SPOR Network in Primary and Integrated Health Care Innovations: General questions

Questions

  1. Was this Network intended to be for Community-Based Primary Health Care (CBPHC)?
  2. As only one network per jurisdiction will be funded, what mechanisms will be incorporated to allow interested researchers to participate or join the funded member network?
  3. How do we connect with the SUPPORT Units? Is there a resource to learn more about the SUPPORT Units that have been funded or will be funded?
  4. The objectives include the requirements on upstream prevention. Do you anticipate the integration of downstream as well?
  5. What is meant by complex needs?
  6. What is meant by geographic scope?
  7. How do you expect the linkages with the CBPHC teams to look?
  8. Are specialists encouraged to participate?
  9. Does the Network focus on any particular disease or condition?
  10. Can you give us some idea of the financial scale of the opportunity for the final network application (after the development phase is completed). That is, what is likely going to be the infrastructure financial scale for the final member networks? Would each network have a funding pool from which it negotiates involvement in different projects across jurisdictions?
  11. Do you expect that there will be dedicated funding for all jurisdictions at the full network stage?
  12. I’m a clinical leader. Assuming I have an idea or have decided to make a system change, how hard will it be to link up with researchers, get matching funds, take it to another province, get SPOR money, etc. Will this help or hinder?

Answers

1. Was this Network intended to be for Community-Based Primary Health Care (CBPHC)?

Following extensive consultations and the advice of the SPOR National Steering Committee, the initial concept of a network focused on primary health care has evolved to encompass primary and integrated services across and beyond sectors of health care, while building on foundations in CBPHC research and service delivery models.

2. As only one network per jurisdiction will be funded, what mechanisms will be incorporated to allow interested researchers to participate or join the funded member network?

Provincial health research funding organizations have agreed to play a point of contact role to help connect interested researchers, decision makers and health professionals with the member network being established in their respective province. Please note that these contacts are not the member network leads; rather, they are playing a linking role by serving as a point of contact. The contacts identified at this stage include:

*For all TBC, please contact Lisa Lemieux (613-948-2398)

3. How do we connect with the SUPPORT Units? Is there a resource to learn more about the SUPPORT Units that have been funded or will be funded?

A complete list of SUPPORT Unit contacts can be found at SPOR SUPPORT Units.

4. The objectives include the requirements on upstream prevention. Do you anticipate the integration of downstream as well?

The pan-Canadian Network will focus on multi-sector integration of upstream prevention strategies and care delivery models that optimize clinical and health outcomes across the life course. It addresses transitions across the prevention and care continuum and places emphasis on models of care that facilitate horizontal and vertical integration within and across sectors of health care (e.g., public health, primary care, secondary care, tertiary care, home and long-term care) and outside of the health. A combination of both downstream and upstream approaches is therefore needed to address this scope.

5. What is meant by complex needs?

Individuals with complex needs are often identified in the literature as a medically and socially vulnerable population sub-group and typically account for a significant amount of health services use and costs. Individuals with complex needs across the life course are a relatively small subgroup of the population responsible for a significant amount of health services use and costs.Footnote 1 For example, in Ontario in 2007, 5% of the population was responsible for 66% of health care expenditure.Footnote 2 Their heavy use of health care services is attributable to a number of complex and interdependent health and system-level factors, including inadequate access to primary and preventive care, suboptimal (or entirely absent) social services, and fragmented service deliveryFootnote 3 as well as individual, social and structural determinants of health that lead to or reinforce conditions of vulnerability (e.g., stigmatization, frailty for the elderly). Individuals with complex care needs are identified in the literature as a medically and socially vulnerable population including, but not limited to, older adults with multiple chronic conditions, the frail elderly, those with mental illness, individuals with complex multimorbidity, low socio-economic status, low self-reported health status, minorities, children and youth with complex care needs, those lacking family or social support, and others.Footnote 3Footnote 4Footnote 5 This subgroup of the population often use the emergency department (ED) for care that could be prevented or treated in a community setting, and are more likely to cycle in and out of hospitals and ED’s and experience gaps in transitions of care. Providing care for individuals with high and complex care needs on an emergency basis is sub-optimal and contributes to fragmented care, inappropriate utilization, high health care costs, and poor health and health equity outcomes. A critical element of successful redesign of care delivery models for this subgroup of the population is the ability to understand the multifaceted and interdependent health, social and system factors that underpin complex care needs and high utilization and to develop corresponding upstream intervention strategies focused on prevention. Experiments such as Medical Homes and Accountable Care Organizations in the United States are examples of efforts to redesign the system and care pathways to support the most effective prevention and management of complex, high needs patients.

