Onil Bhattacharyya, MD, PhD Frigon Blau Chair in Family Medicine Research

1. Overview Onil Bhattacharyya, MD, PhD Frigon Blau Chair in Family Medicine Research Women’s College Hospital University of Toronto

2. 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

3. Schedule 8:15 Overview of BRIDGES Onil Bhattacharyya 9:00 Keynote Ed Wagner 10:00 Integrated Home-based Primary Care Tia Pham 10:20 BREAK 10:40 Coordinated Access to Care from Hospital ED Vicky 11:00 BRIDGES meta-analysis Dr. Fiona Webster 11:30 Lunch and Poster viewing 12:30 Leveraging Lessons Learned Jodeme Goldhar 1:00 Closing Remarks Dr. Wendy Levinson

4. What is the most important problem in health care?

5. What is the most difficult problem in health care?

6. What is the solution?

8. Objective • Create a platform for development of new models of integrated care for complex patients.

9. Family Medicine Community Services Incubating Models of Integrated Care Medicine Psychiatry Primary Care Hospital Across Disciplines Across the Continuum

10. Bridging Different Worlds Health Service Providers Academics Pragmatic Decision-Making Data-Driven Decision-Making Clinical Sciences Basic Sciences HSR Rigorous QI Methodology High Quality Health Services Research Shared Space for Innovation

11. The BRIDGES Process

12. 61 proposals, 9 funded • From Barrie to South Lake

13. Reviewed on • Scientific rigour • System relevance

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

15. Hypothesis Testing Framework

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

17. Collective Impact System Collaborative Project

19. The BRIDGES Collaborative

20. BRIDGES in Brief • 9 projects • 28 lead investigators • 23 Institutions • 2,300+ patients • 30 providers + their patients

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

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

23. 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

24. 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

25. What have we learned?

26. It’s Hard • Recruitment • Targeting • Making the intervention work • Management across institution • Outreach to primary care

27. It’s Easy to get it Wrong Be ready to change • Zoom in/out • User segment pivot • User need pivot • Business architecture pivot • Channel pivot

28. It’s Worth It • Patients appreciate the comprehensiveness • Providers appreciate being connected • Managers appreciate connection to other institutions • Policymakers like the coherence

29. There’s Much More to Do • No magic bullets • No clear answers yet • More people are in the game • Growing potential for cumulative learning

30. Thanks!