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The Health Services Delivery Framework is comprised of three Models of Care (MOCs) and serves as a guide for transformational change to improve palliative care in Ontario. The Model of Care approach rethinks the organization, integration, and delivery of health services for a patient population as they progress along a care pathway.
The first Palliative Model of Care focuses on community settings and applies to individuals in their usual place of residence, including: Adults living in the community; Residents of long-term care homes (LTCHs); and Indigenous communities.
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The Seamless Care Optimizing the Patient Experience – Black Health Initiative (SCOPE BHI) is a multi-year Ontario Health funded effort to improve access to care for Black communities by equipping primary care providers and specialists with streamlined navigation to local health resources. The initiative also prioritizes co-designing culturally responsive care pathways with the Black community, grounded in local needs and identified service gaps.
Community HealthCaring-KW (CHC-KW) received Ontario Health funding to expand mental health supports for Black children and youth in KW4. This initiative builds on existing services by increasing focus on Black populations and community organizations, while ensuring access to the mental health and addictions expertise required to support these patients in a culturally responsive and sensitive way.
Through partnerships with local hospitals, mental health and addictions providers, and community organizations, CHC-KW is working to strengthen care pathways and reduce barriers to timely, appropriate support for Black children and youth and their families.
The Transitions in Care Quality Improvement Plan initiative seeks to improve transitions and access to integrated team-based care, including home and community care, for older adults in order to reduce Alternate Level of Care (ALC) Days.
The Breast Screening Quality Improvement Plan initiative seeks to increase mammography rates in KW4 with a focus on our priority neighbourhoods through public outreach and provider education.
The Chronic Conditions Quality Improvement Plan initiative seeks to improve early detection, intervention and outcomes for people with chronic conditions in KW4 including heart failure, chronic obstructive pulmonary disease (COPD), and diabetes.
The Newcomer App project seeks to create a way for recent newcomers to provide advice to the KW4 partners about how to access relevant information and thereby improve newcomers’ ability to self-navigate local health and social services with accurate, timely, and up-to-date information.
