The aim of the Community Assets Supporting Transitions (CAST) study was to determine the effects, implementation and costs of a hospital-to-home support program for older adults with depressive symptoms and multiple chronic conditions. Core components of the program included home visits, telephone follow-up, and nurse-led care coordination. The researchers worked side-by-side with patients, caregivers and providers from three communities in Ontario to tailor the intervention to each community. The three partner sites/communities were Sudbury, Burlington and Hamilton.
The overall goal of the intervention was to improve health outcomes for older adults with depression and multiple health problems who are transitioning from hospital-to-home care by improving patients’ self-management ability, supporting families and caregivers, and building capacity for primary care and other health and non-health related providers to collaborate in delivering home and community services to these patients.
Editorial in Journal of the American Geriatrics Society
Publication in Special patient-oriented research supplement in the Canadian Medical Association Journal (CMAJ)
Publication in BMC Geriatrics
McMaster Health Forum Top Ten Insights 2-part webinar on how to improve hospital-to-home transitions for older adults with complex health and social needs:
Older Adults with Complex Health and Social Needs Click here to view the recording
Insights from the COVID-19 Response Click here to view the recording
Ontario SPOR Support Unit (OSSU)
Funding was provided by the Ontario SPOR SUPPORT Unit, which is supported by the Canadian Institutes of Health Research and the Province of Ontario.
Additional funding support was provided by the Labarge Foundation
Information Box Group
Community Assets Supporting Transitions (CAST) – A hospital-to-home transitional care intervention
Research Summary (Study 9)