Needs-Perceptive Research by Alliance for Healthier Communities

NEEDS-PERCEPTIVE RESEARCH THE ALLIANCE'S 2016-18 RESEARCH REPORT

A Warm Welcome from the Alliance On behalf of the entire team, I welcome you to the Alliance for Healthier Communities' inaugural research report.Â The Alliance's research program was initiated in the spring of 2016 with the appointment of Dr. Jennifer Rayner as Director of Research & Evaluation. Since then, Jennifer has energetically spearheaded the Alliance's research efforts; expanding the research team, liaising with prominent primary care researchers to build our advisory board, and engaging in research studies that address our member organizations' most pressing knowledge needs. The Alliance research team has proven to be the missing puzzle piece in our work; providing sorely needed data that empirically supports our advocacy efforts and allows us to better tell the story of our member organizations and demonstrate the value of the work they do. The next pages offerÂ a description of our primary research undertakings and a highlight of our collaborations - for a more comprehensive listing, refer to the report's appendix.

Adrianna Tetley, Alliance CEO

Generating Knowledge that Improves Wellbeing The Alliance's research portfolio is firmly embedded in the Model of Health & Wellbeing which underpins all the work that we and our member organizations do. It’s a dynamic, two-way relationship: the Model of Health & Wellbeing – developed based on extensive research evidence- informs the conception and planning of the Alliance’s research projects. In turn, our research findings influence how the model is operationalized and adapted to local contexts, to achieve our common goal of better health for everyone in Ontario, especially those who experience barriers to good health. The Alliance's research program is needs-perceptive; our studies seek to provide the knowledge that our member organizations need to demonstrate their effectiveness, evaluate their care efforts, and enhance their operations so that they continue to provide the highest quality of primary health care for those that need it most.

The Model of Health & Wellbeing is at the core of our research initiatives, which aim to validate the model's attributes and guide its operationalization.

Understanding the Populations We Serve Understanding the needs, capabilities, and priorities of our primary health care clients is the foundation of positive health outcomes. Nowhere is this more apparent than in mental health care; most frequently delivered in a primary care setting. Individuals in need of mental health care are often marginalized and isolated, and have little input into their care plans.To address this issue, we are collaborating on a study to measure primary health care organizations’ readiness to engage individuals receiving mental health and addictions services in their own care plans, to ensure care is aligned with the clients' priorities and needs. This study is undertaken in collaboration with Dr. Nadiya Sunderji from St. Micheal’s Hospital. In collaboration with Dr. Richard Booth from Western University, we are also analyzing socio-demographic characteristics and service utilization patterns in of individuals seeking mental health and addictions services in our mem community health centres (CHCs), with a separate study focusing on older individuals' needs. While these studies examine specific client populations, we hope to extend findings to inform primary health care delivery in general.

By surveying primary health care organization leaders, we will examine barriers & enablers to client engagement in mental health care.

Examining the socio-demographic information and service utilization patterns of clients receiving mental health services will enable us to better understand their care needs.

Taking Stock of New Challenges The Alliance's research program proactively tackles emerging health care issues, anticipating the need for knowledge that informs policy and advocacy efforts. In collaboration with Dr. Astrid Guttman and Dr. Rick Glazier, core scientists form the Institute for Clinical & Evaluative Sciences (ICES), the Alliance will evaluate healthcare and social assistance utilization rates among private and government-sponsored refugee cohorts, including the recent large Syrian refugee wave. These findings are expected to influence health care policy and program planning both in Canada and at the international level. Social isolation is being increasingly recognized as a major threat to the health and wellbeing of individuals. However, the inability to describe and quantify social connectedness hampers investigations into this growing invisible epidemic. The Alliance has undertaken the development of a tool to quantify the degree of social isolation experienced by an individual, to help identify those at risk and assess the impact of targeted programming. We've also capitalized on the experience of primary health care colleagues in the UK to set up our Social Prescribing initiative, which aims to identify the social care needs of clients and connect them with the needed resources in the community, helping set such services up where none currently exist.

The Alliance is at the forefront of refugee care evaluation efforts; examining social assistance utilization and health outcomes among different refugee cohorts.

