Monthly Bulletin of the Alliance's Learning Health System
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Homelessness and Vaccine (In)Equity
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Learning Events & Programs
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Get Involved: Research & Sharing
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Recently Published Research
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Homelessness and Vaccine (In)equity
Data reveals reveals a deadly gap.
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This is a story about health equity, and about how the people who experience barriers to care are often left behind in large-scale public health initiatives, such as mass vaccinations. It is a story about homelessness and how it impacts access to care. It is also a story about the power of linked administrative and practice-based data to help us understand and overcome barriers to care.
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This research program began in 2018 with a study that aimed to quantify homelessness in Ontario using health system administrative data. It achieved about 35% sensitivity – meaning about 35% of people experiencing homelessness could be identified. The research team speculates that sensitivity may have improved to about 50% after CIHI introduced a policy requiring housing status to be recorded at hospital admission and discharge, and practice data from community health centres was linked. Then the COVID-19 pandemic arrived, and the researchers turned their focus to how COVID-19 was impacting people experiencing homelessness.
Perhaps unsurprisingly, they found that this population had disproportionate amounts of infection, hospitalization, ICU admission, and severe illness. These findings received nationwide media attention and contributed to policy change that would make people experiencing homelessness a priority population for vaccination. The next step was to determine whether this policy change was having the desired effect. The research team compared vaccination rates among 23,000 people with recent experiences of homelessness with the rate in the overall population. They found that despite being named a priority population, those experiencing homelessness had a 25% lower rate of vaccination for a first dose and 34% lower rate for a second dose by the end of September, 2021. As Booth notes, “We weren’t necessarily surprised that the rates were lower. The surprise was the magnitude of difference.”
Preventing this kind of inequity in future pandemics will require a whole-of-society response that addresses the root causes of homelessness. Until this is fixed, we need an equitable system of care and supports to address the barriers that homelessness imposes. Earlier and more robust integration of vaccination efforts into primary care settings could be an important part of that.
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What's happening in EPIC research?
These studies will lead to better health care, outcomes, and equity.
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Evaluating the EQ-5D tool for measuring client-reported health outcomes.
Health is not just a physical state that can be observed using instruments and tests. It is also something you feel and experience. But how do you measure feelings and experiences? Understanding the experiential aspects of clients’ health is essential if we want to get a fulsome picture of how they are doing and whether our interventions are effective. It is also essential if we want to empower them to be partners in co-creating their health care.
To facilitate this in our sector, the Alliance has adopted a Patient Reported Outcome Measures (PROMs) tool known as EQ-5D. EQ-5D is a short questionnaire written in plain language. It asks clients to rate their health in five domains: Mobility, capacity for self-care, capacity for usual activities, pain & discomfort, and anxiety & depression, by answering five multiple-choice questions, and then to give a score for their overall health. It is already in use around the world and is available in 200 languages.
Over the next 6-12 months, we will be piloting EQ-5D at six to ten of our member organizations, with a goal of learning how best to implement it in primary health care settings. We will use what we learn from this study to develop an implementation guide to support the scale and spread of the tool in our sector. The EQ-5D Implementation Pilot will seek to answer the following questions:
- What are the barriers and enablers to effectively using the EQ-5D tool?
- How can this tool be incorporated into an organization’s workflow?
- Do clients – especially those who live with barriers to wellbeing – find the tool useable and empowering?
Recruitment for the PROMs hast begun! Participating organizations will receive training over the summer, and they will use the tool with 20 to 25 clients. A mid-term report is expected in January 2023, and the final report and recommendations are expected in May 2023. For more information, check out the recruitment flyer. If you have questions or wish to participate, email EPIC@AllianceON.org.
A better way to measure health complexity at the population level.
For a long time, the Standardized Adjusted Clinical Group Morbidity Index (SAMI) has been used as a measure of health complexity for individuals and populations in Ontario. Diagnoses by physicians and nurse practitioners as well as other health system administrative data are used to generate a number which predicts the likelihood of health system use by individuals within a population group, according to the number and severity of conditions they have. The SAMI is used to determine panel size and to support health care planning. It is also used to advocate for our model of comprehensive primary health care, as the SAMI data regularly show that clients of Alliance member organizations have health care needs that are about 70% more complex than other primary care clients in Ontario.
Despite its usefulness, the SAMI does have its limitations. It is a proprietary system, making it expensive for individual organizations to use as a QI or care planning tool. Its proprietary nature also means we can’t look “under the hood” to see how different diagnoses are weighted in determining complexity. It measures only clinical complexity, ignoring the social and structural determinants of health, which are important predictors of health system usage.
