Issue 27 | January 31, 2024

Bulletin of the Alliance's Learning Health System

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An EPIC Update

The past year has been a busy and exciting one for the EPIC Learning Health System. In this issue, we're showcasing some of the highlights of 2023 and looking ahead to 2024. Read on to discover how our members' commitment to research, learning, and improvement is helping our sector demonstrate health system leadership, showcase the value of or model of comprehensive primary health care, and improve health outcomes for people and communities.

Demonstrating Health System Leadership

Showing and Telling the Value of our Model

Peer & Client-Informed Learning

Advancing Social Prescribing

Research to Empower Quality Improvement

New Tools & Resources

Get Involved: Research & Sharing

Learning Events & Programs

Demonstrating Health System Leadership

The EPIC Learning Health System continues to be a model for learning health systems across Canada and Ontario. Dr. Jennifer Rayner, the Alliance’s Director of Research & Evaluation, was named the Ontario lead for the new Canadian Primary Care Research Network (CPCRN), which was launched in July. She was also appointed Adjunct Scientist at ICES Central. The Alliance’s Common QIP indicators, which our sector developed and ratified in 2018 and members have been using for their annual Quality Improvement Plans (QIPs) since 2019, have been largely adopted by Ontario Health as the 2024-25 suggested indicators for all of primary care in Ontario. Our partners at Ontario Health have told us they see the Alliance and our members as quality improvement leaders within primary health care. For the last few years, the Alliance has been working in partnership with Ontario Health to update our health equity questionnaire and implement it across the health system. These updates were informed by health equity and lived-experience experts as well as findings of the SPARK study, in which Dr. Jen Rayner is a co-investigator. This past spring and summer, the updated questionnaire was pilot-tested by four of our member centres, and we worked with TELUS Health and Ocean to develop custom forms to support its use. Earlier this month, as we rolled out the new questionnaire to Alliance members across the province, Ontario Health Toronto Region implemented it in all of the organizations they fund. Our Social Prescribing team, together with with the Canadian Institute for Social Prescribing, delivered a presentation at the Family Medicine Forum about how social prescribing can help address social needs in family medicine. Their presentation was named one of the conference’s four top Big Ideas. Social Prescribing was also featured in the University of Toronto’s 2023 Family Medicine Report. The story featured findings from our Rx: Community pilot and the personal story of a social prescribing client at Rexdale CHC. Alliance staff partnered with the Centre for Effective Practice to publish a Social Prescribing resource for health professionals, to support implementation of the model in diverse primary care settings.

Showing and Telling the Value of Comprehensive Primary Health Care

Our sector shares a commitment to a model of comprehensive primary health care that is interprofessional, grounded in community development and the social determinants of health, and led by communities. We know that this model delivers better health outcomes for clients and communities, makes care accessible to those who face barriers to health and wellbeing, and fosters more joy in work for members of the care team. We also have evidence to show that it is saving money to keep our health system sustainable. The Alliance worked with health economist Dale McMurchy to examine the health-system savings generated by Alliance members. In 2022 alone, our CHC members' clients made 80,000 fewer emergency department visits than would be expected based on their complex health and social care needs. These averted ED visits saved our health system $27 million dollars! This became a key message of the Alliance’s summer CHCs Work campaign. Health promoters and community developers in our sector provide upstream support for the social and structural determinants of health, and this work is the "secret sauce" that makes our sector's work truly comprehensive. In June, we released a descriptive report of Health Promotion activities in Ontario Health Centres. You may be surprised to learn that in 2020-21, our members recorded over 2500 personal development groups! This work is informing a new research project led by Sara Bhatti, our Research and Evaluation lead, about how best to continually measure and demonstrate the value of health promotion across our sector. This multi-faceted, mixed-methods study includes two advisory groups, one for health promotion staff and one for clients.

