Onil Bhattacharyya, MD, PhD

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Overview
Onil Bhattacharyya, MD, PhD Frigon Blau Chair in
Family Medicine Research Womens College
Hospital University of Toronto
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Acknowledgements

• Executive Committee
• Dr. Vicky Stergiopoulos
• Dr. Gary Naglie
• Dr. Onil Bhattacharyya

• Dr. Wendy Levinson
• Dr. Lynn Wilson
• Dr. Fiona Webster
• Dr. Kaveh Shojania

Key Partners Ontario Ministry of Health and
Long-Term Care Health Quality Branch
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Schedule

• 815 Overview of BRIDGES Onil Bhattacharyya
• 900 Keynote Ed Wagner
• 1000 Integrated Home-based Primary Care Tia
  Pham
• 1020 BREAK
• 1040 Coordinated Access to Care from Hospital
  ED Vicky
• 1100 BRIDGES meta-analysis Dr. Fiona Webster
• 1130 Lunch and Poster viewing
• 1230 Leveraging Lessons Learned Jodeme Goldhar
  
• 100 Closing Remarks Dr. Wendy Levinson

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What is the most important problem in health care?
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What is the most difficult problem in health care?
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What is the solution?
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(No Transcript)
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• Objective
• Create a platform for development of new models
  of integrated care for complex patients.

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Incubating Models of Integrated Care
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Bridging Different Worlds
Health Service Providers
Pragmatic Decision-Making
Data-Driven Decision-Making
Rigorous QI Methodology
Shared Space for Innovation
High Quality Health Services Research
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The BRIDGES Process
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• 61 proposals, 9 funded
• From Barrie to South Lake

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• Reviewed on
• Scientific rigour
• System relevance

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• Study design, data coordination and analysis
• Qualitative evaluation
• Economic evaluation

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Hypothesis Testing Framework


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• Work with HQO and CAHO
• Many potential partners
• No firm results yet

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Collective Impact
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Project Population Model
IMPACT Plus Complex patients Multidisciplinary team consultation
IHBPC Homebound elder Multidisciplinary homecare team
Innovate AFib Atrial Fibrillation Nurse coordinator
PIC COPD COPD Nurse-led self-management
CATCH-ED Frequent ED users in Mental Health Transitional case management
SCOPE GPs with high user patients Phone consultation coordination
H-SOAP Addictions Rapid consultation care
RAPT Mental Health Rapid consultation
ICCT GPs w/ complex older patients Shared or assumed care
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The BRIDGES Collaborative
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BRIDGES in Brief

• 9 projects
• 28 lead investigators
• 23 Institutions
• 2,300 patients
• 30 providers their patients

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

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

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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

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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

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What have we learned?
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Its Hard

• Recruitment
• Targeting
• Making the intervention work
• Management across institution
• Outreach to primary care

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Its Easy to get it Wrong

• Be ready to change
• Zoom in/out
• User segment pivot
• User need pivot
• Business architecture pivot
• Channel pivot

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Its Worth It

• Patients appreciate the comprehensiveness
• Providers appreciate being connected
• Managers appreciate connection to other
  institutions
• Policymakers like the coherence

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Theres Much More to Do

• No magic bullets
• No clear answers yet
• More people are in the game
• Growing potential for cumulative learning

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Thanks!