7. Clinical innovations keeping people at home and out of the hospital
Presentation Materials (members only)
Learning Objectives
At the end of the session, participants will be able to:
- Describe the health care needs and barriers of medically complex patients (MCP) being addressed by the MedREACH project
- Describe the different components of the MedREACH project and how they work together to support the medically complex patient
- Describe the preliminary results of the MedREACH project.
Summary
The MedREACH pilot project (Medical Rapid Education and Assessment for Complete Health) is a demonstration pilot funded jointly by the Ministry of Health and Long-Term Care and the Ontario Medical Association. The goal of MedREACH is to improve the overall health of the medically complex patient (MCP) by seeking to re-forge the therapeutic relationship between the MCP and their family physician and interprofessional team. MedREACH consists of three distinct yet coordinated health care delivery models:
- Primary MedREACH involving clinical nursing outreach to MCPs;
- Specialist MedREACH involving integrated health care delivery by specialists and allied health professionals at McMaster University Medical Centre; and
- Mobile MedREACH involving facilitated interaction between specialists and primary care providers enabling direct and timely consultation for patients with barriers to health care access in their family practice setting or home environment.
The MedREACH project aims to address current gaps in the following areas:
- Medical service provision for MCPs in the primary care and tertiary care setting in order to ensure more timely and coordinated care
- Existing silos of operation in primary and specialty care by building bridges for communication and partnership between primary care and specialty care.
This session will familiarize participants to the MedREACH project framework, how each component of the project was operationalized, and the program evaluation strategy with preliminary results.
Presenters
- Henry Siu, Physician, MedREACH Evaluation Lead, McMaster FHT; McMaster University, Department of Family Medicine
- Laurel Cooke, BES, BScN, RN, Nursing Program Manager, Hamilton FHT
Authors and Contributors
- Hamilton FHT:
- Laurie Panagio
- Janelle Kolenich, RN
- Nicole Steward, MedREACH Project Manager, RN