J Community Health DOI 10.1007/s10900-015-0015-3
ORIGINAL PAPER
Establishing the SouthWestern Academic Health Network (SWAHN): A Survey Exploring the Needs of Academic and Community Networks in SouthWestern Ontario Kathryn Nicholson1 • Jasmine Randhawa2 • Margaret Steele3
Ó Springer Science+Business Media New York 2015
Abstract With the evolving fields of health research, health professional education and advanced clinical care comes a need to bring researchers, educators and health care providers together to enhance communication, knowledge-sharing and interdisciplinary collaboration. There is also a need for active collaboration between academic institutions and community organizations to improve health care delivery and health outcomes in the community setting. In Canada, an Academic Health Sciences Network model has been proposed to achieve such activities. The SouthWestern Academic Health Network (SWAHN) has been established among three universities, three community colleges, community hospitals, community-based organizations and health care providers and two Local Health Integrated Networks (LHINs) in
& Kathryn Nicholson [email protected] Jasmine Randhawa [email protected] Margaret Steele [email protected] 1
Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Centre for Studies in Family Medicine, Kresge Building 2nd Floor, Western University, 1151 Richmond Street, London, ON N6A 5C1, Canada
2
Schulich School of Medicine and Dentistry, Clinical Skills Building 3rd Floor, Western University, 1151 Richmond Street, London, ON N6A 5C1, Canada
3
Hospital and Interfaculty Relations, Departments of Psychiatry, Paediatrics and Family Medicine, Schulich School of Medicine and Dentistry, Clinical Skills Building 3rd Floor, Western University, 1151 Richmond Street, London, ON N6A 5C1, Canada
Southwestern Ontario. A survey was conducted to understand the characteristics, activities, existing partnerships, short- and long-term goals of the academic and community health networks in SouthWestern Ontario to inform the development of SWAHN moving forward. A total of 114 health networks were identified from the two participating LHINs, 103 community health networks and 11 academic health networks. A mailed survey was sent to all networks and responses were analyzed using both quantitative and qualitative approaches. The short- and long-term goals of these networks were categorized into five main themes: Public Health, Education, Research, System Delivery and Special Populations. Overall, this study helped to elicit important information from the academic and community based networks, which will inform the future work of SWAHN. This research has also demonstrated the significance of collecting information from both academic and community partners during the formation of other interdisciplinary health networks. Keywords SouthWestern Academic Health Network Academic Health Sciences Network Community Academia Interdisciplinary Survey
Introduction With the proliferation and evolving fields of health research, health professional education and advanced clinical care comes an increasing need to bring researchers, educators and health care providers together to bridge the gap between institutional ‘‘silos’’ and to enhance communication, knowledge-sharing and interdisciplinary collaboration. There is also a need for active collaboration between academic institutions and community organizations to improve
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health care delivery and health outcomes in the clinical and community setting. Although this collaboration between parties is ideal, it is often challenging to achieve in an everchanging environment. In order to facilitate this union of research, education and health care delivery, Academic Health Sciences Centres (AHSC) were developed. A relatively new term in health care, AHSCs play a pivotal, yet not exclusive, role in the integration of education, research and the delivery of care [1, 2]. An AHSC has been defined in previous literature as the association of ‘‘all university health professional schools, including a Faculty of Medicine, with research enterprises and care delivery organizations that provide physical facilities and funding for education and research, and which are aligned towards a common mission of advancing patient care, education and research’’ [2]. In light of these objectives, there are potential limitations that an AHSC must overcome in order to be successful [3]. For example, there are barriers that arise due to the changing governance model in health care systems which may challenge the ability of an AHSC to successfully fulfill its three missions [4]. To alleviate this challenge and to better align the mandate, strategies, structures and processes of many health-related organizations, a stronger partnership between an AHSC and government is needed [4]. However, the influence of governance may still become a challenge within the academic or health care institutions, where difficult funding choices have to be made. Additionally, the lack of available funding may inhibit an AHSC to successfully and consistently meet their tripartite mission, which focuses on high quality achievements and innovation [4]. Indeed, a robust and strongly integrated model is needed to overcome these considerable barriers. In Canada, a new model of an Academic Health Sciences Network (AHSN) has been proposed by the National Task Force of the Association of Faculties of Medicine of Canada (AFMC) and the former Association of Canadian Academic Health Organizations (ACAHO), which addresses the aforementioned advancements and consistently evolving nature of health care systems and academic medicine [4]. This new AHSN model is defined as a ‘‘set of formal partnerships created by health sciences universities, academic health care organizations and other provider organizations with the goal of improving patient and population health outcomes through mechanisms and structures that develop, implement and advance integrated health services delivery, professional education, and research and innovation’’ [4]. An interdisciplinary complement of academic- and community-based organizations lie at the core of this new model. AHSNs are recognized as the solution to the barriers that were faced by AHSCs in countries, such as the United Kingdom, following a comprehensive analysis conducted by the National Health System [5]. Despite these advantages, there are still a
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number of challenges that AHSNs may have to overcome. For example, tensions between the central direction of the network’s mandate and the local or regional desires must be appropriately evaluated and addressed, guided by inclusive processes that will create the greatest likelihood for success and positive outcomes [6]. Currently, there are seventeen established AHSNs in Canada, with each network centered at one of Canada’s university medical schools and associated with at least one affiliated teaching or research hospital [4]. Some examples of these Canadian AHSNs include: the British Columbia Academic Health Sciences Council (BCAHC), the Saskatchewan Academic Health Sciences Network (SAHSN), the Toronto Academic Health Sciences Network (TAHSN) and les Re´seaux Universitaires Inte´gre´s de Sante´ (RUIS) in Quebec [7–10]. With the highest population of the Canadian provinces and territories, the province of Ontario would greatly benefit from the establishment of a second AHSN, which could address the needs of its more rural regions. Recognizing this important need and opportunity, a SouthWestern Academic Health Network (SWAHN) has been established by three universities (The University of Western Ontario located in London, Ontario, the University of Windsor and the University of Waterloo); three community colleges (Fanshawe College located in London, Ontario, Lambton College located in Sarnia, Ontario and St. Clair College located in Windsor, Ontario); community hospitals; community-based health organizations and health care providers; and two Local Health Integrated Networks or LHINs (Erie St. Clair LHIN and SouthWest LHIN). This newly established SWAHN will serve as a virtual network of academic and community health networks in SouthWestern Ontario. For the purposes of our work, a community health network is defined as a network of health-related organizations that primarily focuses on and is responsible for supplying health care or social services for a specific disease. Examples of a community health network would include the Heart and Stroke Foundation [11], the London/Middlesex Dementia Network (Alzheimer Society) [12] or the SouthWestern Ontario Stroke Network [13]. In comparison, an academic health network is defined as a network with a formal affiliation with an academic institution [4]. More specifically, it is a partnership created by a health sciences university, community college offering health care courses and health-related organizations with the goal of improving patient and population health outcomes through the development and implementation of advanced health services delivery, professional education and health research. Examples of an academic health network would include the Institute for Clinical Evaluative Sciences (ICES) Western [14], the DELiver Primary Healthcare Information (DELPHI) Network at The University of Western Ontario [15] or the
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Gateway Centre of Excellence in Rural Health in Seaforth, Ontario [16]. In order to better inform the establishment of the SWAHN, there was a need to gain information from these academic and community networks. As such, the study described herein had three main objectives. The first objective was to learn about the characteristics of the academic and community health networks that were already existing in SouthWestern Ontario. The second objective was to assess the existing relationships between the already existing health networks and a formal academic institution. The third objective was to determine the interest of these already existing health networks in engaging and participating in SWAHN. Furthermore, this study aimed to understand which short- and long-term issues these health networks wanted to address as collaborating members of SWAHN.
