Community-based Primary Health Care (CBPHC) 12 Innovation Teams
Summary of innovative models, scale-up, knowledge translation products and more (from 2013 to 2019)

Background

The 12 CBPHC Innovation teams were designed to develop and evaluate innovative models for community-based primary health care (CBPHC) that improve the prevention and management of chronic diseases and/or reduce inequities in access to CBPHC and health outcomes in vulnerable populations (see funding opportunity). The program objectives of the teams were five-fold: 1) develop, compare and/or spread innovative models of CBPHC; 2) scale-up successful models; 3) build capacity in CBPHC; 4) evaluate common set of outcome indicators; and 5) improve competitiveness.

The teams were composed of interdisciplinary, interprofessional and cross-jurisdictional researchers, clinicians, decision makers and patients/citizens (Figure 1). The 12 teams focused on intersecting and complementary CBPHC issues, including addressing general primary care transformation challenges (5 teams), managing specific conditions within the context of primary care (4 teams), and primary care transformation within Indigenous communities (3 teams). The research impact of the teams was self-evaluated in March 2019 with respect to the above-mentioned program objectives to date, and the findings are summarized below.

Figure 1 – The 12 team NPIs were localized across 11 Canadian provinces, but collaborated and partnered with stakeholders (researchers, clinicians, citizens, decision-makers) in their own province and across other jurisdictions.

Long description

Researcher	Province	Brief description
Audas/Godwin	Newfoundland	Accessing child/youth mental health services
Grunfeld	Ontario	Community based cancer care along the continuum
Harris	Ontario	Transforming Indigenous PHC delivery
Kaczorowski	Québec	Chronic disease awareness and management
Katz	Manitoba	Transforming PHC in First Nations & rural/remote communities
Haggerty	Québec	Organisational innovations to improve access to PHC for vulnerable groups
Liddy	Ontario	PHC for persons living with HIV/AIDs
Ploeg	Ontario	Community based approaches for older adults and their caregivers
Stewart	Ontario	Person centered innovations for persons with multimorbidity
Wodchis	Ontario	Improving PHC for older adults with complex needs
Wong	British Colombia	Performance measurement & reporting
Young	Alberta	Transforming PHC in the remote North

Innovative models

The 12 teams developed, compared and/or scaled-up novel and existing models of CBPHC across 11 Canadian jurisdictions and 6 other countries, including Australia and New Zealand which were co-funders of the program. Across Canada, the most studied jurisdictions were Ontario (studied by 9 teams), followed by Quebec (6 teams), Manitoba (5 teams), Alberta (4), British Columbia (4), Newfoundland and Labrador (4), Nova Scotia (4), New Brunswick (3), Northwest Territories (1), Nunavut (1), and Prince Edward Island (1).

Scale-up

The teams self-identified the top novel innovation or policy that stemmed from their research which they deemed most important for scale-up. The top innovation arising from each team, as defined by them, is listed below, with a link to the teams’ webpages and/or innovative model:

General CBPHC

• IMPACT – Generalist navigation services
• ACHRU – Community Partnership Program for Diabetes Self-Management
• PACE in MM – Integrated chronic disease prevention & management in multi-morbidity
• iCOACH – Policy to enable interdisciplinary team-based care for integrated CBPHC
• TRANSFORMATION – Patient surveys to routinely integrate patient experiences for quality improvement

Specific conditions

• Access-MH – Patient journey project to gather individual experiences in mental health
• CanIMPACT – eOncoNote: online communication tool to integrate oncology and primary care
• C-ChAMP – Scale-up previously successful CHAP (Cardiovascular Health Awareness Program)
• LHIV – Multiple phases to integrate primary care into HIV specialty care (e.g. eConsult)

Indigenous settings

• FORGE AHEAD – Community-level quality improvement initiative
• iPHIT – First-Nations focused wholistic model of CBPHC inclusive of mental health
• CircHSIT – Research evidence and transformation of Arctic emergency aid services

Additional noteworthy models developed by the teams include (non-exhaustive list):

• CBPHC Scalability Assessment: Ben Charif et al, 2018 cross-sectional study
• IT solutions, such as websites, web portals, online consult service to access cancer care.
• Knowledge Translation tool and products, including synthesis maps, casebook [ PDF (780 KB) - external link ], resource toolkit [ PDF (2.77 MB) - external link ], map of mental health services; and practice guide series [ PDF (5.8 MB) - external link ]
• Performance Measurement Model, such as the one developed by TRANSFORMATION (right click to download).
• Others, including health brokers, health service pop-up events, community programs and partnerships, conceptual frameworks, patient journey approaches, and environmental scans

Further, the teams identified conditions and strategies that led to successful scaling-up of their innovative models, as well as barriers and facilitators, as summarized in the table below.

