Model of Care Toolkit
In the health care system, a network model is a group of specialized services that are delivered and coordinated at one centre and is connected to multiple other centres for treatment delivery and support.
In countries like Canada, where population density varies significantly across regions, network models improve access to care in rural and remote communities. It allows for relatively seamless integration of community centres into these networks and ensures continuity of care in rural and remote regions.
For First Nations, Inuit and Métis, whose care is often complicated by a lack of coordination among hospitals, provincial and territorial health systems, cancer programs and a patient’s home community, network models have the potential to greatly improve continuity of care and enhance timely access to specialized services.
Organized by region, the networks support access to specialist care closer to home. Patient care plans can be developed with specialists in collaboration with providers at community cancer centres rather than relying on patients to travel to receive care. Understanding when a patient needs to visit their oncologist is an important part of the network model. The routine collection and use of Patient Reported Outcomes (PRO) helps trigger the transfer of a patient from a community cancer centre to a tertiary centre. The network model puts the patient at the centre of the care.
The health systems’ pivot to virtual care in response to the COVID-19 pandemic and advances in digital health solutions also enhance the value of network models. These virtual innovations also facilitate case conferencing among network members.
Evidence shows that network models can:
- Improve the time from referral to initial assessment
- Reduce wait-times for accessing specialized services in tertiary centres
- Improve patient outcomes and survival rates.3,4
- Allow patients to remain with their families, caregivers, and support systems
- Enhance access to culturally appropriate care, especially for First Nations, Inuit and Métis patients
- Reduce out of pocket costs for patients and reduce overall cost of care across the health system.5,6
While network models add capacity to ensure more integrated cancer services, these models also require multi-level governance processes that are responsive to the strengths and limitations of jurisdictional cancer programs.
Change management considerations must include input from all levels of a cancer system and include consultation with community health centres to ensure a holistic approach is developed.7
The Ottawa Health Services Network Inc (OHSNI) is a unique inter-jurisdictional network that connects care teams in Nunavut and Ottawa to streamline care delivery for patients living in the territory.
- Practitioners in Nunavut send patient referrals and current medical records to the OHSNI case management team in Iqaluit.
- Referrals are sent to relevant practitioner(s) in Ottawa and appointments are scheduled in consultation with the patient and northern practitioner. When possible, appointments are scheduled together to minimize a patient’s time away from home.
- The patient, who may be accompanied by an escort and/or an OHSNI interpreter, travels to Ottawa to receive care.
- Upon arrival, OHSNI arranges services in English or Inuktitut and walks the patient and their escort through what to expect. Details like travel to and from appointments, who will be at the appointments and the goals of each appointment are covered to ensure the patient is fully informed and comfortable with the process.
- After the appointments have been completed and the patient has returned home, the patient’s case manager calls to discuss next steps and answer any follow up questions a patient may have.
A key success of the initiative is its comprehensive approach to coordinated care. With OHSNI serving as the communication hub, practitioners can share treatment and medical records and collaborate on treatment decision making. The patient-centric approach to care reduces treatment delays and supports a seamless patient experience.
OHSNI also runs in-person and virtual speciality clinics in Nunavut, provides education and training to enhance cultural competency among Ottawa Hospital practitioners, and participates in research activities to further collective understanding of the health care needs of northern populations.
Learn more about OHSNI.
This toolkit includes resources for advanced practice training for nurses. View the training resources.
In response to recruitment challenges of general practitioners to support community cancer clinics, Alberta developed an innovative virtual care model. In the model, a specialized oncology nurse practitioner in a tertiary cancer centre holds virtual weekly clinics with patients in community cancer centres. Nurse practitioners are supported by medical oncologists who coach the nurses in optimal care practices while supporting their ongoing competency development.
At the community cancer centres, community-based registered nurses attend the virtual visits and provide on-site support for patients, working with the tertiary-centre nurse practitioner to facilitate assessments. In some instances, community-based registered nurses lead visits with patients who do not need assessments by nurse practitioners each cycle.
To support best available care, the tertiary centre-based nurse practitioner is available to the community site team throughout the week to guide and address care needs as they arise.
Connect with Alberta’s model lead.
Alberta’s nurse practitioner led virtual care model also includes optimized scope of practice for nurse practitioners. Learn more.
Quebec’s cancer networks organize care and service delivery around specialized and subspecialized interprofessional teams at multiple centres. These disease site-specific networks create clear and defined links between individuals within the care team and teams at different centres. The model has been fully implemented in lung cancer and is being expanded to other disease sites.