To address the SAMI’s limitations, the Alliance has been collaborating with the Canadian Institute for Healthcare Information (CIHI) to develop a new measure of health complexity. Known as the Population Grouping Methodology, or “Pop Grouper,” this new tool will include more sociodemographic data, so the non-clinical determinants of health can be considered. It will also include more robust practice data from Alliance members, thanks to the data-sharing agreement our sector has with CIHI. Such data has until now been minimally included in SAMI calculations.
Proof-of-concept testing has already demonstrated that the complexity of CHC clients, relative to the overall population, is much higher than the SAMI reveals. This is something our sector has known intuitively for a long time; being able to quantify this difference with standardized data will help us demonstrate how essential our sector really is to the creating an equitable and sustainable health system.
For more information about the ongoing development of the Pop Grouper and the importance of having quality data to inform it, contact EPIC@AllianceON.org.
OHRS Benchmarking Report
The Ontario Healthcare Reporting Standards (OHRS) are data standards used by health care organizations in this province for mandatory financial and statistical reporting. Each summer, organizations receive a report containing all their OHRS data for the previous fiscal year. This data is meant to inform internal and external audits, evaluation of programs and services, allocation of funds, and service-delivery planning. Unfortunately, the way it is presented makes it difficult for organizations to use it effectively. The current format of the report is a collection of 70+ Excel spreadsheets, organized at the legacy LHIN level.
Recognizing that this format presents a barrier to understanding and using OHRS data, Four Villages CHC and Access Alliance Multicultural Health and Community Services embarked on a project in 2021 with Tracy Lindsay Consulting to redesign it. The Alliance is building on this work to create a sector-wide report that includes data from all member CHCs. This will make it easier for organizations to get value from their data without having to seek help.
The new report will be released three times each year and include the following features:
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A streamlined spreadsheet of key indicators, organized by functional centre.
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A searchable appendix of all data for those who require additional detail.
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A technical appendix with key definitions and descriptions of indicators and functional centres.
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An interactive, visual dashboard that will allow organizations to compare their performance with their peers.
Watch for the new and improved OHRS report this fall. A draft template has been approved by the EPIC Committee, and we expect 2021 OHRS to arrive this summer. Once received, the data will be put into the template, and the resulting report will be shared directly with Executive Leaders and through the Alliance portal. We will work with members to continuously evaluate and monitor the report in order to ensure it meets their needs.
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Learning Events & Programs
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May
June
Ongoing
Governing for Health Equity Training. This five-part, self-paced online course was created by the Alliance to help boards go beyond diversity and inclusion, and build organizations that are better equipped to advance health equity at every level in the organization, the community, and the health system. Discounts for Alliance members and health equity builders. Register here.
learn more and sign up your team.
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Research & Sharing Opportunities
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Calls for Abstracts
Policy Consultations
May 24, 1:00-4:00 pm - Online consultation sessions on criminal record reform, open to people with lived/living experience of incarceration, criminalization, or record suspension. Public Safety Canada is inviting people to participate in a virtual engagement session on May 24, 2022. Register here by May 22 to participate. Participants are encouraged to familiarize themselves with this discussion paper and fact sheet. Unable to join live? Find other ways to share your input here or by email. Learn more from the Fresh Start Coalition about why criminal record reform is needed.
Clinical Trials & Studies
Social workers in primary health care: What has your daily practice looked like during the COVID-19 pandemic? Dr. Rachelle Ashcroft, a researcher at the University of Toronto, is leading a mixed-methods study called The Structure of Social Work Practice in Ontario Primary Care Teams. Participants will be asked to complete a survey asking about the role of social work, the current and optimal state of practice, and social work leadership. At the end, participants can express their interest in taking part of a focus group. For more information, contact Rachelle Ashcroft at rachelle.ashcroft@utoronto.ca.
Does your organization provide health care or other supports to refugees and asylum seekers? Researchers at the University of Calgary are looking for people working in clinical, public health, or settlement organizations to answer some questions via an online survey. They want to understand who provides care to refugees and asylum seekers in Canada, how this care is coordinated and delivered, how it differs among jurisdictions, and how COVID-19 has impacted it. Participate by completing this short survey. In lieu of an honorarium, the research team will donate $10 to support refugee student scholarships.
Are you a harm reduction service provider and/or an Indigenous person who uses harm reduction services? Communities, Alliances, & Networks (CAAN) and the Dr. Peter Centre are working in partnership to learn how the COVID-19 pandemic has affected harm reduction programs and what new needs have emerged, as well as to identify culturally responsive wise practices. The research will be conducted via online regional sharing circles with harm reduction workers and Indigenous clients. An honorarium will be provided and people can decide in advance on their level of participation. Participants from Ontario are invited to join the sharing circle on June 8 at 1:00 pm. To register or get further information, contact Caterina Kendrick at caterinak@caan.ca or Savannah Swann at sswann@drpeter.org.
