Case study

Home and Community Care Support Services Mississauga Halton

The case study revolves around Home and Community Care Support Services (HCCSS) in Mississauga Halton. Comprising a population of 680,000, with over 50% of residents born outside of Canada, and 51% with low and very low socioeconomic status. Despite a significant population, it has the fewest number of primary care teams, long-term care (LTC), and hospice beds per capita in Ontario.
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Background and goals

The primary issue was the challenge of managing lower extremity wounds, with disagreements between vascular and orthopedic departments on ownership and discrepancies in care depending on who is on call. The closure of the "wound care clinic" due to COVID-19 exacerbated the problem, leading to frustration among emergency room (ER) physicians who sought better access to wound care services.

To address these challenges, a partnership was formed with the division of Vascular Surgery at Trillium Health Partners, led by Dr. Patrick McVeigh, resulting in the creation of the Lower Limb Preservation Program. In collaboration with Home and Community Support Services, we established a home care pathway to orchestrate the journey and clinical needs of patients referred to home care for lower extremity wound care. In addition, in-person visits were undertaken on a weekly basis in 2 ambulatory clinics, conducted by Specialty Provider Organizations.

The project launched in 2021, providing care for 281 patients, resulting in substantial reductions in length of stay on Home Care pathways and ER visits, as well as the preservation of limbs previously considered "non-salvageable". The plan for 2024 is to extend access to the entire Mississauga Halton region.

Partnership approach

The partnership approach involves providing integrated assessment services for patients with lower extremity wounds, currently being managed by HCCSS. These patients are referred from various sources, including primary care and ER physicians, as well as specialists, who rely on Home Care for wound dressing changes in the communityA custom pathway, known as the Lower Limb Preservation Pathway, was created specifically for HCCSS clinics, with plans in place to establish direct support pathways for the SCOPE program, two ERs, one urgent care clinic, and numerous long-term care facilities.

Implementation and challenges

The implementation of the program was initiated at a grassroots level, directly engaging clinics, frontline clinicians, and nurses. We continue to gain support to expand and scale these pathways to include multiple stakeholders.

The key stakeholders involved in this initiative include HCCSS (Home and Community Care Support Services), THP (Trillium Health Partners), Specialty Provider Organizations, and the Mississauga Ontario Health Team.

The work has been divided into two phases, with Phase 1 focusing on 2 separate home care clinics and Phase 2 targeting the remaining HCCSS clinics, along with the SCOPE program, LTC facilities, ERs, and Urgent Care clinics.

Operational and logistic adjustments have required the recruitment of a local Vascular Surgeon and the establishment of buy-in from local specialists, in addition to navigating the administrative challenges of deploying an innovative Value-Based Care solution.

Outcomes and impact

The clinical outcomes and overall impact of the program have been substantial. The length of stay on HCCSS pathways consistently decreased by at least 50%, which is particularly noteworthy considering that initially, only complex wounds were enrolled. The potential impact on less complex patients is likely even greater.

One of the most remarkable achievements of the program is the preservation of a total of 15 limbs in only one year, which otherwise would have required major amputation. The value of this initiative can not be overstated, as it demonstrates the significant improvement in Limb Preservation Care and positive impact on patients' lives.