Monthly Bulletin of the Alliance's Learning Health System |
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This month, we're taking a closer look at three projects where Alliance research staff are either co-investigators or research leaders. Each one will move us closer to our vision of equitable health outcomes for everyone in Ontario.
- How can we choose appointment modalities based on each client's needs and barriers?
- Can linking EMR and administrative data help prevent blindness?
- How can the Alliance improve our collection and use of sociodemographic data for equity?
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Choosing Appropriate Channels |
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Using Data to Help Prevent Vision Loss |
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Collecting & Using Sociographic Data |
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Learning Events & Opportunities |
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Get Involved: Research & Sharing |
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Delivering Care in the Most Appropriate Way
Learning from virtual care to improve channel management
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When the COVID-19 pandemic was declared, everything changed, including how Alliance member organizations delivered care to their clients. Since then, the Alliance has been doing research within our sector to learn from provider and client experiences of delivering and receiving virtual care. Now that the pandemic is starting to wane, they are shifting focus to explore how our members and system partners can choose the most appropriate - and equitable - mode of care for each encounter.
The Lessons from Virtual Care
The Alliance virtual care study took place from April 2020 through January 2021. Our research team, led by our Director of Research and Evaluation, Dr. Jennifer Rayner, extracted EMR primary care and interprofessional team data from 36 Community Health Centres (CHCs). They also conducted an organizational survey and phone interviews with 36 providers and 31 clients. Their findings are being prepared for publication, but you can see a preliminary summary here.
During the study period:
- Over half of the encounters were conducted virtually – by phone, email/text, or videoconference.
- The vast majority of virtual encounters took place by phone.
- Socioeconomic status had almost no influence on the mode of care delivery.
- Most clients and providers found virtual care to be more accessible, flexible, and efficient.
- Virtual care did not work as well for clients with limited or no access to phones, in situations where a physical assessment is needed, or when the client-provider relationship was new.
Building on this Foundation: The Channel Management Study
Dr. Rayner and the Alliance team have teamed up with Dr. Onil Bhattacharyya, Senior Scientist at the Women’s College Hospital Institute for Health System Solutions & Virtual Care (WIHV) and his research team to build on what was learned from the virtual care study. They are doing a deep dive into individual client records in order to understand which types of virtual care are best-suited to different types of clients and different situations, a problem known as “channel management.” |
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Whereas the virtual care study looked at overall patterns for a large number of clients, the channel management study will be based on what’s called a “full-chart review” of a smaller number of clients. The researchers will thoroughly examine the charts of approximately 25 clients with complex healthcare needs who received care through virtual channels over the three-month study period. By looking at every interaction between the clients and their providers over this time, they will create a detailed map of each person’s healthcare journey, including appointments, diagnoses, interventions, and outcomes, extracting across-the-board patterns and informative case studies. These maps will be validated by providers and clients and turned into best practices. Ultimately this study will help providers and teams identify solutions that offer the right features for safe and effective care, make care more accessible to their clients who face barriers, and are likely to be successfully implemented in practice. |
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How Data Helps Prevent Vision Loss
Linking records to advance equitable access to screenings
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The leading cause of blindness among working-age adults in Canada is diabetic retinopathy, a condition where blood vessels in the back of the eye become inflamed and can burst. Approximately 25 percent of people living with diabetes in Canada develop retinopathy, but if it’s detected early, its progress can be stopped or slowed before vision is lost. Currently, more than 450,000 people in Ontario – 40% of those who are living with diabetes – have not had a retinal scan in over two years. This includes many who have never had one.
We know that this shortfall is linked to inequity: People who are marginalized, particularly those born outside of Canada, whose preferred language is not English, or who have a household income of less than $25,000 are less likely than their counterparts to be up-to-date on retinal screenings. They are often unattached to a primary care provider and some don’t have health insurance, so they may not realize that they are eligible for free, regular retinal screenings or how to access them. Project OPEN is using administrative health-system data to help ensure that people who need retinal screenings can get them.