Materials and Methods Subjects
possible response rate [17, 18]. Personalized mailouts were sent to the main contact person that was identified for each academic and community health network. In accordance with the Modified Dillman method, an invitation to participate was sent to the appropriate network contact person, informing them of their selection to participate in our survey. A week later, all networks were sent the first survey package which included: the appropriate survey, a cover letter that invited the participants to complete and return the survey, a letter of information and consent form for the participants to sign and return and a pre-paid postage envelope with a pre-printed return address. A week after this first survey package was mailed, a follow-up letter was sent to all participants thanking those who had completed and returned the surveys and encouraging others to do so at their earliest convenience. Two weeks after the first survey package was mailed, a second survey package was sent which included the same elements of the first survey package. As completed surveys were received, all responses were recorded into an electronic database for statistical analysis, without personal identifiers of the network contact person.
To identify the academic and community health networks of interest for this study, we conducted a systematic search of health networks that were located in the Erie St. Clair and SouthWest LHINs (with the assistance of a librarian at The University of Western Ontario). Once the original list of network names and corresponding network descriptions was created, networks were assessed and removed if they did not meet the previously defined criteria for an academic or community health network. A total of 114 health networks from both the Erie St. Clair and SouthWest LHINs were included in our final sample, 103 of which were community health networks and 11 were academic health networks. An appropriate contact person and their contact information (e.g., mailing address and phone number) for each network was then identified and recorded.
Data Analyses
Survey Development and Administration
Results
A survey was developed by the co-authors (K.N., J.R., M.S.) and was then reviewed and pilot tested by two working groups of SWAHN (included members of academic and community networks): the Community Participation Working Group and the Clinical Outcomes Working Group. A final survey was developed for the community health networks and a second survey was developed for the academic health networks. Ethical approval was successfully obtained from The University of Western Ontario Research Ethics Board (Study No. 104828). Survey administration was conducted according to the Modified Dillman method in order to generate the highest
Of the 114 networks that were contacted, 40 surveys were completed and returned, yielding an overall response rate of 35.1 %. The response rate was notably higher for academic networks as opposed to community, 81.8 and 37.9 %, respectively. When examining the main goals and components of network mandates, the academic and community networks were found to be statistically different (p \ 0.05). As shown in Fig. 1, the main elements of the academic networks’ mandates are research and education of health professionals. In comparison, the main focus of the community networks’ mandates are more distributed between education of patients, health care professionals
Descriptive quantitative analyses were conducted on the closed-ended questions of the surveys, such as calculating frequencies of responses. All quantitative analyses were conducted using SPSS. Thematic qualitative analyses were conducted on the open-ended questions of the surveys. The co-authors coded written responses (e.g., short-term and long-term issues) from the participants into common themes and sub-themes. Responses were examined for the academic health networks (n = 9) and community health networks (n = 31) separately, then patterns of responses were compared between the academic and community networks.
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J Community Health Fig. 1 The main goals or components of the academic and community networks’ mandates
and the general public. Advocacy is an important element for the mandates of academic and community networks. As shown in Fig. 2, academic networks are found to have a much higher frequency of affiliation with academic networks as compared to community networks, with the most frequent affiliations occurring with The University of Western Ontario. Further to this, 88 % (7/8) academic networks stated that they are affiliated with an academic institution, as compared to 52 % (16/31) community networks. Figure 3 demonstrates that the majority of community network members are from the health care field. In terms of community engagement, Fig. 4 displays the frequency and type of engagement in which the academic
Fig. 2 Frequency and type of academic and community networks’ affiliations with academic institutions
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and community networks are involved. A total of 87 % (27/31) of community networks stated they actively participate in community engagement, as compared to 78 % (7/9) of the academic networks. This difference was found to be statistically significant (p \ 0.05), indicating disparities in community engagement between network type. As shown in Fig. 4, community networks are more engaged with public forums, patients or clients, families and collaboration with other organizations, whereas academic networks demonstrate their engagement through reports and guidelines. The primary source of funding for academic and community networks is presented in Fig. 5. For community
J Community Health Fig. 3 Frequency and type of groups to which members of community networks belong
Fig. 4 Frequency and type of community engagement in which academic and community networks are involved
networks, funding primarily comes from the Ministry of Health and Long Term Care, while academic networks rely on a combination of federal funding, foundational research and other sources of funding. The diverse funding sources for academic networks reflects the challenging financial environment currently being experienced by academic researchers. When examining the various types of health care professionals that are involved within academic networks, Fig. 6 demonstrates that the majority of members are physicians, registered nurses and nurse practitioners, as well as health promotion professionals. These academic networks are also composed of psychologists, dieticians,
social workers, and respiratory and speech therapists. As such, there is great potential for inter-professional collaboration among and between network types. In fact, approximately 83 % of responding community networks already collaborate with other networks. Outcome measures were utilized by about 84 % (26/31) and 77 % (7/9) of responding community and academic networks, respectively. As seen in Fig. 7, more academic networks tend to use clearly identified metrics to measure network outcomes, as compared to dashboard metrics. There is also a diversity of outcome measure types that are being used by academic networks, including Community Impacts of Research Oriented Partnerships (CIROP)
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J Community Health Fig. 5 Primary sources of funding for academic and community networks
Fig. 6 Frequency and type of health care professionals involved in academic networks
measures [19], annual reports to funding bodies, balanced score cards and psychometric tools (Table 1). In terms of previous knowledge about SWAHN, 78 % (7/9) of responding academic networks indicated that they were aware of this initiative, as compared to only 23 % (7/ 30) of community networks. Clearly, this information has not been disseminated as consistently and comprehensively to community organizations. After completing this survey, however, the majority of networks were interested in learning more, and becoming involved, in the SWAHN initiative. More specifically, 84 % (26/30) and 78 % (7/9)
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of responding community and academic networks, respectively, indicated this interest. This response fulfilled one of the key objectives of this study and established a positive beginning in having pre-existing community and academic health networks in SouthWestern Ontario engage and participate as active members in SWAHN. In addition to establishing the characteristics of existing academic and community networks in SouthWestern Ontario, all networks were asked to describe the three local health issues that they believe SWAHN can tackle in the next 2 and 5 years, recorded as short- and long-term goals,
J Community Health Fig. 7 Frequency and type of outcome measures used by academic networks
Table 1 Other outcome measures used by academic networks (in addition to dashboard and metrics)
Categories
Frequency
Psychometric tools
2
Measures of Community Impacts of Research Oriented Partnerships (CIROP)
1
Report to the Ministry of Health and Long Term Care annually Feedback and use of both psychometric instruments and qualitative approaches
1 1
Balanced score card in development
1
Annual reports to funding bodies
1
Other
1
respectively. The themes and sub-themes of the responses from both the academic and community networks are presented in Tables 2, 3, 4 and 5. As shown in Table 2, a greater emphasis was placed by academic networks on system delivery and education when asked about the shortterm goals that SWAHN can address in the next 2 years. A similar trend was seen in the long-term goals as listed by the academic networks. As seen in Table 3, there is again a notable emphasis on system delivery, as compared to research and education. Tables 4 and 5 display the short- and long-term goals of the community networks, which SWAHN can address in the next 2 and 5 years, respectively. From the community networks’ perspective, there is a strong focus on system delivery and special populations.
