Ontario Health Teams: Integrating Health Equity & Community

#Introduction

Integrated care has been seen as a remedy for traditionally siloed care. Integrated care  bridges acute care, primary care, and community and social services (Singer et al. 2001) to provide patient-centred, holistic, and cost-effective care to people with complex needs (WHO 2016). Collaborative or integrated health care delivery has proven to be effective for patients with complex medical needs (Ivbijaro et al. 2014; Mitchell et al. 2015) and is now seen as a necessary innovation to address the challenges associated with medical complexity. Delivering integrated care requires us to coordinate and streamline services across multiple organizations and sectors (Embuldeniya et al. 2021; Grone & Barbero-Garcia 2001). Several examples of integrated care exist worldwide. In Ontario, we are aiming to do this through Ontario Health Teams (OHTs).

Despite this trend and ongoing efforts to integrate care, integrated care initiatives across the globe are not achieving the goals intended. Other jurisdictions who are further along in this journey than Ontario have now begun to shift from integrated health system care towards integrated community-based care. These jurisdictions are seeing success in achieving their intended goals after changing their approach. Ontario’s decision-makers and participants in OHTs have an opportunity now to influence the design of OHTs to incorporate community-centered approaches. 

Extending the benefits of integrated care to the general population requires combining the scope of integrated care with a population health approach (Alderwick et al. 2015; Kaene et al. 2017; Huynh 2014). This approach to care considers a wide range of factors and interrelated conditions that influence the health of populations over the life course, identifies systematic variations in their patterns of occurrence, and applies the resulting knowledge to improve the health and well-being of those populations. This approach also commonly shifts the focus to prevention, multiple determinants of health, equity in health, intersectoral action and partnerships, and understanding needs and solutions through community outreach (Huynh, 2014). Despite each OHT having an attributable population based on geography and health care pathways, OHTs also have focused priorities on specific populations. At maturity, OHTs are expected to take a population health approach that includes health promotion, disease prevention and other primary and community supports for the full attributed population, since this is what will keep people healthy.

This document outlines the evidence and rationale for ensuring health equity and community involvement within OHTs. It also includes a Toolkit for Actions, which can help organizations to ensure the goals of OHTs are met. This is a living document; more case studies, tools, and resources will be added over time. For now, examples have been taken from around the world of strong integrated health care models.