Phuc Dang , Ph .D. S tuden t , Un i ve r s i t y o f V i c to r i aMade l yn P. Law, Ph .D. , B rock Un i ve r s i t yLaura Cousens , Ph .D. , B rock Un i ve r s i t yMiya Narush ima , Ph .D. , B rock Un i ve r s i t y

Using Network Analysis to Understand and Advance Falls Prevention Referral Pathways

Background

Falls result in negative health outcomes and have major health care cost implicationso [Public Health Agency of Canada (PHAC), 2006]

1 in 3 older adults in Canada will experience at least one fall annuallyo (Scott, Peck, & Kendall, 2004; Tinetti & Speechley, 1989)

Falls are the leading cause of hospitalization among seniors in Canadao (PHAC, 2006)

In 2004, falls accounted for $6.2 billion or 31% of Canada’s overall injury costo (SMARTRISK, 2009)

Falls Prevention Landscape

International

Prevention of Falls

Network Europe –

Network of Various

Stakeholders

National

Canadian Falls

Prevention Curriculum

Falls Prevention Initiative

Provincial

Falls and Fall Injuries Best

Practice Guideline (RNAO)

Integrated Provincial

Falls Prevention

Project (LHIN)

Niagara Region

43 Agencies (e.g., CCAC, Rehabilitation, Physical

Activity, Support Services)

Rationale

Fall Prevention Network of Niagara (FPNN) identified referral pathways between agencies as a core area to explore and make improvements

FPNN partnered with Brock University and Health Nexus to develop a network survey and network maps

Review of Literature

Foundational Research in Network

Analysis

Social networks (Valente, 2010; Scott,

1998; Borgatti, Mehra, Brass, & Labianca, 2009)Graph theory (Valente,

2010)Anthropology (Valente,

2010)

Organizational Sciences Research

Collaboration (Powell et al., 1996; Barley,

Freeman, & Hybels, 1992)

Legitimacy (Human & Provan, 2000; DiMaggio

& Powell, 1983)Partnerships (Cousens &

Slack, 1996) Linkages (MacLean,

Barnes, & Cousens, 2011)

Health Research

Collaboration and Linkages (Barnes,

MacLean, & Cousens, 2010; Provan, Harvey, &

Guernsey deZapien, 2005; Nicaise, Tulloch,

Dubois, Matanov, Priebe, & Lorant, 2012; Gregson,

Sowa, & Flynn, 2011; Fredericks, 2005)Referrals (Kwait,

Valente, & Celentano, 2001; Krauss, Meuller, &

Luke, 2001)

Varying applications of measures from network analysis

Varying methodological approaches to understanding network analysis

Research Purpose and Questions

Purpose: to understand the referral linkages that exist among falls prevention agencies in the Niagara region using a network analysis approach

Research Questions:1. What internal factors influence the level of

collaboration and integration in the network of falls prevention agencies?

2. What external factors influence the level of collaboration and integration in this case?

Methodology and Methods

Methodology and Methods

Methodology• Single case study

o (Yin, 2009)

Methods• 15 participants interviewed• Individual interviews and document analysis

o (Yin, 2009)

Data Analysis• Constant comparative approach

o (Glaser & Strauss, 1967; Corbin & Strauss, 2008)

Results

Internal Factors• (1) Health professionals initiating services,

(2) Communication strategies, (3) Formal partnerships, (4) Trust, (5) Program awareness, (6) Referral policies

External Factors• (1) Client characteristics, (2) Primary

and community care collaboration, (3) Networking, (4) Funding

Key Recommendations• (1) Electronic database, (2) Electronic

referral form, (3) Educating office staff, (4) Education days

Conclusion

Key aspect of referrals is connections between health professionals

Important to have appropriate logistics for referrals

Vital to establish rapport among health professionals

Limitations

Sampling strategyo Purposeful sampling strategy applied

Network surveyo Response rate from network survey

Research Framingo Community-based participatory research (CBPR)

could have been applied

Implications

Practice implicationso Marketing strategies to educate office staff on

programs available

o Develop a standardized referral form

o Develop an electronic database of falls prevention programs

o Utilize electronic system in primary care

o Create opportunities for face-to-face meetings

Implications – Client Feedback Loop

Future Directions

Interventional Studyo Develop electronic standardized referral form

and test its effectiveness

Theoretical Studyo Understand the role of primary care in ensuring

effective falls prevention referrals

References

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Questions