Onil Bhattacharyya, MD, PhD Frigon Blau Chair in Family Medicine Research Women’s College Hospital University of Toronto Overview

Acknowledgements – Dr. Wendy Levinson – Dr. Lynn Wilson – Dr. Fiona Webster – Dr. Kaveh Shojania 2 Key Partners: Ontario Ministry of Health and Long-Term Care – Health Quality Branch Executive Committee – Dr. Vicky Stergiopoulos – Dr. Gary Naglie – Dr. Onil Bhattacharyya

Schedule 8:15 Overview of BRIDGES Onil Bhattacharyya 9:00 Keynote Ed Wagner 10:00 Integrated Home-based Primary Care Tia Pham 10:20 BREAK 10:40 Coordinated Access to Care from Hospital ED Vicky 11:00 BRIDGES meta-analysis Dr. Fiona Webster 11:30 Lunch and Poster viewing 12:30 Leveraging Lessons Learned Jodeme Goldhar 1:00 Closing Remarks Dr. Wendy Levinson

What is the most important problem in health care?

What is the most difficult problem in health care?

What is the solution?

Objective Create a platform for development of new models of integrated care for complex patients.

Family Medicine Medicine Psychiatry Across Disciplines Across the Continuum Community Services Primary Care Hospital Incubating Models of Integrated Care

Bridging Different Worlds Health Service Providers Pragmatic Decision- Making Data-Driven Decision- Making Academics HSR Clinical Sciences Basic Sciences Rigorous QI Methodology Shared Space for Innovation High Quality Health Services Research

The BRIDGES Process SolicitSelectSupportScale

Solicit SelectSupportScale 61 proposals, 9 funded From Barrie to South Lake

Solicit Select SupportScale Reviewed on Scientific rigour System relevance

Solicit Support SelectScale Study design, data coordination and analysis Qualitative evaluation Economic evaluation

15 Hypothesis Testing Framework

Solicit Scale SupportSelect Work with HQO and CAHO Many potential partners No firm results yet

Project Collaborative System Collective Impact

ProjectPopulationModel IMPACT PlusComplex patientsMultidisciplinary team consultation IHBPCHomebound elderMultidisciplinary homecare team Innovate AFibAtrial FibrillationNurse coordinator PIC COPDCOPDNurse-led self- management CATCH-EDFrequent ED users in Mental Health Transitional case management SCOPEGPs with high user patients Phone consultation + coordination H-SOAPAddictionsRapid consultation + care RAPTMental HealthRapid consultation ICCTGPs w/ complex older patients Shared or assumed care

The BRIDGES Collaborative

BRIDGES in Brief 9 projects 28 lead investigators 23 Institutions 2,300+ patients 30 providers + their patients

Communication between institutions Joint care delivery Joint management across institutions SCOPE IHBPC PIC COPD TEAM CATCH ED ICCT Integration Across the Continuum

Building BRIDGES Continuous testing and improvement Co-leadership w/ psychiatry Characterizing key elements of QI Building trust and sharing

Impacts Tested model for incubating pilot projects – Adapted for provincial pilot initiative Strong collaboration b/w departments and CCAC All models sustained after funding Synergy w/ Health Links

Key Deliverables Increase likelihood of project success in terms of effectiveness and learning Assess impact of overall initiative and potential of models Project results by 2015

What have we learned?

It’s Hard Recruitment Targeting Making the intervention work Management across institution Outreach to primary care

It’s Easy to get it Wrong Be ready to change Zoom in/out User segment pivot User need pivot Business architecture pivot Channel pivot

It’s Worth It Patients appreciate the comprehensiveness Providers appreciate being connected Managers appreciate connection to other institutions Policymakers like the coherence

There’s Much More to Do No magic bullets No clear answers yet More people are in the game Growing potential for cumulative learning

Thanks!