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Southlake Regional Health Centre takes leading role in developing specialized healthcare program for complex patients
Hospital named as one of 19 early-adopters to launch the first Health Links

For Immediate Release

Newmarket, Ontario – January 15, 2013: Southlake Regional Health Centre has been selected to develop a plan to link health care services for patients with complex medical conditions in South Simcoe and Northern York Region. Announced recently by the Ontario Ministry of Health and Long-Term Care, Health Links is a program that will bring health care providers together to work as a team to improve care and reduce hospital stays for seniors and others with complex conditions.

In order to roll this program out province-wide, the Ministry is working to identify Program Coordinators within each region to tailor Health Links to the specific needs of that region. For its initial launch, 19 regions have been identified with program coordinators assigned to each. Southlake is one of two early adopters coordinating partners for Health Links in the Central Local Health Integration Network (LHIN) and will take the lead, working to build collaboration between family care providers, specialists, long-term care, home care and other community supports for South Simcoe and Northern York Region.

“The directive behind this strategy is to find better, more innovative ways to provide healthcare solutions to complex patients,” says Gary Ryan, hospital Chief Operating Officer. “Plus, since no two areas within Ontario have exactly the same needs, rather than create a one-size-fits-all program, the Ministry has instead elected to make sure they have a common program with local, and even individual flexibility.”

Currently in the discovery and planning phase, Southlake, along with its partners which include Central Community Care Access Centre (CCAC), Stevenson Memorial Hospital and a number of primary care and physician specialists in the area, will be developing a Health Link that caters to distinct differentiators in its region. “Our region has a growing population, particularly amongst seniors” says Ryan. “We must plan so that our resources address existing demand and can stretch to meet greater demand in the future.” The region is also an interesting mix of urban and rural populations. “While a portion of our population is within an easy commute to first-class health services, others must travel long distances,” Ryan adds.

The primary goal of Health Links is to bring local health care providers together as a team to create individualized plans for those most in need. By improving coordination and information sharing, family doctors will have access to their patients’ entire health records and be able to connect patients more quickly with services they need including specialists, home care and other community supports. As a result, these patients will spend less time waiting for services and ultimately lessen health concerns that send them to hospital.

One of the major drivers for Health Links is the value of information-sharing amongst all partners who serve individual patients so that everyone has access to the same information. “As a general public, many people think this already exists; that with the click of a computer mouse, healthcare records are available to those who need them,” says Ryan. “The truth is, we are not there yet, and for people with complex medical issues, many of whom do not have the ability to comprehend or accurately share their own medical situation, a complete medical picture is key to the best outcomes.”

To begin this process, Southlake and its partners, will identify those people who would significantly benefit from individualized care by identifying patients who have spent the longest periods of time in hospital and have required multiple admissions. Then, an analysis of what they were admitted for and why they spent so much time in hospital will lead to prevention planning. “Hospitals are designed to do a tremendous job at short stays,” says Ryan. “But when people must remain in hospitals for long periods of time, it is rarely the best solution for them.” For these multiple and long-stay patients, the Southlake Health Links team will study what conditions caused them to be there, then work together, alongside the patient and perhaps their family, to co-design a solution to eliminate the issue altogether, or establish alternatives to hospital stays.

“As an example, we may find we have a patient who has had multiple admissions, spending countless nights in Southlake, and when we look deeper into her story, find that there are gaps in her ongoing care because she has no family physician to oversee her healthcare,” says Ryan. “Consequently, each time she becomes overwhelmed by a medical condition, she visits emergency. Working together with the patient and our partners, we will co-design a solution that will not only secure a family physician, but also look at the bigger picture to see how we can provide better, individualized healthcare, possibly in ways that are completely different than the options available today.”

Other examples of Health Links initiatives that could be developed include:
  • Reduced time from a primary care referral to specialist consultation for complex patients.
  • Reduced time from referral to first home care visit.
  • Reduced alternate level of care (ALC) days in hospital.
  • An enhanced experience with the health care system for patients with the greatest health care needs.

“Whatever the solution, Health Links will allow us to cut through some of the red tape to provide an individualized care plan that will produce the best outcomes,” adds Ryan.

It is expected that identified patients in the South Simcoe and Northern York Region will begin hearing from the Health Link team as early as March or April, 2013. For more information on the Health Links program, visit the Ontario Ministry of Health and Long-Term Care website at www.health.gov.on.ca.


For more information, please contact:
Judy Murdoch
Media and Government Relations Specialist
Southlake Regional Health Centre
(t) 905-895-4521, ext. 6068
(e) jmurdoch@southlakeregional.org

Southlake Regional Health Centre
596 Davis Drive, Newmarket, Ontario   L3Y 2P9
Tel: 905-895-4521   |   TTY: 905-952-3062
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