Seamless Care Between Community and Acute Care

This theme is aligned with the Ministry of Health’s vision for an integrated system of care to meet the needs of patients and providers.

It also supports the vision for the new St. Paul's, where integration of programs and services will enable smoother transitions for patients at home, in the community, in the new hospital or elsewhere on the new campus, allowing them to receive the right care at the right time and in the right place. This integrated model will help healthy people stay healthy, while providing high-quality critical care when they are very sick.

Examples/features of seamless care:

  • Care that used to be provided in hospitals is provided in the community (e.g., low intensity, high volume surgical procedures).
  • Primary Care Networks operating 24/7 and providing most of the care needed by the entire population in their catchment area, including urgent care, lab and diagnostic imaging.
    • These networks also provide rapid access to specialists (and vice versa) because of shared Electronic Health Records (EHR), virtual care, and other digital platforms.
  • Hospital clinical programs will redesign their inpatient care models, shifting to inter-disciplinary team-based care for the “whole person” (especially managing mental and physical health together).

The Ask

Given this context, help us answer the following:

  • Over the next 7 years, what are the goals you want to see accomplished in our pursuit of an integrated system of care to meet the needs of patients and providers?
  • What are some "quick wins" that we should be pursuing in this area?

Share your ideas below!

This theme is aligned with the Ministry of Health’s vision for an integrated system of care to meet the needs of patients and providers.

It also supports the vision for the new St. Paul's, where integration of programs and services will enable smoother transitions for patients at home, in the community, in the new hospital or elsewhere on the new campus, allowing them to receive the right care at the right time and in the right place. This integrated model will help healthy people stay healthy, while providing high-quality critical care when they are very sick.

Examples/features of seamless care:

  • Care that used to be provided in hospitals is provided in the community (e.g., low intensity, high volume surgical procedures).
  • Primary Care Networks operating 24/7 and providing most of the care needed by the entire population in their catchment area, including urgent care, lab and diagnostic imaging.
    • These networks also provide rapid access to specialists (and vice versa) because of shared Electronic Health Records (EHR), virtual care, and other digital platforms.
  • Hospital clinical programs will redesign their inpatient care models, shifting to inter-disciplinary team-based care for the “whole person” (especially managing mental and physical health together).

The Ask

Given this context, help us answer the following:

  • Over the next 7 years, what are the goals you want to see accomplished in our pursuit of an integrated system of care to meet the needs of patients and providers?
  • What are some "quick wins" that we should be pursuing in this area?

Share your ideas below!