Literature Collection

BACKGROUND: Health-system leaders are increasingly faced with making decisions about whether and how to use a wide range of current and emerging health-system innovations to address complex system and policy challenges. Health-system innovations can broadly include new ways of doing things at a system level, such as new approaches to govern health systems, care delivery, funding models, health policy or better ways to integrate health and social services. However, Canada has historically struggled with the adaptation and uptake of health-system innovations. This multicomponent study aimed to explore the challenges, approaches and implementation considerations for creating an integrated innovation system that enables the adaptation and uptake of health-system innovations from the perspectives of citizens and health system leaders in Canada. METHODS: We synthesized the best-available evidence into an evidence brief and a subsequent plain-language version (a citizen brief) in consultation with a steering committee and key informants, including policymakers, leaders of systems, organizations and professional organizations, industry representatives, citizen leaders and researchers. These briefs informed deliberations in four citizen panels (n = 48 participants) and a national stakeholder dialogue with health-system leaders (n = 23 participants) to identify key challenges, approaches, implementation considerations and next steps that could be taken. RESULTS: Citizen panel participants and health-system leaders highlighted barriers such as culture and mindsets that resist health-system innovations, limited targeted funding for health-system innovations and processes that encourage sustainability, lack of mechanisms to adapt health-system innovation in local contexts and limited health human resources due to competing interests across health systems. Both groups emphasized the need for people-centred approaches to establish shared goals and vision, identify gaps and map what has worked to drive health-system innovations, set priorities and discuss how each stakeholder group can contribute to building and reviewing implementation considerations such as resources and funding related for the adaptation and uptake of health-system innovations. CONCLUSIONS: The findings provide insight for ongoing efforts to improve the development, implementation and evaluation efforts to enhance and harness health-system innovation to strengthen health systems in Canada. Collaboration from within and between governments and sectors will ultimately help to increase the value gained from health-system innovations.

INTRODUCTION: Many adults involved in the criminal justice system have various healthcare needs. The Veterans Health Administration (VHA) operates programs to connect criminal justice-involved veterans to healthcare, including primary care. This study examined veterans in the Veterans Justice Programs (VJP) to understand which veterans are not empaneled in VA primary care and their associated characteristics and service use. METHODS: A retrospective cohort study was conducted with 20 395 veterans who participated in VJP in 2023. Data on sociodemographic characteristics, clinical status, primary care empanelment, and service utilization from VHA medical records were analyzed. RESULTS: Across the country, about 88% of veterans in VJP were empaneled in primary care who attended a mean of 3.63 (SD = 4.63) primary care visits over 12 months compared to a mean of 0.18 (SD = 0.54) primary care visits among veterans not empaneled. Bivariate analyses found that empaneled veterans in VJP were significantly less likely to have any mental health or substance use disorder than non-empaneled veterans. However, multivariable analyses revealed the characteristics most strongly and significantly associated with empanelment in primary care among VJP veterans were use of outpatient medical care (aOR = 16.53, 95% CI = 9.32-31.43), use of outpatient mental health/substance use treatment (aOR = 1.83, 95% CI = 1.27-2.70), military sexual trauma (aOR = 1.66, 95% CI = 1.35-2.06), and being non-Hispanic black (aOR = 1.61, 95% CI = 1.35-1.96 compared to Hispanic black or white). CONCLUSIONS: Empanelment in primary care is associated with use of behavioral healthcare among criminal justice-involved veterans indicating opportunities for integrated care initiatives in VHA facilities.