Through Project OPEN, Diabetes Action Canada and the Alliance for Healthier Communities are bringing a person-centred, equity-based approach to addressing the screening shortfall. Diabetes Action Canada chose to work with the Alliance because they recognize that CHCs are trusted places where underserved, vulnerable people and communities feel safe receiving health care. This project is being led by Dr. Michael Brant and Dr. Valeria Rac, scientists at University Health Network. It is supported through funds from a generous donor and Fighting Blindness Canada.
Many people who participate in diabetes education programs at Community Health Centres (CHCs) aren’t regular primary care clients, so the CHC’s Electronic Medical Record (EMR) system may not indicate whether they are up-to-date on screenings. Data is shared through the Alliance’s Business Intelligence Tool (BIRT) with ICES every six months, which enables important EMR data to be linked with administrative data to determine who has not been screened for diabetes retinopathy. Typically this is where the work stops. Information about the percentage of people overdue for screening would be reported back to the organizations, but the individuals who have not been screened would not be identified.
Project OPEN is putting the learning health system framework in action by ensuring the data provided is actionable. This has been enabled through a detailed research ethics application and acceptance from the Information and Privacy Commissioners Office. In this study, the CHC plays a dual role as both ICES’ agent and member of the research team. Participating CHCs act (legally) as ICES’ agent for the purposes of asking potential participants to be contacted by a researcher about the study, and then switch hats to act (legally) in the capacity as the researcher (who is part of the overall study team) when performing the recruitment. This has enabled ICES to provide a list of patient IDs directly back to the CHC who can then identify, reach out and contact the patients who are eligible to be screened.
Since this is a new way of using and sharing personal health information, Ontario’s Information and Privacy Commissioner has been extensively consulted to ensure that it is done in a way that respects and protects each person’s privacy. Clients who are contacted by the designated CHC employee are provided information about the study and have the option to learn more and participate.
Clients who agree to participate are offered a screening through a Tele-Retina program being offered at select CHCs in Ontario. This proactive management ensures that the client can access the screening location, and it helps to ensure that it is done in a culturally safe, person-centred way by members of a trusted team. Clients are then invited to participate in a follow-up interview about their experience, and the findings from these interviews will help ensure that the program continues to be developed in ways that meet their needs. The entire project is being evaluated to ensure that people who are being missed for screenings like this can be identified and through targeted outreach can receive these important screenings.
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Improving Sociodemographic Data Collection
Empowering Better Decisions for Health Equity
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When properly collected and used, sociodemographic data about clients and communities can help healthcare providers and policymakers make good decisions about health interventions, advocacy, and system design.
Before and throughout the COVID-19 pandemic, the Alliance has called for more rigorous sociodemographic data collection across the health system. During our 2020 annual general meeting, our members unanimously resolved to achieve an 80% completion rate for sociodemographic data collection by 2024.
To help our members reach this goal, Alliance researchers have undertaken a study that examines how sociodemographic data is collected and used by Community Health Centres (CHCs). Eight CHCs volunteered to participate, including a mix of rural, urban, Francophone, and Northern centres. In total, 63 staff members, board members, and the executive leader from each participating CHC have participated in individual interviews and focus groups about their experiences collecting and using this data and their role in helping to improve data collection and use.
What our members told us
Participants in this project have shared that they appreciate the value of sociodemographic data but that they don’t know how well their centres are doing at collecting it. They also noted several barriers to data collection, including accessibility challenges, burden, discomfort, and capacity limitations. However, they also suggested strategies for overcoming these barriers. Where centres had experienced success, they reported on promising practices.
The foundational role of leadership was a recurring theme throughout the process. Collecting and meaningfully using sociodemographic data is complex and time-consuming, so the work needs to be prioritized and resourced appropriately. Here are some ways that Executive Leaders and Board Directors can become involved in this work and hold their organizations to high standards:
- Invest in tools such as tablets and kiosks to facilitate data collection.
- Include training about in sociodemographic data collection as part of staff orientation, to create a culture where this is normal and expected work;
- Demonstrate the value of the data by meaningfully use it for planning and decision-making;
- Be transparent with staff and clients about how much progress your organization is making towards its data-collection goals.
