1. IMPACT PLUS Co-Principal Investigators Dr. Ross Upshur Sunnybrook Academic Family Health Team Sunnybrook Health Sciences Centre Dr. Howard Abrams University Health Network Taddle Creek Family Health Team Co-Investigators Dr. Jocelyn Charles, Dr. Leslie Nickell, & Shawn Tracy (Sunnybrook Family Health Team) Dr. Pauline Pariser (Taddle Creek Family Health Team) Dr. Nasreen Ramji & Dr. Sheila Lakhoo (St. Michael’s Hospital Family Health Team) Dr. Thuynga Pham (Southeast Toronto Family Health Team) Collaborating Agencies Toronto Central Community Care Access Centre SPRINT (Senior Peoples’ Resources in North Toronto) Regional Geriatric Program of Toronto (Sunnybrook) Research Team Jason Nie, Li Wang, Dr. Jana Bajcar and all the clinical team members at the 4 participating Family Health Teams

2. IMPACT PLUS: a comprehensive model of Assessment Care Planning Mentorship and training ▪ Interprofessional problem solving model ▪ Includes PCPs, CCAC worker, pharmacist, RNs, NPs, social workers, physiotherapist, OT, dieticians, trainees PLUS ▪ Psychiatrist & General Internist

3. Patient and Family Family Physician Resident Physician Pharmacist DietitianPTOTInternist Psychiatris t Social Worker Nurse Homecare Coordinator IMPACT PLUS

4.  Can address confluence of complex chronic illness with psychiatric co-morbidities and social determinants in real time  Introduces theories and concepts of illness behavior  Supports group process of team

5. Relevance of General Internist “One Stop Shopping” : Simplifies treatment for multiple conditions “Appropriate Use”. Able to say no. Gives permission to PCPs Transfer of knowledge and modeling of clinical approach to other health professionals and trainees Occasionally makes a brilliant diagnosis just like Dr. House.

7. The IMPACT protocol Patient Selection & Invitation Team Deliberation Document. & Debrief Group Discussion 1 Patient Welcome & Initial Patient Interview Group Discussion 2 HCP Assessments Care Plan and Next Steps

8. RESULTS

9. Marital Status (%) Married30.8% Single48.7% Widowed20.5% Sex (%) Male39.7% Female60.3% Age, mean (SD)78.94(13.5) Number of medications, mean (SD)12.60(5.11) Number of chronic conditions, mean (SD) 9.17(3.09) Complexity Score, mean (SD)21.77(7.17)

11. “I didn’t notice the time go by and I was happy to be interviewed by so many people, yeah, and listening to their suggestions and all that, which was great. I mean, you all talk among yourselves, suggest what is best for the patient and I think that is really great, you can’t beat that at all.” ~Patient “It was like togetherness… I was very much involved in that and I liked it. I felt so much better on the way home. I don’t know why – my heart was lifted and after being so depressed for such a long time, you know, I felt I could laugh again.” ~Patient

12. “… it’s brilliant and it’s functional and it’s beneficial and it provides security, emotional security and support for not only the patient, but the family.”

13. “IMPACT is the first time that I really felt like I was involved in interprofessional care It’s my first time that I really felt like a valuable team player and I really felt like I’ve gotten to understand the patient’s condition from more than a nutrition standpoint. To really understand more of what the patient is going through as a whole person.” - Dietitian

14. “What I feel truly sets this clinic apart is the ability to directly observe professionals from other health disciplines as they interact with the patient. It gives you insight into the role of other disciplines that you simply cannot get any other way and and makes the clinic discussion much more dynamic.” - PGY3 Internal Medicine

15. Patients :  feel cared for and heard, given time to actually surface what is important  Co-develop care plans that focus on what is achievable given very diverse and complicated treatment burdens Family caregivers:  feel supported  able to give voice to their stress  feel empowered to continue to deal with difficult and complex situations

16. Health Care Providers:  experience true inter-professional learning,  Are able to crowd-source solutions to complex problems  Reduce stress/burnout through group support and validation that creates a “way forward” with complex patients  increase their willingness to care for a challenging patient population  Find patients are easier to manage in subsequent primary care visits

17. It’s do-able! It’s presentable: From Local to International Everybody likes it It disseminates: Now in 4 LHIN’s It’s adaptable: TIP (Telehealth IMPACT Plus)

18.  Funding model; works for FHTs  PCP “Chagrin Factor”  Team skills  Extending to solo HCPs  Type III Error ( error): “Necessary but not sufficient”

19.  The IMPACT+ team gratefully acknowledges:  Our patients and their families  Our colleagues  Our funding partners