IMPACT PLUS
Co-Principal Investigators
Dr. Ross Upshur
Sunnybrook Academic Family Health Team
Sunnybrook Health Sciences Centre
Dr. Howard Abrams
University Health Network
Taddle Creek Family Health Team
Co-Investigators
Dr. Jocelyn Charles, Dr. Leslie Nickell, & Shawn Tracy (Sunnybrook Family Health Team)
Dr. Pauline Pariser (Taddle Creek Family Health Team)
Dr. Nasreen Ramji & Dr. Sheila Lakhoo (St. Michael’s Hospital Family Health Team)
Dr. Thuynga Pham (Southeast Toronto Family Health Team)
Collaborating Agencies
Toronto Central Community Care Access Centre
SPRINT (Senior Peoples’ Resources in North Toronto)
Regional Geriatric Program of Toronto (Sunnybrook)
Research Team
Jason Nie, Li Wang, Dr. Jana Bajcar
and all the clinical team members at the 4 participating Family Health Teams
IMPACT PLUS: a comprehensive model of
• Assessment
• Care Planning
• Mentorship and training
▪ Interprofessional problem solving model
▪ Includes PCPs, CCAC worker, pharmacist, RNs,
NPs, social workers, physiotherapist, OT,
dieticians, trainees
PLUS
▪ Psychiatrist & General Internist
IMPACT PLUS
Family
Physician
Resident
Physician
Homecare
Coordinator
Nurse
Social
Worker
Pharmacist
Patient
and
Family
Dietitian
Psychiatris
t
PT
Internist
OT

Can address confluence of complex chronic
illness with psychiatric co-morbidities and
social determinants in real time

Introduces theories and concepts of illness
behavior

Supports group process of team
•
• “One Stop Shopping” : Simplifies treatment for multiple conditions
• “Appropriate Use”. Able to say no.
• Gives permission to PCPs
• Transfer of knowledge and modeling of clinical approach to other
health professionals and trainees
• Occasionally makes a brilliant diagnosis just like Dr. House.
The IMPACT protocol
Patient
Selection &
Invitation
Document. &
Debrief
Team
Deliberation
Group
Discussion 1
Care Plan
and Next
Steps
Patient
Welcome &
Initial Patient
Interview
HCP
Assessments
Group
Discussion 2
RESULTS
Marital Status (%)
Married
Single
30.8%
48.7%
Widowed
20.5%
Age, mean (SD)
39.7%
60.3%
78.94 (13.5)
Number of medications, mean (SD)
12.60 (5.11)
Sex (%)
Male
Female
Number of chronic conditions,
mean (SD)
9.17 (3.09)
Complexity Score, mean (SD)
21.77 (7.17)
“I didn’t notice the time go by and I was happy to be
interviewed by so many people, yeah, and listening to
their suggestions and all that, which was great. I mean,
you all talk among yourselves, suggest what is best for
the patient and I think that is really great, you can’t beat
that at all.” ~Patient
“It was like togetherness… I was very much involved in that
and I liked it. I felt so much better on the way home. I
don’t know why – my heart was lifted and after being so
depressed for such a long time, you know, I felt I could
laugh again.” ~Patient
“… it’s brilliant and it’s functional and it’s beneficial
and it provides security, emotional security and
support for not only the patient, but the family.”
“IMPACT is the first time that I really felt like I was
involved in interprofessional care It’s my first time
that I really felt like a valuable team player and I
really felt like I’ve gotten to understand the patient’s
condition from more than a nutrition standpoint. To
really understand more of what the patient is going
through as a whole person.” - Dietitian
“What I feel truly sets this clinic apart is the
ability to directly observe professionals from
other health disciplines as they interact with the
patient. It gives you insight into the role of
other disciplines that you simply cannot get any
other way and and makes the clinic discussion
much more dynamic.” - PGY3 Internal Medicine
Patients :
 feel cared for and heard, given time to actually surface
what is important
 Co-develop care plans that focus on what is achievable
given very diverse and complicated treatment burdens
Family caregivers:
 feel supported
 able to give voice to their stress
 feel empowered to continue to deal with difficult and
complex situations
Health Care Providers:
 experience true inter-professional learning,
 Are able to crowd-source solutions to complex problems
 Reduce stress/burnout through group support and validation
that creates a “way forward” with complex patients
 increase their willingness to care for a challenging patient
population
 Find patients are easier to manage in subsequent primary
care visits
It’s do-able!
It’s presentable: From Local to International
Everybody likes it
It disseminates: Now in 4 LHIN’s
It’s adaptable: TIP (Telehealth IMPACT Plus)

Funding model; works for FHTs

PCP “Chagrin Factor”

Team skills

Extending to solo HCPs

Type III Error (
error):
“Necessary but not sufficient”

The IMPACT+ team gratefully acknowledges:
 Our patients and their families
 Our colleagues
 Our funding partners