Help is on the way
A full report about this study will be published in early 2022, along with a suite of tools that will help Alliance member organizations advance their data collection. These include:
- A guide to using extended demographics form and toolbar in the TELUS PS Suite EMR.
- A placemat that centres can use to evaluate their progress and compare it with their peers.
- Resources for staff, including a script, plain-language glossary, and client brochure.
- A collection of case studies of teams that have been successful in this work.
- A learning collaborative focused on applying quality improvement methods to sociodemographic data collection.
Collecting sociodemographic data about clients is not easy, and the goal of reaching 80% data completion by 2024 is an ambitious one. However, our members set this goal because they know that it can be achieved. Their shared commitment to improving care and advancing health equity in Ontario is a powerful motivator. By applying a Learning Health System approach, we can draw on expertise that already exists within our sector to take this important step towards greater health equity.
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Upcoming Learning Events & Programs |
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November
November 3, 5:30 pm – 2021 Peggy Hill Lecture on Indigenous Health: Wabanong: Where We Begin Again, Stories of Truth & Visions of Reconciliation. Get updated on current and ongoing work in Indigenous health from leading Toronto Indigenous community members. This upcoming webinar is presented by University of Toronto’s Medical Alumni Association (MAA) in partnership with their Office of Indigenous Health and the Women’s College Hospital’s Centre for Wise Practices in Indigenous Health. Learn more about the panelists here; register for free here
November 9, 8:30 am - 12:00 pm – Community Resilience Summit. What is community resilience, and how can we intentionally build it into our communities to protect each other from the effects of adversity?
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This free, half-day workshop will build your understanding of what goes into building resilient & equitable communities. Keynote address by Dr. Michael Ungar. Sponsored by the ACEs Coalition of Guelph & Wellington, Guelph CHC and other community partners. Register for free here.
- We know this workshop will leave you excited to get to work, so pre-register now for our Alliance-only follow-up session, Community Resilience: Rolling Up Our Sleeves on December 8.
November 15-17 – National Indigenous Diabetes Conference: Our Ways – Healing Through Traditional Health and Wellness. Join clinicians & interprofessional providers, Elders, diabetes prevention workers & educators, academics, and health system leaders from across Turtle Island to learn about and share community-based practices in diabetes prevention and self-management among Indigenous Peoples. For information, see the flyer and the conference webpage. Register here.
November 17, 12:00 pm – Introduction to ONCA: Education Session. Great news for non-profits, Ontario’s Not-for-Profit Corporations Act (ONCA) has come into effect as of October 19, 2021! ONCA received royal assent in 2010, but was put on hold until the Ontario Business Registry could be updated. The Alliance is partnering with AFHTO, NPLCA, and IPHCC to present an introductory webinar on how to comply with new ONCA regulations. More information and registration here.
Ongoing
website to learn more and sign up your team.
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Save the date! The BETTER team will be presenting this program to Alliance member organizations and OHT partners at a lunch 'n' learn session on Monday, December 13. Watch this space for details next month, or pre-register now!
Applications open now for TUTOR-PHC 2022-2023. Transdisciplinary Understanding and Training on Research – Primary Health Care (TUTOR-PHC), is a one-year capacity-building program for inter-disciplinary research. It is open to graduate students, post-doctoral fellows, mid-career clinicians, and decision makers from across primary health care. Participants receive research training, university credit, feedback on their own research, and opportunities for mentoring and networking from TUTOR-PHC alumni. For more information, see the flyer here (en français ici).
Interactive Online Medical Education from ECHO at UHN: Check out their latest offerings here. Participants can earn CPD credits and present their client cases for peer support.
