Towards Value in an Integrated Care Environment: Early Lessons from an Ontario Health Team.

Integrated healthcare models are being experimented with in many jurisdictions as a way to improve patient care and lower system costs. This commentary presents early lessons from one Ontario Health Team as it works towards new models of care. The authors recount early discussions on developing an integrated health services network, how funding for "winter surge initiatives" became an opportunity to test ideas and how these experiences are informing current planning. Some of the early lessons learned include the value of trusted relationships, moving care upstream and framing problems as collective challenges.

A population-based approach to integrated healthcare delivery: a scoping review of clinical care and public health collaboration.

BACKGROUND: A population-based approach to healthcare goes beyond the traditional biomedical model and addresses the importance of cross-sectoral collaboration in promoting health of communities. By establishing partnerships across primary care (PC) and public health (PH) sectors in particular, healthcare organizations can address local health needs of populations and improve health outcomes. The purpose of this study was to map a series of interventions from the empirical literature that facilitate PC-PH collaboration and develop a resource for healthcare organizations to self-evaluate their clinical practices and identify opportunities for collaboration with PH. METHODS: A scoping review was designed and studies from relevant peer-reviewed literature and reports between 1990 and 2017 were included if they met the following criteria: empirical study methodology (quantitative, qualitative, or mixed methods), based in US, Canada, Western Europe, Australia or New Zealand, describing an intervention involving PC-PH collaboration, and reporting on structures, processes, outcomes or markers of a PC-PH collaboration intervention. RESULTS: Out of 2962 reviewed articles, 45 studies with interventions leading to collaboration were classified into the following four synergy groups developed by Lasker's Committee on Medicine and Public Health: Coordinating healthcare services (n = 13); Applying a population perspective to clinical practice (n = 21); Identifying and addressing community health problems (n = 19), and Strengthening health promotion and health protection (n = 21). Furthermore, select empirical examples of interventions and their key features were highlighted to illustrate various approaches to implementing collaboration interventions in the field. CONCLUSIONS: The findings of our review can be utilized by a range of organizations in healthcare settings across the included countries. Furthermore, we developed a self-evaluation tool that can serve as a resource for clinical practices to identify opportunities for cross-sectoral collaboration and develop a range of interventions to address unmet health needs in communities; however, the generalizability of the findings depends on the evaluations conducted in individual studies in our review. From a health equity perspective, our findings also highlight interventions from the empirical literature that address inequities in care by targeting underserved, high-risk populations groups. Further research is needed to develop outcome measures for successful collaboration and determine which interventions are sustainable in the long term.

Charge-separation in uranium diazomethane complexes leading to C-H activation and chemical transformation.

The reaction of diphenyldiazomethane with [((t-BuArO)3tacn)UIII] (1) results in an eta(2)-bound diphenyldiazomethane uranium complex. This complex exhibits unusual electronic properties as a charge-separated species with a radical anionic open-shell ligand, [((t-BuArO)3tacn)UIV(eta2-NNCPh2)] (2). Treating Ph2CN2 with a uranium complex that contains a sterically more demanding adamantane functionalized ligand, [((AdArO)3tacn)UIII] (3) results in an unprecedented C-H activation and nitrogen insertion to produce a five-membered heterocyclic indazole complex, [((AdArO)3tacn)UIV(eta(2)-3-phen(Ind))] (5). X-ray crystallography and spectroscopic characterization of these two compounds show that the [((t-BuArO)3tacn)UIV(eta(2)-NNCPh2)] compound is a U(IV) complex with a radical anionic ligand, whereas [((AdArO)3tacn)UIV(eta(2)-3-phen(Ind))] is a U(IV) f (2) species with a closed-shell ligand.