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Integrated Care

Integrated care improves patient care by focusing on transitions into and out of the healthcare system, and coordination of care. 

Integrated care is a coordinated approach to care that brings together providers from different specialties, including primary and community care, to collaborate on a person’s care for as long as it is needed. Each member of the team understands his or her role and the roles of the other team members.

The Integrated Care Approach

  • Person-Centred – Care is designed with the patient and family to achieve best outcomes.
  • Collaborative – Inter-professional teams work together to provide personalized care with each patient.
  • Continuous – Providers plan and navigate with the patient and family over time to address their changing needs.

Goals

  • Continually improve patient outcomes and experiences through partnerships
  • Implement integrated patient care for patients with complex needs

Key Initiatives

  • Implement integrated models for palliative care in cancer centres and primary care
  • Implement integrated models for palliative and end of life care for renal patients and families
  • Develop and implement a model for chemotherapy delivered in the home to ensure consistency in access and quality 
  • Develop an integrated care planning model and process targeting complex cancer patients

Publications

 

Year Title Authors Citation Category
2016 Cost trajectories for cancer patients Wodchis WP, Arthurs E, Khan AI, Gandhi S, MacKinnon M, Sussman J. Curr Oncol. 2016 Feb;23(Suppl 1):S64-75. doi: 10.3747/co.23.2995. Epub 2016 Feb 29. PubMed PMID: 26985150; PubMed Central PMCID: PMC4780583. Cancer
2016 A multi-method review of home-based chemotherapy Evans JM, Qiu M, MacKinnon M, Green E, Peterson K, Kaizer L. Eur J Cancer Care (Engl). 2016 Sep;25(5):883-902. doi: 10.1111/ecc.12408. Epub 2015 Nov 6. Review. PubMed PMID: 26545409. Cancer
2016 Integrating cancer care beyond the hospital and across the cancer pathway: a patient-centred approach Evans JM, Matheson G, Buchman S, MacKinnon M, Meertens E, Ross J, Johal H. Healthc Q. 2015;17 Spec No:28-32. PubMed PMID: 25562131. Cancer