Speaker
Description
Background:
Transitions in Care and Services (TICAS), a Best Practice Guideline (BPG) developed by the Registered Nurses’ Association of Ontario (RNAO), provides evidence-based recommendations to support safe, equitable, and coordinated transitions across health systems. Grey Bruce Public Health implemented the guideline using a systematic and innovative approach and developed an evaluation plan that considered program diversity, indicator selection, and data quality. Early findings suggest improved coordination of transitions and positive client outcomes.
Aim:
This session describes how TICAS was adapted for public health, how the RNAO NQuIRE® Data Dictionary and program evaluation indicators were integrated, and presents preliminary findings from two programs.
Methods/Implementation Approach:
The Knowledge-to-Action Framework guided implementation of recommendations across seven programs. Population Health and Health Promotion models informed adaptation by identifying clients, services, and transitions unique to public health. The Harm Reduction program integrated a process indicator into an existing reporting system to measure external referrals at the individual client level. The Health Promotion program implemented an outcome indicator to measure 30-day follow-up after internal transitions of municipal clients at the systems level. A transitions-focused question is also being considered for the organizational client satisfaction survey.
Results/Outcomes:
Evaluation activities range from planning to monthly data collection. In Harm Reduction, preliminary findings show an approximate 190% increase in monthly referrals over six months compared with baseline data. Health Promotion is collecting data to evaluate municipal capacity-building and referral outcomes. The proposed client satisfaction survey question will further assess continuity, follow-up, and service coordination across programs.
Lessons Learned/Implications for Practice:
Selected indicators appear feasible and effective for evaluating interventions. Early findings suggest increased referrals may improve equitable access to services, while municipal engagement transitions may strengthen coordinated responses and support broader outcomes. Lessons learned highlight the importance of evaluation design, interprofessional engagement, and embedding indicators within existing program activities.
Author(s) Credentials and Title
Lisa Alguire, BSc.N, RN, Public Health Nurse, Grey Bruce Public Health
Janet Kwansah, RN, MBA, MPH, Chief Nursing Officer, Program Manager, Grey Bruce Public Health
Cynthia Stone, RN, MSc(N), Public Health Nurse, Grey Bruce Public Health
What RNAO BPG or tool/toolkit is your abstract related to?
Transitions in Care and Services Best Practice Guideline
| Organization Name | Grey Bruce Public Health |
|---|
