Access resources | Resources by OHT building block

RISE provides a ‘one-stop shop’ for four types of resources that can support rapid learning and improvement among Ontario Health Teams (OHTs): 1) RISE resources, including RISE briefs (RB) and webinars, among others; 2) resources prepared by other partners; 3) resources prepared by the Ministry of Health; and 4) hyperlinks to curated searches of Health Systems Evidence and Social Systems Evidence for systematic reviews of the research literature and related document types (for when no dedicated OHT resources exist).

Here we focus on resources by OHT building blocks. The full description of these building blocks can be found in RISE brief 1 on OHT building blocks, and this infographic summarizes the building blocks and how they can be drawn on to support a population-health management approach. To support teams invited to submit an application to join cohort 2 of OHTs, we note links to relevant questions in the full application.

If you know of a resource that would be helpful to other OHTs, please send it to rise@mcmaster.ca.

Building block #1: Defined patient population within a population-health management approach (who is covered and are their needs being equitably addressed?)
[Part of ‘Section 1: About your population' (question 1.1 about who you will be accountable for at maturity) in the full application]

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Domains RISE resources Partner resources Ministry resources Curated searches
All or most domains RB28: Identifying how Ontario Health Teams can meet the needs of rurally based patients and community partners in mixed urban-rural and predominantly rural environments

RISE brief for citizens: Identifying how Ontario Health Teams can meet the needs of rurally based patients and community partners in mixed urban-rural and predominantly rural environments

Rapid synthesis: Supporting population-health management to meet the needs of patients and community partners in rural and mixed urban-rural environments

Webinar on how OHTs can approach their work with an attributed population

RB32: Enhancing the implementation supports available to support population-health management by northern Ontario Health Teams

RS: Identifying community-based models of care that address the needs of ethno-racial communities

RS: Exploring models to support trans individuals’ access to care

RS: Strategies to improve health outcomes and care experiences for black women with cancer 
HCSL tool on unpacking an attributed population

The Public and Patient Engagement Collaborative has developed the Supporting Equity Centred Engagement: A Step-by-Step Guide with Tailored Resources which highlights key considerations with tailored resources to support OHTs to bring a stronger equity focus to their engagement work
 
1) Target-population definitions   ICES paper that informed the ministry’s approach to attribution   Browse results
2) Geographic-area definitions        Browse results
3) Patient-access targets Plain language summary - LEAN healthcare can improve length of stay and wait times in outpatient care     Browse results
4) Service-delivery (volume) targets       Browse results
5) Sustained care-relationship targets Plain language summary - Increased continuity of care can lead to reduced mortality rates     Browse results






Building block #2: In-scope services (what is covered?)
[Parts of ‘Section 2: About your team' (question 2.1 in the full application and sections 2.1.1 and 2.1.2 in the supplementary template) and ‘Section 3: Leveraging lessons learned from COVID-19’]

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Domains  RISE resources  Partner resources  Ministry resources  Curated searches
All or most domains RB29: Examining intersections
between Ontario Health Teams and
specialty service lines


RISE brief for citizens: Establishing
intersections between Ontario Health
Teams and specialty service lines


RS - Examining the intersections between Ontario Health Teams and Specialty Service Lines

RISE brief for citizens: Establishing intersections between Ontario Health Teams and broader human services

RISE brief 30: Examining intersections between Ontario Health Teams and broader human services

RS - Establishing intersections between Ontario Health Teams and broader human services

RS - Examining the intersections between Ontario Health Teams and public health

RS - Examining intersections between Ontario Health Teams and home and community care

RS - Engaging physicians in Ontario Health Teams

RS - Intersections between Ontario Health Teams and long-term care

RCA resource about rehabilitative care to support teams completing a full application

   
6) Service-inclusion definitions       Browse results
7) Service-exclusion definitions       Browse results
8) Service site decisions Plain language summary - Integrated care can increase access and patient satisfaction, but the effect on admissions, emergency admissions, length of stay, service usage, and costs     Browse results