6. What is meant by geographic scope?

For the purpose of this Network, geographic scope is the extent to which Canadians, community-based practices and their patients/priority populations are directly involved. For example, in the United Kingdom, 80% of practices are members of the primary care research Network. So as new findings emerge about the effectiveness of, for example, new biomarker screening tests for cancer or case managers for chronic disease, all practices that are engaged in producing new knowledge become invested in applying these findings to practice. If this approach is coupled with policy and clinical leadership, then the implementation strategies needed for systems change can be optimized for more rapid scale-up and uptake of successful interventions as well as broad scale disinvestment in ineffective strategies. For more information, please see the Membership Requirements page – requirement number 8 and Appendix 1.

7. How do you expect the linkages with the CBPHC teams to look?

CIHR’s Signature Initiative on Community-Based Primary Health Care (CBPHC) recently funded 12 Innovation Teams across the country. These teams are a key asset in Canada’s CBPHC landscape and, given their cross-jurisdictional mandate (including international in three cases), most member networks will have representatives of these teams within their jurisdiction. To build on synergies, and to incorporate advances in models of CBPHC and methodologies for cross-jurisdictional and international comparisons that the teams will pioneer, each member network will be expected to develop linkages with individuals involved in the CBPHC Innovation Teams. For more information, please see the Membership Requirements page – requirement number 9.

8. Are specialists encouraged to participate?

Yes. In line with the overall scope, the Network is designed to engage specialists from a range of disciplines from across the care continuum to address the stated priority focus of the Network (see Funding Opportunity for details).

9. Does the Network focus on any particular disease or condition?

No, it is not meant to focus on any specific disease or condition but more broadly on new approaches to the delivery of integrated health care (including primary prevention and primary health care) both horizontally and vertically across the care continuum to address:

  • individuals with complex needs across the life course, showing capacity to evolve the network's scope over time to include age groups from children to older adults; and,
  • multi-sector integration of upstream prevention strategies and care delivery models.

10. Can you give us some idea of the financial scale of the opportunity for the final network application (after the development phase is completed). That is, what is likely going to be the infrastructure financial scale for the final member networks? Would each network have a funding pool from which it negotiates involvement in different projects across jurisdictions?

Above and beyond the Network Development Funds, CIHR has $12.5M available for the Network and this will be matched 1:1 by partners for a total five-year investment of $25M. Of this $25M, a portion will be available to each member network and the Network Coordinating Centre for operating funds once they are approved as members into the pan-Canadian SPOR Network after the Phase II application. The balance of the $25M will then be available for the Network’s cross-jurisdictional research and research priorities (this will be the majority of these funds).

Member networks that are interested in a particular Network research priority will collaborate on developing a cross-jurisdictional comparative protocol.

11. Do you expect that there will be dedicated funding for all jurisdictions at the full network stage?

Yes, once approved as a member network, each will receive an annual operations award to help support and maintain its core operations. In keeping with the funding principles of SPOR, this funding must be matched 1:1.

12. I’m a clinical leader. Assuming I have an idea or have decided to make a system change, how hard will it be to link up with researchers, get matching funds, take it to another province, get SPOR money, etc. Will this help or hinder?

It is hoped that the network concept/model will provide a mechanism to help overcome this very issue. The tripartite leadership will automatically connect researchers, clinicians, and policy leaders. The requirement for engagement of key stakeholders across the care continuum will provide ready access to a network of researchers. The leadership council will provide a mechanism of linking the member networks with each other to identify shared cross-jurisdictional priorities. The jurisdictional networks will be an important asset/infrastructure to leverage for other opportunities – including applying for programmatic or project grants on challenges that are specifically local (and therefore ineligible for the Network's research).

Footnotes

Footnote 1

Malone RE. (1995). Heavy users of emergency services: social construction of a policy problem. Social Science & Medicine, 40(4): 469-77

1

Footnote 2

Wodchis et al, ICES, 2012 CAHSPR Conference

2

Footnote 3

Malone RE. (1995).

3

Footnote 4

LaCalle E. Rabin E. (2010). Frequent Users of Emergency Departments: The Myths, the Data, and the Policy Implications. Annals of Emergency Medicine, 56(1): 42-8

4

Footnote 5

Khan Y. Glazier RH. Rahim M. Schull MJ. (2011). A Population-based Study of the Association between Socioeconomic Status and Emergency Department Utilization in Ontario, Canada. Academic Emergency Medicine, 18(8)

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