The Population Health Analytics Lab has led several program evaluation initiatives in collaboration with partners at the University Health Network (UHN). Integrated Care is a new model of care aimed at improving patient, caregiver and care provider experiences, with a focus on creating a well coordinated care for patients across the health continuum. Our lab collaborates with healthcare partners to evaluate novel integrated care programs.
The University Health Network (UHN) is a major network of hospitals in Toronto, Ontario that has recently developed integrated care programs to support comprehensive care in the hospital to home continuum. In partnership with the team at UHN’s Integrated Care Program, we co-designed a process and outcome evaluation for the integrated care program implemented in the Thoracic Surgery department. To do so, we used a mixed methods approach, including interviews with patients and caregivers, and health care providers, in addition to an analysis of hospital administrative data.
Key learnings:
The Thoracic Surgery Integrated Care program at UHN achieved notable successes with respect to positive health care experiences for patients and caregivers. We also observed a small overall decrease in costs and improved outcomes, including decreases in length of stay, emergency department visits and readmissions.
Related Publications:
- Chiodo S, O’Neill M, Ayanian T, Diemert LM, Chang M, Sundaram S, Seymour C, & Rosella LC. (2023). How patients define success for integrated care: How the University Health Network identifies iterative improvement priorities (S1). 23(S1), Article S1. https://doi.org/10.5334/ijic.ICIC23249
- Kornas K, O’Neill M, Liang CY, Diemert LM, Ayanian T, Chang M, & Rosella LC. (2021). Health care providers’ experiences with delivering person centered care in an Integrated Care Program for thoracic surgery patients in Ontario, Canada. Journal of Integrated Care, 29(3), 346–356. https://doi.org/10.1108/JICA-10-2020-0068
- O’Neill M, Kornas K, Liang C, Diemert L, Ayanian T, Chang M, & Rosella LC. (2023). Experiences and Reported Outcomes of Patients and Caregivers Enrolled in an Integrated Care Program for Thoracic Surgery: A Qualitative Evaluation (1). 23(1), Article 1. https://doi.org/10.5334/ijic.6540
The University Health Network has also built collaborations with community health services to formulate strategies to integrate social needs support within clinical programs. In partnership with the Gattuso Centre for Social Medicine at the University Health Network, our team co-designed evaluations of their programs focused on integrating social determinants of health into care delivery. These evaluations were conducted in a collaborative and participatory manner, ensuring active engagement of program stakeholders, with a focus on emphasizing their experiences and needs.
Key learnings:
We evaluated several novel programs that were supported by the UHN’s Social Medicine Program:
- The Food RX program was a community-based intervention to alleviate food insecurity for high-needs households through at-home deliveries of food boxes in partnership with FoodShare. Our evaluation found that food box delivery was an effective strategy for improving quality of life, mental wellbeing, and physical wellbeing for food insecure communities, particularly during the COVID-19 pandemic.
- The Peers in the Emergency Department (ED) program is a collaboration with UHN and The Neighbourhood Group who trained Peer Support Workers with knowledge of homelessness, substance use or mental health issues gained through recent lived/living experience. We demonstrated the critical roles of Peers in the ED to support patient care and improve the working environment for healthcare professionals working in th ED.
- The Mobile Health Clinic (MHC) was a collaboration with Telus Health for Good and the Parkdale Queen West Community Health Centre, low-barrier primary health care, harm reduction, and mental health services at five convenient locations. Our evaluation found that the MHC alleviated major barriers to access for marginalized populations.
Related Publications:
- O’Neill M, Michalski C, Hayman K, Hulme J, Leston F, Kellen A, Steer L, Dube S, Diemert LM, Kornas K, Schoffel A, Rosella LC, Boozary A, & The Neighbourhood Group Community Services (Lorie Steer). (2024). “Whatever journey you want to take, I’ll support you through”: A mixed methods evaluation of a peer worker program in the hospital emergency department. BMC Health Services Research, 24(1), 147. https://doi.org/10.1186/s12913-023-10532-5
- Wiens K, O’Neill M, Redelmeier RJ, Wali S, Chagpar A, Dube S, Diemert LM, Michalski C, Ziebell B, Elliott S, Campbell L, Rosella LC, Boozary A. Can the Healthcare System Improve Food Security? A Need for Collaborative Community Partnerships. Healthc Q. 2022 Jul;25(2):26-33. doi: 10.12927/hcq.2022.26892. PMID: 36153681. https://doi.org/10.12927/hcq.2022.26892