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Purpose: An integrated care system identified quality improvement (QI) capacity as a gap in advancing their integrated quality care priorities and improvement efforts. Here we describe the design and implementation of a QI capacity building program that aimed to (1) build QI capacity amongst diverse integrated care system members and (2) apply QI principles to advance integrated quality care priorities. Design/methodology/approach: The integrated care system leaders, including community members, partnered with the University of Toronto Centre for Quality Improvement and Patient Safety to co-design and deliver the QI capacity building program focused on improving cancer screening rates. An existing acute care capacity building program was adapted. Content included QI tools, data to identify and monitor QI priorities, equity considerations, and empowering participants as change agents. Findings: Participants were satisfied with the content and delivery of the program. Some described using QI tools and strategies in practice following the workshop. Challenges to using the tools included the current pressures facing primary care and the health system, resources, and data availability. Practical implications: This QI capacity building program was challenging but feasible. Clarifying the target audience, being attentive to co-design, acknowledging post-pandemic system challenges and proactively addressing variable knowledge and barriers to QI work in practice will inform future iterations of this program. Originality/value: While many examples of QI education programs exist, the majority target a single healthcare sector. We describe a novel QI capacity building model that bridges healthcare sectors and includes patient partners and community members as teachers and participants. [ABSTRACT FROM AUTHOR]

Objective: To engage with patients, caregivers and care providers to co‐design components of an intervention that aims to improve delayed hospital discharge experiences. Design: This is a qualitative study, which entailed working groups and co‐design sessions utilizing World Café and deliberative dialogue techniques to continually refine the intervention. Setting and Participants: Our team engaged with 61 participants (patients, caregivers and care providers) in urban and rural communities across Ontario, Canada. A 7‐member Patient and Caregiver Advisory Council participated in all stages of the research. Results: Key challenges experienced during a delayed discharge by patients, caregivers and care providers were poor communication and a lack of care services. Participants recommended a communication guide to support on‐going conversation between care providers, patients and caregivers. The guide included key topics to cover and questions to ask during initial and on‐going conversations to manage expectations and better understand the priorities and goals of patients and caregivers. Service recommendations included getting out of bed and dressed each day, addressing the psycho‐social needs of patients through tailored activities and having a storyboard at the bedside to facilitate on‐going engagement. Discussion and Conclusions: Our findings outline ways to meaningfully engage patients and caregivers during a delayed hospital discharge. Combining this with a minimal basket of services can potentially facilitate a better care experience and outcomes for patients, their care providers and families. [ABSTRACT FROM AUTHOR]

Background: We report on the impact of two system-level policy interventions (the Long-Term Care Homes Act [LTCHA] and Public Reporting) on publicly reported physical restraint use and non-publicly reported potentially inappropriate use of antipsychotics in Ontario, Canada.Methods: We used interrupted time series analysis to model changes in the risk-adjusted use of restraints and antipsychotics before and after implementation of the interventions. Separate analyses were completed for early ([a] volunteered 2010/2011) and late ([b] volunteered March 2012; [c] mandated September 2012) adopting groups of Public Reporting. Outcomes were measured using Resident Assessment Instrument Minimum Data Set (RAI-MDS) data from January 1, 2008 to December 31, 2014.Results: For early adopters, enactment of the LTCHA in 2010 was not associated with changes in physical restraint use, while Public Reporting was associated with an increase in the rate (slope) of decline in physical restraint use. By contrast, for the late-adopters of Public Reporting, the LTCHA was associated with significant decreases in physical restraint use over time, but there was no significant increase in the rate of decline associated with Public Reporting. As the LTCHA was enacted, potentially inappropriate use of antipsychotics underwent a rapid short-term increase in the early volunteer group, but, over the longer term, their use decreased for all three groups of homes.Conclusions: Public Reporting had the largest impact on voluntary early adopters while legislation and regulations had a more substantive positive effect upon homes that delayed public reporting. [ABSTRACT FROM AUTHOR]