For patients, centralizing specialized services in small centres improves access to expertise within rural and remote areas and timeliness of access to services. The program’s “quick access desk” streamlines the diagnosis and treatment planning process and reduces costs associated with unnecessary testing or duplication of diagnostic services.8
For team members, the network promotes knowledge sharing across sites leading to improved standardized protocols and homogenous practice. The team-based approach helps reduce isolation of the staff and develop the resilience of individuals and organizations.
Learn more about Quebec’s cancer networks.9
A small community in New Zealand developed a model to support the delivery of palliative care services across a broad geographic area. A centralized hospice serves as a ‘hub’ of palliative care expertise, providing inpatient and homecare services, and consults and provides expert guidance for primary health care providers who serve as palliative care ‘spokes’ within the community and regional hospitals.
The model aims to have most palliative and end-of-life care provided by primary health care providers, with specialist palliative care services managing complex cases and providing guidance where necessary. The interprofessional team includes palliative medicine specialists, allied health professionals and family physicians.
The hub-and-spoke model encourages regional collaboration and standardization of care. Evaluation of the model shows reduced costs for the system, the patient. With a focus on rural and remote communities, it has shown to be of value for the country’s Indigenous communities as it supports access to timely and culturally appropriate care.
New Zealand’s hub-and-spoke model also connects primary health care teams with oncology specialists. Learn more about coordination with primary care.
Learn more about the New Zealand’s hub-and-spoke model.10
- Andermann A. Taking action on the social determinants of health in clinical practice: a framework for health professionals. CMAJ. 2016;188(17-18):E474-E483.
- Riley-Behringer M, Davis MM, Werner JJ, Fagnan LJ, Stange KC. The evolving collaborative relationship between Practice-based Research Networks (PBRNs) and clinical and translational science awardees (CTSAs). J Clin Transl Sci. 2017;1(5):301-309.
- Stone CJL, Vaid HM, Selvam R, Ashworth A, Robinson A, Digby GC. Multidisciplinary clinics in lung cancer care: A systematic review. Clin Lung Cancer. 2018;19(4):323-330.e3.
- Brown BB, Patel C, McInnes E, Mays N, Young J, Haines M. The effectiveness of clinical networks in improving quality of care and patient outcomes: a systematic review of quantitative and qualitative studies. BMC Health Serv Res. 2016;16(1).
- Hunter RM, Davie C, Rudd A, et al. Impact on clinical and cost outcomes of a centralized approach to acute stroke care in London: A comparative effectiveness before and after model. PLoS One. 2013;8(8):e70420.
- Reeders J, Ashoka Menon V, Mani A, George M. Clinical profiles and survival outcomes of patients with well-differentiated neuroendocrine tumors at a health network in new South Wales, Australia: Retrospective study. JMIR Cancer. 2019;5(2):e12849.
- Tremblay D, Touati N, Roberge D, et al. Understanding cancer networks better to implement them more effectively: a mixed methods multi-case study. Implement Sci. 2016;11(1):39.
- Labbe C, Martel S, Fournier B, Saint-Pierre C. P1.15-13 wait times for diagnosis and treatment of lung cancer across the province of Quebec, Canada. J Thorac Oncol. 2018;13(10):S615-S616.
- Ministère de la Santé et des Services sociaux. Cadre de référence pour la mise en place de réseaux par siège tumoral. Accessed December 2, 2021. https://publications.msss.gouv.qc.ca/msss/document-002357
- Canadian Hospice Palliative Care Association. Innovative Models of Integrated Hospice Palliative Care, the Way Forward Initiative: An Integrated Palliative Approach to Care.; 2013. Accessed November 24, 2021. http://www.hpcintegration.ca/media/40546/TWF-innovative-models-report-Eng-webfinal-2.pdf
- Sedgewick JR, Ali A, Badea A, Carr T, Groot G. Service providers’ perceptions of support needs for Indigenous cancer patients in Saskatchewan: a needs assessment. BMC Health Serv. Res. 2021;21(1)
- Ontario Health (Cancer Care Ontario). Complex Malignant Hematology Models of Care: Recommendations for Changes in the Roles and Composition of the Multidisciplinary Team and the Setting of Care to Improve Access for Patients in Ontario – March 2017. Accessed December 2, 2021. https://www.cancercareontario.ca/en/guidelines-advice/types-of-cancer/43051%5d
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