Expanding our Capacity for Peer-Supported and Client-Informed Learning

Collaborative learning is key to an effective learning health system. Since officially launching our learning health system in 2019, we have hosted three learning collaboratives, added several communities of practice, and developed a new, coaching-supported model called RALI.   Our second learning collaborative, Foundations of Equity, was focused on helping our members improve their sociodemographic data collection processes. It wrapped up in April, and we're excited to share that the teams who completed the program saw a 25% increase in their data completeness rate! Our third learning collaborative, Increasing efficiency to improve access to care, was launched in September. In between these two learning collaboratives, we piloted a new initiative called Rapid Action & Learning Intensive (RALI), a kind of Learning Collaborative—lite. RALI was designed to help teams apply change ideas that worked for their their peers in the learning collaboratives. After it was piloted over the summer, RALI has been refined and will be launched again this spring. Participants complete four online modules and a workbook, and their learning is supported with dedicated coaching. Email [email protected] to learn more or sign up. Please note: At this time, RALI is available to Alliance members only. We launched two new Communities of Practice to support peer-to-peer knowledge exchange and informal mentorship. The Finance Community of Practice first met in February, and the Health Promotion Community of practice had their first meeting in October. In total, we now have nine communities of practice on the go. The National Safer Supply Community of Practice (NSS-CoP) continued to deepen the evidence base for the value of safer supply and develop our understanding of best practices. In 2023, the NSS-CoP hosted 5 Hot Topic webinars and 12 Research Spotlight webinars. We also launched our new lived-experience advisory group, the EPIC Client & Community Research Partners Committee, in January. This small group of dedicated clients and community members support research projects at Alliance and at other organizations we work with, by providing guidance based on their diverse and rich expertise.

Advancing the Spread of Social Prescribing to Improve Population Health

The Alliance brought Social Prescribing to Canada in 2019. Since then it has continued to grow, evolve, and spread. The EPIC Learning Health System is the home of Social Prescribing at the Alliance. Our two Social Prescribing communities of practice (Ontario-based and Canada-wide) continued to grow and mature. Both groups meet regularly as a space for peers to connect and learn together. In addition to the communities of practice, the Social Prescribing team hosts regular skill-building Lunch and Learns on topics like motivational interviewing or using data to drive improvement. In October 2023, the Social Prescribing team delivered our second annual virtual Social Prescribing conference, Cultivating Connections: Pathways to Wellbeing. The event attracted over 300 attendees from 200 different organizations, who participatied in three simultaneous conference streams.   Through our PHAC-funded Social Prescribing for Better Mental Health project, we have distributed $2.2 million to Alliance member sites to develop and implement social prescribing pathways that support mental wellness. We provide focused coaching to support these 28 centres with implementation, measurement, and improvement of tailored social prescribing programs. This year, we'll be supporting an additional 13 centres with coaching through a spread initiative. 2023 also saw the launch of the Black Focused Social Prescribing project. The Alliance is working together with four Black-led CHCs to co-create culturally competent programs and social prescribing pathways for Black families and their communities. This includes developing new culturally relevant tools, rooted in Afrocentric values, such as the Wheel of Life.

Conducting Research to Empower Learning and Quality Improvement

Alliance staff are currently leading, co-leading, or advising over 20 research projects. We do this by partnering with researchers in universities and institutes across Canada and beyond. We are also contributing practice-based data from our sector to dozens of others. What we learn from these projects will contribute to making primary health care more equitable, effective, and sustainable. Some examples of this research were highlighted above. Here are a few more examples of research we've been doing over the past year. We're running a pilot study at 6 CHCs of the EQ-5D tool for Patient Reported Outcome Measures. Our mid-study progress report was released last spring and has been submitted to the Ontario Ministry of Health. Early findings are that the tool is easily integrated into existing workflows; clients find it accessible and easy to complete; and it can help guide intake and follow-up conversations. In partnership with researchers at Memorial University of Newfoundland, we're undertaking a longitudinal, cohort-based costing study that will help us measure the value of CHCs for population health and system sustainability. Our practice-based learning network (PBLN) is working with research partners at Western University to develop artificial intelligence solutions for supporting and strengthening the primary health care workforce. Dr. Jen Rayner is part of a multi-sector, interprovincial research team that's conducting a mixed-methods study on Primary Care for Individuals with Severe Mental Illness (PRISMi). Dr. Rayner is also a co-lead investigator for CanTreatCOVID, a pan-Canadian, randomized controlled trial of COVID-19 interventions. We are continuing to work with our partners to advance access to team-based care for clients of solo primary care providers. Keep an eye on EPIC News for updates and publications.