Introduction: East Toronto Health Partners (ETHP) is implementing a new integrated care model (ICM). ETHP is comprised of 50+ health and social organizations in East Toronto, with a leadership council consisting of patient/caregivers and six anchor organizations representing the continuum of care. ETHP is co-creating an IC model in which hospital, primary care, community providers and patients and families work together as one coordinated team in order to improve population health, patient and provider experience, and value for money (Quadruple Aim). Aims Objectives Theory or Methods: The aim is to create a learning health system within ETHP by embedding rapid cycles of evaluation to support learning, knowledge transfer, and decision making for scale and spread of ICM. A developmental evaluation (DE) approach is employed to achieve this goal. The priority population includes seniors with chronic care needs and their caregivers, and individuals with mental health challenges and substance use issues. ETHP's mandate is to expand the model's scope and coverage to cover the entire population of East Toronto. DE started in the fall of 2020 and is set up for 2 years. Highlights or Results or Key Findings: In our year 1 of DE, an evaluation steering committee including two patient partners was created to provide advice on the ongoing evaluations. To build capacity, evaluation workshops are being held focusing on evaluation types, developing logic models, and measurement. An early implemented ETHP's intervention, winter Surge initiative, was chosen to be evaluated at the project level (total of 15 projects). An evaluation template was developed for use across projects. The embed researcher worked closely with the project leads to develop logic models and choose appropriate measures. Projects used quantitative and qualitative methods to analyze their data. Main findings are: a) significant investment in knowledge-building around choosing appropriate metrics at the project-level is needed; b) system-level identified through the evaluation (e.g. primary care attachment) needs to be collaboratively addressed at the ETHP-level; c) evaluation processes need to be refined to meet the needs of the teams. Conclusions: ETHP is using DE to create a more integrated system of care for residents and providers across East Toronto. In its early stages, DE has focused on building internal evaluation capacity for internal teams to engage in ongoing evaluation activities creating a community of practice. Implications for applicability/transferability sustainability and limitations: By embedding rapid cycles of evaluation, ETHP aims to support strategic expansion of integrated models of care across its entire population. The focus on building internal evaluation capacity and an evaluation community of practice ensures sustainability. [ABSTRACT FROM AUTHOR]

Introduction: Integrated Comprehensive Care (ICC) program, developed in 2012 by St. Joseph's Health System(SJHS) in Ontario, Canada targeted several conditions including Chronic Obstructive Pulmonary Disease (COPD) and Congestive Heart Failure (CHF). Designed with extensive consultation with patients, the program significantly improves transition from hospital to home. In 2015, the program was expanded to all acute hospitals in region. Practice change implemented: a single collaborative team whose care coordinators are accountable to hospital with responsibility for planning and overseeing all care delivered in community; single integrated care path from hospital to home with one point of contact for patient and caregivers; single shared medical record accessible to all team members; simple technology; and bundled funding. Aim: Improving patient outcomes, experience, and system efficiency are main aims of ICC. Central to development of ICC is integrating care and bundling payment. Care integration programs brings together expertise and skills across sectors while bundled payment models offer providers financial incentives for such collaboration. By bringing integrated care and bundled funding together,ICC program is set to facilitate pursuit of Triple Aim. Populatin& stakeholders: Community dwelling residents admitted with COPD or CHF and require home care post discharge. Program developed and implemented in collaboration: Home&Community care, community health centers, existing COPD/CHF programs;specialty clinics and physicians, primary care teams;patients and caregivers;hospitals. Timeline: ICC is ongoing operational program (no longer a pilot project). Governance and committee structures, and leads (Executive, Medical, Operations) for each organization were confirmed in the first quarter of the program in 2015. Finance model and cost sharing, care pathways for integrated care and bundle wer finalized in the second quarter. Hiring and training of staff, as well as confirming electronic medical records were aslo part of the tasks completed during the second quarter. Patient recruitment, patient engagement, execution of the communication plan, data monitoring and reconciliation, evaluation and reporting, and sustainability planning are ongoing. Highlights: Impactful innovations are implementation of bundled funding improving outcomes and experiences without new funding. ICC team empowered to make decisions in the best interests of the patients and have complete flexibility in care planning decisions; all care team members access single patient record. ICC resulted in statistically significant reduction in Length of stay,ED visits, readmissions, and increased system capacity. Sustainability &transferability: ICC was successfully spread across 9 hospitals. Robust governance structure enabled ongoing engagement with all stakeholders to support sustainability, testing innovative ways to support further integrations. ICC directly informed provinces bundled funding policy. Regular formal and informal touchpoints of integrated team enables real time problem resolution and ongoing Quality Improvement. Conclusion, discussion, lessons learned: ICC increased quality and reduced unwarranted variation for eligible patients. ICC maximized efficiency of healthcare resource utilization, increased patient-centred care, increased patient, caregiver, and provider satisfaction, and continues to inform policy development. Main lessons learned; targeted patient and provider engagement is essential to success in efforts to spread and scale; bundle holder needs to be organization with greatest risk; care coordinators must be accountable to hospital; single lead homecare agency key success factor in supporting integrated team. [ABSTRACT FROM AUTHOR]

