Building Bridges to Integrate Care (BRIDGES)
BRIDGES is an initiative funded by the Ontario Ministry of Health and Long-term Care to develop and test new models of care which link hospitals, primary care and community services to provide comprehensive care to patients with complex chronic disease. The model aims to: (i) engage multiple institutions and health care providers to deliver more integrated care, (ii) optimize health outcomes and the use of health care resources, and, (iii) have the potential to be replicated across the province.
The House Calls Program is participating in a component of the BRIDGES initiative through the Integrated Home-Based Primary Care (IHBPC) study. This study aims to improve access and build capacity for the care of home-bound seniors. The study’s co-principle investigators include Dr. Mark Nowaczynski (Clinical Director, House Calls), as well as Drs. Samir Sinha, Sabrina Akhtar, and Thuy-Nga (Tia) Pham.
BRIDGES will inform provincial efforts to improve health care transitions by highlighting successful models, providing local evidence of their application, and creating an impetus for health system change.
Dr. Carole Cohen
Geriatric Psychiatrist at Sunnybrook Health Sciences Centre
Dr. Cohen provides psychiatric services within the community, as well as ongoing assessment and support to seniors living with mental health issues.
Dr. Sheila Neysmith
Professor and Associate Dean of Research, RBC Chair in Applied Social Work Research, University of Toronto. In 2007, Dr. Neysmith was engaged by the House Calls Advisory Committee to be the research partner through the University of Toronto to document and evaluate the House Calls program’s impact on clients’ quality of life, services delivered, and team communication. Initially funded through a RBC Doctoral Fellowship program, the research was then funded through a Social Sciences and Humanities Research Council of Canada (SSHRC) grant called “Beyond the Weekly Bath: Building 21st Century Home Care Policy”. This research came to an end in 2009, but Dr. Neysmith remains involved with House Calls as a Volunteer Advisor. Dr. Neysmith is an active participant on the House Calls Advisory Committee providing leadership to the program and research advice when applicable.
Green Shield Canada Foundation
GSC, the country’s only national not-for-profit health and dental benefits specialist, created the Green Shield Canada Foundation (GSCF) in 1992 to act as a catalyst, supporting innovative ideas that pave the way for fundamental, big-picture change in Canadian health care. Its strategy is designed to build community capacity, strengthen public policy and advance knowledge in the health care field to ensure long-term change and address urgent needs.
The Green Shield Canada Foundation funded the launch of the Green Shield Canada Foundation Health Innovation Collaborative (GSCF HIC) in 2012 as a three-year collaborative project involving five innovative health care partners in Canada. The GSCF HIC is a project organization that is truly collaborative in nature. As the first of its kind in Canada, the GSCF HIC involves five innovative health care partners that are working together with the GSCF by sharing knowledge, expertise and resources to identify and solve the unmet needs of seniors living with multiple chronic conditions. The GSCF HIC’s goal is to create innovative solutions that improve the life in the years, and the years in the life, of older adults aged 65 plus with multiple chronic conditions. It also aims to optimize the quality of care for seniors and expand opportunities for care at home by providing long term funding with the goal for projects to become self-sustaining after a three-year period.
Mount Sinai Hospital
House Calls began its collaborative partnership with Mount Sinai Hospital and Dr. Samir Sinha, Mount Sinai’s Director of Geriatrics, in November 2011. Dr. Sinha’s integrated, inter-professional team addresses each older person’s care in hospital with the goal that when possible, the patient will be able to return home. The House Calls interdisciplinary team provides comprehensive and client centred care for patients so they can remain living at home. With an emphasis on communication and safe transition home from hospital, House Calls works together with Mount Sinai to provide a true continuum of care.
VHA Home HealthCare
VHA Home Healthcare is a not-for-profit, charitable organization providing 24/7 health care and support services to people of all ages and cultural backgrounds when, where and how they want it. They offer high-quality, multi-lingual care to people throughout Ontario to support a more independent life. VHA is a full participant in House Calls providing the Nurse Practitioner, the Occupational Therapists, the Physiotherapist and the Rehab assistant. VHA also participates in the Advisory Committee providing leadership to the program as well as the service delivery work group.