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Maturity model for integrated primary care in Toronto, Canada


Jocelyn Charles ,

Toronto Central Local Health Integration Network; Sunnybrook Health Sciences Centre; University of Toronto, CA
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Marsha Barnes,

Toronto Central Local Health Integration Network, CA
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Pauline Pariser

Toronto Central Local Health Integration Network; University of Toronto; University Health Network, CA
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Primary care delivery in Ontario is characterized by largely unorganized independent physician groups who provide care to a roster of patients under a variety of contracts and payment mechanisms with the province and local health integration authorities.   Toronto has the greatest population diversity and one of the least organized primary care delivery structures in Ontario.

Over the past several years, the Toronto Central Local Health Integration Network (LHIN) has been working with a committed group of family physician champions to develop a strategy and co-design a local implementation plan to improve timely access and increase integration of primary care with hospital and community care within its five subregions.

After extensive consultations and significant investment in improvement initiatives, the primary care strategy, now in its third year, was in need of a structured framework to articulate in concrete, measurable terms the implementation of the shared vision, goals and objectives.   To do this it partnered with the Centre for Urban Health Studies in Toronto to develop a maturity model that builds on the Ontario College of Family Physicians’ Patient Medical Home (PMH). A consensus building approach was used with a facilitated group session of 25 primary care, hospital, and community care leads. This was followed by iterative feedback on the model by primary care experts. The model provides a road map that can be used to measure progress across seven key elements and five maturity levels.

The maturity model is intended for wide application and use.  It’s main audiences are  the local primary care clinical leads to ensure consistency and shared understanding of the future vision and foundational elements to achieve it across the diverse neighbourhoods of Toronto; the LHIN to allow for alignment across a number of inter-related strategies and to measure progress; and sub-region  health service providers to bring the vision to life through a clear roadmap and allow for mapping against provincial association strategies (e.g. PMH).

The model has seven elements (1. Primary Care Attachment; 2. Primary Care Access;  3.  Continuity of Care; 4.  High Performing and Integrated Interprofessional Teams; 5.  Cross Sectoral Governance and Shared Accountability; 6.  Primary Care Communication and Information Management; and 7.  Primary Care Leadership and Engagement) that must be included in sub-region planning and organization initiatives.  Within each of these elements there are 5 levels of maturity.   The elements have been drafted to enable easy understanding by providers in the field and with sufficient clarity to allow consistent measurement.

The maturity model encompasses the key elements of a well organized primary care system and articulates characteristics that are necessary to enhance both integration with the broader health care system and improve access and care to the population.

How to Cite: Charles J, Barnes M, Pariser P. Maturity model for integrated primary care in Toronto, Canada. International Journal of Integrated Care. 2019;19(4):46. DOI:
Published on 08 Aug 2019.


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