CONSTELLATIONS Living Lab: Improving the Care Transitions of Older Adults Living with Neurocognitive Disorders

Perceived quality of care: The variation in the Physician Enabling Skills Questionnaire (PESQ) scores.

The PESQ is a 34-item scale with six subscales, used to assess the ability of family physicians to empower their patients. Total scores range from 34 to 170, with higher scores indicating greater patient autonomy facilitation. The PESQ aligns with recommendations from systematic reviews for improving care transitions, emphasizing patient and caregiver participation, provider empowerment, and decision-maker support for incremental change. This questionnaire demonstrates adequate internal consistency and has been validated in French within Quebec. Pre-Post Comparison: Scores will be compared to identify statistically significant changes from the patient's perspective. A variation of 6.8 PESQ points between T=0 and T=15 months will be considered significant. Subgroup Comparisons: Scores will be analyzed across subgroups based on recruitment points (ED, HCT, FMG) to explore any differences in perceived care quality related to the point of initial contact.

Quality of life: The variation in the EQ-5D-5L questionnaire scores.

The EQ-5D-5L is a widely-used instrument for assessing both health status and health-related quality of life.This standardized tool evaluates five key dimensions of health: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Within each dimension, individuals indicate their level of severity across five response options, allowing for a nuanced understanding of their health state. Primary Comparison: Pre-intervention (T=0) vs. Post-intervention (T=15 months) to assess the overall impact of the CoMPAS+ MNCD Program. Secondary Comparisons: Changes between T=0 and T=9 months, and between T=9 months and T=15 months to track the trajectory of changes over time. Subgroup Analyses: Changes between different subgroups (e.g., recruitment points: ED, HCT, FMG)

Treatment burden: The variation in the Multimorbidity Treatment Burden Questionnaire-French (MTBQ-F) scores.

The Multimorbidity Treatment Burden Questionnaire, French-Canadian version (MTBQ-F), is a brief, 13-item tool designed to assess the treatment burden experienced by adults with chronic conditions. It identifies individuals with high treatment burdens and evaluates the impact of interventions aimed at improving their quality of care and life. MTBQ-F scores categorize treatment burden as follows: no burden (0), low (below 10), medium (10-22), and heavy (22 and over). The questionnaire boasts strong internal consistency and serves as a valuable resource for gauging the effectiveness of interventions intended to reduce treatment burden and enhance care transitions. Primary Comparison: Pre-intervention (T=0) scores vs. Post-intervention (T=15 months) scores to assess the overall impact of the Program on the treatment burden experienced by the older adults living with a MNCD. Subgroup Analyses: Changes between different subgroups (e.g., recruitment points: ED, HCT, FMG)

Caregiver burden: The variation in the Zarit questionnaire scores.

The Zarit Burden Interview is the most widely used standardized tool for assessing caregiver burden. It presents caregivers with a series of 12 questions (shortened version) about the challenges they face in caring for individuals with mild neurocognitive disorder (MNCD). Caregivers respond to each statement on a 5-point Likert scale, indicating their level of agreement. The total score, ranging from 0 to 48, is calculated by summing the responses to all 12 items. Higher scores reflect a heavier burden, with scores above 20 indicating a severe burden. Primary Comparison: Pre-intervention (T=0) scores vs. Post-intervention (T=15 months) scores to assess the overall impact of the Program on the caregivers' burden. Secondary Comparisons: Changes between T=0 and T=9 months, and between T=9 months and T=15 months to track the trajectory of changes over time. Subgroup Analyses: Changes between different subgroups (e.g., recruitment points: ED, HCT, FMG)

Qualitative content analysis of the patients and caregivers' wishes (Open-ended question).

At the conclusion of each telephone interview, participants will be posed an open-ended question asking the participants what they would change in the healthcare system if they had a magic wand. An inductive approach will be used to iteratively develop codes and themes to categorize patient responses. This question will be asked to both patients and caregivers five times throughout their participation: at baseline (T=0), and at 3, 9, 12, and 15 months.

Impact of the Program at the population level: Variations of performance indicators for every LSN

This analysis will compare performance indicators (number of ED visits, number of home care services, others) and their evolution over time between two groups: Participating FMGs (Family Medicine Groups) within selected Local Services Networks (LSNs). Control LSNs - These are LSNs with non-participating FMGs, serving as a comparison group. Leveraging data provided and overseen by INESSS, the impact of the CoMPAS+ TNCM workshops will be assessed by comparing performance indicators at two key time points: Baseline: Indicator values from the pre-workshop years (2018-2021). Post-Intervention: Indicator values in the years following the workshop (2023-2025). This comparison will reveal changes in performance indicators over time and any differences between the participating FMGs and the control group.