Discussion Overall, the short- and long-term goals that the responding academic and community networks deemed as important were categorized into five main themes. These themes were consistent among both types of networks, and were areas in which the SWAHN initiative could be involved moving forward. More specifically, the five main categories are comprised of the following goals: (1) Public Health—
Policy, Advocacy and Social Determinants of Health; (2) Education—Inter-Professional Education, Public Education, Continuum of Education, Curriculum; (3) Research; (4) System Delivery—Health Care Resources, Delivery, Models of Care, Intervention, Infrastructure and Funding; and (5) Special Populations—Seniors/Aging, Mental Health, Stroke, Chronic Obstructive Pulmonary Disease, Diabetes, Developmental Disabilities and Chronic Diseases. Similar trends are seen in the goals listed by academic and community networks as both network types place a large emphasis on system delivery. In contrast to academic networks, community-based networks more strongly focus on special populations, as compared to education and research, as there is a growing proportion of special populations, such as seniors and mental health issues in the SouthWestern Ontario community. As reported by the Health System Intelligence Project (HSIP), there is a greater than average population of seniors and those that suffer from chronic conditions, such as high blood pressure, heart disease and diabetes [20]. Notable insight was provided by the academic and community surveys, particularly regarding the structure, functioning and funding of these networks. This information is vital in terms of forming a collaborative and interdisciplinary network-ofnetworks. However, it was clear that inconsistent metrics
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J Community Health Table 2 Type and frequency of short-term goals highlighted by academic networks Category
Sub-category
System Delivery
System Delivery
Frequency 6
Child and adolescent mental health service coordination and gaps
1
Transitions from paediatric to adult care (low volume, high cost)
1
Primary care reform
1
Primary care connected to other parts of health care system (e.g., hospitals, Community Care Access Centres, specialists)
1
Coordination of efforts to increase efficiency
1
Reduce emergency room wait times and crowding (after-hours clinics) Health Care Resources Access to rural services
2
Embed health care library professional roles within programs
1
Patient engagement in their chronic care
1
Information Sharing
Education
2
Coordinated communication
1
Improve collaboration and communication between health care providers
1
Professional Education
3
Professional development of health care library professionals in areas such a systematic reviews, searching of grey literature
1
Integrate common information and data literacy learning outcomes into curriculum for interdisciplinary health professions
1
Increase continuing professional development Inter-Professional Education (IPE)
Public Health
Special Populations
IPE as a delivery model of care
1
Transforming health education to integrate IPE learning
1
Social Determinants of Health
3
Poverty
1
Social inclusion
1
Stigma
1
Special Populations
3 1
High prevalence of multimorbidity (multiple chronic disease) Diabetes Rural Medicine Research
1 1
Identify the true burden of mental health in the community
of success are being used among the responding networks, which can create challenges in evaluation. The three main objectives of this study were achieved and will inform the SWAHN development moving forward. Through the various questions within our two surveys, we were able to gain an enhanced understanding of the composition of existing networks in SouthWestern Ontario and the pre-existing structure of these organizations. This survey also provided insight into the already established relationships between the networks and academic institutions in the area. Additionally, there was also great interest expressed by responding networks to both
1 1 1
Higher rates of brain injury/concussion in rural youth
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1 2
Medication safety and addiction
Research
1 4
1
learn more and become engaged with the SWAHN initiative. Limitations While this survey will help to direct and shape the development of SWAHN, it is important to note that some academic and community networks within the Erie St. Clair and SouthWest LHINs may have been missing from our systematic search, and thus would not have been able to contribute to the survey findings. As such, SWAHN will continue to reach out to both academic and community networks moving
J Community Health Table 3 Type and frequency of long-term goals highlighted by academic networks Category
Sub-category
System Delivery
System Delivery
Frequency 7
Better coordination of mental health services
1
Addressing systemic stigma in provision of services
1
Child and adolescent mental health service coordination and gaps
1
Transitions from paediatric to adult care (low volume, high cost)
1
Primary care reform
1
Primary care connected to other parts of health care system (e.g., hospitals, Community Care Access Centres, specialists) Improving the integration of care
1
Health Care Resources
3
Strengthen access and financial support for collection of evidence-based resources to support clinical practice/ research needs across the region
1
Senior and dementia care in rural communities
1
Promote safe environments for treatment of mental health Intervention Improve management of chronic diseases
1
Develop and integrate technology to support based best practices (e.g., seamless access to point of care tools, linking of resources in electronic health records) Inter-Professional Education (IPE)
1
Preparing faculty and practitioners to practice IPE competence Education
Research
1 1
Innovation in integrating learning across programs
Research
1 2
Integrating IPE practice to provide learning
Rural Medicine
1 1
Infrastructure
Special Populations
1 2
Implementation of best practices in addressing mental health, poverty and social inclusion
Education
1
1 1
Higher than provincial averages of chronic disease in rural populations
1 2
Develop regional clinical librarianship model to support dissemination of evidence-based research into clinical practice (right skills, right time, right role)
1
Rural specific health research and health promotion
1
forward. Another limitation of this work was the challenge of the networks to align their short- and long-term goals with the SWAHN mandate. This limitation could be overcome by further articulating and refining the mandate of SWAHN, particularly as it relates to the functioning of the academic and community networks. An additional solution would be for SWAHN to host a number of focus groups, in which network members would be able to understand the mandate of SWAHN and to communicate how their network could collaborate within this larger network most effectively.
Conclusion and Implications It was noted that networks were not consistent in the outcome measures they have in place to evaluate the effectiveness and success of their work. This lack of consistency warrants the
development of standards that could be used by all networks. This development could be facilitated by SWAHN and would enable the creation of a comprehensive and comparable set of measures across various health-related organizations. It was also noted that a common theme among both academic and community networks was the lack of funding and/or concerns regarding funding. Although this is a challenging facet in all areas, SWAHN can help organize an information database that provides all member networks access to funding and collaboration opportunities. SWAHN could also work collaboratively with the academic and community networks to advocate for better funding. In conclusion, this study provided important and timely insight into the currently existing academic and community health networks in two LHINs in SouthWestern Ontario and how the establishment of SWAHN could most benefit these networks, in terms of their current and future needs.
