Using Network Analysis to Understand and Advance Falls Prevention Referral Pathways

1. Using Network Analysis to Understand and Advance Falls Prevention Referral Pathways Phuc Dang, Ph.D. Student, University of Victoria Madelyn P. Law, Ph.D., Brock University Laura Cousens, Ph.D., Brock University MiyaNarushima, Ph.D., Brock University

2. Background • Falls result in negative health outcomes and have major health care cost implications • [Public Health Agency of Canada (PHAC), 2006] • 1 in 3 older adults in Canada will experience at least one fall annually • (Scott, Peck, & Kendall, 2004; Tinetti & Speechley, 1989) • Falls are the leading cause of hospitalization among seniors in Canada • (PHAC, 2006) • In 2004, falls accounted for $6.2 billion or 31% of Canada’s overall injury cost • (SMARTRISK, 2009)

3. Falls Prevention Landscape

4. 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

5. Review of Literature Varying applications of measures from network analysis Varying methodological approaches to understanding network analysis

6. 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: • What internal factors influence the level of collaboration and integration in the network of falls prevention agencies? • What external factors influence the level of collaboration and integration in this case?

7. Methodology and Methods

8. Methodology and Methods • Methodology • Single case study • (Yin, 2009) • Methods • 15 participants interviewed • Individual interviews and document analysis • (Yin, 2009) • Data Analysis • Constant comparative approach • (Glaser & Strauss, 1967; Corbin & Strauss, 2008)

9. Results

10. Conclusion Key aspect of referrals is connections between health professionals Important to have appropriate logistics for referrals Vital to establish rapport among health professionals

11. Limitations • Sampling strategy • Purposeful sampling strategy applied • Network survey • Response rate from network survey • Research Framing • Community-based participatory research (CBPR) could have been applied

12. Implications • Practice implications • Marketing strategies to educate office staff on programs available • Develop a standardized referral form • Develop an electronic database of falls prevention programs • Utilize electronic system in primary care • Create opportunities for face-to-face meetings

13. Implications – Client Feedback Loop

14. Future Directions • Interventional Study • Develop electronic standardized referral form and test its effectiveness • Theoretical Study • Understand the role of primary care in ensuring effective falls prevention referrals

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16. Questions