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Policy PointsConsiderable investments have been made to build high‐performing primary care systems in Canada. However, little is known about the extent to which change has occurred over the last decade with implementing programs and policies across all 13 provincial and territorial jurisdictions.There is significant variation in the degree of implementation of structural features of high‐performing primary care systems across Canada. This study provides evidence on the state of primary care reform in Canada and offers insights into the opportunities based on changes that governments elsewhere have made to advance primary care transformation. Context: Despite significant investments to transform primary care, Canada lags behind its peers in providing timely access to regular doctors or places of care, timely access to care, developing interprofessional teams, and communication across health care settings. This study examines changes over the last decade (2012 to 2021) in policies across 13 provincial and territorial jurisdictions that address the structural features of high‐performing primary care systems. Methods: A multiple comparative case study approach was used to explore changes in primary care delivery across 13 Canadian jurisdictions. Each case consisted of (1) qualitative interviews with academics, provincial health care leaders, and health care professionals and (2) a literature review of policies and innovations. Data for each case were thematically analyzed within and across cases, using 12 structural features of high‐performing primary care systems to describe each case and assess changes over time. Findings: The most significant changes include adopting electronic medical records, investments in quality improvement training and support, and developing interprofessional teams. Progress was more limited in implementing primary care governance mechanisms, system coordination, patient enrollment, and payment models. The rate of change was slowest for patient engagement, leadership development, performance measurement, research capacity, and systematic evaluation of innovation. Conclusions: Progress toward building high‐performing primary care systems in Canada has been slow and variable, with limited change in the organization and delivery of primary care. Canada's experience can inform innovation internationally by demonstrating how preexisting policy legacies constrain the possibilities for widespread primary care reform, with progress less pronounced in the attributes that impact physician autonomy. To accelerate primary care transformation in Canada and abroad, a national strategy and performance measurement framework is needed based on meaningful engagement of patients and other stakeholders. This must be accompanied by targeted funding investments and building strong data infrastructure for performance measurement to support rigorous research. [ABSTRACT FROM AUTHOR]

The aging cohort of persons living with human immunodeficiency virus (HIV) in Canada has reached a critical point, with nearly half now 50 years age or older. Older persons living with HIV have specific needs which can be effectively addressed by geriatric specialists. However, the recognition of HIV care as a domain of geriatrics is recent, resulting in a lack of clinical recommendations and modern care models for delivering geriatric care to this population. Virtual care has been demonstrated to reduce existing barriers to accessing HIV care in some populations but before it can be adapted to geriatric HIV care a critical first step is to acknowledge and understand disparities in socioeconomic circumstances, technology access and ability and cultural differences in experiences. This protocol marks the initial step in a comprehensive program of research aimed at co-designing, implementing, and evaluating culturally-appropriate virtual geriatric care for diverse older adults living with HIV. The study employs qualitative methods with older adults living with HIV to lay the groundwork, to inform the future development of a virtual model of geriatric care. We will explore the perspectives of diverse groups of older persons with HIV on (1) The value and necessity of culturally-tailored virtual interventions for geriatric HIV care; and (2) Recommendations on how best to engage older persons with HIV in the future co-design of a virtual model of geriatric HIV care. Ultimately, a more culturally-appropriate approach to care will foster a more inclusive and supportive healthcare system for all individuals affected by HIV including those who are aging. Researchers can utilize this research protocol to employ qualitative co-design and participatory methods with diverse older adults living with HIV. [ABSTRACT FROM AUTHOR]

How does leadership emerge and function when multiple health care organizations come together to form a network? In this qualitative comparative case study, we draw on distributed leadership theory to examine the leadership practices that manifested during the implementation of three coordinated care networks. Thirty leaders and care providers participated in semistructured interviews. Interview data were inductively analyzed using thematic analysis. Although established in response to the same policy initiative, each case differed in its leadership approach and implementation strategy. We found that manifestation of distributed leadership was contingent on the presence of an individual leader who acted as a unifying force across their respective network. Our findings suggest that policies to encourage the development of interorganizational networks should include sufficient resources to support an individual leader who enables distributed leadership. [ABSTRACT FROM AUTHOR]

