Abstract
Seven Ontario Health Teams (OHTs), each a group of cross-sectoral health service organizations collaborating to integrate care, were chosen to lead the modernization of home and community care. We explore the models key transformation ideas and report on the barriers and facilitators to implementation. The findings of this study will be of interest to people designing an implementing integrated care projects as well as evaluators and researchers who learn from and support these programs. The evaluation of the leading projects in-home care was flexible, engaging and interactive and undertaken in partnership with each project as well as system stakeholder. We aimed to support learning and development through our approach. While the central team was made up of researchers, we sought input from project staff and committees in the design and interpretation of findings.This research reports on the qualitative component of a mixed-methods evaluation of the seven projects. Data collection included document review, approximately in-depth -hour discussions about the model with each program, observations of meetings at different levels (monthly planning meetings at three selected OHTs and cross-OHT/ system-level meetings), monthly informal interviews with the seven OHT leads, in-depth interviews with three selected OHTs (n=24) and focus groups with remaining four OHTs. While preliminary meetings began in mid-2023, data collection started in earnest in November 2023 and ended in June 2024. Data were thematically analyzed, focusing on understanding key model components and drivers of change. Barriers and facilitators were sourced primarily through focus groups and interviews. In examining the key elements of the leading projects, four groups emerged, focusing on either neighbourhood, primary care connectivity, palliative care populations or supporting those in the community with high needs. Across OHTs, care change ideas included changing how clinical team members worked together, reconceptualizing the care coordinator role, and sharing information across the care team. Each model type additionally developed unique change strategies. The primary care model embedded care coordinators within primary care settings, while the neighbourhood model emphasized the benefits of salaried home care teams and co-location. These differences were informed by the need to address local issues of concern, build on strengths, and mitigate challenges. The projects had unique implementation challenges that stemmed from factors such as differing relationships among organizations or individuals, human resource challenges; as well as common challenges (shifting timelines). Facilitators included the history of collaboration and local resources and embedded the project into a broader OHT strategy. While the intervention and evaluation take place in Ontario, Canada, the findings will be of interest to those implementing or evaluating programs to improve home care integration in international settings.The findings presented here are part of a larger evaluation study. Additional qualitative data (interviews and focus groups) will be collected after program implementation. Patient and provider experiences, as well as health service utilization and outcome data, will be analyzed to provide a fulsome understanding of the model, what changes are implemented, and what the effects of the program are. Results are shared with project and systems stakeholders through ongoing evaluation reports.