EPIC News, Issue 25: August 2023

Issue 25 | August 30, 2023

Bulletin of the Alliance's Learning Health System

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Learning Collaborative: Access to Care

CCRF: Advancing the Science of MSK Care

Cultivate Connections

at the SP Conference

New Tools &

Resources

Get Involved: Research & Sharing

Learning Events & Programs

Improving Efficiency and Access to Care:

Learning Collaborative 3 Launches this Fall

This fall, the Alliance will launch its third learning collaborative, Increasing Efficiency to Improve Access to Care. This learning collaborative will marry various Quality Improvement methodologies, including the Model for Improvement and Lean thinking, with the principles of access and efficiency to support teams in their work.

What’s a learning collaborative?

A learning collaborative is a 9-12 month learning system that brings together peers from multiple centres to seek improvement in a focused topic area, with guidance from a QI coach. Our first learning collaborative, Equitably Improving Cancer Screening Rates, focused on helping organizations equitably tackle their post-pandemic screening backlogs. Our second one, Foundations of Equity, focused on improving the completeness, usability, and currency of sociodemographic data. This one will help organizations looking to increase efficiency at their centre.

Why focus on efficiency?

Efficiency is one of IHI’s six Dimensions of Quality. All six are intertwined, so improvement targeting one dimension can positively impact some or all of the others. Improving efficiency will often also improve timeliness (access to care), effectiveness (better health outcomes) and client-centred care (client experience).

Although “efficiency” is often thought of as reducing resource use (decreasing waste), we will approach it in the positive sense of maximizing the use of resources. Increasing efficiency in this sense has the potential to build capacity for more client visits or even an increase in your panel size. Better is always possible!

Teams who participate in the learning collaborative will choose their own opportunity to increase efficiency. This could include small efforts to reengineer workflows, empower all team members, or maximize technology, which could yield the capacity for additional client visits and potential increases in panel size. Examples include but are not limited to:

Improving efficiency in the intake process.
Optimizing the care team to ensure all are working to their scope of practice.
Optimizing rooms, equipment, and staff.
Improving chronic disease management.

Thinking of joining?

Like all of our learning collaboratives, Increasing Efficiency to Improve Access to Care is open to all Alliance member organizations, and it’s free to participate. However, space is limited, and participation does involve a commitment to meaningful engagement.

To get started, register for this informational Lunch ‘n’ Learn webinar on September 28. Attendance (either live or via recording) is required in order to join the learning collaborative. At the webinar, you’ll get a detailed description of what a learning collaborative is, what’s involved when participating in one, and the supports you’ll receive. You’ll also hear examples of successful efficiency improvements made previously at Ontario CHCs, and you’ll be able to ask any questions you have about this learning collaborative.

Advancing the Science of Chiropractic Care

Reducing the Burden of Musculoskeletal Pain

Each year, musculoskeletal (MSK) pain affects 11 million people in Canada and costs our economy over $20 billion. People who live with MSK pain are at risk of disability, loss of employment, and harmful substance use. The Canadian Chiropractic Research Foundation (CCRF) wants to change this. CCRF supports scientific research and knowledge transfer in order to improve access to care for MSK health.

EPIC News spoke with Robert Harris, Executive Director of CCRF, about the organization’s goals, the research they fund, and partnership opportunities for community-based healthcare organizations.

Funding Project-Based Research

Since 2019, CCRF has provided over $1.25 million in grants to nearly 40 research projects, ranging in size from $10,000 to $250,000. Grant applications are invited twice per year, and successful projects are chosen on the basis of scientific and ethical rigour and their potential to advance one of the organization’s four research priorities: basic science, clinical science, health systems, and population health.

Robert speaks with particular pride about a project CCRF is funding in Pimicikamak Okimawin (Cross Lake First Nation), in Northern Manitoba. This research partnership with the Pimicikamak Okimawin community will make chiropractic interventions for MSK pain available through the community’s nursing station as part of a comprehensive spine care model developed with the community. It will also incorporate clinician education and Indigenous-led health promotion activities, including an educational movement program informed by traditional Cree dance. Initially funded by CCRF and the Canadian Chiropractic Association, in cooperation with World Spine Care Canada, this project has been further expanded through a substantial grant from Health Canada.

