solutions that facilitate understanding of and focusing on an individual - Focusing on patient needs, and providing an accessible communication solution, leads to improved experiences and improved health outcomes. - Cross sector improvement initiatives, focused on patients' needs, is a valid method to achieve system improvement. - Partnering with patients and caregivers creates a patient centered culture and leads to sustainable improvement. Discussions: The PATH partnership, with patients and caregivers as equal partners, is unique in Ontario and has impact beyond the PATH community. PATH led to the creation of Health Links, a Ministry of Health sponsored cross-sector improvement initiative and accelerated patient engagement across Ontario. PATH partners will sustain and expand PATH improvements through grant funding, Ministry of Health support, PATH partner contributions, and local health region funding. PATH's interventions are unique to this community, however, cross sector partnership, engaging patients and caregivers as partners, mobile technology solutions, and Aging Well Plans are transferable, with locally informed modifications. Lessons learned: Launch/Set-up: Site visits to potential applicants were crucial in selecting the PATH community from among 27 applicants. Well-defined project governance structure was important for making course corrections. Phase 1: Story Gathering. Planning and attention to recruitment, and personal contact with patients and caregivers, resulted in a high retention rate. Gathering 20-30 stories will elucidate key themes for improvement work. Important to prepare health care providers to hear from patients about the personal impact of system miscues. Phase 2: Co-design. Strong project management to organize, facilitate and capture input is critical to maintaining progress. Technology partner being embedded in all team work is crucial. Phase 3: Pilot. TBD [ABSTRACT FROM AUTHOR]