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Integration of Care SHIFE Project Report

SHIFE Project Executive Summary

Background: Many homeless men remain on the street or in shelters due to lack of coordination between health and shelter care resulting in a revolving door cycle between shelter, hospital and street. The Seaton House Street to Community Shelter-Hospital Integration, Fusion and Evaluation (SHIFE) Project aims to break this cycle through improved coordination and integration of shelter and hospital harm reduction, infirmary, community care referral, discharge planning, and continuity of care programs between the Seaton House (SH) homeless men’s shelter and St Michael's Hospital (SMH) in Toronto. The project was initially planned to run from October 2002 to September 2003, but was extended to March 31, 2004 due to the impact of Sudden Acute Respiratory Syndrome or SARS. The project continues through sustainability activities carried on at SH and SMH.

Methods: The project was comprised of four smaller projects. The SHIFE Project Report Parts 2 - 6 are the detailed reports for the sub-projects. The Infirmary Evaluation Project was comprised of three smaller projects: two of the projects used survey methodology to evaluate family medicine resident and client satisfaction with their experiences in the Rotary Club of Toronto Infirmary (RCTI) (Report Parts 2 and 3 respectively); the third project was a chart review that examined various indicators of care provision in the RCTI (Report Part 4). The Intake and Triage Planning Project (Report Part 5) used qualitative methods to develop self-sustaining intake and triage protocols for SH that will ensure timely assessment of all clients and referral to specialized Seaton House programs that can best care for them. The Primary Care Referral Program Development Project (Report Part 6) used program development methods to create a program designed to make primary care appointments for clients who would benefit from accessing primary care in the community. The prototype program has been implemented and is part of a rigorous Randomized Controlled Trial (RCT). Finally, the SH-SMH Integration Development and Awareness Project (Report Part 7) used qualitative methods to develop processes, guidelines, forms and an information pathway to strengthen communication and care coordination for patients moving between SH and SMH.

Results: The key project outcome associated with each SHIFE sub-project is described here. First, information from the Infirmary Evaluation Projects has been and will continue to be used to improve client care and trainee experiences in the RCTI. Second, a self-sustaining health status intake program is now in place at SH and all clients admitted to the facility (5000/year) are processed through this intake and then triaged; a more in-depth evaluation is conducted for men who are still homeless three months after the initial intake. Third, a self-sustaining database of primary care physicians has been developed and is being used to refer clients to physicians in the community; more than 160 of the targeted 300 men have been enrolled in the RCT. Finally, a SH Client Service Worker now works at SMH in a new liaison position, an Integration Steering Committee has been developed, and multiple processes and procedures are now in place to improve the flow of people and information between SH and SMH.

Conclusions: The SHIFE project has been successful in meeting objectives for all projects. Organizational change, planned program evaluations and additional strategies targeted at making program changes self-sustaining will ensure that positive outcomes resulting from the SHIFE project remain after the project has ended. Anecdotal information from staff and clients at SH and other agencies suggest that the changes made and being made as a result of this project are positively impacting homeless men in Toronto.

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