The Alliance is committed to continuous learning that can advance our collective vision of the best possible health and wellbeing for everyone living in Ontario.
Although we have always been committed to research, evaluation, and quality improvement, we recognize that there is more we can do at the centre and sector level to bring these elements together. On October 29, 2020, our Executive Leaders’ Network approved making an intentional shift to become a Learning Health System. An LHS is brings together information from practice and research and feeds it back to teams in ways that are meaningful and useable to them. This in turn leads to practice change that improves care.
- Read the Report, “Towards a Learning Health System: Better Care Tomorrow When We Learn from Today.”
- See the accompanying two-page infographic
- Watch a 12-minute introductory video, presented by Dr. Jennifer Rayner
Our journey of becoming a Learning Health System has been underway for more than five years, and it has been a focus of the Alliance’s work since 2019. Formally adopting this shift as a strategy is not the end of the journey but the beginning of a new phase.
Over the next few months, you will see several changes implemented as we continue this shift:
- We are redeveloping portions of our website to make learning and QI more visible.
- We are launching EPIC News, a monthly LHS eBulletin, in November 2020. Use this form to sign up – make sure the box “Learning Health System Updates” is checked.
- We are launching a new practice-based learning network (PBLN) for clinicians and other providers in our sector. This will be the seventh PBLN in Ontario and the first one focused on equity and interprofessional health care. There’s still room for you at the table – contact Sara.Bhatti@AllianceON.org for more information or to become a participant.
- We are reimagining and updating the regional decision support specialist (RDSS) role to be more focused on support for improvement and change.
- The former Performance Management Committee (PMC) has been renamed the Equity, Performance, Improvement and Change (EPIC) Committee, and their work has been reimagined to have an enhanced focus on guidance for the Alliance’s research program and support for our members’ quality improvement activities. The EPIC brand and logo will appear on many of our LHS materials.
Want to participate in a research project with us or request data for your academic or community-based research? Email jennifer.rayner@allianceON.org.
Keep up with the latest news - follow #AllianceONResearch and #AllianceONLearns on Twitter!
Looking for a full list of our research publications and presentations? Check out our research library.
Our research program interacts with the Model of Health and Wellbeing in two ways: The model informs our research questions and methods, and the knowledge generated by our research provides insights into how best to operationalize the model and adapt it to local contexts. Research helps us to understand the populations we serve; to recognize emerging health challenges, such as loneliness and isolation; and to evaluate new and ongoing programs and services so we know what’s working and where there are opportunities for improvement.
Research also helps us to tell our story. We know our members’ work is immensely valuable to the communities and individuals they serve. In order to ensure that our partners and stakeholders recognize this, we need clear data. This includes quantitative data – numbers – that demonstrate this value at a system and population level, as well as qualitative data – stories – that show how our work impacts individual patients, caregivers, and providers. Sharing our knowledge through conferences, presentations and publication in peer-reviewed journals helps us reach as many people as possible.
The Alliance’s research program is spearheaded by Dr. Jennifer Rayner, our Director of Research and Evaluation. Dr. Rayner is also an adjunct research professor at the Schulich School of Medicine and Dentistry at Western University. However, like our members’ work, our research portfolio is collaborative and crosses sector lines. We work with over 50 research partners from academia, primary care, and public health.
Here are some recent research highlights:
- Characteristics of health care related to mental health and substance use disorders among Community Health Centre clients in Ontario: a population-based cohort study. This article by Jennifer Rayner and research partners at Western University and ICES describes CHC client populations with a history of mental illness, substance use disorders, or both. It compares their demographic characteristics, health system use and related health risks.to those of people who have similar diagnoses but do not use CHC services. It finds that those who use CHC services are younger, less likely to be rostered to a primary care provider, more likely to have comorbidities, and more likely to experience housing instability or other forms of material deprivation. Consistent with these differences, they are more frequent users of emergency and specialist services. These findings point to a need for more research directed towards understanding this population and developing targeted interventions for them.
- Illustrating the Patient Journey through the Care Continuum: Leveraging Structured Primary Care Electronic Medical Record (EMR) Data in Ontario, Canada using Chronic Obstructive Pulmonary Disease as a Case Study. This article by Jennifer Rayner and research partners from the Canadian Institute for Health Information (CIHI) describes a data partnership between the Alliance and CIHI. Linking structured EMR data collected by the alliance to administrative data, they were able to illustrate the journey of clients through the care continuum, using COPD as a case study. Published May 19, 2020.
- Interactive report and narrative report about Mental Health & Addictions clients at the centre and sector levels. The interactive tool, sent to individual member centres, was developed using data from BIRT that was sent to CIHI for data linkage in 2018. It includes a sociodemographic profile that can help you understand and plan care for the people in your community who experience challenges with mental health and/or addiction. It also includes linked data which profiles the client journey at the CHC, the ED, and at the hospital. This tool lets you examine your own CHC’s data and compare your centre to similar organizations. This will help you better plan mental health & addictions care for your communities, facilitate knowledge-sharing and peer support, and show you where you have successes to celebrate and opportunities to improve. It is accompanied by a narrative report, Patterns of Community Care for Mental Health and Addictions, which summarizes key findings at the sector level. This is the second of two proof-of-concept projects done in partnership with CIHI.