The Alliance is responding to the invisible loneliness epidemic with the development of a social isolation quantification tool and the undertaking of a social prescribing project.

Evaluating Our Service Delivery Efforts Evaluating primary health care service delivery and associated outcomes is at the core of the Alliance's research program mission. Understanding what contributes to improved health outcomes will allow us to create a set of best practices that further inform our members’ service delivery. To this end, the Alliance research team has collaborated with Dr. Carol Mulder from the Association of Family Health Teams of Ontario (AFHTO), as well as Dr. Rick Glazier, Dr. Simone Dahrouge, and Dr. Michael Green at ICES on a project examining practice attributes that promote the delivery of high quality health care in CHCs and FHTs (family health teams). An evaluation of a specific primary health care intervention at an Aboriginal Health Access Center (AHAC) is also under way in collaboration with Maamwesying: North Shore Community Health Services Inc. The Naandwe Noojimowin evaluation project will evaluate the implementation and health outcomes of a 5-day residential, indigenous-led mental health program. Results will provide indication of the efficacy of the program as a culturally appropriate, valid mental health treatment approach.

In collaboration with scientists from ICES and the AFHTO, the Alliance is examining practice attributes associated with better quality of care in CHCs and FHTs.

The Alliance is working with the Maamwesying AHAC to examine an innovative mental health treatment program incorporating traditional healing practices.

Evaluating Our Service Delivery Efforts Part of what distinguishes our Model of Health & Wellbeing is that it considers the upstream socio-demographic factors that converge to cause ill health in addition to the immediate medical causes of illness. In practice, this is reflected by the breadth of our members' extensive community development initiatives which address the socio-economic determinants of health.To date, these initiatives have not been formally evaluated, resulting in missed improvement opportunities. In collaboration with Dr. Robert Case from the University of Waterloo, the Alliance is planning a multi-centre analysis of community development initiatives, drawing upon data from our Community Reporting Initiative Tool (CIRT). Results will allow impact assessment and inform future development efforts. Another evaluation project the Alliance is collaborating on examines the outcomes of the innovative online portal-based educational program COMBAT (Combining alcohol interventions with tobacco addictions treatment in primary care) when delivered through a Primary Health Care provider portal, as opposed to a secure patient portal.This work is led by Dr. Peter Selby from the Centre for Addiction and Mental Health (CAMH).

We will examine factors contributing to the success of our members' community development efforts in order to inform future programming.

We will evaluate the impact of an online smoking and alcohol use intervention using a patient-centred versus provider-administered delivery portal.

Demonstrating Our Effectiveness One of the largest research projects in the Alliance's research portfolio is the Advancing Access to Team-Based Care (AA-TBC) initiative, an implementation-evaluation blended project spanning 7 LHINS and involving multiple CHCs. AA-TBC matches individuals with complex care needs cared for by non-team physicians with the inter-professional team at a partner CHC that offers the extended services required by the individual.This project is being led by Dr. Rayner and Dr. Walter Woodchis from the University of Toronto, in addition to a large collective of scientists, patient & caregiver representatives, and ministry officials. The lack of comprehensive client encounter data hampers service planning, program evaluation, and effectiveness measurement efforts. Through Count Everyone,The Alliance is working to create a comprehensive registry of all clients receiving LHIN/MOH-funded services at CHCs. Team-based data will be linked at ICES to provide CHCs with reporting analytics, and a CHC data set will also be sent to the MOHLTC to be used for planning, policy, and evaluation. To demonstrate the cost-effectiveness of our CHCs' operations, a costing study is currently underway, aiming to develop a streamlined and comparable costing approach for CHCs in Ontario.

We are evaluating our team-care expansion initiative for scale-up recommendations.

To more accurately reflect the work of our members, the Alliance is developing a comprehensive service provision registry for CHCs.

The Alliance is also developing a costing system that more accurately reflects CHCs' operating costs.

