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

2. Funding Acknowledgement
This Transformation of Indigenous Primary Healthcare Delivery (FORGE AHEAD) program is supported by the Canadian Institutes of Health Research (

3. 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

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

5. Background & Rationale

6. Diabetes in Indigenous Peoples
Indigenous peoples in Canada experienceT2DM prevalence rates that are 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 /100,000 for the general population

7. 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

8. 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

9. Transformative Community-based Primary Healthcare (CBPHC) Initiative

10. 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

11. 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

12. Governance & Team Structure

14. 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

15. 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

16. 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

17. 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

18. Investigators/Collaborators
Communities

19. Program Logo

20. 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

21. 1 2 4 3

22. Program Objectives & Research Projects

23. 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.

24. 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

25. 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

26. Goals of Today’s Meeting

27. 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

28. 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