Building block #3: Patient partnership and community engagement (how are patients engaged?)
[Parts of ‘Section 4: How will you transform care’ in the full application (question 4.4 about patient partnership and questions 4.3.1-4.3.4  about working with Indigenous, Francophone, COVID/flu-vulnerable and other populations), as well as part of ‘Section 1 About your population’ (question 1.3 about equity considerations within your population)]

To navigate to this section of the resources page directly in future, copy the following link and paste it in your browser: https://www.mcmasterforum.org/rise/access-resources/resources-by-oht-building-block?tab=3

Domains  RISE resources  Partner resources  Ministry resources  Curated searches
All or most domains RS: Identifying community-based models of care that address the needs of ethno-racial communities

RS: Exploring models to support trans individuals’ access to care

RS: Strategies to improve health outcomes and care experiences for black women with cancer
PPEC developed Creating Engagement Capable Environments in Ontario Health Teams: A Framework for Action in collaboration with patient, family, and caregiver partners and engagement leads from OHTs, the MPFAC Chair, and the Ministry of Health. This framework outlines the competencies, supports and enablers needed to build engagement-capable OHTs along with a one-stop shop of resources to facilitate learning and development.

The Muskoka and Area OHT developed an FAQ document to support learning about PFC partnership, engagement, and co-design.

The Institute for Better Health created an OHT Patient, Caregiver & Community Engagement Learning Series

   
9) Proactive patient and public engagement

RB14 on caregiver empowerment

Rapid synthesis on empowering caregivers to deliver home-based restorative care

Citizen panel on engaging with patients, families and caregivers to support Ontario Health Teams

Plain language summary - Five areas should be prioritized to increase public participation and influence in local decision-making
Change Foundation’s inventory of engagement and co-design resources
  Browse results
10) Responsive patient relations Plain language summary - Patient‐reported health information and patient education can improve healthcare professionals’ adherence to recommended clinical practice     Browse results 
11) Patient values       Browse results
12) Community engagement

RB5 on community engagement

RB25 on Ontario French-language health-planning entities and how they can support OHTs as a health-system partner

Webinar on engaging and improving care for francophone communities

Webinar on how OHTs can meaningfully engage their community and develop appropriate mechanisms for communication

Plain language summary - Community engagement, culture centeredness, systems thinking, and integrated knowledge translation are key to implement health interventions in Indigenous communities

East and Downtown East Toronto OHTs' framework for community engagement

ETHP community engagement event checklist

HCSL community map prototype and database

  Browse results 
13) Indigenous peoples engagement       Browse results 
14) Cultural sensitivity       Browse results








Building block #4: Patient care and experience (how are patient experiences and outcomes measured & supported?)
[Parts of ‘Section 1: ‘About your population’ (question 1.2 about who will be your focus in year 1) and ‘Section 4: How will you transform care’  in the full application]

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Domain  RISE resources  Partner resources  Ministry resources  Curated searches
All or most domains 

Learning and improvement collaboratives online forum (Quorum)

Webinar on population-health management

OHT provincial learning and improvement forum

HSPN practice guide on understanding and meeting the needs of patients and caregivers

HSPN practice guide on how patient and caregiver needs can be met by providers and managers

HSPN webinar on logic models

 

HCSL care pathways for youth that can be used in population-health management

Jurisdictional scan of select integrated-care systems   
15) Proactive patient identification       Browse results
16) Individualized care planning                   Browse results
17) Care pathways       Browse results
18) Health literacy support Plain language summary - Organizations can respond to the health literacy needs of patients by improving health information and services and making them easier to understand, access, and apply     Browse results
19) Digital access to health information Plain language summary - The effect of providing patients with access to their electronic health record is unclear      Browse results
20) Shared decision-making Plain language summary - Interventions for
increasing the use of shared decision making by healthcare professionals
 