Tools and Resources

Funding Opportunities Health Workforce Innovation Challenge Join between now and April 24 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. Tools for Improvement and Highest-Quality Care Sustainable Communities: A Guide to Community Asset Mapping | Free PDF from Falls Brook Centre This guide to community asset mapping may be helpful for health promoters, community developers, and others who wish to work with people in their communities to develop an inventory attributes and advantages of the community that support its quality of life. This toolkit contains step-by-step instructions for facilitating an asset mapping workshop, as well as worksheets and an evaluation form for participants. Created by Falls Brook Centre and shared by the Tamarack Institute. Two new videos about the impact of social prescribing from the Ontario Social Prescribing Community of Practice These videos, featuring social prescribing programs at Regent Park CHC and Lakeshore NPLC showcase social prescribing in action and demonstrate its positive impact on clients’ health and wellbeing. In Case You Missed It Implementation Support for the Updated Health Equity (Sociodemographic) Questionnaire | Recorded Webinar Our updated Health Equity Questionnaire was launched on Thursday, January 11, with a special lunch ‘n’ learn webinar. The recording, slide deck, and links to other resources to support implementation of the questionnaire can be found here. For more information or implementation support, email [email protected]. Orientation to the 2024-25 QIP Program | Recorded Webinar The QIP Navigator is now open to receive Quality Improvement Plans (QIPs) for primary health care organizations and Collaborative Quality Improvement Plans (CQIPs) from Ontario Health Teams. On Wednesday, January 18, the Alliance held an orientation webinar for this year’s QIP programs, with an overview of priority issues and indicators as well as information about available resources from the Alliance and Ontario Health. You can watch the recording and access the slide deck and links here.  Social Prescribing in a Public Health Context | Recorded Webinar Watch this webinar to hear from social prescribing and public health experts, who describe how social prescribing can be implemented within a public health context. Originally live streamed December 6.  New in our Library Neighbourhood influences on youth mental health and stress levels during the first six months of the COVID-19 pandemic | Cities & Health Researchers from Western University examined how health-related behaviours, neighbourhood features, and demographic factors may relate to changes in youth mental health and stress levels during the first six months of the pandemic. Through a survey conducted with youth in London, Ontario, the researchers explored how age, gender, ethnicity, dietary habits, physical activity levels, and availability of parks, fast food, convenience stores and grocery stores could correlate with mental health and stress levels. They conclude that public spaces played an essential role and suggest policy implications for including youth perspectives in the planning of the public realm. See it in our library. Supporting Caregivers in Primary Care | New Tip Sheet from the Ontario Caregiver Organization Despite providing approximately 75% of the care in our health system, caregivers are struggling to get by. To help primary health care providers support them, the Ontario Caregiver Organization (OCO) created this one-page tip sheet which includes practical takeaways and links to free tools for both caregivers and providers. Also available in French. COVID & Flu Health Promotion Resources | CanTreatCOVID These five images from the CanTreatCOVID study can be used as posters or social media cards. They contain health-promotion messages about COVID and flu testing, vaccination and symptom identification, as well as information about the study and how to enroll.  There's lots more in our library - check it out here!

Looking for more? Consider subscribing to these newsletters to receive regular updates from Alliance system partners: The Indigenous Voice | Daadibaajimo CACHC/ACCSC eNewsletter Healthcare Excellence Canada Updates National Safer Supply Community of Practice Newsletter Institute for Healthcare Improvement Newsletter

Learning Events & Programs

Alliance 2024 Conference: Co-Designing the Future of Primary Health Care Wednesday, June 5 - Thursday, June 6 | In Person (Richmond Hill) This year's conference theme reflects a shared vision and action-orientation towards strengthening the foundation of our healthcare system. At this year's annual conference, we'll explore the health impacts of emerging issues such as AI, climate change, and our changing socio-economic environment. We'll focus on how these issues affect equity-deserving groups and others who experience marginalization and barriers to accessing the social and structural determinants of health. This future-facing conference is designed to offer rich learning experiences equally suited to people who work in primary health care, community and system partners, and policy- and decision-makers.  Registration opens in March. Learn more here or consider submitting a learning-session proposal. We've just extended the deadline to February 5.

