Better tArgetting, Better outcomes for frail ELderly patients (BABEL)

We expect that the alignment of patient wishes with the care that is received will be beneficial to patients, their families and caregivers. This type of intervention has the potential to reduce unnecessary transfers to emergency departments and hospitals, as well as reducing unnecessary procedures.

Possible Research Results

Anticipated FindingsWe believe that a more standardized approach as proposed here will lead to the carrying out of care plans that are safer and more aligned with the wishes of residents and their families.  It will also decrease the burden on the healthcare system.

Impact of Findings: Using a common framework and language, we hope to ensure that high risk elderly persons will be appropriately identified in order that we may offer personalized care plans across home care and LTC. The three large-scale projects in this research program will serve as an important precedent for co-innovation with knowledge users and pave the way towards greater health system integration for frail seniors. Each project in our program is scalable because they make use of adapted and available evidence-informed interventions, standardized wide used risk assessment and secondary data. In the future, other comparable projects could easily be implemented using our approach.

About the Project

Older people often suffer from many different chronic conditions, and they can be subject to memory and mobility problems, incontinence, and falls.  These people are vulnerable to poor health outcomes when they become ill, a state known as frailty.  Health decline after an episode of care, such as a visit to the emergency department, are common in the frail elderly.   Care plans need to be changed to take their special needs in consideration.  We have focused our approach in two areas: frail elderly in home care and nursing homes.

Over the next 3 years, we will conduct a multi-phased mixed-methods evaluation (quantitative observational, qualitative, and pragmatic experimental evaluations) of three linked implementation projects. Each project is evidence-informed, based on tested implementation strategies, and supported by local decision makers. We will implement our interventions on existing common models of assessment and care that respond to risk of adverse outcomes in frail older persons in home care and LTC. We will continue our efforts to establish a pan-Canadian collaboration of knowledge users and researchers from many settings to ensure that inter-jurisdictional differences are considered and integrated into all evaluations.

The three linked projects along the continuum of care will: 1) expand the use of an evidence-informed chronic cardiorespiratory management home care program developed and pilot tested in Ontario; 2) introduce best-practice advanced care planning and care interventions in LTC homes; 3) expand the deployment of interRAI instruments into LTC homes and home care programs in Quebec in a manner that will allow for the evaluation of the impact of the use of these systems and their associated care planning protocols compared with usual practice.

Project Team

Principal Investigators:

Paul Hébert, MD — Centre de recherche du Centre Hospitalier de l’université de Montréal (CHUM)

Allan Garland, MD, MA, BS — University of Manitoba

John Hirdes, PhD — University of Waterloo


Veronique Boscart, RN, MScN, MEd, PhD — Conestoga College

Susan Bronskill, PhD, MSc — Institute for Clinical Evaluative Sciences

James Downar, MD, CM, MHSc, FRCPC — University of Toronto

Marcel Émond, MD, MSc — Université Laval

David Feeny, PhD, MA, BA — McMaster University

Michelle Grinman, MD, FRCPC, MPH — University of Calgary

Heather Keller, PhD, RD, FDC — University of Waterloo

Linda Lee, MD, MCISc(FM), CCFP, FCFP — McMaster University

Robert McKelvie, MD, PhD, MSc, BSc, FRCPC — McMaster University

Lori Mitchell, PhD — Winnipeg Regional Health Authority

Patrick Quail, MB — University of Calgary

Clare Ramsey, MD, FRCPC — University of Manitoba

Project Contact: Paul Hébert —

TG 2015-15

Key words: interRAI, long-term care facility, home care, nursing homes, advanced care planning, end-of-life care, personalized targeted interventions, person centered decisions, implementation, standardized risk assessments