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J Community Health Table 4 Type and frequency of short-term goals highlighted by community networks
Category
Sub-category
Frequency
System Delivery
Health Care Resources Better coordination Improved government funding Improved service availability Better access Funding following patient Supporting improved collaboration Supporting patient engagement Better access to high-needs patients Patients with intellectual delay/developmental disabilities Emergency rooms friendly to patients with developmental delay Community respite care for complex care children Transportation Home care Physicians for all people Funding for patients with dementia and their caregivers Community and health-related outreach Intervention Medical reconciliation Proper use of anti-microbial techniques Mental health Evidence based programs for mental health Non-biological modalities Enhanced use of best practices Prevention Cancer screening Healthier lifestyles Reduction in number of smokers Education of general public on disease and disease prevention Improved parenting skills Long-Term Care Cognitive problems, behavioural issues Value of occupational therapy Assessment of admission criteria Government Funding Inter-Professional Care Collaborative care by increasing nursing scope of practice Collaborative teams Program Evaluation Increased knowledge of program evaluation/metric development Information Sharing Enhanced knowledge of funding opportunities Electronic Records Training Staff education Education of behavioural skills Education about developmental disabilities Formation of a division of palliative care Post graduate palliative care courses Education Increase in education about rural medicine
16 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 6 1 1 1 1 1 1 5 1 1 1 1 1 3 1 1 1 3 2 1 1 1 1 1 1 1 5 1 1 1 1 1 1 1
Education
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J Community Health Table 4 continued
Category
Sub-category
Special Populations
Special Populations Increased anti-microbial resistant organisms in hospital
1
Mental health
1
Chronic disease
1
Diabetes
1
Chronic obstructive pulmonary disease
1
Congestive heart failure
1
Aboriginal communities
1 3
Increased awareness
1
Community-based
1
Long-term care
1
Aging Population
2
Transportation Elder abuse Rural Medicine
1 1 2
Delivering enhanced rural medicine
1
Lack of funding
1
Public Health
5
Prevention
2
Patient advocacy
1
Self-management
1
Enhanced policy
1
Social Determinants of Health Poverty Research
8 1
Increased anti-microbial resistant organisms in community
Dementia
Public Health
Frequency
Research
2 2 2
Faster knowledge translation
1
Enhanced coordination of palliative care
1
Table 5 Type and frequency of long-term goals highlighted by community networks Category
Sub-category
Frequency
System Delivery
Health Care Resources
14
Increased funding for home care
1
Availability Accessibility
1 1
Transitions from hospital to home and community care
1
Lack of resource coordination
1
Improving health care services
1
Greater integration along full care continuum
1
Support capacity planning
1
Better access to high-needs patients
1
Patients with intellectual delay/developmental disabilities
1
Emergency rooms friendly to patients with developmental delay
1
Recruitment and retention of health care staff
1
Funding for patients with dementia and their caregivers
1
Physicians for all people
1
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J Community Health Table 5 continued Category
Sub-category Inter-Professional Care
1
Collaborative teams
1
Proper use of anti-microbial techniques Enhanced use of best practices Information Sharing
1 1 2 1
More information of what sources of funding are available
1
Enhanced information technology Building health system infrastructure to support chronic disease prevention and management Network Improve collaboration Share knowledge between networks to reduce duplicated efforts Funding Advocate for front line funding Education
2 1 1 2 1 1 1 1 4
Low cost seminars
1
Rural community
1
Public education
1
Palliative care curriculum for undergraduate students Special Populations
1 13
Mental health
3
Chronic disease
2
Diabetes
1
Increased anti-microbial resistant organisms in hospital Increased anti-microbial resistant organisms in community
1 1
Complex clients with complex comorbidity and multimorbidity
1
Stroke
1
Mental health (e.g., depression, suicide)
1
Abuse and addictions
1
Aboriginal communities
1
Aging Population
5
Supporting family caregivers
1
Senior friendly hospitals
1
Elder abuse care and intervention
1
Providing quality home care
1
Providing senior care in the context of higher demands
1
Dementia
3
Community-based
1
Long Term Care Advocate for National Dementia Policy
1 1
Rural Medicine
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2
Information on grant opportunities Infrastructure
Special Populations
2
Value of primary care in community health centres Intervention
Education
Frequency
2
Lack of funding
1
Promotion of rural practice for physicians
1
J Community Health Table 5 continued Category
Sub-category
Frequency
Public Health
Public Health
7
Research
Conflicts of interest
Healthy eating for children
1
Healthier lifestyles for adults
1
Disease prevention
1
Patient advocacy
1
Self-management
1
Nutrition
1
Policy
1
Research
5
Examining readmission to hospitals
1
Linkage with community networks Increased participatory research
1 1
Facilitating knowledge translation and bringing evidence-based best practices to primary care
1
Research into the uniqueness of rural practice
1
None.
Ethical standard Ethical approval was successfully obtained from The University of Western Ontario Research Ethics Board (Study No. 104828). The authors obtained informed consent from all participants, who received and completed a consent form before their participation in the study.
References 1. Bressler, B. (2009). Securing the future of Canada’s Academic Health Sciences Centres. Academic Health Sciences Centres— National Task Force. Retrieved from http://www.ahsc-ntf.org/ docs/AHSCs/Case%20Study%20and%20ES%20Reports/Final% 20Versions%20with%20CIP/01.13-FINAL-CaseStudy-E-En.pdf. 2. Lozon, J., & Fox, R. (2002). Academic Health Sciences Centres Laid Bare. Healthcare Papers, 2(3), 10–36. doi:10.12927/hcpap. 2002.17202. 3. Blumenthal, D., & Meyer, G. S. (1996). Academic health centers in a changing environment. Health Affairs, 15(2), 200–215. doi:10.1377/hlthaff.15.2.200. 4. National Task Force on the Future of Canada’s Academic Health Sciences Centres. (2010). Three Missions One Future: Optimizing the Performance of Canada’s Academic Health Sciences Centres. Retrieved from http://www.acaho.org/docs_new/ AHSCs/Final%20NTF%20Report/AHSCNTFFinalReportMay 312010.pdf. 5. Walshe, K., & Davies, H. T. O. (2013). Health research, development and innovation in England from 1988 to 2013: From research production to knowledge mobilization. Journal of Health Services Research & Policy, 18(3 Suppl), 1–12. doi:10. 1177/1355819613502011. 6. Fish, D. R. (2013). Academic health sciences networks in England. The Lancet, 381(9882), e18–e19. doi:10.1016/S01406736(12)60866-6. 7. Practice Education in British Columbia. (2013). Retrieved from http://www.practiceeducation.org.
8. Saskatchewan Academic Health Sciences Network (SAHSN)— University of Saskatchewan. (2014). Retrieved from http://sas khealthsciencesnetwork.ca. 9. Toronto Academic Health Science Network. (2014). Retrieved from http://www.tahsn.ca. 10. Limites des territoires des RUIS. (2014). Retrieved from http:// www.msss.gouv.qc.ca/statistiques/atlas/atlas/index.php?id_ carte=86. 11. Heart Disease, Stroke, and Healthy Living—Heart and Stroke Foundation of Canada. (2014). Retrieved from http://www.heart andstroke.com/site/c.ikIQLcMWJtE/b.2796497/k.BF8B/Home. htm. 12. Alzheimer Society of London Middlesex. (2013). Retrieved from http://www.alzheimerlondon.ca. 13. Southwestern Ontario Stroke Network. (2014). Retrieved from http://swostroke.ca. 14. Institute for Clinical Evaluative Services (ICES) Western. (2014). Retrieved from http://www.ices.on.ca/western. 15. DELPHI—DELiver Primary Healthcare Information. (2014, March 26). Retrieved from https://www.schulich.uwo.ca/famil ymedicine/research/csfm/delphi. 16. Gateway Centre of Excellence in Rural Health. (2014). Retrieved from http://www.gatewayruralhealth.ca/. 17. Dillman, D. A. (1978). Mail and telephone surveys: The total design method. New York: Wiley. 18. Hoddinott, S. N., & Bass, M. J. (1986). The Dillman total design survey method. Canadian Family Physician, 32, 2366–2368. 19. National Collaborating Centre for Methods and Tools (2013). Measuring impact of research partnerships: The CIROP Tool. Hamilton, ON: McMaster University. Retrieved from http:// www.nccmt.ca/registry/view/eng/171.html. 20. Bains, N., Dall, K., Hay, C., Pacey, M., Sarkella, J., & Ward, M. (2004). Population Health Profile: South West LHIN. Health System Intelligence project. Retrieved from http://www.health. gov.on.ca/transformation/providers/information/resources/pro files/profile_southwest.pdf.