Training, Capacity-building and Stakeholder engagement

The teams helped to train the next generation of trainees and engaged in their capacity-building activities students (total of 311), postdoctoral fellows (total of 95), clinicians, community partners/patients (40) and early-career researchers with skills in CBPHC researchacross Canada and internationally. Several capacity-building and training activities were held across all teams, including 186 courses, lectures or seminars; 155 workshops; 115 thesis supervisions; and other activities, such as international partnerships (e.g., Vilans in the Netherlands), summer schools, knowledge exchange events, training of volunteer navigators, clinical “bootcamps”, webinars, forums and presentations. In certain instances, trainees who began with the CBPHC Teams as post-doctoral fellows, then secured scientist positions, leading successful grant-funded programs, whilst continuing to collaborate with the Teams.

In addition to their respective within-team capacity building activities, the 12 teams engaged in cross-team capacity building efforts including the TUTOR-PHC program, a trainee-led working group, and more. The cross-team capacity-building strategy is reported in Nicholson et al, 2020. Trainees from the ACHRU team also produced a video on their training experiences. Further, to address CBPHC priorities relevant to different populations and contexts, the teams applied a multi-stakeholder lens and further engaged decision-makers, policy-makers, patients, citizens, caregivers and community members, in their research program.

Common indicators project

The teams collaborated to identify and measure the impact and value of their innovations on health system outcomes, using common indicators for six domains: access, comprehensiveness, coordination, effectiveness, equity, and healthcare costs. Through this common effort, the teams report that new relationships across the teams were forged, including collaborations on publications between researchers and trainees (see Wong et al, 2019;  Ben Charif et al, 2018; Ploeg et al., 2019; Kendall et al., 2018), further enriching the training experience. The common indicators working group was co-led by Dr Sabrina Wong and Dr Jeannie Haggerty.

Competitiveness

Teams showcased outstanding competitiveness at the national and international level in the CBPHC field and beyond. By spring 2019, the 12 teams published peer-reviewed journal articles (over 200), technical reports (total of 52), policy briefs and guidelines for policy (56), and interviews with journalists (24) and articles in mass media (57). Further, in addition to the total CIHR investment of $33.4M for this program, the 12 teams secured funds from 105 additional sources amounting to a sizable total of $46.8M, originating from the public sector ($41.7M total), non-profit sector ($4.3M) and from industry ($0.8M).

Publications & Media attention

Funding leveraged

Forging connections with the Primary and Integrated Health Care Innovations (PIHCI) Network

Funded through CIHR’s Strategy for Patient-Oriented Research (SPOR), the PIHCI Network was created to foster new alliances between research, policy and practice to create dynamic learning networks to improve the delivery of integrated and cost-effective health care, including primary health care. Important synergies were forged between the PICHIN and the CBPHC teams. Seven of the CBPHC teams shared leadership roles, memberships, objectives and activities with the PIHCI Networks, four teams were awarded SPOR-PIHCI grant funding, and one team played a key role in the development of a PIHCIN in the Northwest Territories.  

CBPHC Teams' Advice for other research teams, funding agencies and partners

• Stakeholder engagement: Involve patients, decision makers and health system partners in priority setting, early and throughout the entire project.
• Plan time and budget accordingly to enable relationship-building and maintenance of these relationships throughout the project.
• Long funding timeline was beneficial in the preparation of the teams and the programs.
• From program inception, consider scalability, local context, and a knowledge translation (KT) strategy (include a KT expert and broker, if possible)
• Cross-jurisdictional research: Plan time to access data from organizations and government agencies; and to obtain research ethics and institutional approvals across sites

Conclusion

The CBPHC teams made important and valuable contributions to the science and practice of CBPHC, training the next generation of CBPHC scientists, and fostered new collaborations between research, policy and practice in CBPHC. Many of their innovative ideas have been scaled-up and spread to multiple jurisdictions, strengthening the performance of CBPHC systems and improving the health of Canadians and communities.

Publications & Knowledge Translation products

Please see below a non-exhaustive list of selected publications, knowledge translation (KT) products and social media websites stemming from the 12 CBPHC Teams’:

Date modified:

2022-06-15