Prioritizing Partnerships

Robert notes that partnerships are central to the way CCRF works. “A partnership happens when each organization has something of high value to offer the other, so we can get more out of work we’ve already done,” says Robert. In many cases, CCRF provides funding and grant-administration expertise while their partners provide research expertise, local knowledge, and interprofessional collaborators. An additional benefit of research partnerships is the breaking down of silos, which in turn helps build a more resilient, effective, and equitable health system.

To illustrate this, Robert describes a research partnership with the Canadian Memorial Chiropractic College, the University, and the Sherbourne Health Centre, one of several organizations serving marginalized people in downtown Toronto. This project will pilot the implementation of a low-barrier spinal stenosis “boot camp” in a team-based primary health care setting in Toronto’s inner city. Spinal stenosis is especially prevalent amongst marginalized people who face barriers to care because it is primarily a “wear and tear” condition related to a history of manual labour or time spent on one’s feet. Robert is excited about the potential for this project to address a significant health inequity, especially once it is scaled up and spread to similar organizations.

Research funding from CCRF can help Alliance member organizations expand access to innovative MSK pain care for their clients and communities. Our members are desirable partners because of their robust sociodemographic and clinical datasets, trusted relationships with community and system partners, and high-functioning interprofessional teams. In the last issue of EPIC News, we shared the story of a clinical trial currently underway at Langs CHC, for which CCRF funded the initial pilot. After connecting with several other Alliance member organizations at our 2023 conference, Robert is excited about the potential for more such partnerships to emerge.

Getting Involved

Each year, the CCRF puts out two RFPs for research projects to fund. The most recent round took place in spring of 2023, and a full list of successful projects will be published on CCRF’s website in September. Requirements and thematic priorities for the next round will be announced in October.

If your organization has a research question or a project in mind, watch for the announcement and consider submitting a letter of intent. You’ll need to have one Canadian Doctor of Chiropractic (DC) in your research team (they do not have to be employed by/at your centre). Check out the previous RFP and the grant FAQs to familiarize yourself with the process and criteria. To participate in the RFP or to explore other partnership opportunities, reach out To Robert Harris to start a conversation.

Cultivating Connections: Pathways to Wellbeing

Registration open for the 2023 Social Prescribing Conference

The Alliance’s Social Prescribing conference is back! On Thursday, October 19, people from across and beyond Canada will come together virtually to learn, share, and connect at Cultivating Connections: Pathways to Wellbeing. It features two streams of diverse learning sessions, two keynote speakers, and opportunities to network with your peers. Here is a special sneak preview for EPIC News readers.

Keynote Speakers

This year’s conference will feature two keynote speakers. While the conference team is still waiting to confirm the show-opener, they’re happy to announce that Kami Norland will deliver the closing address. Kami is a social entrepreneur and health care leader who specializes in building capacity for compassionate leadership. She began her career in art therapy and rural mental health; her passion for trauma-informed care, resilience-building, and health equity motivated her to pursue leadership opportunities where she could champion systemic change. She has since worked with health care organizations and systems across the US, helping them build their capacity for community-based care that integrates resilience, compassion, and mental wellbeing.

Learning Sessions

With over 20 high-quality abstracts submitted, the planning committee for this year’s conference faced an exciting but challenging problem: How do you narrow down such an extensive selection into a single day of programming? Tackling the problem was made easier by having three streams of content. Attendees can move freely between streams, allowing them to partially curate their own experience. In the spirit of connection-building, the committee also pulled together panels of presenters whose work is closely aligned. In the end, though, it still came down to hard choices.