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ORIGINAL PAPER
Establishing the SouthWestern Academic Health Network (SWAHN): A Survey Exploring the Needs of Academic and Community Networks in SouthWestern Ontario Kathryn Nicholson1 • Jasmine Randhawa2 • Margaret Steele3
Ó Springer Science+Business Media New York 2015
Abstract With the evolving fields of health research, health professional education and advanced clinical care comes a need to bring researchers, educators and health care providers together to enhance communication, knowledge-sharing and interdisciplinary collaboration. There is also a need for active collaboration between academic institutions and community organizations to improve health care delivery and health outcomes in the community setting. In Canada, an Academic Health Sciences Network model has been proposed to achieve such activities. The SouthWestern Academic Health Network (SWAHN) has been established among three universities, three community colleges, community hospitals, community-based organizations and health care providers and two Local Health Integrated Networks (LHINs) in
& Kathryn Nicholson [email protected] Jasmine Randhawa [email protected] Margaret Steele [email protected] 1
Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Centre for Studies in Family Medicine, Kresge Building 2nd Floor, Western University, 1151 Richmond Street, London, ON N6A 5C1, Canada
2
Schulich School of Medicine and Dentistry, Clinical Skills Building 3rd Floor, Western University, 1151 Richmond Street, London, ON N6A 5C1, Canada
3
Hospital and Interfaculty Relations, Departments of Psychiatry, Paediatrics and Family Medicine, Schulich School of Medicine and Dentistry, Clinical Skills Building 3rd Floor, Western University, 1151 Richmond Street, London, ON N6A 5C1, Canada
Southwestern Ontario. A survey was conducted to understand the characteristics, activities, existing partnerships, short- and long-term goals of the academic and community health networks in SouthWestern Ontario to inform the development of SWAHN moving forward. A total of 114 health networks were identified from the two participating LHINs, 103 community health networks and 11 academic health networks. A mailed survey was sent to all networks and responses were analyzed using both quantitative and qualitative approaches. The short- and long-term goals of these networks were categorized into five main themes: Public Health, Education, Research, System Delivery and Special Populations. Overall, this study helped to elicit important information from the academic and community based networks, which will inform the future work of SWAHN. This research has also demonstrated the significance of collecting information from both academic and community partners during the formation of other interdisciplinary health networks. Keywords SouthWestern Academic Health Network Academic Health Sciences Network Community Academia Interdisciplinary Survey
Introduction With the proliferation and evolving fields of health research, health professional education and advanced clinical care comes an increasing need to bring researchers, educators and health care providers together to bridge the gap between institutional ‘‘silos’’ and to enhance communication, knowledge-sharing and interdisciplinary collaboration. There is also a need for active collaboration between academic institutions and community organizations to improve
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health care delivery and health outcomes in the clinical and community setting. Although this collaboration between parties is ideal, it is often challenging to achieve in an everchanging environment. In order to facilitate this union of research, education and health care delivery, Academic Health Sciences Centres (AHSC) were developed. A relatively new term in health care, AHSCs play a pivotal, yet not exclusive, role in the integration of education, research and the delivery of care [1, 2]. An AHSC has been defined in previous literature as the association of ‘‘all university health professional schools, including a Faculty of Medicine, with research enterprises and care delivery organizations that provide physical facilities and funding for education and research, and which are aligned towards a common mission of advancing patient care, education and research’’ [2]. In light of these objectives, there are potential limitations that an AHSC must overcome in order to be successful [3]. For example, there are barriers that arise due to the changing governance model in health care systems which may challenge the ability of an AHSC to successfully fulfill its three missions [4]. To alleviate this challenge and to better align the mandate, strategies, structures and processes of many health-related organizations, a stronger partnership between an AHSC and government is needed [4]. However, the influence of governance may still become a challenge within the academic or health care institutions, where difficult funding choices have to be made. Additionally, the lack of available funding may inhibit an AHSC to successfully and consistently meet their tripartite mission, which focuses on high quality achievements and innovation [4]. Indeed, a robust and strongly integrated model is needed to overcome these considerable barriers. In Canada, a new model of an Academic Health Sciences Network (AHSN) has been proposed by the National Task Force of the Association of Faculties of Medicine of Canada (AFMC) and the former Association of Canadian Academic Health Organizations (ACAHO), which addresses the aforementioned advancements and consistently evolving nature of health care systems and academic medicine [4]. This new AHSN model is defined as a ‘‘set of formal partnerships created by health sciences universities, academic health care organizations and other provider organizations with the goal of improving patient and population health outcomes through mechanisms and structures that develop, implement and advance integrated health services delivery, professional education, and research and innovation’’ [4]. An interdisciplinary complement of academic- and community-based organizations lie at the core of this new model. AHSNs are recognized as the solution to the barriers that were faced by AHSCs in countries, such as the United Kingdom, following a comprehensive analysis conducted by the National Health System [5]. Despite these advantages, there are still a
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number of challenges that AHSNs may have to overcome. For example, tensions between the central direction of the network’s mandate and the local or regional desires must be appropriately evaluated and addressed, guided by inclusive processes that will create the greatest likelihood for success and positive outcomes [6]. Currently, there are seventeen established AHSNs in Canada, with each network centered at one of Canada’s university medical schools and associated with at least one affiliated teaching or research hospital [4]. Some examples of these Canadian AHSNs include: the British Columbia Academic Health Sciences Council (BCAHC), the Saskatchewan Academic Health Sciences Network (SAHSN), the Toronto Academic Health Sciences Network (TAHSN) and les Re´seaux Universitaires Inte´gre´s de Sante´ (RUIS) in Quebec [7–10]. With the highest population of the Canadian provinces and territories, the province of Ontario would greatly benefit from the establishment of a second AHSN, which could address the needs of its more rural regions. Recognizing this important need and opportunity, a SouthWestern Academic Health Network (SWAHN) has been established by three universities (The University of Western Ontario located in London, Ontario, the University of Windsor and the University of Waterloo); three community colleges (Fanshawe College located in London, Ontario, Lambton College located in Sarnia, Ontario and St. Clair College located in Windsor, Ontario); community hospitals; community-based health organizations and health care providers; and two Local Health Integrated Networks or LHINs (Erie St. Clair LHIN and SouthWest LHIN). This newly established SWAHN will serve as a virtual network of academic and community health networks in SouthWestern Ontario. For the purposes of our work, a community health network is defined as a network of health-related organizations that primarily focuses on and is responsible for supplying health care or social services for a specific disease. Examples of a community health network would include the Heart and Stroke Foundation [11], the London/Middlesex Dementia Network (Alzheimer Society) [12] or the SouthWestern Ontario Stroke Network [13]. In comparison, an academic health network is defined as a network with a formal affiliation with an academic institution [4]. More specifically, it is a partnership created by a health sciences university, community college offering health care courses and health-related organizations with the goal of improving patient and population health outcomes through the development and implementation of advanced health services delivery, professional education and health research. Examples of an academic health network would include the Institute for Clinical Evaluative Sciences (ICES) Western [14], the DELiver Primary Healthcare Information (DELPHI) Network at The University of Western Ontario [15] or the
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Gateway Centre of Excellence in Rural Health in Seaforth, Ontario [16]. In order to better inform the establishment of the SWAHN, there was a need to gain information from these academic and community networks. As such, the study described herein had three main objectives. The first objective was to learn about the characteristics of the academic and community health networks that were already existing in SouthWestern Ontario. The second objective was to assess the existing relationships between the already existing health networks and a formal academic institution. The third objective was to determine the interest of these already existing health networks in engaging and participating in SWAHN. Furthermore, this study aimed to understand which short- and long-term issues these health networks wanted to address as collaborating members of SWAHN.
