Literature Collection

BACKGROUND: Health care is fragmented, stigmatizing, and often does not meet the needs of people living with HIV who present to care with significant complexity. Integrated care is an evidence-based solution, but rarely is enacted across hospital and community settings. Education for community workers that builds capacity toward integrated care is an essential missing piece. METHODS: Here we describe a qualitative study of the ECHO HIV Psychiatry, a virtual educational series that supports a community of practice of community workers in the HIV sector in Toronto, Canada. The educational series is 9 sessions long and occurs twice/year, reporting here on 4 cycles of the series, from April 2023 to December 2024. Utilizing participant interviews (n = 29) and ethnographic observation of education sessions, we conducted an abductive analysis, utilizing concepts of adaptive expertise and Knowledge Building Communities (KBCs) to better understand our participant narratives. Adaptive expertise is a theoretical framework in health professions education that describes capabilities that support healthcare workers to navigate complexity in modern healthcare. KBCs in healthcare leverage collaboration and diverse perspectives to support the generation of new solutions. RESULTS: Participants' main learning from the ECHO was an approach to caring for clients with significant complexity (including mental health concerns), and the learning mechanisms which supported this include: (1) Explicit value placed on diverse domains of knowledge created psychological safety for risk taking; (2) Perspective exchange with people in different roles facilitated confidence for community workers, as well as epistemic humility (humility about what is known or knowable); and (3) Learning in the ECHO led to new knowledge creation through collaboration and improvisation. CONCLUSIONS: Results of this study demonstrate how education can support community workers with an approach to complexity, and that this kind of learning may empower community workers to expand the scope of their role, collaborate across hospital and community, and create new solutions to difficult-to-solve problems in health care. These are features of a Knowledge Building Community.

To make good decisions, health leaders need information about their communities and the health workforce available to meet their needs. Raw data and indicators of population needs and workforce capacity must be transformed into usable intelligence that can support decision-making. Using the case study of integrated primary care workforce planning in Toronto, we outline our workforce planning framework, and with a focus on workforce analysis, describe the inputs and outputs that are needed for planning, key steps in the conversion of data to intelligence, and the impact of the approach. Raw data flow from data partners through a planning model into a six-step workforce analysis that renders the results of data analysis, modelling, synthesis and visualization relevant, and accessible to planners and decision-makers. We highlight important challenges and considerations related to data standardization, comprehensiveness, granularity, accessibility, and timeliness, and envision a system that more effectively supports workforce planning and decision-making.

Hazardous alcohol use remains a major contributor to acute and chronic liver disease, while alcohol-associated liver disease (ALD) is a leading indication for liver transplantation. In recent years, embedded, interprofessional ALD clinics have improved access to alcohol use disorder care within hepatology and liver transplantation, but more work is needed to meet this challenge. The literature is lacking regarding scaling procedures to provide services for increasingly large ill patient populations. This article begins to fill this gap by describing "expanded ALD care": broad, innovative, longitudinal, interprofessional care delivery strategies surpassing standalone clinics. Drawing from analogous patient populations served by collaborative models in primary care and comprehensive eating disorder treatment, the expanded ALD care framework proposes practical strategies toward specific innovations: equipoise between biomedical and psychosocial care elements, increased clinician number and reach, long-term patient relationships, harm reduction and palliative care, outreach to external agencies and clinicians, and enhanced support for patients and families. The article also defines attributes of innovative healthcare systems that support expanded ALD care.