Invitations have just gone out to the authors of the selected presentations, and the conference team hope to be able to announce the full program soon. Watch this page for updates! For now, they can share that there will be 12 learning sessions in three streams. Some of the key themes include:

Social prescribing with youth
Social prescribing for older adults
Innovative research findings
Interprofessional approaches to social prescribing without a link worker
Indigenous perspectives on social prescribing and land- and culture-based healing
Music on prescription
Innovative approaches to asset mapping
Training & resources for building your social prescribing skills

Experiential Sessions and Networking Tables

To add some movement and community to your day, attendees can take part in up to three experiential sessions: Art and drumming, movement, and rest. The day will begin with dedicated time and virtual tables for networking, so attendees can meet and chat with peers from across Canada (and beyond) who have similar goals, challenges, and considerations.

October 20 Human Connection Event

Social prescribing so much bigger and more diverse than a one-day conference could ever convey. To make room for more, the conference team has created space for an additional event, Combating Isolation and Empowering Human Connection through Social Prescribing, taking place all across Ontario on October 20. Alliance member organizations and their local partners are invited to participate by hosting in-person events for their clients, staff, and community members to join. This is a chance to celebrate the beauty of human connection and the potential of social prescribing. The Alliance is offering a variety of supports for those who want to take part, including virtual office hours and a digital toolkit full of logos, messaging, and designs. Check this page for more information and ideas, or register your Human Connection event here.

Tools and Resources

Funding Opportunities

Deadline Tuesday, October 3 | Midwifery Expansion

Funding is available from the Ministry of Health to add or expand Indigenous Midwifery Programs (IMPs) and Expanded Midwifery Care Models (EMCMs) for low-risk pregnancy and reproductive care. This program has been developed in partnership with the Association of Ontario midwives. Funding is available for:

Expansion of Existing IMPs
New IMPs
Expansion of Existing EMCMs
New EMCMs

Check out this page for details about the program and contact information for additional support from the ministry or AOM. If you would like to apply, please request an application form by emailing Midwifery@ON.ca, and specify in the subject line which application form you are requesting.

Deadline November 1, 2023 | Harkness Fellowships in Health Care Policy and Practice Innovations. Successful applicants will spend a year in the US conducting internationally comparative research with mentorship from leading US experts. Learn more here. Apply here.

Join anytime between now and April 24, 2024 | Health Workforce Innovation Challenge | Do you want to earn funds for your organization while testing new ideas and solutions for retaining and supporting your workforce? Healthcare Excellence Canada is offering a 12-month Open Innovation Challenge, and participating teams can earn up to $112,000 to develop and implement their ideas. The sooner you join, the more you can earn! All participants will be supported through peer networking, expert coaching, and learning events. Learn more here and here, and sign up here for a virtual Q&A on July 19.

Tools for Improvement and Highest-Quality Care

Educational Support for Clinicians on Anxiety and Depression. The Centre for Effective Practice is offering Mainpro+ accredited educational support (academic detailing) for primary care clinicians from a trained clinical pharmacist. These can integrate the most up-to-date evidence and quality standards to help clinicians identify comprehensively assessing anxiety and depression in adults, and enable a stepped approach to therapies.

Webinars, Podcasts, and News You May Have Missed

The latest episode of Statistics Canada's podcast Eh Sayers explores the significance of the 2021 StatsCan census, which was the first time the national census collected and published data on gender dversity.

Self-determination in Indigenous health. August 9 was the UN’s International Day of the World’s Indigenous People. This editorial in the August edition of The Lancet called on health systems to respect, support, and prioritize “Indigenous leadership, knowledges, cultural expression, and continuity and resilience.” The authors note the huge reversal in disparities that occurred when First Nations peoples in Australia were empowered to lead their own response to the COVID-19 pandemic. In Ontario, the Indigenous Primary Health Care Council is leading the journey towards Indigenous self-determination in health. Check out their I ndigenous Health Systems Transformation framework document to learn more.

Podcast: How connection and belonging can change the culture of our health system. Natasha Beaudin from the Alliance and Sonia Hsiung from the Canadian Institute of Social Prescribing were special guests for HIROC’s latest Healthcare Change Makers podcast. They talk about the growth of Social Prescribing in Canada from a small pilot at 11 Ontario CHCs into a movement that extends across Canada and beyond.