Context: During the last decade, Canada's provinces and territories have embarked on primary care reform toward high-performing systems. A paper entitled "Towards Primary Care Strategy" identified 12 features of high-performing primary healthcare systems. Objective: This study examines the evolution of primary care systems across Canada between 2013 and 2021. Study design and Analysis: A multiple comparative case-study approach was used to explore changes in the 13 Canadian jurisdictions. Each case consisted of: (1) qualitative interviews with academics, provincial leaders, and healthcare professionals) and 2) a document and literature review of policies and innovations. Data for each case were thematically analyzed using the 12 features of high-performing primary care to describe each case and assess changes over time. This was followed by cross-case analyses. Setting: Canada. Population studied: Primary care systems. Intervention/Instrument: Evolution of primary care systems. Outcome measures: Progress in the 12 features of high-performing primary care systems. Results: We found that British Columbia, Alberta, Ontario, and Quebec have made the most significant progress toward primary care transformation in Canada, although no jurisdiction has achieved all attributes. There has been considerable progress in adopting health information technology across the country. Four jurisdictions have established a policy direction for primary care. Some jurisdictions have or are implementing collaborative primary care governance models. More jurisdictions are involved in patient enrollment and supporting quality improvement training. Experimentation with new interprofessional team models and funding arrangements continues. However, more investments are needed for wide-scale implementation of primary care governance mechanisms, interprofessional teams and funding arrangements, patient engagement, comprehensive performance measurement systems, leadership development, systematic evaluation, and building research capacity. Conclusion: The pace of primary care transformation has been slow in Canada. While there has been some progress toward high-performing systems, each jurisdiction has distinct opportunities to advance primary care to the level of best-performing countries. Further funding investments are needed by federal and provincial/territorial governments and by regional health authorities for primary care transformation. [ABSTRACT FROM AUTHOR]

Introduction: Integrated care networks (ICNs) are rising in the health policy landscape as new promising delivery systems that provide better connected, seamless and responsive patientcentred care and services to local populations. With community engagement at its core, this new model brings health and social service providers and patients together in order to design population health-based solutions to care. Robust, representative, and evidence-based engagement is critical to the success of ICNs. However, to this day, few attempts have been made to develop researchbased assessment tools that measure the nature of existing community engagement structures amongst ICN partners. Aims, Objectives, Theory or Methods: Building on a scoping review and empirical data we aim to demonstrate to integrated health system practitioners an evidence-based community engagement assessment tool. This tool can help identify pools of prospective community members and delineate evidence-based approaches to communication and engagement. We systematically investigated bibliographic databases to search, screen and select relevant literature on integrated care community engagement. The preliminary tool was then reviewed and further developed by integrated health partners, patients, and academic advisors before its pilot with integrated health partners. Given that development of this tool is at a pilot stage, ICIC session attendees will also be invited to offer feedback during and after the conference presentation. Highlights or Results or Key Findings: First, the presentation will show features of The Community Assessment Tool. This includes a series of open and closed-ended (binary and Likert scale) questions that are to be administered to the partners within ICNs who are known to regularly interface with patients, caregivers, volunteers and community members. It will also show how principles for effective community engagement including equity, diversity and inclusion and access to engagement, in addition to theories of community organization and community building have been incorporated. The tool will be displayed on the digital platform used to pilot it in three integrated care networks in early 2022 in Ontario ('Ontario Health Teams'). Next it will offer methodological insights on developing assessment tools in addition to recommendations for future practice emanating from its community co-design and pilot phases. Finally we will share preliminary results from the pilot and demonstrate how this data will inform and impact community engagement strategy and mapping. Conclusions: Building on partners' strengths is a common approach when implementing innovative approaches across network structures. Consequently, before each integrated care network starts its community engagement activities, it is critical to create a window of equal opportunity through which to understand existing community engagement structures amongst its partners using standardized techniques. Implications for applicability/transferability, sustainability, and limitations: This tool has the potential inform and guide community engagement activities by filling a current critical gap; the rapid assessment of existing community engagement structures and activities amongst partner organizations within an integrated care network. It's function ultimately supports fulsome engagement reflective of the whole community that networks are designed to serve. [ABSTRACT FROM AUTHOR]

Introduction: The Burlington Ontario Health Team is a collaboration of health and social service providers who plan and work together, as one coordinated team, to provide integrated services and supports to meet the health needs of Burlington and surrounding communities (Ontario, Canada). Together, interested groups from primary care, community paramedicine, home and community services, acute care, and patient partners designed and launched the Community Remote Care Management (RCM) program in November 2020. Patient partners played key roles in contributing toward program vision, program design, and survey/materials development. The RCM program connects individuals managing chronic disease or isolating at home with mild COVID-19 symptoms with an interdisciplinary team using remote monitoring technology. Patients and caregivers may bring their own devices or borrow a tablet/biometric devices to measure their vitals and communicate with the clinical team regarding managing their chronic conditions and connecting them to available resources. Objectives: We will employ a mixed methods approach to evaluate the degree to which the RCM program has changed patient and caregiver experiences, selfmanagement and system navigation outcomes, and provider experience. We will use program data to examine program enrollment, assessment, care planning, escalation workflows, and community connections. We will summarise results from patient and provider experience surveys and conduct interviews with program participants. Additionally, operational documents such as minutes and notes will be reviewed and summarised to evaluate the internal processes of the program. Results: An earlier review of assessment data revealed that patients with chronic disease were screened to have significant needs in depressed mood/loneliness, recent high acute care use, and additional comorbidities. Patients were most often connected with a pharmacist, respiratory therapist, or system navigator. We anticipate that patients and caregivers will gain insight about their health condition and signs and symptoms, report more timely access to advice and support, and ultimately, be more confident in their ability to self-manage beyond the program. We also anticipate that the ability to share information on the same platform will improve providers' ability to work with patients, caregivers, and other providers. Conclusion: We anticipate that the RCM program will demonstrate positive changes to the quintuple aim and achieved through a strong community focus, integrating health and social services, and simplifying communication between patients, caregivers, and providers. Implications: The RCM program is a key initiative of the Burlington Ontario Health Team to bring together holistic needs assessment, care planning, and system navigation for patients, caregivers, and care providers. If shown to be successful, the goal is to expand this model to other populations such as those with social or physical frailty. [ABSTRACT FROM AUTHOR]