Materials and Methods Subjects
possible response rate [17, 18]. Personalized mailouts were sent to the main contact person that was identified for each academic and community health network. In accordance with the Modified Dillman method, an invitation to participate was sent to the appropriate network contact person, informing them of their selection to participate in our survey. A week later, all networks were sent the first survey package which included: the appropriate survey, a cover letter that invited the participants to complete and return the survey, a letter of information and consent form for the participants to sign and return and a pre-paid postage envelope with a pre-printed return address. A week after this first survey package was mailed, a follow-up letter was sent to all participants thanking those who had completed and returned the surveys and encouraging others to do so at their earliest convenience. Two weeks after the first survey package was mailed, a second survey package was sent which included the same elements of the first survey package. As completed surveys were received, all responses were recorded into an electronic database for statistical analysis, without personal identifiers of the network contact person.
To identify the academic and community health networks of interest for this study, we conducted a systematic search of health networks that were located in the Erie St. Clair and SouthWest LHINs (with the assistance of a librarian at The University of Western Ontario). Once the original list of network names and corresponding network descriptions was created, networks were assessed and removed if they did not meet the previously defined criteria for an academic or community health network. A total of 114 health networks from both the Erie St. Clair and SouthWest LHINs were included in our final sample, 103 of which were community health networks and 11 were academic health networks. An appropriate contact person and their contact information (e.g., mailing address and phone number) for each network was then identified and recorded.
Data Analyses
Survey Development and Administration
Results
A survey was developed by the co-authors (K.N., J.R., M.S.) and was then reviewed and pilot tested by two working groups of SWAHN (included members of academic and community networks): the Community Participation Working Group and the Clinical Outcomes Working Group. A final survey was developed for the community health networks and a second survey was developed for the academic health networks. Ethical approval was successfully obtained from The University of Western Ontario Research Ethics Board (Study No. 104828). Survey administration was conducted according to the Modified Dillman method in order to generate the highest
Of the 114 networks that were contacted, 40 surveys were completed and returned, yielding an overall response rate of 35.1 %. The response rate was notably higher for academic networks as opposed to community, 81.8 and 37.9 %, respectively. When examining the main goals and components of network mandates, the academic and community networks were found to be statistically different (p \ 0.05). As shown in Fig. 1, the main elements of the academic networks’ mandates are research and education of health professionals. In comparison, the main focus of the community networks’ mandates are more distributed between education of patients, health care professionals
Descriptive quantitative analyses were conducted on the closed-ended questions of the surveys, such as calculating frequencies of responses. All quantitative analyses were conducted using SPSS. Thematic qualitative analyses were conducted on the open-ended questions of the surveys. The co-authors coded written responses (e.g., short-term and long-term issues) from the participants into common themes and sub-themes. Responses were examined for the academic health networks (n = 9) and community health networks (n = 31) separately, then patterns of responses were compared between the academic and community networks.
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J Community Health Fig. 1 The main goals or components of the academic and community networks’ mandates
and the general public. Advocacy is an important element for the mandates of academic and community networks. As shown in Fig. 2, academic networks are found to have a much higher frequency of affiliation with academic networks as compared to community networks, with the most frequent affiliations occurring with The University of Western Ontario. Further to this, 88 % (7/8) academic networks stated that they are affiliated with an academic institution, as compared to 52 % (16/31) community networks. Figure 3 demonstrates that the majority of community network members are from the health care field. In terms of community engagement, Fig. 4 displays the frequency and type of engagement in which the academic
Fig. 2 Frequency and type of academic and community networks’ affiliations with academic institutions
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and community networks are involved. A total of 87 % (27/31) of community networks stated they actively participate in community engagement, as compared to 78 % (7/9) of the academic networks. This difference was found to be statistically significant (p \ 0.05), indicating disparities in community engagement between network type. As shown in Fig. 4, community networks are more engaged with public forums, patients or clients, families and collaboration with other organizations, whereas academic networks demonstrate their engagement through reports and guidelines. The primary source of funding for academic and community networks is presented in Fig. 5. For community
J Community Health Fig. 3 Frequency and type of groups to which members of community networks belong
Fig. 4 Frequency and type of community engagement in which academic and community networks are involved
networks, funding primarily comes from the Ministry of Health and Long Term Care, while academic networks rely on a combination of federal funding, foundational research and other sources of funding. The diverse funding sources for academic networks reflects the challenging financial environment currently being experienced by academic researchers. When examining the various types of health care professionals that are involved within academic networks, Fig. 6 demonstrates that the majority of members are physicians, registered nurses and nurse practitioners, as well as health promotion professionals. These academic networks are also composed of psychologists, dieticians,
social workers, and respiratory and speech therapists. As such, there is great potential for inter-professional collaboration among and between network types. In fact, approximately 83 % of responding community networks already collaborate with other networks. Outcome measures were utilized by about 84 % (26/31) and 77 % (7/9) of responding community and academic networks, respectively. As seen in Fig. 7, more academic networks tend to use clearly identified metrics to measure network outcomes, as compared to dashboard metrics. There is also a diversity of outcome measure types that are being used by academic networks, including Community Impacts of Research Oriented Partnerships (CIROP)
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J Community Health Fig. 5 Primary sources of funding for academic and community networks
Fig. 6 Frequency and type of health care professionals involved in academic networks
measures [19], annual reports to funding bodies, balanced score cards and psychometric tools (Table 1). In terms of previous knowledge about SWAHN, 78 % (7/9) of responding academic networks indicated that they were aware of this initiative, as compared to only 23 % (7/ 30) of community networks. Clearly, this information has not been disseminated as consistently and comprehensively to community organizations. After completing this survey, however, the majority of networks were interested in learning more, and becoming involved, in the SWAHN initiative. More specifically, 84 % (26/30) and 78 % (7/9)
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of responding community and academic networks, respectively, indicated this interest. This response fulfilled one of the key objectives of this study and established a positive beginning in having pre-existing community and academic health networks in SouthWestern Ontario engage and participate as active members in SWAHN. In addition to establishing the characteristics of existing academic and community networks in SouthWestern Ontario, all networks were asked to describe the three local health issues that they believe SWAHN can tackle in the next 2 and 5 years, recorded as short- and long-term goals,
J Community Health Fig. 7 Frequency and type of outcome measures used by academic networks
Table 1 Other outcome measures used by academic networks (in addition to dashboard and metrics)
Categories
Frequency
Psychometric tools
2
Measures of Community Impacts of Research Oriented Partnerships (CIROP)
1
Report to the Ministry of Health and Long Term Care annually Feedback and use of both psychometric instruments and qualitative approaches
1 1
Balanced score card in development
1
Annual reports to funding bodies
1
Other
1
respectively. The themes and sub-themes of the responses from both the academic and community networks are presented in Tables 2, 3, 4 and 5. As shown in Table 2, a greater emphasis was placed by academic networks on system delivery and education when asked about the shortterm goals that SWAHN can address in the next 2 years. A similar trend was seen in the long-term goals as listed by the academic networks. As seen in Table 3, there is again a notable emphasis on system delivery, as compared to research and education. Tables 4 and 5 display the short- and long-term goals of the community networks, which SWAHN can address in the next 2 and 5 years, respectively. From the community networks’ perspective, there is a strong focus on system delivery and special populations.
