Literature Collection

BACKGROUND: Family or friend caregivers of older adults are critical in helping older adults navigate fragmented health and social systems, but they face significant challenges in doing so. Their needs for support, information, and resources are often unmet or remain largely invisible to health and social systems and public policy. In Ontario, Canada, Ontario Health Teams (OHTs) were established to integrate and streamline health care services. However, emerging evidence suggests that despite the requirement to integrate patient and caregiver advisors in these activities, caregivers still face substantial navigation barriers. OBJECTIVE: This study aimed to systematically evaluate the amount, nature, and accessibility of information provided on each of the 58 OHT websites. Specifically, we focused on information on services and supports for older adults and their caregivers. METHODS: Between November 2024 and May 2025, we conducted an environmental scan of all 58 OHT websites. Using a 5-point Likert scale, 2 team members independently rated how easy or difficult it was to identify services and supports for older adults and their caregivers. They also documented each service and support listed on each website and provided additional details on the experience of navigating the website in an open-text comment. The ratings were discussed in team meetings, and discrepancies were resolved through team consensus. Data analysis included thematic analysis of the services identified and of open-text responses (positive and negative experiences of navigating the websites, rationales for the ratings), as well as descriptive statistics of the ease of access ratings and of the types of services listed on OHT websites. RESULTS: Almost 60% of the websites were rated as difficult or very difficult to navigate, and 33% provided insufficient information on services and supports. However, information quality and accessibility varied significantly between websites. While some featured clear, well-organized resources, others were poorly designed, lacked a well-functioning search function, or provided vague or incomplete descriptions of services and supports. Design features that improved the accessibility and usefulness of websites included user-friendly, simple navigation and direct links to relevant services. In contrast, poorly designed websites often require multiple steps to access essential information, risking exacerbating caregiver burden. CONCLUSIONS: Our findings highlight significant barriers for caregivers to access and navigate health and social service information, despite the intended goals of OHTs to improve system navigation. Health care system reforms focusing on integrated care need to include older adults and their caregivers as priority populations. Older adults and caregivers need to be engaged systematically and comprehensively, including in the development, design, and evaluation of health care system websites. Further, standards of public reporting need to be developed, and integrated care networks need to be required to follow these standards. This will help to improve transparency and accountability.

BACKGROUND: The Veterans Health Administration (VHA) greatly expanded the proportion of health care services it purchases from community providers over the last decade, which could impact the quality of care and create care fragmentation. Continuity of care between inpatient and outpatient care delivery systems is critical for high-quality mental health care. OBJECTIVE: To compare rates of outpatient follow-up visits between VHA-purchased and VHA-delivered psychiatric hospitalizations, overall and by VHA facility. METHODS: Using VHA electronic medical records and community care claims data, we compared 7-day and 30-day outpatient follow-up rates across VHA-purchased and VHA-delivered settings. We estimated follow-up rates and comparisons overall as well as separately for 4 diagnosis groups and separately across VHA facilities. RESULTS: Our sample included 64,784 hospitalizations; more than 30% were VHA-purchased as opposed to VHA-delivered. Compared with VHA-delivered hospitalizations, follow-up rates were 30.1 (95% CI: 27.8-32.5) percentage points lower at 7 days and 22.5 (95% CI: 20.8-24.1) percentage points lower at 30 days for VHA-purchased hospitalizations. Lower follow-up rates occurred for neurocognitive disorder discharges for both VHA-purchased and delivered care. Follow-up rates at 30 days were significantly lower for VHA-purchased hospitalizations at 121 out of 128 facilities and significantly higher at no facility. CONCLUSIONS: VHA enrollees seeking mental health care and VHA program managers could benefit from data on psychiatric care quality differences between community providers and VHA providers. From a system perspective, VHA-purchased care quality reports and value-based purchasing contracts could include outpatient follow-up quality measures to incentivize higher quality care.

BACKGROUND: As healthcare systems transition toward person-centred integrated care (PC-IC), goal-oriented care (GOC) has gained prominence as a conceptual approach to aligning care with what matters most to patients. However, there is limited empirical insight of how GOC is enacted in daily practice and what competencies this requires from providers. This study explores how primary care providers enact GOC in daily practice to inform future training and competency development. METHODS: A focused, team-based ethnographic approach was used, combining non-participant observations with short reflective interviews. Primary care providers were purposively sampled from a cohort who completed interprofessional GOC training, ensuring disciplinary diversity. Data were analysed using thematic analysis to identify behaviours and competencies underpinning GOC in practice. RESULTS: Providing GOC requires competencies beyond knowledge or task-specific skills, and is enacted through contextual, relational, and reflective competencies. Providers showed contextual awareness by linking care actions to patients' lived experiences and personal goals. They built relational trust through open, authentic, and non-hierarchical communication to co-create care decisions with patients. Reflective competence was shown when providers reassessed care decisions in light of patient goals, assumptions, and team input. CONCLUSIONS: These findings highlight the importance of strengthening reflective competencies in training of primary care providers. In practice, this entails supporting providers to reflect on their professional responsibilities, alongside those of the other disciplines they work with in health and social care; and critically engage with assumptions. This reflective capacity is key to embedding GOC in daily practice and aligning care with what truly matters to patients.