Improving early palliative care in primary healthcare teams. The CAPACITI program (Project ECHO) provides three 6-week training modules for primary care teams Apply by August 19 for first session (begins November 10; more scheduled through 2021, 2022, and early 2023. Visit the CAPACITI
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Research & Sharing Opportunities |
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Networking and Collaborative Learning
Obesity Canada Action Teams: Obesity Canada is working on creating a framework as part of a National Obesity Strategy and is looking for experts and students from various disciplines to apply to their Action Teams. These are small working groups that will focus on conducting strategic research that will support the creating of a national framework. Each has a different area of focus: Research/training, Education, Policy, and Community Engagement. Lots of information and link to apply here.
Coaching Series: Using the Implementation Guide for the Delirium Quality Standard to change care in your workplace. Individuals and teams welcome. See registration links for individual sessions below. Presented by Ontario Health and the Regional Geriatric Program, Toronto.
SPIDER Learning Collaborative: De-prescribing dangerous medications. Can data-driven QI activities help de-prescribe potentially harmful medications, for medically complex senior clients? Help answer this question and improve health outcomes for your clients by participating in a 12-month learning collaborative, starting this fall. EMR queries will be provided to help participating Alliance members identify clients who would benefit. Contact Jennifer Rayner for more information.
Study Participants Wanted
Help the Women’s College Hospital improve lung cancer screening accessibility. Researchers want equity-trained and trauma-informed primary care providers from Community Health Centres help co-build a newe-learning curriculum that will enhance lung cancer screening accessibility for priority populations. Email Dr. Ambreen Sayani if you are interested in participating or have any questions.
Share your experiences working with uninsured migrants. Researchers want to hear from health care providers who have experience providing health care services to uninsured migrants. What they learn will inform policy recommendations and will be shared through community events. Confidential interviews will be conducted over Zoom. Email Melissa Anderson to participate or learn more.
Clients who are planning a pregnancy are invited to participate in a randomized controlled trial of a new initiative that may help them improve their health and health-seeking behaviour. The Healthy Life Trajectory Initiative (HeLTi) Canada study is part of a global project evaluating the effectiveness of technology-based care provided by specially-trained public health nurses. Visit HeLTI Canada's website to learn more, or follow @HeLTICanada on social media.
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Funding and Awards
DEADLINE EXTENDED! 2021 Lori Chow Memorial Award: Nominations begin for health professionals who advocate for, and are passionate about, social determinants of health and their significance in health promotion. For those who know a leader in their field who meets these qualifications, consider submitting a nomination form. Submit your application by November 1, 2021.
2021 SPOR Evidence Alliance Seed Grant. This year's theme is Knowledge Dissemination and Implementation with Patient Partnership Using an Equity, Diversity, Inclusion and Social Justice Lens. Apply by December 6.
Guidance & Tools to Support Practice
Just launched! I ndigenous Cultural Safety Training from the Indigenous Primary Health Care Council. The training series is called Anishinaabe Mino’ayaawin – People in Good Health; the first course in the series is Foundations of Indigenous Cultural Safety, has been created in partnership with the IPHCC's Indigenous Knowledge Keepers' Circle, bioethicists, and Indigenous patient navigators from across Ontario. It is grounded in a two-eyed-seeing approach to knowledge. It's an online, multi-media course that takes about three hours to complete. Enrolment is free for individuals and organizations. Email the IPHCC ICS Team for more information or to register. If your organization provides care for Indigenous clients, has Indigenous staff, or works with Indigenous community partners, consider using the free Ne'iikaanigaana ("All My Relations") Toolkit to help you implement your cultural safety learnings and create safer environments for Indigenous people.
Knowledge exchange hubs for substance use and public health: The number of these resources has been increasing substantially over the last 2 years. If your organization is working in safer supply and/or other harm reduction approaches, or is thinking of starting one of these programs, these are great sources of information and guidance.
Tailored messages about COVID-19 vaccines for your hesitant clients: The Canadian Primary Care Information Network (CPIN) is looking for physicians and NPs to participate in a study that will use the CPIN platform to communicate with clients who feel hesitant about the COVID-19 vaccines. M Participating providers will receive CPIN services free for one year and will be compensated for their time. For more information, see the research flyer ( English and French) or contact the study team at info@cpin-rcip.com.
Recently Published Research
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