Champlain LHIN – Health Links Update July 2016

Champlain LHIN – Health Links Update July 2016

Health Links – Update July 27, 2016

The following are highlights of the Champlain Local Health Integration Network (LHIN) Board of Directors meeting held in Ottawa, Ontario on July 27, 2016.

Since 2014, the Champlain LHIN has been working to establish and grow 10 Health Links across the region. An innovative model of care, Health Links aims to improve the health care experience for some of the nearly 27,000 people in our region with highly complex needs – those who have four or more chronic conditions (e.g., diabetes, lung health, cardiac, stroke), challenges with living conditions (e.g., income, housing, disability), use high-cost health services, and would benefit from better care coordination.

By the end of 2018-19, the goal is to for 10,000 of these patients to receive care from teams consisting of a family doctor or nurse practitioner and providers from other sectors, such as mental health and additions services, home care, community support services, and social services. Working together, the team engages with the patient and caregivers to coordinate and wrap services around the patient to meet his or her health goals.

Family physician Dr. Jonathon Fitzsimon spoke to the LHIN Board about his experience working within the Arnprior Region Ottawa West Health Link over the last two years. In one example, he described a patient who received medical attention from a member of her Health Links care team while she was at home. As a result, she got the timely care she needed, and avoided being admitted to hospital. “We’ve saved hospital resources, but most importantly, it’s such a better outcome for the patient,” Dr. Fitzsimon said.

In the short term, increasing the number of people cared for by Health Links must be accomplished by leveraging existing resources. A number of strategies are being used, including practicing change management, developing innovative approaches to coordinated care, primary care engagement, and developing electronic solutions for connectivity among Health Link partners.

Expanding Health Links supports the LHIN’s strategic direction of sustainability to increase the value of our health system for the people it serves.