- Impact of comprehensive care on health care use among a cohort of marginalized people living with hepatitis C in Toronto. This study by researchers at South Riverdale CHC, the University of Toronto, ICES, and several hospital and community health partners, provides evidence that comprehensive, community-based care, including harm reduction, leads to better health outcomes for people who use drugs and have chronic Hepatitis C infection. Participants in the study received comprehensive HCV care and harm-reduction support from South Riverdale CHC, Regent Park CHC, and Sherbourne Health. Published November 12, 2019.
- Using Equity Data to Improve Cancer Screening in Ontario CHCs. This poster by the Alliance research team, Access Alliance, and TAIBU CHC provides evidence that CHCs are fulfilling their mandate of improving health equity. Generally, racialized women and women with low incomes are at a high risk of not undergoing regular cervical cancer screenings. Women who are attached to CHCs are much more likely than the general population to be up-to-date with their screenings, despite the fact that a much larger percentage of CHC clients are from "high risk" populations. Using health equity data allows CHCs to tailor interventions to their local populations to improve screening rates. Presented at the 47th NAPCRG Annual Meeting in November 2019.
Here are some of our ongoing research projects:
- Primary care and COVID-19 Response: Social distancing and shortages of personal protective equipment (PPE) has meant that many primary care providers are managing their practices mainly by telephone and in some cases e-mail and video calls. Many patients are fearful of seeking care in person at primary care offices and clinics. For those reasons, there has likely been a large decrease in in-person primary care office visits and an increase in telephone, e-mail video calls. This study explores the magnitude of those shifts in care and the change in overall volumes of services provided.
- Virtual care during COVID-19 and implications for future care delivery: This study will use qualitative and quantitative data from Alliance member centres to help us understand how community primary health care teams implemented virtual care during COVID-19, the facilitators and barriers they experienced, and the client and provider experience.
- Rx: Community: We recently completed a year-long pilot of social prescribing at 11 CHCs across Ontario. The work is now ready for scale and spread around the province. The final report is available here. More in-depth research is continuing, and we anticipate more scholarly publications to come out in Spring 2021.
- TeamCare: Nearly 30 teams are currently participating in TeamCare projects, under various names including SPiN, PINOT, PACT, and Expanding Team-Based Care. While these projects differ in funding, structure, and scope, they all have two things in common: Increasing access to interprofessional heal care for patients of family physicians in the community and participating in an ongoing evaluation program to track the impact of the projects and help us understand what makes them successful. A concurrent investigation with ICES is underway to help us get a better understanding of where there are gaps in access to interprofessional primary care as well as the demographic risks and needs among Ontario’s population.
- Effectiveness of interdisciplinary teams and other primary care reforms in Ontario: This CIHR-funded study will measure the effectiveness of primary care introduced in Ontario over the last 15 years, in terms of health costs, ED utlization, hospital admissions and mortality. To study will focus on the transition away from fee-for-service payments and the shift to team-based models.
- Refugee and Newcomer Health: We are currently participating in or providing data access for six concurrent studies on immigrant health and access to health care among immigrants and refugees in Ontario. With research partners from Centre for Addiction and Mental Health, the University of Toronto, Ryerson University, the Dalla Lanna School of Public Health, ICES, and the Wellesley Institute, we are examining health system utilization, inequities in cancer screening rates and access to care for chronic conditions among immigrants and refugees in Ontario. We are also exploring whether the so-called “Healthy Immigrant Effect” still holds and whether it extends to mental health care. This research will help us advocate for equitable and effective policies to support the health needs of newcomers to Canada.
- Screening for Poverty and Related Social Determinants and Intervening to Improve Knowledge of and Links to Resources (SPARKS) Study: This four-year, CIHR-funded study will facilitate the development of a Canadian standard for sociodemographic data collecton and the identification of social needs in primary care. An integrated pilot will be followed by a large cluster randomized controlled trial of an anti-poverty intervention.
- Complex health needs, mental health, and addiction: In addition to the studies described above under Rx: Community and Immigrant Health, we are involved in a number of studies that explore the intersection of medical complexity, mental health, and health services utilization. With partners from ICES, CIHI, SickKids Hospital, Western University, and the University of Toronto, we are examining how people in Ontario access the mental health care system, what barriers they face, and how effectively interprofessional team-based primary care can help dismantle these barriers and improve the health of clients with complex needs. With our ICES research partners, we are also exploring how effectively the health system is supporting the mental health needs of people in First Nations communities.
Here's how we're sharing our learnings:
As studies are published and presented at conferences, we post links to them in our online research library.
We are also developing tools that will help us communicate what we've learned with policymakers, Alliance members, and the public in ways that are meaningful and accessible. This will allow our members to turn information into action and will help us to continue advocating for healthier public policy. These include a series of Lunch-n-Learn webinars, where researchers, Alliance members, and others share practical and experiential knowledge with Alliance members and others in the health sector. Recent webinars include panel discussions on online groups and programs and supportive care for residents in group living settings, both set against the backdrop of COVID-19.
Our 2016-18 Research Report provides an overview of research conducted between 2015 and 2018. An updated version, featuring research from 2018-2020 will be available in Spring 2021.
Here's how to stay in touch:
If you would like to learn more about our research program, participate in a research project with us, or wish to request data for your academic or community-based research, please email Jennifer Rayner at jennifer.rayner@allianceON.org.
Follow #AllianceONResearch and #AllianceONLearns on Twitter