Lancet Healthy Longevity Editorial: Primary care workers vital for healthy longevity

This editorial in the August edition of The Lancet Healthy Longevity calls on governments and health-care systems in countries around the world to make long-term commitments to training, recruitment, and support of primary health care workers to address the current human resources crisis. They argue that equitable access to high-quality, accessible primary health care is essential to support the complex health care needs of ageing populations.

New in our Library

Primary health care utilization in the first year after arrival by refugee sponsorship model in Ontario, Canada: a population-based cohort study. ICES scientists, including the Alliance's Director of Research and Evaluation, Dr. Jennifer Rayner, examined health care usage by asylum-seekers in Ontario who were sponsored through different models. They found that privately-sponsored refugees who arrived before or during the Syrian refugee crisis experienced lower CHC usage and delayed access to primary healthcare compared to asylum seekers associated with other settlement models. This changed after CHCs mobilized in response to the crisis. This suggests that private sponsors may have initially lacked information about how to navigate the healthcare sector and that the CHC response helped close the information gap.

Establishing internationally accepted conceptual and operational definitions of social prescribing through expert consensus: a Delphi study. This paper describes how research about different people's understandings of what Social Prescribing means led to the development of a new framework: The Common Understanding of Social Prescribing (CUSP).

Household food insecurity and health service use for mental and substance use disorders among children and adolescents in Ontario, Canada. This paper by ICES scientists brings together survey responses and healthcare data to demonstrate that food insecurity is associated with greater need for mental health care among young people in Ontario.

A Multidimensional Social Inquiry into the Loneliness Problem: Urbanization, Technological Mediation, and Neoliberal Individualism. This paper from researchers at the University of Alberta takes a critical look at loneliness research and proposes that new research and policy addressing the problem should go beyond public health and prioritize examining our built and virtual environments and our culture, and create whole-of-society solutions.

Looking for more?

Consider subscribing to these newsletters to receive regular updates from Alliance system partners:

Learning Events & Programs

September

Starting and resuming in September | ECHO at UHN fall programs now open for registration. Each session includes a lecture by a subject matter expert and real case discussions presented by participants (you can bring your own anonymized cases to discuss). Participants get access to an interprofessional specialist team. Open to all health care providers; CPD credits are available!

Liver | Mondays, 12:00–1:30 pm | Ongoing (spots available). Resumes September 11
Concussion | Wednesdays, 4:30–4:45 pm | NEW! Starts September 13
Chronic Pain & Opioids | Thursdays, 12:30–2:00 pm | Ongoing (spots available). Resumes September 7
Rheumatology | Fridays, 12:00-1:30 pm | Ongiong (spots available). Resumes September 8.

Visit the UHN ECHO website for more information. Register here.

September 12 - 14 | PxP: For patients, by Patients | Virtual Conference

PxP is a brand new conference about patient engagement, led and designed by patients, specifically for patients. Unlike other patient engagement resources, which are designed primarily for researchers, this one is tailored for patient partners and other individuals with lived experience. Researchers are also welcome to attend! Register now . Check out the online PxP Resource Hub online hub or sign up for the PxP newsletter for more patient-developed resources about patient engagement.

Tuesday, September 19, 9:00 am - 4:00 pm | Challenging Structural Substance Use Stigma In Person Pilot Workshop | Ottawa. This free and interactive in-person workshop is an an opportunity for health and social service providers in the Ottawa area to explore the impacts of structural stigma related to substance use. As it is a pilot, attendance is limited to 25 people. 1545 Carling Avenue, Ottawa.- free lunch and coffee included. Register here. Presented by the Canadian Public Health Association (CPHA) and the Community Addictions Peer Support Association (CAPSA). More information available here, or contact Sophie Chochla or CPHA.