Creating a Culture of Continuous Learning The Alliance strives to create a culture of continuous improvement through innovation, one where new knowledge is continually integrated into health care delivery - in other words, to increase our and our member organizations' capacity as a Learning Health System (LHS) by increasing data a and tools available for quality improvement, evaluation, and research. One of the most exciting initiatives in the Alliance research portfolio is the Learning Health System for Ontario Primary Care (LeHSOn-PC), an innovative research project employing artificial intelligence and interactive visualization tools to generate more person-centered diagnoses and care plans. Using Chronic Kidney Disease (CKC) as a prototype, artificial intelligence tools will be used in real-time to analyze EMR data from individuals similar to the client during the consult, producing recommended treatment plans visualized in an easy manner to promote a conversation regarding care goals between the provider and the client. The project will be based at select Alliance CHCs, under the leadership of Dr. Rayner and Dr. Merrick Zwarenstein from the University of Western Ontario, with the aim of eventually expanding the model to include other chronic diseases such as diabetes.

The Alliance is partnering with a large collective of scientists, primary care providers, and other stakeholders to implement artificial intelligence tools that automate research and enhance the real-time integration of findings into client-provider consults for more client-centered care.

By the Numbers

Primary health care research initiatives

External studies including opt-in data from our members

National & International conferences & presentations

50+

Collaborators from academia, primary care, & public health

Peer-reviewed articles in national and international journals

Ensuring Data Comprehensiveness Our partnership with the Institute for Clinical and Evaluative Sciences (ICES) facilitates the voluntary inclusion of our members' primary health care data in important studies and analyses. Voluntary data opt-ins ensure that the needs of our clients, their care experience, and the work our members do is reflected in primary care research studies and associated findings. Over the past two years, 20 research projects (and counting) facilitated through ICES have included CHC data and yielded important findings with the potential to impact policy and care provision. These projects have examined a broad range of topics. A few are listed below; for a more complete listing, please refer to the appendix. A highlight of ICES projects including opt-in CHC data: Primary care physician comprehensiveness algorithm comparison with MOH Sub-region population planning data to inform LHIN and MOHLTC Cancer screening rates among disadvantaged and immigrant populations by model of care

Partnerships Dr. Rayner is a member of the INSPIRE-PHC (Innovations Strengthening Primary Healthcare through Research) network, which brings together of over 125 Ontario Primary Care (PHC) researchers, clinician-scientists, and policymakers to share knowledge and expertise. . Dr. Rayner is also a member of Centre for Studies in Family Medicine (CSFM) at the Schulich School of Medicine and Dentistry in Western University. Members of the CSFM team share expertise and collaborate on important primary care research projects.

The Canadian Centre for Advanced Practice Nursing Research (CCAPNR) at McMaster University also benefits from Dr. Rayner's expertise, through her post doctoral fellow membership. The CCAPNR is a collective of inter-disciplinary researchers tackling problems challenging health and social services.

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Student Projects The Alliance has welcomed many students over the past two years. They have examined different topics and joined us for varying amounts of time but they all invariably brought an inquisitive spirit and a strong sense of enthusiasm for the work of our members and the issues impacting delivery of quality care to all. Below is a highlight of our students' recent projects: Rebecca Lyon, an MPH practicum student from the University of Toronto’s Dalla Lana School of Public Health joined the Alliance research team in January 2018 to work on a case study on the operationalization of the Model of Health & Wellbeing at Wellfort CHC. Natasha Tobias, an MPH practicum student from Western University, joined the Alliance in May 2018. Natasha is looking at community governance to understand how CHCs that exemplify this attribute operationalize community ownership, and the impact this has on program delivery. Usman Khan is .an MPH student from Western University, starting his practicum with the Alliance in May 2018. Usman is aiming to develop an understanding of care and services provided by the inter-professional teams at CHCs to people with mental health and addiction issues, to facilitate optimal incorporation of mental health care in a primary care model. Sydney Jopling, a Masters student at the Institute of Health Policy, Management and Evaluation at UofT, is undertaking an evaluation of the Solo Physicians in Need (SPiN) teamcare initiative. She is co-supervised by Dr. Rayner.

