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Ontario Medical Review
Dec. 23, 2020
Ryan Joyce
This article originally appeared in the November/December 2020 issue of the Ontario Medical Review magazine.

Spotlight on the Hills of Headwaters Collaborative OHT

Dr. Amy Catania discusses the OHT rising to the challenge during COVID-19

by Ryan Joyce 
OMA Member Relations, Advocacy & Communications 

The Hills of Headwaters Collaborative became an Ontario Health Team (OHT) candidate just three months before the COVID-19 pandemic began. However, the organizations involved in the OHT began collaborating years ago to improve and integrate local health services in the Dufferin and Caledon regions.  

“A primary goal of this OHT – or any OHT – is for local organizations to work together to break down barriers patients face by simplifying access to health services, easing transitions and ultimately improving patient outcomes,” said Dr. Amy Catania, chief of family medicine at Headwaters Health Care Centre and the OHT’s lead physician. “We are incredibly fortunate to provide care within this group of local health organizations that have been partnering for years, setting us up for early success in the OHT model.” 

Participating organizations in the OHT include Headwaters Health Care Centre, Dufferin Area Family Health Team (FHT), Wellington-Dufferin-Guelph Public Health, Caledon Community Services, Dufferin Child and Family Services, Bethell Hospice and the Canadian Mental Health Association of Peel Dufferin. Through long-standing partnership, these organizations already had mutually agreed-upon priorities for their community. These include improving integration of, and access to, mental health and addictions services, creating an integrated palliative care team and enhancing services and programs for individuals with complex health care needs who are currently seeing and receiving care from multiple providers.  

Improved patient experience 

So far, these collaborative efforts have led to an improved experience for patients and have reduced emergency department visits, the OHT’s primary success metric. Previously, patients experienced longer wait times, had to repeatedly share their medical history, made multiple visits to the ER, or simply fell through the cracks.  

Another major early success for the Hills of Headwaters OHT is becoming one of the first in Ontario to employ a community paramedicine model, which has been shown to divert unnecessary emergency department visits. The model involves expanding the profession’s scope of practice to include health interventions that do not traditionally involve paramedics. For example, paramedics now stock palliative care medications and in an emergency they can deliver them quickly to patients, who no longer need to wait for a pharmacist to fill a prescription.   

When the pandemic began, the new OHT was put to the test as it responded quickly to the evolving health needs of its community. “Many things have changed because of COVID-19, such as shifting our priority toward caring for acutely ill COVID patients,” said Dr. Catania. “But one thing that has not changed is our commitment to effectively respond to the needs of our community and engaging all physicians practising locally.”  

One of the key objectives of the OHT model is to ease transitions for patients when they are discharged from hospital and sent home, ensuring they have appropriate follow-up care if they need it. During the pandemic, the Hills of Headwaters OHT moved quickly to set up a virtual process between the local hospital and the Dufferin Area FHT. When hospitalized COVID-19 patients are stabilized and discharged – but require follow-up care – a respiratory therapist at the FHT remotely monitors these patients. Paramedics are also on board as first responders in a patient emergency.   

The expansion of digital tools is another way care delivery has been strengthened locally. Home and community care now has access to patients’ electronic medical records (EMRs), improving inter-organization communication and reducing patient wait times. If a patient in palliative care is declining, one health organization or provider can use an electronic communication modality in the EMR. Another organization or provider that has capacity to care for the patient will respond, significantly decreasing the amount of time it takes to make a care connection.  

The importance of physician engagement  

When asked about the factors contributing to early successes of the OHT model, Dr. Catania says it is all about relationships – among organizations, patients and solo physicians. “To have a truly integrated local health system that results in best possible patient outcomes, collaboration among all physicians is necessary, but first you need to engage them in a meaningful way,” offers Dr. Catania. The methods Dr. Catania has employed to increase physician engagement have directly contributed to the early success of the Hills of Headwaters OHT. A proactive survey revealed the priorities of local physicians are medical education and social networking. In response, the OHT began tailoring engagement opportunities to meet these priorities, which helped improve participation. 

When the pandemic began, the priorities for these physician engagement sessions pivoted toward providing local COVID-19 updates and provided accurate information about community resources available. This forum has been a game changer, through demonstrating value of the OHT model among physicians and increasing local physician engagement exponentially. This is helping further integrate care during the pandemic and will continue to do so in the future, as the OHT is in the process of creating a physician association and is committed to sustaining the gains it has made in physician engagement.  

In its OMAThoughts white paper, Early Learnings and Recommendations for the Evolution of Ontario Health Teams, the OMA recommends that physicians should form physician associations to support effective physician leadership on governing boards within OHTs. Physician associations lend credibility to physician participation in the broader OHT, as they offer a legitimate mechanism by which physicians represent their peers on any OHT governing board. The OMA envisions a model where physicians organize within OHTs into self-governing entities – namely, unincorporated associations or corporations. These physician associations should include primary care physicians and community- and hospital-based specialists.  

Dr. Catania looks optimistically toward the future. “We know the OHT model is working for our community,” she said. “Once the pandemic is behind us, we are looking forward to refocusing our efforts toward improving mental health and addictions care, palliative care and integrating care for patients with complex care needs. That’s when we will really see our goals come to life.”