A unique team at Hamilton Health Sciences (HHS) has been awarded with the highest honour for health quality & safety in Ontario for its work in providing care to vulnerable, under-served populations in Hamilton.
Hospital 2 Home is an innovative, community-based group of health professionals who partner with patients, caregivers, primary care, and other community service providers to address health disparities and facilitate easier access to health services. This afternoon, the team was honoured with the prestigious Minister’s Medal, presented by Minister of Health and Long-Term Care, the Honourable Eric Hoskins at the Health Quality Transformation conference in Toronto. The annual award recognizes health system champions who have demonstrated exceptional, sustainable work in improving quality and safety of health in Ontario. Just three medals were awarded across Ontario.
Addressing more than health concerns
“Hospital 2 Home collaborates with patients to optimize their health and quality of life by identifying needs and developing a coordinated care plan with primary care teams and health, community and social service partners,” says Kelly O’Halloran, director of community & population health services at HHS. “We work together to ensure our patients can fill their prescriptions, attend medical appointments, and access food and adequate housing. The team focuses on what is most important to the patient and what is most concerning to them about their health. Through this, patient engagement is high and a true partnership between the patients and the team is established, enhancing our patients’ experience.”
Utilizing Ontario’s Health Links Model of Care, the team uses standardized criteria to identify patients who are at the greatest risk for poor health outcomes and works with these patients in the community. Commonly, these patients have multiple chronic health conditions, and are facing social and economic barriers to achieving good health, such as poverty, lack of a support network and/or mental health issues.
“This is a very proud moment for HHS and for our Hospital 2 Home team,” said Dr. Wes Stephen, executive vice president of clinical operations & chief operating officer, HHS. “They exemplify patient-centred, collaborative care. It’s an example we’re leading with as we embark on our transformative journey into the next 20 years.”
The proof is in the numbers
Since it was established in 2014, Hospital 2 Home has supported close to 800 patients in the Hamilton and Niagara area. Key impacts of their work includes reduced emergency room visits and fewer hospital stays for patients who have been supported by this program:
• 25.2% reduction in emergency room visits in Hamilton, and a 20.3% reduction in emergency room visits in northwest Niagara.
• 50.0% reduction in inpatient visits in Hamilton, and a 44.7% reduction in inpatient visits in northwest Niagara.
• 55.8% reduction in 30-day re-admissions in Hamilton, and a 51.9% reduction in 30-day readmissions in northwest Niagara.
“Hospital 2 Home works with some of the most vulnerable patients in the Hamilton Niagara area who are part of chronically under-served populations,” says Dr. Eric Hoskins, Minister of Health and Long-Term Care. “Their leadership has led to impressive results for both patients and the health care system, and that wouldn’t be possible without the important partnerships they form with their patients.”