Onil Bhattacharyya, BRIDGES co-leadDepartment of Family and Community Medicine

University of Toronto

Building BRIDGES to Integrate Care

March 30, 2015

AcknowledgementsExecutive Committee

– Lynn Wilson– Gillian Hawker– Molyn Lescz– Kaveh Shojania

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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

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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.

2011

5

Initially 4 Key ideas• Partnership• Integrating primary care, hospital and

community services• Support for rigorous evaluation• Portfolio of projects

BRIDGES Concept

Solicit Select Support Scale

BRIDGES Process

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Evolution of BRIDGES

2011

2012

2013

2014

2015

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

3 models

45 models

Redesign of Virtual Ward

Project

Collaborative

System

BRIDGES Model

9

• First cross-department partnership of this size• Unique incubator model in Canada• Brought practice, policy and research

communities together• 9 projects implemented, all sustained

What did We Achieve?

10

• Expanding partnership• Support co-leadership by primary care,

hospital and community services• Balance rigour and responsiveness in

evaluation• Defining success in a portfolio

What did we learn?

11

BRIDGES has unique knowledge of common care integration challenges

2011 2012 2013 2014 2015

4 years of experience

Academics Front-Line Providers

23

Insti

tutio

ns

28 P

roje

ct In

vesti

gato

rs

2,30

0+

Com

plex

Pati

ents

Mixed methods

Academic and front-line expertise

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Areas of Learning for BRIDGES

Evidence review

Logic Model

Team formation

Issue Identification

DesignProcess

Measures

Model adaptation

Hypothesis Testing

Implementation

Redesign

Implementation results

Indicators Qualitative

Quantitative

Study design

Evaluate

Promising Model

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BRIDGES Care Model

14

Supporting Inception to Impact

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• Shift in business model• Deepen partnerships with system stakeholders• Adapt evaluation to project stage• Evaluate the portfolio

What do we take forward?

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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

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Challenges Addressed by MCP Projects

18

MCP Project Stages

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• Opportunity for exchange and shared learning• Tools to communicate activities• Tools to survey challenges and opportunities• Visual analytics for communication and

analysis

Building an MCP Collaborative

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• 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

Implications for Ontario

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Reflections

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