Wednesday, September 20, 12:00 pm - 1:00 pm | The key role of health equity in addressing the climate crisis and other environmental risks | Webinar

Climate change is a significant and growing driver of health inequities even here in Canada. However, there are cost-effective ways for primary health care organizations to mitigate the inequitable impacts of climate change on the health of their clients and communities. Our guest presenters will clearly describe the links between the impacts of climate change and other social and structural determinants of health, demonstrating how climate change intersects with and compounds them. They will also provide clear, actionable steps and climate-responsive strategies and tactics your organization can adopt with minimal investment of time or energy. Register here.

Thursday, September 28, 12:00 pm - 1:00 pm | Introducing Learning Collaborative 3: Increasing efficiency to improve access to care | Webinar

Our 3^rd learning collaborative will help participating organizations make care more accessible by increasing efficiency. Curious? Check out the article above for more, and join our informational Lunch ‘n’ Learn Webinar on September 28.

October

Thursday, October 5, 8:30 am - 4:30 pm | Pride in Patient Engagement in Research (PiPER) Research Day | Hybrid (Toronto)

This is the inaugural PiPer Research Day, offered virtually and in-person at the University of Toronto. Keynotes, panels, virtual poster sessions, interactive workshops, storysharing sessions, and an art exhibit will explore themes including:

Advancing Inclusion, Diversity, Equity, Accessibility, & Allyship
Deepening Practices, Approaches, and Considerations
Building Capacity for Partnership
Measuring Engagement & Impact

The program also includes the launch of PiPER’s Patient Engagement in Research Toolkit. Open to everyone. Patients, caregivers, and family members; health care leaders; researchers; policymakers; and learners are encouraged to attend. Learn more about PiPER and the research day here. Register here. In-person spots are limited.

Starting Tuesday, October 10 | MindWell for Healthcare Workers from Wellness Together Canada | Online Learning. MindWell for Healthcare Workers is a free, 4-week online course designed by and for healthcare workers to help reduce stress and burnout and increase resilience & well-being. It is produced by Wellness Together Canada, a mental health and substance use support program funded by the Government of Canada and other partners. Visit this page for more information about the program as well as links to other courses and resources that support your work and your wellbeing. Register here by October 14.

Tuesday, October 24 & Wednesday, October 25 | AGE-WELL Annual Conference – The Future of Healthy Aging | Toronto. The AGE-WELL Annual Conference is an annual event that brings together stakeholders who set the agenda for the future of technology and aging. Register by September 8 for early-bird prices .

Wednesday, October 25 | AFHTO 2023 Conference: Team Based Care – Making it a reality for all | Hybrid (Toronto)

The Association of Family Health Teams of Ontario (AFHTO) is holding their annual conference on October 25. This one-day, hybrid event features keynotes by Dr. Tara Kiran and author Nina Spencer, the annual Bright Lights Awards Ceremony, learning sessions, posters, and exhibits. This year’s conference calls for bold action to address inequities in access to team-based, whole-person care. Learn more here and register here by October 3 for early-bird rates.

December

December 20-13 | IHI Forum 2023 | Orlando, Florida

This year’s Institute for Healthcare Improvement (IHI) annual forum is a 4-day event with 10 topic tracks, including Building Improvement Capability, Population Health, and Workforce Well-being. There are over 160 sessions and five keynote speakers, including Erin Brockovich and Don Berwick. Early bird rates available! Information and registration here.

Ongoing Training and Collaborative Learning

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. EMR queries will be provided to help participating Alliance members identify clients who would benefit. Contact Jennifer Rayner for more information.

October 9 - December 10 | Integrated Care Online Academy | Online Learning

The International Federation for Integrated Care (IFIC) Canada has a few spots left in their Fall 2023 Online Certificate in Integrated Care cohort. This 5-module course runs from October 9 until December 10 2023 and requires a minimum of 30 hours study time. Check out the brochure or register here.