Alliance Research Team

Rafal Ramzi MSc (McGill) Assistant

Dr. Jennifer Rayner PhD Biostatistics & Epidemiology (Western) Director, Research & Evaluation

Dariya Gusovsky MSc (UCL, UK) Policy Analyst

Natasha Tobias MPH (Western) Practicum Student

Rebecca Lyon MPH (UofT) Practicum Student

Usman Khan MPH (Western) Practicum Student

Research Advisory Council (RAC)

Adrianna Tetley RAC Chair; CEO, Alliance for Healthier Communities

Dr. Imaan Bayoumi Assistant Professor, Department of Family Medicine, Queen's

Dr. Kathryn Brohman Associate Professor; Smith School of Business, Queen's

Dr. Robert Case Associate Professor, Social Development Studies, Renison University College

Dr. Simone Dahrouge Scientist; Vice-Chair, Research, Department of Family Medicine; University of Ottawa

Dr. Rick Glazier Senior Scientist, ICES Core Scientist, Centre for Urban Health Solutions, St. Michael's Hospital

Dale McMurchy President, Dale McMurchy Consulting

Dr. Laura Muldoon Primary care physician; Somerset West Community Health Centre

Research Advisory Council (RAC)

Dr. Andrew Pinto Public Health and Preventive Medicine specialist; family physician; St. Michael's Hospital

Dr. Yogendra Shakya Senior Research Scientist, Access Alliance Assistant Professor (Adjunct), DLSPH, UofT

Dr. Walter Wodchis Professor, IHPME, UofT Research Chair, Trillium Health Partners

Dr. Merrick Zwarenstein Professor, Schulich School of Medicine & Dentistry, Western Senior Scientist, ICES

Wangari Tharao Program and Research Manager; Women’s Health in Women’s Hands (WHIWH) Community Health Centre

Pamela Williamson Executive Director; Noojmowin Teg Health Centre

Appendix Primary Research Projects Advancing Access to Team-Based Care (AA-TBC; variable start dates) Principal Investigators: Jen Rayner - Research & Evaluation Lead, Alliance for Healthier Communities; Walter Wodchis - Professor, IHPME at UofT. An Evaluation of Community Development Initiatives in Ontario Community Health Centres (April, 2018). Robert A. Case - Professor, University of Waterloo.; Jen Rayner - Research & Evaluation Lead, Alliance for Healthier Communities. Optimizing Canada's Healthcare for Refugees (April, 2018). Principal Investigators: Astrid Guttman - Chief Science Officer, ICES; Richard Glazier - Primary Care Program Leader, ICES; Jen Rayner- Research & Evaluation Lead, Alliance for Healthier Communities. Learning Health System for Ontario Primary Care (LeHSOn-PC; Jan., 2018). Principal Investigators: Merrick Zwarenstein - Professor, Family Medicine, Western University; Jen Rayner - Research and Evaluation Lead, Alliance for Healthier Communities.

Social Prescribing: Connecting People, Health and Community (June, 2018). Principal Investigator: Jen Rayner - Research & Evaluation Lead, Alliance for Healthier Communities Social Isolation Tool (Aug., 2017). Principal Investigator: Jen Rayner - Research and Evaluation Lead, Alliance for Healthier Communities. Count Everyone (May, 2017). Principal Investigator: Jen Rayner - Research & Evaluation Lead, Alliance for Healthier Communities Justice Perceptions of Family Physicians & Nurse Practitioners on Community-Governed Interprofessional Teams - Phase 2 (July, 2016). Principal Investigators: Laura Muldoon - Physician, Somerset West CHC; Jen Rayner - Research and Evaluation Lead, Alliance for Healthier Communities. Costing Study (??). Principal Investigators: Jen Rayner Research and Evaluation Lead, Alliance for Healthier Communities; Walter Wodchis - Professor, IHPME at UofT.

Collaborations Examining if a Patient Portal (designed to give patients secure access to health information) is a More Effective Method for Delivering Brief Interventions and Offering Educational Resources to Patients (May, 2018). Principal Investigator: Dr. Peter Selby - Deputy Physician-in-Chief, Education, and the Chief, Primary Care, Centre for Addictions & Mental Health (CAMH).

What practice attributes promote better quality of care in interprofessional teams such as FHTs and CHCs? (July, 2017). Principal Investigators: Carol Mulder -Provincial Lead, Quality Improvement and Decision Support (QIDS), AFHTO, and Jen Rayner -Research and Evaluation Lead, Alliance for Healthier Communities.

