An integrated community-based approach to caring for people living with heart failure has taken on a central role in optimizing health outcomes and healthcare resources in Ontario.
The Complex Optimization and Community Hub (COACH) program is a collaboration between Boehringer Ingelheim Canada and the SPACE Clinic, St. Michaels’ Hospital and Cardio Pulmonary Services Kitchener Waterloo. The unique approach focuses on expanding and optimizing accessible services to people living with heart failure by collaborating with community-based cardiology clinics across Ontario, to create a web of care that embraces people living with heart failure on their journey towards better health.
The initiative aligns with the objectives of Ontario Health by integrating hospital discharge processes and specialist referrals with the broader community healthcare system. Through guideline-directed medical therapy and enhanced support by allied healthcare professionals, it aims to enhance transitions between community and hospital care, optimizing patient flow within clinics and reducing re- hospitalizations. COACH sites are providing much needed intensive management for people living with heart failure when hospital-based heart function clinics are at capacity. COACH addresses the unique needs of people living with heart failure while providing community-based care close to home.
COACH is already yielding promising results at several site locations across Ontario, where patients have experienced enhanced care and outcomes, and reduced re-hospitalizations.
These results showcase the power of innovative co-designed partnerships and set the stage for a future where comprehensive support becomes the norm for people living with cardiovascular conditions. Learn more about our collaboration.