• To answer the main research question, "What are the characteristics and care needs of individuals at Bridgepoint Health?"
• To analyze the characteristics of the Bridgepoint patient population using hospital assessment data and semi-structured interviews with our patients.
• To examine Bridgepoint patient characteristics as they relate to mental health, social health, physical health, socio-demographics, and health experiences and outcomes.
• To improve the understanding of complex chronic disease.
• To present our findings to local, national and international audiences.

Key Findings

• Complex care requires a different model of care than the acute model, characterized by providers who are given the capacity (i.e., the tools) to respond to changing, fluctuating health problems of patients, and meet the physical, social and mental health needs of those they serve.
• Many patients with complex chronic disease experience mental health challenges including depressive symptomology, stress and anxiety.
• Transitions are problematic: Greater support and expectation management is required at both admission and discharge. Appropriate linkages to other points of care is required at discharge and should be better established.
• This patient population spans all ages, is extremely diverse, and is characterized by a mix of health problems, symptoms and illness histories.

Team Members

• *Dr. Kerry Kuluski, Research Scientist, Bridgepoint Collaboratory for Research and Innovation
• Dr. Renée Lyons, TD Scientific Director and Bridgepoint Chair in Complex Chronic Disease Research, Bridgepoint Collaboratory for Research and Innovation
• Dr. Celeste Alvaro, Research Scientist, Bridgepoint Collaboratory for Research and Innovation
• Dr. Bob Bernstein, Lead Physician, Bridgepoint Family Health Team
• Alexis Schaink, Epidemiologist, Bridgepoint Collaboratory for Research and Innovation