Measuring Organizational Readiness for Client Engagement (March, 2018). Principal Investigator: Nadiya Sunderji - Psychiatrist, St.Michael's Hospital.

Mental health system utilization of older adults in Ontario: Detecting indicators and generating a predictive model to inform care, resource allocation, and advocacy for the future ( Feb., 2017). Principal Investigator: Richard Booth - Assistant Professor, School of Nursing, Western University.

Immunization Coverage Among Newcomers to Ontario (March, 2018). Principal Investigator: Sarah Wilson - Adjunct Scientist, ICES; Medical epidemiologist, Public Health Ontario. Naandwe Noojimowin Evaluation (Formerly known as Beauty For Ashes; Sept., 2017). Co-Principal Investigators: Jennifer Walker - Canada Research Chair in Indigenous Health, Laurentian; Core Scientist, Institute for Clinical and Evaluative Sciences (ICES); Gloria Daybutch, Executive Director, Maamwesying.

Decreasing Health Disparities: An Evaluation of a Novel Model of HIV Care in a Canadian Population with High Rates of Homelessness and Substance Abuse (June, 2016). Principal Investigator: Michael Silverman - Chair of Infectious Diseases, Schulich School of Medicine & Dentistry at Western University.

Institute of Clinical Evaluative Sciences (ICES) Projects with Opt-In CHC Data Infants Born to Women with Disabilities: Health and Healthcare (April, 2018). Principal Investigator: Hillary Brown - ICES; UofT, Scarborough. Comparison of Primary Care Asthma Performance Indicators (PC-API) Between Patients Referred to the Primary Care Asthma Program (PCAP) and Patients Not Referred to the PCAP (April, 2018). Principal Investigator: Wenjia Chen; Teresa To - The Hospital for Sick Children. Building a Better Understanding of Belonging, Mental Health, and Addictions: Mapping & Measuring the Needs of People Facing Mental Illness and/or Addictions Who Use Ontario Health Centers (Jan., 2018). Principal Investigator: Richard Booth - Western University. The Healthy Immigrant Effect in Mental Health (Jan., 2018). Principal Investigator: Joyce Cheng - CAMH; UofT. INSPIRE-PHC 2: Innovations Supporting Primary Health Care through Research (Jan., 2018). Principal Investigator: Rick Glazier - ICES.

HIV Prevalence, Access to Care & Treatment in People in Provincial Correctional Facilities in Ontario (Nov., 2017). Principal Investigator: Fiona Kouyoumdijan - St. Michael's Hospital; ICES. Primary Care Physician Comprehensiveness Algorithm Comparison with MOH (Aug., 2017). Principal Investigator: Rick Glazier - ICES. Rate of Cancer Screening by Area Income, Immigration Status and Primary Care in Ontario by LHIN and Sub-Region (April, 2017). Principal Investigator: Rick Glazier - ICES. Interprofessional Teams Access Gaps in Care (April, 2017). Principal Investigator: Rick Glazier - ICES. Attachment, Access, Continuity and Mental Health Gaps in Care (April, 2017). Principal Investigator: Rick Glazier - ICES. Practice-Based Primary Care Denominators for Ontario Sub-Regions (Feb., 2017). Principal Investigator: Rick Glazier - ICES.

Institute of Clinical Evaluative Sciences (ICES) Projects with Opt-In CHC Data Prisoner Participation in Cancer Screening in Ontario, Canada: a Retrospective Cohort Study (Feb., 2017). Principal Investigator: Fiona Kouyoumdijan - St. Michael's Hospital; ICES.

Maternal and Perinatal Outcomes in Women Who Experience Incarceration in Ontario, Canada: A Retrospective Cohort Study (Oct., 2016). Principal Investigator: Fiona Kouyoumdijan - St. Michael's Hospital; ICES.

Gender Disparities in Child Health and Healthcare by Maternal Country of Origin (Jan., 2017). Principal Investigator: Ariel Pulver - Dalla Lana School of Public Health, UofT.