Discussion Overall, the short- and long-term goals that the responding academic and community networks deemed as important were categorized into five main themes. These themes were consistent among both types of networks, and were areas in which the SWAHN initiative could be involved moving forward. More specifically, the five main categories are comprised of the following goals: (1) Public Health—
Policy, Advocacy and Social Determinants of Health; (2) Education—Inter-Professional Education, Public Education, Continuum of Education, Curriculum; (3) Research; (4) System Delivery—Health Care Resources, Delivery, Models of Care, Intervention, Infrastructure and Funding; and (5) Special Populations—Seniors/Aging, Mental Health, Stroke, Chronic Obstructive Pulmonary Disease, Diabetes, Developmental Disabilities and Chronic Diseases. Similar trends are seen in the goals listed by academic and community networks as both network types place a large emphasis on system delivery. In contrast to academic networks, community-based networks more strongly focus on special populations, as compared to education and research, as there is a growing proportion of special populations, such as seniors and mental health issues in the SouthWestern Ontario community. As reported by the Health System Intelligence Project (HSIP), there is a greater than average population of seniors and those that suffer from chronic conditions, such as high blood pressure, heart disease and diabetes [20]. Notable insight was provided by the academic and community surveys, particularly regarding the structure, functioning and funding of these networks. This information is vital in terms of forming a collaborative and interdisciplinary network-ofnetworks. However, it was clear that inconsistent metrics
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J Community Health Table 2 Type and frequency of short-term goals highlighted by academic networks Category
Sub-category
System Delivery
System Delivery
Frequency 6
Child and adolescent mental health service coordination and gaps
1
Transitions from paediatric to adult care (low volume, high cost)
1
Primary care reform
1
Primary care connected to other parts of health care system (e.g., hospitals, Community Care Access Centres, specialists)
1
Coordination of efforts to increase efficiency
1
Reduce emergency room wait times and crowding (after-hours clinics) Health Care Resources Access to rural services
2
Embed health care library professional roles within programs
1
Patient engagement in their chronic care
1
Information Sharing
Education
2
Coordinated communication
1
Improve collaboration and communication between health care providers
1
Professional Education
3
Professional development of health care library professionals in areas such a systematic reviews, searching of grey literature
1
Integrate common information and data literacy learning outcomes into curriculum for interdisciplinary health professions
1
Increase continuing professional development Inter-Professional Education (IPE)
Public Health
Special Populations
IPE as a delivery model of care
1
Transforming health education to integrate IPE learning
1
Social Determinants of Health
3
Poverty
1
Social inclusion
1
Stigma
1
Special Populations
3 1
High prevalence of multimorbidity (multiple chronic disease) Diabetes Rural Medicine Research
1 1
Identify the true burden of mental health in the community
of success are being used among the responding networks, which can create challenges in evaluation. The three main objectives of this study were achieved and will inform the SWAHN development moving forward. Through the various questions within our two surveys, we were able to gain an enhanced understanding of the composition of existing networks in SouthWestern Ontario and the pre-existing structure of these organizations. This survey also provided insight into the already established relationships between the networks and academic institutions in the area. Additionally, there was also great interest expressed by responding networks to both
1 1 1
Higher rates of brain injury/concussion in rural youth
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1 2
Medication safety and addiction
Research
1 4
1
learn more and become engaged with the SWAHN initiative. Limitations While this survey will help to direct and shape the development of SWAHN, it is important to note that some academic and community networks within the Erie St. Clair and SouthWest LHINs may have been missing from our systematic search, and thus would not have been able to contribute to the survey findings. As such, SWAHN will continue to reach out to both academic and community networks moving
J Community Health Table 3 Type and frequency of long-term goals highlighted by academic networks Category
Sub-category
System Delivery
System Delivery
Frequency 7
Better coordination of mental health services
1
Addressing systemic stigma in provision of services
1
Child and adolescent mental health service coordination and gaps
1
Transitions from paediatric to adult care (low volume, high cost)
1
Primary care reform
1
Primary care connected to other parts of health care system (e.g., hospitals, Community Care Access Centres, specialists) Improving the integration of care
1
Health Care Resources
3
Strengthen access and financial support for collection of evidence-based resources to support clinical practice/ research needs across the region
1
Senior and dementia care in rural communities
1
Promote safe environments for treatment of mental health Intervention Improve management of chronic diseases
1
Develop and integrate technology to support based best practices (e.g., seamless access to point of care tools, linking of resources in electronic health records) Inter-Professional Education (IPE)
1
Preparing faculty and practitioners to practice IPE competence Education
Research
1 1
Innovation in integrating learning across programs
Research
1 2
Integrating IPE practice to provide learning
Rural Medicine
1 1
Infrastructure
Special Populations
1 2
Implementation of best practices in addressing mental health, poverty and social inclusion
Education
1
1 1
Higher than provincial averages of chronic disease in rural populations
1 2
Develop regional clinical librarianship model to support dissemination of evidence-based research into clinical practice (right skills, right time, right role)
1
Rural specific health research and health promotion
1
forward. Another limitation of this work was the challenge of the networks to align their short- and long-term goals with the SWAHN mandate. This limitation could be overcome by further articulating and refining the mandate of SWAHN, particularly as it relates to the functioning of the academic and community networks. An additional solution would be for SWAHN to host a number of focus groups, in which network members would be able to understand the mandate of SWAHN and to communicate how their network could collaborate within this larger network most effectively.
Conclusion and Implications It was noted that networks were not consistent in the outcome measures they have in place to evaluate the effectiveness and success of their work. This lack of consistency warrants the
development of standards that could be used by all networks. This development could be facilitated by SWAHN and would enable the creation of a comprehensive and comparable set of measures across various health-related organizations. It was also noted that a common theme among both academic and community networks was the lack of funding and/or concerns regarding funding. Although this is a challenging facet in all areas, SWAHN can help organize an information database that provides all member networks access to funding and collaboration opportunities. SWAHN could also work collaboratively with the academic and community networks to advocate for better funding. In conclusion, this study provided important and timely insight into the currently existing academic and community health networks in two LHINs in SouthWestern Ontario and how the establishment of SWAHN could most benefit these networks, in terms of their current and future needs.