Urban health care organizations: How have you incorporated health equity into virtual care for structurally marginalized communities? A team of researchers from Women's College Hospital is conducting case studies of health equity and virtual primary care across Canada. If you'd like more information or are interested in participating, contact the research coordinator at simone.shahid@wchospital.ca
Share your experiences working with uninsured migrants. Researchers want to hear from health care providers who have experience providing services to uninsured migrants. What they learn will inform policy recommendations and will be shared through community events. Confidential interviews will be conducted over Zoom. Email Melissa Anderson at andersm@yorku.ca to participate or learn more.
Collaborative Learning
SPIDER Learning Collaborative: De-prescribing dangerous medications. Can data-driven QI activities help de-prescribe potentially harmful medications, for medically complex senior clients? Help answer this question and improve health outcomes for your clients by participating in a 12-month learning collaborative. EMR queries will be provided to help participating Alliance members identify clients who would benefit. Contact Jennifer Rayner for more information.
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Recently Published Research
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Articles
Reports
Assessment of the Implementation of Safer Supply Pilot Projects. This independent report by Dale McMurchy consulting is a preliminary assessment of safer supply pilot projects in British Columbia, Ontario, and New Brunswick. The programs and the assessment were funded by Health Canada, through the Substance Use and Addictions Program (SUAP). Overall, the report finds that the programs have been extremely valuable to clients, and that there needs to be funding to expand access to them. It also describes five key learnings for developing and implementing such programs effectively.
Virtual Care in Canada: Strengthening Data and Information. This report from the Canadian Institute for Health Information (CIHI) explores the current landscape of Canadian virtual care data and information. It includes a snapshot of available virtual care data from CIHI, the provinces and territories, and pan-Canadian health care organizations. It also recommends new areas of pan-Canadian focus for measuring the quality and accessibility of virtual care. To learn even more, visit CIHIs Virtual care in Canada web page or email your questions to virtualcare@cihi.ca.
Addressing Cervical Cancer Screening Inequity among Newcomer Women via HPV Self-Sampling. Access Alliance conducted this research to build evidence on community-based and culturally sensitive ways to promote HPV self-sampling for cervical cancer screening among women who were never-screened or under-screened. They found that culturally appropriate self-sampling kits, adequate education and training, and availability of safe and accessible healthcare were key enablers for increasing the rate of cervical cancer screening in this population. See links at bottom of the article to access the report in English and French as well as client-facing fact sheets in nine languages.
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Funding Available
Is your organization is new to research? Up to $10K is available from the Canadian Institutes of Health Research to help plan, implement, evaluate, scale, or spread programs that support LGBTQIA/2S health and wellbeing. To be eligible, your organization must have no prior research experience or be the current recipient of a grant from the same program. Projects must have an intersectional lens. More information here.
Guidance & Tools to Support Quality Improvement
Recorded Webinar: Understanding the 2021 Practice Profile. On April 12, 2022, the Alliance hosted a webinar to help orient members to the newly updated CHC practice profile. This resource is produced annually by the Alliance for Healthier Communities and the Institute for Clinical Evaluative Sciences (ICES). It combines Community Health Centre (CHC) Electronic Medical Record (EMR) data with provincial billing and administrative data to provide information on the clients served by Ontario’s CHCs. It has now been revamped and updated for 2021. The video recording, slide deck, links to the practice profile and its appendices are available here along with other resources to help you understand and use the data.
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Alliance Members: Consider using measures from the common QIP indicators developed by and for the our sector in 2018.
New knowledge hub from Access Alliance and the Canadian Association of Community Health Centres (CACHC): CACHC and Access Alliance have partnered to produce this centralized hub of multilingual resources created by and for community health centres. By adopting or adapting tools developed by your peers, you can save yourself the work of building them from scratch.
Bite-Sized Info Sheets about Comprehensive Primary Health Care
The Alliance has developed four new 1- and 2-page reports about comprehensive primary health care. These were created to help support you in advocating for the sector when talking to policymakers, system partners, or other leaders and decision-makers. They define primary health care, demonstrate what we mean when we say it's the foundation of the health system, and provide evidence to support our claims that this model works.
Some may want to print these up and share them as hardcopies, so we've included a QR code on each one. This will take the reader back to the electronic version, so they can follow all the hyperlinks.
Watch for French-language versions, coming soon!
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