Care of Hotel Dieu HIV Oupatient Clinic Patients (July, 2016). Principal Investigator: Flora Matheson ICES.

Post-Release Health Care Utilization in an HIV+ Population (Nov., 2016). Principal Investigator: Fiona Kouyoumdijan - St. Michael's Hospital; ICES.

Sociodemographic characteristics of young children receiving primary health care and community based supports at Ontario Community Health Centres (Feb., 2016). Principal Investigator: ??

Examining Inequities in Access to Care in Ontario by Immigrant Class (Nov., 2016). Principal Investigator: Laura Anderson - Wellesley Institute. Cancer Screening Rates Among Disadvantaged and Immigrant Populations by Model of Care (Oct., 2016). Principal Investigator: Mandana Vahabi - Ryerson University.

LHIV (and sub-projects LHIV Linkage; OCS and Attrition) (Jan, 2016). Principal Investigator: Curtis Cooper - University of Ottawa, Ottawa Hospital Research Institute.

Peer-Reviewed Publications Rayner, J., Muldoon, L., Bayoumi, I., McMurchy, D., Mulligan, K., Tharao, W., (June., 2018). Delivering Primary Health Care as Envisioned - A Model of Health and Wellbeing Guiding Community-Governed Primary Care Organizations. Journal of Integrated Care 26 (3): 231-241. Rayner, J., Glazier, R., Donald, F., Martin-Misener, R. (submitted July, 2018). Understanding Nurse Practitioner Outcomes in Ontario, Canada. Rayner, J., Glazier, R., Donald, F., Martin-Misener, R. (submitted July, 2018). Nurse Practitioner Standardized Reporting: A mixed methods review of the Nurse Practitioner Reporting Tool.

Glazier, R.H., Rayner, J., and Kopp, A. (2015). Examining Community Health Centres According to Geography and Populations Served, 2011/12-2012/13. Toronto, Ontario: Institute for Clinical and Evaluative Sciences Martin-Misener, R., Kilpatrick, K., Donald, F., Rayner, J., Bryant-Lukosius, D., Valaitis, R., Carter, N., Miller, P.A., Landry, V., Harbman, P., Charbonneau-Smith, R., McKinlay, R.J., Ziegler, E., Boesveld, S., Lamb. A. (2016). Nurse Practitioner Caseload in Primary Health Care: Scoping Review. International Journal of Nursing Studies, pp. 170-182 DOI information: 10.1016/j.ijnurstu.2016.07.019

Rayner, J., & Muldoon, L. (2017). Staff Perceptions of Community Health Centre Team Function in Ontario. Can Fam Physician,63 (7): 335-340.

Conference Presentations Rayner, J. Advancing Access to Team-Based Care. Achieving Excellence Together Conference (2018, June 18) Toronto, Canada Presenting on AA-TBC. Rayner, J. and Zwarenstein, M. Learning Health Systems: How to harness data to improve the health of populations served. AOHC Health Equity Action and Transformation Conference (June 13-14, 2018) Toronto, Canada. 19th Canadian Collaborative Mental Healthcare Conference (2018, June 1-2), Toronto, Canada: Gusovsky, D. Rethinking Successful Outcomes: How do Interprofessional Teams in CHCs Challenge understandings of effective Outcomes in Mental Healthcare. Tang, V., Ion, A., Rayner, J., Mulder, C., QI4CC team, and Sunderji, N. Readiness for Patient Engagement in Ontario's Primary Care Teams.

Canadian Association of Health Services and Policy Research (CAHSPR) Conference (2018, May 29-30) Montreal, Canada: Rayner, J. Harnessing the Power of Data to Improve the Health of Populations. Rayner, J., and Zwarenstein, M. Learning Health Systems within Ontario Community Health Centres. Rayner, J., Zwarenstein, M., Reid, R., and Forrest, C. Learning Health Systems (LHS) speed healthcare improvement. Baker, G.R., Rayner, J. Adaptation and standardization of integrated care practices to facilitate scale-up and spread: Insights from Ontario case studies . 18th International Conference on Integrated Care (2018, May 23-25), Utrecht, Germany.