Introduction: In 2015, an integrated care and payment initiative (ICPI)--launched as the "Integrated Funding Model"--aimed at integrating care and payment across hospitals and homes to improve quality and decrease cost of care was piloted in Ontario. One of the main sources of cost containment for ICPIs is the shortened acute length of hospital stay due to early discharge. Unpaid care provided by friends and relatives is instrumental to success of such interventions. Increased reliance on informal caregivers, however, might contribute to known adverse health and financial consequences of caregiving making caregivers' contributions to ICPIs unsustainable in the long run. Despite this, caregivers are often underrepresented in ICPI designs and evaluations. The purpose of this study was to develop an instrument (Caregiver Experience Survey [CES]) that measures the consequences of ICPI on caregivers. Methods: A multiphase study design was used to develop CES: 1) Development of a questionnaire pool: Guided by a modified "Triple Aim" framework, grey and scoping literature reviews focusing on quantitative articles were conducted to identify common instruments used to measure caregivers' health, experience, and costs. Findings were shared with key stakeholders (caregivers, patients, researchers, and policy makers) to gain first-hand knowledge on what should be measured from caregivers' perspectives. A series of literature reviews were then conducted focusing on psychometric properties of identified instruments. 2) Development of CES: Specific items or questionnaires were chosen in consultation with the research team; CES was then developed and revised in consultation with caregivers. 3) Pilot sample and psychometric properties: To test the validity and reliability of CES, it is being administrated among a sample of ICPI caregivers. Results: CES has 58 items and 3 main domains (health, experience, and costs). EQ-5D-5L is used to measure caregivers' health. The 4-item version of the Zarit Burden Interview is used to measure caregiving burden. Eighteen questions were adopted from a variety of questionnaires to measure caregivers' experiences in and before leaving the hospital, and in the community. The cost section contains 21 items to measure the economic value of informal care, productivity loss, opportunity costs, and uses of healthcare and social services. Additionally, sociodemographic information is gathered (10 items). Discussion: CES is a generic survey that captures the entirety of a caregiver's experience with ICPI allowing for a thorough investigation of its unintended impacts on caregivers. When the effects of ICPI are known, measures can be taken to provide caregivers with adequate support ensuring the sustainability of their contribution. Conclusion, Lessons Learned, Suggestions for Future Research: This study provides evidence that contributes to the design and evaluation of ICPIs. Lessons learned from stakeholder engagement resulted in identification of three main areas that require further investigation: caregivers' healthcare utilization costs, changes in patients' care utilization due to presence of caregivers, and the dyadic pattern of care for patients/caregivers. Limitations: Reviews were limited to electronic health sciences databases and quantitative studies; additionally, the scoping review was limited to Alzheimer/Dementia caregiving. Consequently, landmark instruments might have been missed in development of the questionnaire pool. [ABSTRACT FROM AUTHOR]