Plain language summary - There is a growing interest in shared decision-making interventions for healthcare professionals, but there is uncertainty regarding how effective they are, and how to best implement them
    Browse results
21) Self-management planning and support   HLLN resource about health coaching   Browse results
22) Virtual-care services       Browse results
23) Proactive chronic-disease management       Browse results
24) Population-based health promotion and disease prevention       Browse results
25) Integrated-care models

Rapid synthesis on lessons learned from integrated-care initiatives in Ontario to inform Ontario Health Teams

Rapid synthesis examining health hubs and their potential to inform Ontario Health Teams

Rapid synthesis on leveraging integrated care during Ontario's COVID-19 response

Plain language summary - New integrated-care models may improve patient satisfaction, perceived quality of care and patient access


  Browse results
26) Coordination services Rapid synthesis on examining care coordination in the home-and community-care sector     Browse results
27) Transition services Evidence brief on hospital-to-home transition for older adults with complex health and social needs in Ontario

Stakeholder dialogue summary on hospital-to-home transitions for older adults with complex health and social needs in Ontario

Plain language summary - Building a complete list of a person’s medication before care transitions can help reduce improper usage of medications, but it is still unclear whether this improves health outcomes for patients
OH standards playbook on transitions between hospital and home   Browse results
28) System-navigation services Rapid synthesis on examining system navigation for Ontario Health Teams HLLN resource about patient navigation
  Browse results
29) Patient-reported experience measures       Browse results
30) Patient-reported outcome measures       Browse results
31) Integration measures       Browse results
32) Public-facing website describing above services       Browse results



















Building block #5: Digital health and information sharing (how are data and digital solutions harnessed?)
[Part of ‘Section 4: How will you transform care’ in the full application (question 4.2 about how your team will provide virtual and digitally enabled care)]

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Domains  RISE resources  Partner resources Ministry resources  Curated searches
 All or most domains   OntarioMD virtual and digital tool advisory service

OntarioMD peer-leader program

OntarioMD webinar series
Digital health playbook  
33) Patient portal   Ontario Health standards for patient portals
  Browse results
34) Electronic medical record   OntarioMD matrix of integrated EMR products
  Browse results
35) Electronic health record Plain language summary - The effect of providing patients with access to their electronic health record is unclear
OntarioMD EHR certification
  Browse results
36) Digital health tools Plain language summary - Integrated care can increase access and patient satisfaction, but the effect on admissions, emergency admissions, length of stay, service usage, and costs

Plain language summary - Clinical decision‐support systems on mobile devices aim to improve the adherence of primary-care providers to guidelines, the quality of care and patient outcomes, but their effectiveness remains unclear
Ontario Health online appointment booking standards    Browse results
37) E-consultations for patients Plain language summary - Telehealth consultations can produce positive outcomes for acute and chronic care

Plain language summary - Mobile technologies can help improve communication between different healthcare providers, however more studies are needed to confirm their effectiveness
OntarioMD virtual care resources

Ontario Health virtual care vendor list

Ontario Health virtual visits verification standard
  Browse results
38) E-consultation among providers Plain language summary - Mobile technologies can help improve communication between different healthcare providers, however more studies are needed to confirm their effectiveness     Browse results
39) Data privacy and security   OntarioMD privacy and security training
  Browse results
40) Data harmonization across organizations, sectors and systems Plain language summary - Moving from paper‐based information systems to electronic information systems can allow staff to collect some routine health information faster and with fewer mistakes, but many evidence gaps remain      Browse results
41) Data modelling and analysis RB8 on data analytics     Browse results
42) Data sharing and use   OntarioMD health report manager

OntarioMD i4C dashboard 

Ontario Health information exchange standard
  Browse results
43) Single point of contact for digital-health activities       Browse results





Building block #6: Leadership, accountability and governance (how are governance & delivery arrangements aligned, and how are providers engaged?)
[Part of ‘Section 2: About your team’ (question 2.3 about how your team can leverage previous experiences collaborating to deliver integrated care)]