Introduction: The Community Wellness Hub is the first step of a long-term vision to support older adults in the communities where they live. It is a collaboration of health care, social care, and housing providers that seeks to (1) proactively identify and respond to physical, mental, and social needs using community resources, and (2) offer transitional and residential options along the continuing care continuum. The Community Wellness Hub is located in an apartment building with mixed market and rent-geared-to-income units. Residents joining the Community Wellness Hub receive individualised support from the Wellness Coordinator as well as monthly workshops/clinics from partner organisations. Residents can consent to sharing health information within the circle of care, so that service providers plan and monitor care as an integrated team. Objectives: The exploratory case study will reflect the perspectives of providers, residents, and caregivers. The providers' perspective will be explored via a series of focus groups focusing on the facilitators and barriers they encountered while building this innovative collaborative model. The residents and caregivers' perspective will be described through a number of interviews that will assess their experiences with the Community Wellness Hub. Additionally, documents related to the implementation and operation of the Hub will be analysed to provide a detailed description of the intervention. The final component of the case study is an on-site observation that will be conducted by an embedded evaluator. This component is meant to describe the daily interactions between the residents and the providers within the Community Wellness Hub. Results: In this case study, we will highlight multiple perspectives: health care, social care, and housing providers; those involved in leadership, operational, and service delivery roles; as well as the perspectives of residents and their caregivers. Providers are anticipated to speak about changes in awareness and understanding of the roles and contributions of other sectors and how this might facilitate coordinating residents' care. Experiences of residents and caregivers will reflect on what worked well and areas where there is room for improvement. Conclusions: The Community Wellness Hub is founded on strong leadership and relationship building across sectors as well as a shared commitment to learn and grow together. This is reflected in improved service coordination and enhanced resident, caregiver, and provider experiences. Implications: The Community Wellness Hub is a key initiative of the Burlington Ontario Health Team to bring together holistic needs assessment, care planning, and system navigation for older adults in the community. We hope to share specific motivators, enablers, challenges, and opportunities that will be helpful as the Community Wellness Hub seeks to spread the model throughout the region as well as to others learning from our unique partnership experience. [ABSTRACT FROM AUTHOR]

Objectives: Airway management starts from the use of a nasal prong for oxygenation to successful endotracheal intubation for the ventilation. Intubation has been one of the most studied subject in anesthesiology. Various methods and gadgets have been advocated for its success. We aimed to evaluate the rate of successful intubations using the ordinary borescope and a stylet through Fekry Oral Intubating Airway (FOIA) in a manikin. Methodology: This manikin-based study enrolled 35 trainees, who performed endotracheal intubation guided by the borescope and used FOIA as a conduit. Every trainee was allowed two attempts. The primary outcome was to assess the success rate of intubation. Secondary outcomes included the precise time to intubate, number of attempts, and the need for external manipulations. Results: Our results revealed that 62.9% of the participants performed the intubation successfully (success rate) and 51.43% succeeded to intubate the manikin in the first attempt. External manipulation was needed by 71.4% of the participants in the form of cricoid pressure or laryngeal movement to visualize the glottic view. The time needed for a successful intubation ranged from 16 to 120 sec with a median of 50 sec and a mean of 69.37 ± 42.26 sec. Conclusion: A combination of Fekry Oral Intubating Airway, a borescope and an intubating stylet can be used for endotracheal intubation in remote areas, where advanced airway management aids are not available. Future studies are warranted to optimize this technique. [ABSTRACT FROM AUTHOR]

Patient-centred care is a key priority for governments, providers and stakeholders, yet little is known about the care preferences of patient groups. We completed a scoping review that yielded 193 articles for analysis. Five health states were used to account for the diversity of possible preferences based on health needs. Five broad themes were identified and expressed differently across the health states, including personalized care, navigation, choice, holistic care and care continuity. Patients' perspectives must be considered to meet the diverse needs of targeted patient groups, which can inform health system planning, quality improvement initiatives and targeting of investments., (Copyright © 2021 Longwoods Publishing.)