A recent article published in the Healthcare Quarterly details how the East Toronto Health Partners’ (ETHP) integrated system of care was invaluable to local COVID-19 response efforts. It also reflects on how this will affect further integration and the healthcare system’s policy and procedures going forward. Mark Fam, the Vice President of Programs at Michael Garron Hospital (MGH) and a speaker at the upcoming Integrated Care Virtual Summit, co-authored this article. The following is a summary of its key points and takeaways. All quotes, facts and statistics originate from that article.
“The story of East Toronto’s planning for COVID-19 is about mobilizing our acute care, community and primary care providers as a whole and working together in shared purpose.”
The ETHP is a network of social services and healthcare organizations working together to build a system of integrated care in Toronto’s east end. This includes joint leadership roles and the initial sharing of funds across organizations. This collective allocation of resources paved the way for instrumental decisions made at the beginning of the pandemic, such as utilizing MGH’s winter flu surge funds to finance mask-fit testing, personal protective equipment (PPE) distribution for local family practices and more. Despite these initiatives, Ontario’s integration efforts as a whole are still lacking and the pandemic has made that more evident than ever.
Coronavirus hit Ontario right as the province was ramping up its transition to an integrated approach. There is limited research on the importance of an integrated care network when responding to a widespread health catastrophe, but the article’s authors note that the steps needed to successfully construct a system of integrated care are similar to those required to respond to a global pandemic.
“Both scenarios are complex and dynamic, requiring a shared sense of purpose, trusted personal and organizational relationships across different sectors, distributed leadership and a strong role for organized primary care networks.”
When the first presumptive COVID-19 cases emerged in Canada, leaders from the East Toronto Family Practice Network (representing more than 270 local family physicians and an anchor partner of ETHP) as well as community health centres mobilized with the infection control specialists at MGH to strategize a plan of action for the community. Crucial measures organized by MGH and local primary care were key to avoiding hospitals surges — something that proved problematic in other countries that were hit hard earlier and had less time to prepare. More examples can be found in the original article below, but some of these vital steps include:
- Opening a community-based testing and assessment centre
- Arranging weekly calls with family physicians and community partner organizations with MGH’s infection control physician lead
- Staffing the assessment centre with a rotation of family physicians and nurse practitioners from across the community, allowing emergency department physicians and other hospital specialists to focus on patients needing urgent care
- Creating acute care beds in a local retirement home and adult palliative care beds in a local children’s hospice to achieve hospital capacity
This local integrated approach reduced the case fatality rate of COVID-19 positive residents in East Toronto’s long-term care homes from 40 per cent during the first outbreak to 16 per cent by the fourth.
“Although further study is required, the successive reduction in mortality rates correlates to progress in the integrated team’s response as team members from different organizations learned to work together more seamlessly, used rapid learning cycles to improve infection prevention practices and frontline staff knowledge and provided increasingly coordinated clinical care with long-term care staff to support residents in situ.”
Residents from homeless shelters, respite centres and group homes were also supported in a collaborative effort conducted by community health centres with help from MGH infection control specialists. This laid the groundwork for Toronto-wide assistance in providing these vulnerable populations, particularly shelter residents, with mass testing and facilitating physical isolation during COVID-19 recovery.
Physician leaders from the East Toronto Family Practice Network also implemented a plan to tackle some of the less obvious impacts COVID-19 had on the healthcare system. Impacts like resource restrictions and healthcare barriers experienced by community members with serious health conditions unrelated to COVID-19. The physician leaders built four community “hubs” incorporating integrated teams of primary care, home care, community care, housing providers and local community volunteers. Although the hubs are still forming, some examples of what they have already achieved include (more can be found in the original article below):
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Utilizing mobile medical units, allowing seniors with complex, chronic health conditions quick access to primary care services
- Channeling the knowledge of local community partners in high-density priority neighbourhoods to educate residents on how to wear masks correctly, COVID-19 testing, self-screening and physical distancing
- Providing culturally sensitive COVID-19 education and assistance in multiple languages so community members could use essential services like grocery delivery
In response to COVID-19, East Toronto’s healthcare system leveraged a network of integrated care across private and public sectors. This presents an opportunity for systematic transformation and policy change in the future by harnessing this newfound knowledge and experience. But what does this mean for integrated care going forward? ETHP maintains that their “core partnership” had a huge impact on how they initially responded to COVID-19. And they can’t imagine what that would have looked like without an integrated system of care in place.
“If there is a silver lining to this terrible pandemic for Ontarians, it is that we avoid returning to a ‘normal’ state and instead emerge with a stronger, more resilient and more integrated healthcare system.”
Click here to read Mark Fam et al.’s original article in its entirety.