Upcoming Courses at Rainbow Health Ontario | Online Learning. Sign up and sign in to RHO's learning platform to access these free courses:

2SLGBTQ Foundations / Fondements 2SLGBTQ | self-directed, always available
2SLGBTQ Older Adults and Inclusive Care | self-directed, always available
Puberty Suppression for Trans Youth in Primary Care | September 7 and October 6
Removing the Barriers | September 19
2SLGBTQ Emotional and Mental Health | September 28 and November 9

Research & Sharing Opportunities

Research Partners Needed

Rainbow Health Ontario (RHO) is making a podcast series on 2SLGBTQ health, and they're looking for people to share their perspectives.

If you're a health care provider based in Ontario and have a question abuot caring for 2SLGBTQ clients/patients, submit your question here.
If you're a 2SLGBTQ person who would like to share your experience about an encounter in the health care system that others might learn from, reach out by email with the subject line "RHO Podcast"

Looking for primary health care organizations who help vulnerable people get ID. Not having ID is a significant barrier to many of the social and structural determinants of health including shelter, income, and health care. The Thunder Bay ID Action Group, a collective of organizations in Thunder Bay who are working together to help low-income and other vulnerable individuals to get ID. They’re looking for other organizations doing similar work in order to exchange knowledge. If this is you, please email Anita Jean, Manager of Community Digital Health Equity. Want to learn more? Check out their research-informed calls to action regarding access to birth certificates.

Clinical Trials and Participatory Research

Help recruit participants for CanTreatCOVID. The Alliance is a partner in this pan-Canadian study that compares outcomes with different COVID-19 treatments in primary care. You can help by inviting your clients (and others in your network) to participate. This handy recruitment toolkit includes posters for your clinic or program space, banners for your website, a short video, and information about signing up. Please share this opportunity with your team by posting this flyer, which has been customized for Alliance members, in your shared space.

Interviews and Focus Groups

Racialized stroke survivors and family members/caregivers: Your lived-experience expertise can help develop knowledge about the needs and goals of racialized people after a stroke, as well as the gaps in support and services available to them. Researchers at the University of Toronto are looking for people who are Black/African, South Asian, or Chinese to share their experiences in meetings and through photovoice. Participants will be compensated. See the flyers linked above or email Hardeep Singh for more information.

Surveys

Online Questionnaire: Safe LTC Act | Respond by Thursday, September 21:

The Government of Canada is developing a Safe LTC act to ensure that people in long-term care get the care they deserve. They are currently conducting engagement activities to inform the development of the Act. Share your views about long-term care by responding to this questionnaire by September 21. This questionnaire is open to everyone; please share it widely with your networks.

Survey for your older adult clients: A graduate student at the University of Toronto is surveying older adults about how they use the Internet for health information, and how they would like to learn new information for their health maintenance and improvement. Anyone aged 55+ is welcome to participate, especially those who are Indigenous, racialized, 2SLGBTQ+; have disabilities; or live in rural/remote areas. Consent form and survey here. For further information, please reach out to Mary Hynes by email or at (416) 597-3422 ext. 7775.

Does your organization provide health care or other supports to refugees and asylum seekers? Researchers at the University of Calgary are looking for people working in clinical, public health, or settlement organizations to answer some questions via an online survey. They want to understand who provides care to refugees and asylum seekers in Canada, how this care is coordinated and delivered, how it differs among jurisdictions, and how COVID-19 has impacted it. Participate by completing this short survey . In lieu of an honorarium, the research team will donate $10 to support refugee student scholarships. See flyer (English or French) for more information.

Advocacy

Action for Safer Supply, a working group composed exclusively of people who use drugs who are all members of the National Safer Supply Community of Practice, is submitting an open letter to the federal government about the sustainability of safer supply and harm reduction programs across the country. The working group invites all people who use drugs, drug user organizations, associations, and groups, and any community-led harm reduction initiatives to sign on.

October 23-27 is Canadian Patient Safety Week. It's an annual campaign led by Healthcare Excellence Canada to inspire extraordinary improvements in healthcare safety and quality. Learn here about ways to participate. Register here to stay informed, order materials, and get access to events and resources. More information available here.