Collaboration Opportunities

Many Strategy for Patient Oriented Research (SPOR) funding opportunities require applicant teams to be made up of researchers, and patient and knowledge user partners, from multiple Canadian provinces/territories. This page lists applicants searching for cross-jurisdictional collaborators in BC for upcoming funding opportunities. For more information about these opportunities, please contact

Co-Designing Relational Continuity Interventions for Inner City Patients Experiencing Hospital-Primary Care Transitions

Principal Investigator: Ginetta Salvalaggio, University of Alberta

Seeking: Collaborations with primary care researchers in Canadian cities who have interest in transitions in care, urban underserved populations, or (ideally) both.

Project overview: Patients who receive care from a steady team of professionals do better than patients without continuity of care. Unfortunately, despite their poor health and many health care needs, inner city patients have less continuity of care than other patients. Continuity between the hospital and the patient’s primary care home is especially important during and shortly after a hospital admission, yet little work has focused on the best way to support continuity during this transition period. Our research will a) involve inner city patients, hospital professionals, and primary care professionals in designing supports for the hospital-community transition period and b) explore the processes involved in getting such supports ready for implementation.

Goals of proposed research: This study will explore inner city patient and clinician experiences with the hospital-primary care transition, engage participants in co-designing relational continuity interventions to improve the experience of transition, and assess the facilitators and barriers to implementation readiness for co-designed interventions. The proposed research will foster patient and clinician engagement and create new healthcare-related knowledge with the potential to scale care transition innovations to other settings.

Background and rationale for proposed research: Continuity of care is associated with improved health outcomes. However, inner city populations experience relatively low continuity of care. This socially and medically complex group experiences a high unmet need for care, will often seek high-cost hospital care as the only 24/7 access point into the health system, and faces many obstacles to accessing primary care before and after the hospital event. Existing interventions to improve the hospital-primary care transition do not emphasize relational continuity—a construct that inner city patients consider central to the development of trust, treatment adherence, and self-care Relational continuity can reduce patient risk in a fragmented care environment and reconnect inner city patients to primary care. Interventions designed to improve continuity during inner city hospital-primary care transitions demonstrate mixed results; however, little attention has been focused on relational continuity and patient engagement during this critical time period.

Research aims and methods: The aims of the proposed study are 1) to characterize inner city patient and clinician experiences of the hospital-primary care transition, and 2) to elicit the processes involved in readying emerging co-designed interventions for implementation. This observational study will adopt a participatory research lens, involving patients and clinicians iteratively throughout intervention design, implementation, and knowledge translation. The study involves three phases: 1) Establishing care transition communities of practice and eliciting patient and clinician experiences of transitions in care; 2) Iteratively co-designing relational continuity interventions to improve transitions in care; and 3) Assessing barriers and facilitators to co-design and implementation of transition supports. Data collection will be primarily qualitative using establish cognitive task analysis approaches (e.g. concept mapping).

Team expertise: Our team brings together experts in health services research, patient engagement, and implementation science and leverages existing hospital-community partnerships to carry out the proposed research. The NPA is a clinician researcher experienced in community-engaged research and implementation science. Co-investigators have complementary collective experience in organizational psychology, complex adaptive systems, qualitative research, and co-design methods.

Expected outcomes: Both patient engagement and transitions in care are increasing priorities for modern health systems. Health service partners will work with patient partners to co-design relationship-centered transition supports adapted to the local context. We will determine facilitators and barriers to the co-design and implementation process that can inform future inner city health service implementation activities.