Onil Bhattacharyya, BRIDGES co-lead Department of Family and Community Medicine University of Toronto Building BRIDGES to Integrate Care March 30, 2015

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

Faculty/Presenter Disclosure Relationships with commercial interests: – Research lead on a study of primary care models in low and middle income countries. It is funded by the UK Charity the International Centre for Social Franchising with funding from Gates Foundation, GlaxoSmithKline, Merck, Novartis, Novo Nordisk, and Vodafone. This program has received NO Commercial support This program has received NO in-kind support Potential for conflict(s) of interest: – None for the work discussed in this presentation

Our Mission To develop an incubator to test new models of integrated care for Ontarians with complex needs. To gain insights into the key drivers and barriers to health system change and assist with scale-up of successful initiatives

Initially 4 Key ideas Partnership Integrating primary care, hospital and community services Support for rigorous evaluation Portfolio of projects 5 BRIDGES Concept

SolicitSelectSupportScale BRIDGES Process

Evolution of BRIDGES Future BRIDGES as an incubator to support innovation and test models Developed the BRIDGES infrastructure Meta- evaluation Added psychiatry Initial qualitative findings Evaluation of the BRIDGES model Medically Complex Patient (MCP) pilot 6 models 9 models Formalize learning and support provincial efforts Built Collaborative 7 3 models 45 models Redesign of Virtual Ward

Project Collaborative System BRIDGES Model

First cross-department partnership of this size Unique incubator model in Canada Brought practice, policy and research communities together 9 projects implemented, all sustained 9 What did We Achieve?

Expanding partnership Support co-leadership by primary care, hospital and community services Balance rigour and responsiveness in evaluation Defining success in a portfolio 10 What did we learn?

BRIDGES has unique knowledge of common care integration challenges years of experience Academics Front-Line Providers 23 Institutions 28 Project Investigators 2,300+ Complex Patients Mixed methods Academic and front-line expertise 11

Areas of Learning for BRIDGES Evidence review Logic Model Team formation Issue Identification Design Process Measures Model adaptation Hypothesis Testing Implementation Redesign Implementation results Indicators Qualitative Quantitative Study design Evaluate Promising Model 12

13 BRIDGES Care Model

Supporting Inception to Impact 14

Shift in business model Deepen partnerships with system stakeholders Adapt evaluation to project stage Evaluate the portfolio 15 What do we take forward?

Evaluating a Portfolio of Projects MCP evaluation Addressing Grand Challenges in system integration for people with complex needs Assessing project stage Building a collaborative Evaluating a portfolio of projects – Qualitatively – Quantitatively 16

Challenges Addressed by MCP Projects 17

MCP Project Stages 18

Opportunity for exchange and shared learning Tools to communicate activities Tools to survey challenges and opportunities Visual analytics for communication and analysis 19 Building an MCP Collaborative

Integration is hard work Many models will need to be redesigned and recombined before they succeed System changes should be tested with practice changes Similar approaches can be used to integrate across sectors 20 Implications for Ontario

Reflections Assume it isn’t going to work initially Pace yourself Document your journey Keep reaching 21