FORGE AHEAD: Community-driven Innovations and Scale-up Toolkits Steering Committee Meeting June 10, 2013 Toronto, Ontario

Funding Acknowledgement This Transformation of Indigenous Primary Healthcare Delivery (FORGE AHEAD) program is supported by the Canadian Institutes of Health Research (www.cihr-irsc.gc.ca).

Forms and Contact Information Verification Please take a moment to review the following documents that can be found in your folder: Release Form for Group Picture Affiliation/Role and Contact information Verification Forms for expense re-imbursements

Presentation Outline Background & Rationale The CIHR CBPHC Initiative Governance & Team Structure Program Logo Program Objectives & Research Projects Goals of Today’s Meeting

Background & Rationale

Diabetes in Indigenous Peoples Indigenous peoples in Canada experienceT2DM prevalence rates that are 2 - 5 times higher than the general population First Nations communities experience significant care gaps and are affected with a much higher T2DM burden in a relatively younger population Studies have also reported higher rates of complications and comorbidities Chronic kidney disease, coronary artery disease, neuropathy and retinopathy Mortality rate due to T2DM is 19.5/100,000 compared to 13.3/100,000 for the general population

Healthcare Delivery Primary healthcare delivery system for First Nations communities is dominated by acute and episodic care management rather than chronic disease care Poor coordination between provincially funded hospitals/specialty care and federal nursing care in most First Nations communities Currently models of service vary by province and degree of isolation of community and ranges from nursing stations supported by itinerant physicians to fully staffed community hospitals

Factors Influencing Health Higher rates of adverse health outcomes in Indigenous peoples can be attributed of a number of factors and barriers including: Social determinants of health (lack of education, higher unemployment rates, poor living conditions) Lifestyle (diet and physical activity) Genetic susceptibility Historical, political and psycho-social factors Fragmented healthcare (includes high healthcare staff turnover) Poor chronic disease management and limited or non-existent surveillance

Transformative Community-based Primary Healthcare (CBPHC) Initiative

CIHR’s CBPHC Initiative Three main components: Innovation Teams – interdisciplinary team to support and foster innovative approaches to chronic disease prevention & management, and improvement of care for vulnerable populations Health Care Professional Scientists – cultivate & support clinical leadership with a vision for innovative change, collaborative skills to facilitate implementation and the research capacity to develop a programmatic approach to progressive scientific investigation Patient-Oriented CBPHC Network – to address the challenges of scale-up…the network will need to act as a coordinating and dissemination hub for innovative care models and their outcomes and establish priorities

CIHR’s CBPHC Initiative Deliverables: Incorporate the three components (innovative teams, health care professional scientists, patient- oriented CBPHC network) Substantial impact on the advancement of knowledge, capacity for CBPHC research and on the health of the population and on social and economic benefits for Canada Develop innovative models of CBPHC that will improve health outcomes Advance knowledge and increase capacity through scale-up of innovative models

Governance & Team Structure

Team Structure Steering Committee Will meet annually to overview program, review progress, provide recommendations and expert advise for continued progress, and promote public & team relations Funds in year 1, 3 and 5 allow for face-to-face meetings

Team Structure Operational Sub-Committee Will meet monthly to provide high level oversight, address and devise solutions to key problems and implementation questions via teleconference

Team Structure Working Groups Five working groups to reflect the core components of FORGE AHEAD (PRA, KT & Policy, Methods & Analysis, Readiness, Mentoring & Training) Working groups will be responsible for tool development, address challenges as they are encountered, lead on methods, encourage meaningful engagement with all team members

Team Structure Community Advisory Boards Once communities are recruited, a community advisory board (CAB) will be developed in each community CAB membership will be determined by each community but should include representation from various levels in the community (Band leadership, health leadership, an Elder, a youth etc) CABs will advise and ensure cultural relevance

Investigators/Collaborators Communities

Program Logo

FORGE AHEAD LOGO Four logos have been developed for your input and selection The goal was to develop a simple logo that could be used on all templates (websites, brochures, business card etc)  no image Concept was to incorporate: International blue diabetes ring Aboriginal medicine wheel colours Program name

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Program Objectives & Research Projects

Objectives & Research Projects Developing and Conducting a Survey of Indigenous Primary Healthcare Capacity and Delivery Models Determining Existing Best Practices Designed by and for Indigenous Communities and relevant Healthcare Policies Year 1 1. Assess the current healthcare delivery and funding models used in Indigenous communities in Canada Community Change Readiness Consultations Clinical Change Readiness Tool Development and Validation Clinical Change Readiness Consultations Years 2 - 4 2. Assess community and clinical readiness to address and change chronic disease care.

Objectives & Research Projects Integrate Diabetes Prevention and Management: Community-driven Activities Years 2-4 3. Enhance patient access to available community resources for chronic disease care Years 2-5 4. Implement and evaluate community and clinic quality improvement initiatives to improve chronic disease management Development of a Community Diabetes Registry Implementation and Integration of a Diabetes Surveillance System Transformation of Indigenous Primary Healthcare Delivery Quality Improvement Intervention Cost Analysis of Chronic Disease Healthcare Transformation Clinical Change Readiness Consultations

Objectives & Research Projects Create scale-up tool-kits Analyze and disseminate program-end results Recommend policy changes Year 5 5. Develop and implement knowledge translation strategies for sustainment and scale-up

Goals of Today’s Meeting

Morning Break-Out Sessions KT & Policy Working Group Draft survey for Project #1 and discuss distribution through the FNIHB regional offices Readiness Working Group Adapt community readiness tool to T2DM Discuss clinical readiness tool development Methods & Analysis Working Group Determine data to be collected for the economic analysis Identify leveraging/spin offs for summer & fall 2013

Afternoon Break-Out Sessions KT & Policy Working Group Draft survey for Project #1 and discuss distribution through the FNIHB regional offices Participatory Working Group Determine inclusion/exclusion criteria for community recruitment Finalize the CRA and determine recruitment timeline Mentoring & Training Working Group Finalize student selection criteria, process and review students End of June deadline for submission of CVs Determine training needs and methods