To navigate to this section of the resources page directly in future, copy the following link and paste it in your browser: https://www.mcmasterforum.org/rise/access-resources/resources-by-oht-building-block?tab=6

Domains  RISE resources  Partner resources  Ministry resources  Curated searches 
All or most domains RB19 on collaborative governance templates (to be read before the BLG resources in the next column)

Webinar on collaborative governance

RB3 on collaborative governance

REP39 on accountability models that are focused on primary-care organizations providers participating in local-health system initiatives

REP41 on the functions that local-systems are responsible for and the ways in which they are held accountable for performing these functions

BLG guidance about collaborative governance templates

BLG templates for a collaboration agreement, decision-making framework agreement, fund holder and indemnity agreement, and project agreement

Guidance for OHTs on collaborative decision-making arrangements   
44) Distributed cross-sectoral leadership capabilities

RB 2 on leadership infrastructure and work plans

Webinar on leadership infrastructures for OHTs

Rapid synthesis on supporting transitions to local-system leadership in Ontario

    Browse results
45) Accountable-care organizations

RB11 on accountable-care organizations

Rapid synthesis on accountable care organizations

    Browse results
46) Network governance  

AFHTO Ontario Health Team Starter Kit 


Browse results
47) Proactive provider engagement RB4 on primary-care provider leadership and engagement

Plain language summary - Leadership skills in primary care settings can help healthcare workers provide better care to patients involving multiple health professionals, while addressing all the patient’s needs

Plain language summary - Relational leadership practices in the workplace can lead to positive outcomes for the nursing workforce, healthcare organizations, and patients
    Browse results
48) Culture of teamwork, collaboration and adaptability       Browse results







Building block #7: Funding and incentive structure (how are financial arrangements aligned?)

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Domains  RISE resources  Partner resources  Ministry resources  Curated searches
 All or most domains        
49) Population costs and cost drivers       Browse results
50) Integrated fund holding       Browse results
51) Contracts        Browse results
52) Re-investments of savings       Browse results

Building block #8: Performance measurement, quality improvement, and continuous learning (how is rapid learning & improvement supported?)
[Part of ‘Section 4: How will you transform care’ (question 4.1 about performance measures you propose to use to monitor success in year 1)]

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Domains  RISE resources  Partner resources  Ministry resources  Curated searches
All or most domains 

RB21 on Ontario Health (Quality) and how it can support OHTs as a health-system partner

Rapid synthesis on the role of coaching in health-system transformations

HSPN formative evaluation of developing OHTs

HSPN findings from the survey on organizing for OHTs

HSPN practice guide on how can organizations implement integrated care

Ontario Health cQIP guidance document

Ontario Health cQIP technical specifications

   
53) Performance measurement across the quadruple aim and across sectors  Plain language summary - Patient‐reported health information and patient education can improve healthcare professionals’ adherence to recommended clinical practice

Plain language summary - Five categories of factors influence the use and de-implementation of low-value care

Plain language summary - Clinical networks can improve patient outcomes and allocation of health funding, but more research on their effect on patient and professional experiences is needed

Plain language summary - It is unclear which approach of continuous quality improvement is most effective in health and social care
    Browse results
54) Guidelines and other sources of best evidence RB9 on evidence sources

Plain language summary - Clinical decision‐support systems on mobile devices aim to improve the adherence of primary-care providers to guidelines, the quality of care and patient outcomes, but their effectiveness remains unclear
    Browse results
55) Local area-focused rapid learning and improvement       Browse results
56) Problem-focused rapid learning and improvement       Browse results
57) Rapid learning and improvement collaboratives RB13 on communities of practice

Plain language summary - Quality Improvement Collaboratives used to implement clinical guidelines may save more money than they cost to implement
    Browse results
58) Rapid learning and improvement competencies RB12 on rapid-learning and improvement     Browse results