February Navigating the Link Between Alzheimer’s Disease and Fall Risks: Understanding, Prevention, and Care Friday, February 16, 12:00 pm| Free Webinar Presented by the Loop Fall Prevention Community of Practice, this presentation provides a comprehensive overview of Alzheimer’s Disease, its impact on fall risks, and strategies for prevention and care. It aims to educate both care partners and healthcare professionals on the importance of understanding and addressing fall risks in people living with Alzheimer’s disease. Register here. April Health Data for All of Us: Earning Trust Through Transparency Tuesday, April 23 | Hybrid Conference (Online & Montreal) HDRN Canada hosts this annual hybrid in-person and online forum for researchers and members of the public to learn about and explore a range of topics related to health data access and use in Canada. Learn more here - registration to come. June  CPRI Research Symposium: Current Evidence and Promising Practices for Complex Child and Youth Mental Health and Development Thursday, June 23 | Hybrid Conference (Online & London, ON) This symposium is ideal for audiences interested in children and youth with complex combinations of needs, including researchers, students, and those who work in allied health professions, medicine, education, justice, direct care, or policy. The symposium will include morning and afternoon plenary speaker sessions and workshop speaker panels, a lunch-hour research poster session, and networking opportunities. Learn more here. Register here.

Ongoing Training and Collaborative Learning Rapid Action & Learning Intensive on Sociodemographic data collection (RALI-SDD) Coming soon - Alliance members only! RALI-SDD is launching soon! Participants gain access to four self-paced online learning modules, dedicated coaching support, and a workbook to help you track your progress. RALI was developed as a way to help organizations apply the learnings of our second learning collaborative, which was all about improving sociodemographic data collection. It's free to enroll and available to Alliance members only. If interested, please email [email protected] to learn more or sign up. 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.

Research & Sharing Opportunities

Public consultation: Barriers to Dental Care Online Survey | Respond by April 21 | Please Share Widely The Royal College of Dental Surgeons of Ontario (the regulatory body for all dentists in the province) is looking at ways to address inequities in access to oral health care, including developing two new documents: A Standard of Practice that will set out dentists’ legal, professional, and ethical obligations when accepting new patients; and A Professionalism Guide that will set out the values, principles, and duties dentists have as oral health care professionals. You can help inform the development of these documents by completing this online survey by April 21. It will take approximately 20 to 30 minutes to complete. Want to see the questions first? Download a PDF of the survey here. If you have questions, please reach out to the RCDSO by email. The Alliance and our partners at the Ontario Oral Health Alliance have long advocated for more equitable access to dental care and see this as a very positive step forward. Please share this survey with link your colleagues, clients, and community members.

Calls for Abstracts Advancing Social Prescribing for Health Wellbeing | Submit your Abstract by February 12 The Canadian Institute for Social Prescribing’s international conference takes place in Toronto, September 26-27. They are inviting interested individuals to submit learning-session and poster proposals aligned with these conference streams. Submit your proposal here by February 12. Clinical Trials and Participatory Research Help recruit participants for CanTreatCOVID. The Alliance is a partner in this pan-Canadian study that compares outcomes of 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, videos, 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. New! Check out this short video featuring CanTreatCOVID project scientists, including the Alliance's Director of Research & Policy, Dr. Jennifer Rayner. Focus Groups and Interviews Provider Experience Study: Primary Care for Individuals with Serious Mental Illness (PriSMI)  Take part in a single 60-minute interview about your experiences PriSMI is a CIHR-funded research program about the role of primary care in managing chronic illness among people living with serious mental illness (SMI). People with SMI often experience barriers to care, and understanding how primary care services are provided to them may help reduce avoidable hospitalizations and deaths. For the provider interview study, the PriSMI team is looking for family physicians and primary care nurse practitioners to describe their experiences caring for people living with SMI. Participants will receive a $120 honorarium for a 60-minute interview. Interested? Please check your eligibility here. For more information, contact [email protected]. Surveys Nominate High-Performing Early Career Family Physicians Researchers at the Universities of Toronto and Manitoba are conducting a study to identify the capabilities and competencies of high-performing family physicians. This study will contribute to the development of a Capability Framework for family medicine. Nominated physicians will be asked to complete an online survey and will receive financial compensation for their time. See this flyer for details about eligibility. For more information, please contact Dr. Monica Aggarwal.  Interprofessional providers in primary care teams: Primary Care Teams Capacity Estimator (CapEs) Study Help develop evidence for how your profession adds capacity to primary care teams. Participate via a series of online surveys | 6-9 weeks. More information about the study is available here.  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. For RNs Practicing in Primary Care Settings Help researchers understand how clinic funding models impact registered nursing roles. This 15-minute online survey asks about your workplace, roles, team functioning, and team management of patients. See the recruitment poster or email Dr. Julia Lukewich.

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