Conference Presentations Parpia, R., and Rayner, J. Association of measures of marginalization and use of Ontario Community Health Centres for preventative and social determinants of health-related care in young children. Pediatric Academic Societies (PAS) 2018 Meeting (2018, May 5-8) Toronto, Canada.

North American Primary Care Research Group Conference (2016, Nov.12-16), Colorado, USA: Donald, F., Martin-Misener, R., Rayner, J. Patient Characteristics and Other Factors that Influence Nurse Practitioner Patient Panel Size. Oral Presentation.

Carter, N., Martin- Misener, R., Donald, F., Kilpatrick, K., Bryant-Lukosius, D., Raynor, J., Ziegler, E., Bennewies, N. Perspectives of Primary Care Team Members on Factors that Influence Nurse Practitioner Workload, Productivity and Caseload (oral presentation). Advanced Practice Nursing Deutsches Network 4th International Congress (2017, September 8) Frieburg, Germany . Shift the Conversation: Community Health and Wellbeing - AOHC 2017 Conference (2017, June 7-8), Toronto, Canada: Rayner, J., and Zwarenstein, M. Innovation, Research and Learning: Building a Learning Health System (learning session). Haj-Ali, W. and Rayner, J. Making use of data to drive practice improvement (learning session).

Rayner, J., Muldoon, L., Bayoumi, I., Tharao, W., McMurchy, D. Community Health Centres: Creating a Roadmap to Improved Health and Wellness. Poster Presentation. Rayner, J. Donald, F., Glazier, R. Understanding Activities for NPs in Ontario: A Comparison of Standardized Data Reporting, Time and Motion Data and Focus Group Results. Poster Presentation. Martin-Misener, R., Rayner, J., Donald, F. Perspectives of Primary Care Team Members on Factors that Influence Nurse Practitioner Activities and Patient Panel Size. Oral Presentation

Conference Presentations Association of Ontario Health Centres, Annual General Meeting (2016, June 8-9) Toronto, Canada: Rayner, J. Key Note Address. An Evidence based Model of Health and Wellbeing: Deliver, Demonstrate, Communicate! Rayner, J. & Kroeker, A. Understanding Health Inequities and Access to Primary Care in the SW LHIN. Association of Family Health Teams 2016 Conference (2016, Oct. 17-18), Toronto, Canada. Rayner, J. & Kroeker, A. Understanding Health Inequities and Access to Primary Care in the SW LHIN. Association of Family Health Teams 2016 Conference (2016, Oct. 17-18), Toronto, Canada: Rayner, J. Understanding NP activities in Family Health Teams: A tale of three data sources. Leading primary care to strengthen a polpulation-focused health system.

Students Victoria Jean Howgego, Masters of Nursing, Western University, Summer Practicum Student "Ontario Community Health Centres:The Future of Primary Care " Sydney Jopling, Masters student at IHPME, UofT. Cosupervised by Jen Rayner "An interprofessional team-based primary health care program for patients with complex health and social needs: impact on health services utilization" Natasha Tobias, MPH stdent, Western University Summer Practicum Student "Operationalization of Community Governance at the CHC level" Usman Khan, MPH stdent, Western University, Summer Practicum Student "Evaluation of Mental Health and Addictions services offered at CHCs" Jacqueline Kueper PhD student, Epidemiology & Biostatistics, Western University PhD student, working on LeHSON project "Learning Health System for Ontario Primary Care (LeHSOn-PC)"

Rebecca Lyon, Masters of Public Health, Dalla Lana School of Public Health, UofT. Practicum student "Case study on the oprtationalization of the MHWB at Wellfort CHC" Nicole Pilato Masters of Nursing, Western University Summer Practicum Student "Social Isolation Screening Tool" Julia Fusrova, PhD, York Unviersity, Faculty of Environemtnal Studies. Knowledge Management internship student "Evaluating the evaluation: what works, for whom and when" Anum Khan, PhD, University of Toronto "Managing multi-morbidity in primary care: Examining integration efforts within and across organizational boundaries" Amanda Arsenault Masters of Nursing, Western University. Summer Student "Evaluation Framework for a primary care outreach project for Migrant Workers ‘Truly Green’"

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Prepared by: Rafal Ramzi