Abstract
Background: in 5 Canadians do not have a family doctor, and persons with cognitive/behavioural disabilities are even less likely to have suitable access; HIRO therefore collaborated with a diverse working group to develop a sustainable and equitable model of care for clients with cognitive/behavioural disabilities in the community.
Approach: This oral presentation is applicable to multiple groups, including; Community-based organizations seeking integrated collaboration (involving regulated workers, unregulated workers, and client voices); Persons with acquired brain injuries, mental illness, and/or behavioural deficits including dementias and developmental populations that can benefit from access to consistent primary care; Policymakers seeking lessons learned for integrated care approaches in the community sector.After completing a literature review and environmental scan including extensive stakeholder consultation, Head Injury Rehabilitation Ontario (HIRO) identified an opportunity to enable more equitable access to primary care for cognitively impaired/behavioural clients. HIRO then applied a co-design approach engaging unregulated staff, allied health clinicians, specialists, primary care providers, an ethics advisor, and clients and families with lived experiences to develop a sustainable and equitable model of care for community clients. During these collaborative sessions individuals were prompted and encouraged for diverse thinking, ethical and moral values analysis, and honest but necessary critical appraisal of status quo; all participants had space to lead different discussions, identify real and perceived barriers, and ultimately all participants contributed to the final model design. Recommendations were summarized, collaborated upon again, and 'finalized' (while recognizing a need for ongoing monitoring and subsequent evolution).The resulting model strengthens partnerships with primary care, home care, and other community providers to improve client care and access. Actions to implement the model included:) Engagement of dedicated Primary Care providers,2) Leadership training and education including role clarity,3) Enhanced client recordkeeping software,4) Embedded interprofessional communication standards, and5) Assigning a dedicated clinician to monitor the implementation and ongoing evolution of client care needs and population health considerations (i.e. to flag when to reconvene/modify the model using a co-design approach again)
Results: Almost five years since the transition to this model, initial results suggest:) HIRO clients and their families perceive improved access and quality of care with an integrated community care model,2) HIRO clients reduced the frequency of inappropriate/unnecessary urgent care usage, and3) HIRO unregulated and regulated staff perceived improvement in interdisciplinary collaboration and client care outcomes.Note: The formal mixed-methods analysis will be complete by August 2024.With a dedicated commitment to co-creating and evolving shared values, HIRO enabled integrated quality care for clients with cognitive/behavioural challenges and allowed for opportunities for sustained health and wellness in the community sector.
Implications: Despite challenges regarding access to care that may seem daunting, leaders must make the effort to seek out diverse persons with shared values, and to purposefully foster conditions to have generative, collaborative discussions to make systemic change. Without a willingness to share power and humility with a multifaceted group, change can feel like an uphill battle instead of a collaborative design.We recognize the importance of ongoing engagement of providers, clients, and families who embrace innovation, commit to challenging work, forgive mistakes, and continue to work toward the long-term vision and evolution of an integrated community-based model. HIRO is inspired to share its collaborative approach and lessons learned to spread and scale, to promote health equity for others as well.