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J Community Health Table 4 Type and frequency of short-term goals highlighted by community networks
Category
Sub-category
Frequency
System Delivery
Health Care Resources Better coordination Improved government funding Improved service availability Better access Funding following patient Supporting improved collaboration Supporting patient engagement Better access to high-needs patients Patients with intellectual delay/developmental disabilities Emergency rooms friendly to patients with developmental delay Community respite care for complex care children Transportation Home care Physicians for all people Funding for patients with dementia and their caregivers Community and health-related outreach Intervention Medical reconciliation Proper use of anti-microbial techniques Mental health Evidence based programs for mental health Non-biological modalities Enhanced use of best practices Prevention Cancer screening Healthier lifestyles Reduction in number of smokers Education of general public on disease and disease prevention Improved parenting skills Long-Term Care Cognitive problems, behavioural issues Value of occupational therapy Assessment of admission criteria Government Funding Inter-Professional Care Collaborative care by increasing nursing scope of practice Collaborative teams Program Evaluation Increased knowledge of program evaluation/metric development Information Sharing Enhanced knowledge of funding opportunities Electronic Records Training Staff education Education of behavioural skills Education about developmental disabilities Formation of a division of palliative care Post graduate palliative care courses Education Increase in education about rural medicine
16 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 6 1 1 1 1 1 1 5 1 1 1 1 1 3 1 1 1 3 2 1 1 1 1 1 1 1 5 1 1 1 1 1 1 1
Education
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J Community Health Table 4 continued
Category
Sub-category
Special Populations
Special Populations Increased anti-microbial resistant organisms in hospital
1
Mental health
1
Chronic disease
1
Diabetes
1
Chronic obstructive pulmonary disease
1
Congestive heart failure
1
Aboriginal communities
1 3
Increased awareness
1
Community-based
1
Long-term care
1
Aging Population
2
Transportation Elder abuse Rural Medicine
1 1 2
Delivering enhanced rural medicine
1
Lack of funding
1
Public Health
5
Prevention
2
Patient advocacy
1
Self-management
1
Enhanced policy
1
Social Determinants of Health Poverty Research
8 1
Increased anti-microbial resistant organisms in community
Dementia
Public Health
Frequency
Research
2 2 2
Faster knowledge translation
1
Enhanced coordination of palliative care
1
Table 5 Type and frequency of long-term goals highlighted by community networks Category
Sub-category
Frequency
System Delivery
Health Care Resources
14
Increased funding for home care
1
Availability Accessibility
1 1
Transitions from hospital to home and community care
1
Lack of resource coordination
1
Improving health care services
1
Greater integration along full care continuum
1
Support capacity planning
1
Better access to high-needs patients
1
Patients with intellectual delay/developmental disabilities
1
Emergency rooms friendly to patients with developmental delay
1
Recruitment and retention of health care staff
1
Funding for patients with dementia and their caregivers
1
Physicians for all people
1
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J Community Health Table 5 continued Category
Sub-category Inter-Professional Care
1
Collaborative teams
1
Proper use of anti-microbial techniques Enhanced use of best practices Information Sharing
1 1 2 1
More information of what sources of funding are available
1
Enhanced information technology Building health system infrastructure to support chronic disease prevention and management Network Improve collaboration Share knowledge between networks to reduce duplicated efforts Funding Advocate for front line funding Education
2 1 1 2 1 1 1 1 4
Low cost seminars
1
Rural community
1
Public education
1
Palliative care curriculum for undergraduate students Special Populations
1 13
Mental health
3
Chronic disease
2
Diabetes
1
Increased anti-microbial resistant organisms in hospital Increased anti-microbial resistant organisms in community
1 1
Complex clients with complex comorbidity and multimorbidity
1
Stroke
1
Mental health (e.g., depression, suicide)
1
Abuse and addictions
1
Aboriginal communities
1
Aging Population
5
Supporting family caregivers
1
Senior friendly hospitals
1
Elder abuse care and intervention
1
Providing quality home care
1
Providing senior care in the context of higher demands
1
Dementia
3
Community-based
1
Long Term Care Advocate for National Dementia Policy
1 1
Rural Medicine
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2
Information on grant opportunities Infrastructure
Special Populations
2
Value of primary care in community health centres Intervention
Education
Frequency
2
Lack of funding
1
Promotion of rural practice for physicians
1
J Community Health Table 5 continued Category
Sub-category
Frequency
Public Health
Public Health
7
Research
Conflicts of interest
Healthy eating for children
1
Healthier lifestyles for adults
1
Disease prevention
1
Patient advocacy
1
Self-management
1
Nutrition
1
Policy
1
Research
5
Examining readmission to hospitals
1
Linkage with community networks Increased participatory research
1 1
Facilitating knowledge translation and bringing evidence-based best practices to primary care
1
Research into the uniqueness of rural practice
1
None.
Ethical standard Ethical approval was successfully obtained from The University of Western Ontario Research Ethics Board (Study No. 104828). The authors obtained informed consent from all participants, who received and completed a consent form before their participation in the study.
References 1. Bressler, B. (2009). Securing the future of Canada’s Academic Health Sciences Centres. Academic Health Sciences Centres— National Task Force. Retrieved from http://www.ahsc-ntf.org/ docs/AHSCs/Case%20Study%20and%20ES%20Reports/Final% 20Versions%20with%20CIP/01.13-FINAL-CaseStudy-E-En.pdf. 2. Lozon, J., & Fox, R. (2002). Academic Health Sciences Centres Laid Bare. Healthcare Papers, 2(3), 10–36. doi:10.12927/hcpap. 2002.17202. 3. Blumenthal, D., & Meyer, G. S. (1996). Academic health centers in a changing environment. Health Affairs, 15(2), 200–215. doi:10.1377/hlthaff.15.2.200. 4. National Task Force on the Future of Canada’s Academic Health Sciences Centres. (2010). Three Missions One Future: Optimizing the Performance of Canada’s Academic Health Sciences Centres. Retrieved from http://www.acaho.org/docs_new/ AHSCs/Final%20NTF%20Report/AHSCNTFFinalReportMay 312010.pdf. 5. Walshe, K., & Davies, H. T. O. (2013). Health research, development and innovation in England from 1988 to 2013: From research production to knowledge mobilization. Journal of Health Services Research & Policy, 18(3 Suppl), 1–12. doi:10. 1177/1355819613502011. 6. Fish, D. R. (2013). Academic health sciences networks in England. The Lancet, 381(9882), e18–e19. doi:10.1016/S01406736(12)60866-6. 7. Practice Education in British Columbia. (2013). Retrieved from http://www.practiceeducation.org.
8. Saskatchewan Academic Health Sciences Network (SAHSN)— University of Saskatchewan. (2014). Retrieved from http://sas khealthsciencesnetwork.ca. 9. Toronto Academic Health Science Network. (2014). Retrieved from http://www.tahsn.ca. 10. Limites des territoires des RUIS. (2014). Retrieved from http:// www.msss.gouv.qc.ca/statistiques/atlas/atlas/index.php?id_ carte=86. 11. Heart Disease, Stroke, and Healthy Living—Heart and Stroke Foundation of Canada. (2014). Retrieved from http://www.heart andstroke.com/site/c.ikIQLcMWJtE/b.2796497/k.BF8B/Home. htm. 12. Alzheimer Society of London Middlesex. (2013). Retrieved from http://www.alzheimerlondon.ca. 13. Southwestern Ontario Stroke Network. (2014). Retrieved from http://swostroke.ca. 14. Institute for Clinical Evaluative Services (ICES) Western. (2014). Retrieved from http://www.ices.on.ca/western. 15. DELPHI—DELiver Primary Healthcare Information. (2014, March 26). Retrieved from https://www.schulich.uwo.ca/famil ymedicine/research/csfm/delphi. 16. Gateway Centre of Excellence in Rural Health. (2014). Retrieved from http://www.gatewayruralhealth.ca/. 17. Dillman, D. A. (1978). Mail and telephone surveys: The total design method. New York: Wiley. 18. Hoddinott, S. N., & Bass, M. J. (1986). The Dillman total design survey method. Canadian Family Physician, 32, 2366–2368. 19. National Collaborating Centre for Methods and Tools (2013). Measuring impact of research partnerships: The CIROP Tool. Hamilton, ON: McMaster University. Retrieved from http:// www.nccmt.ca/registry/view/eng/171.html. 20. Bains, N., Dall, K., Hay, C., Pacey, M., Sarkella, J., & Ward, M. (2004). Population Health Profile: South West LHIN. Health System Intelligence project. Retrieved from http://www.health. gov.on.ca/transformation/providers/information/resources/pro files/profile_southwest.pdf.
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