Leveraging Community Partners to Reduce Health Inequities in Lower Limb Preservation

The Lower Limb Preservation (LLP) demonstration project is built on the Canadian Ontario Health Team (OHT) model, and is a new way of organizing and delivering care that is more connected to patients in local communities, with the goal of better coordinated, more integrated care. LLP project focus is on reducing health inequities and preventing avoidable lower limb amputations through community chiropody clinics and hospital-community-primary care partnerships. We aim to serve marginalized and underserved populations across Toronto, Canada. There is a concerted effort to reach transient communities (homeless or under housed), Black, Indigenous and People of Colour, and those who do not regularly seek health care. We have partnered with the following groups and organizations within the OHT to co-design the integrated clinical pathways and models of care: - Community Health Centers: non-profit organizations that provide primary health and health promotion programs for individuals, families and communities. - Homeless shelters and drop-in centers where hot meals are provided (including one specifically for Indigenous populations). - University Health Network: A multi-site hospital that provides quaternary, specialized care in downtown Toronto. - Primary Care networks including one that focuses on people living on the street and in shelters, encampments and precarious housing across Toronto Our project team led the co-design of an OHT integrated clinical pathway and care model with the goal to reduce incidence of avoidable lower limb amputations. Pathway includes early identification of those at risk, chiropody foot care services provided in high priority/need communities, and health promotion and education to enable person-centered control over health. Hospital-Community-Primary care partnerships include a shared resource delivering care in both community and hospital settings, collaboration between the hospital emergency department and community homeless shelters, primary care networks and hospital outpatient clinic, and joint health education and promotion session delivery by community and hospital providers. Partnering and building relationships at the Hospital-Community-Primary care level allows for a cross continuum, integrated care delivery of health care beyond hospital walls to congregate and underserved populations within Toronto. Results: Since October 2023 launch, LLP project has shown promising results and evoked great excitement amongst all partners. Community chiropody clinics are scheduled through Spring 2024. To date, all clinics have reached capacity and provided much needed chiropody and foot care services to many underserved pockets within the region. Joint health education and health promotion sessions have also been highly attended. As time progresses, impacts include: strengthened hospital-primary-community care partnerships, regular screening and foot care, earlier treatment and health promotion, and reduced incidence of avoidable lower limb amputations. Learning for International Audience: Power of Partnerships - Hospital-Community-Primary care partnerships have played a vital role in addressing health determinants by providing care to those in underserved, high priority communities, improving population health longer-term, and reducing health inequities. This partnership has helped to build new connections and establish trust with marginalized and underserved communities. Next Steps: Implement all aspects of the pathway, focusing on hospital ED and community shelters along with social medicine partnerships, and demonstrate value to obtain sustainable funding.

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