Lessons learned from implementing a surge capacity support program for COVID-19 contact management in Ontario.

SETTING: In Ontario, local public health units (PHUs) are responsible for leading case investigations, contact tracing, and follow-up. The workforce capacity and operational requirements needed to maintain this public health strategy during the COVID-19 pandemic were unprecedented. INTERVENTION: Public Health Ontario's Contact Tracing Initiative (CTI) was established to provide a centralized workforce. This program was unique in leveraging existing human resources from federal and provincial government agencies and its targeted focus on initial and follow-up phone calls to high-risk close contacts of COVID-19 cases. By setting criteria for submissions to the program, standardizing scripts, and simplifying the data management process, the CTI was able to support a high volume of calls. OUTCOMES: During its 23 months of operation, the CTI was used by 33 of the 34 PHUs and supported over a million calls to high-risk close contacts. This initiative was able to meet its objectives while adapting to the changing dynamics of the pandemic and the implementation of a new COVID-19 provincial information system. Core strengths of the CTI were timeliness, volume, and efficient use of resources. The CTI was found to be useful for school exposures, providing support when public health measures were lifted, and in supporting PHU's reallocation of resources during the vaccine roll-out. IMPLICATIONS: When considering future use of this model, it is important to take note of the program strengths and limitations to ensure alignment with future needs for surge capacity support. Lessons learned from this initiative could provide practice-relevant knowledge for surge capacity planning.

RéSUMé: CONTEXTE: En Ontario, ce sont les bureaux de santé publique qui s'occupent des enquêtes de cas, de la recherche des contacts et des suivis. Pendant la pandémie de COVID-19, les besoins opérationnels et de capacité de la main-d'œuvre à combler pour conserver cette stratégie de santé publique ont atteint une ampleur jamais vue. INTERVENTION: L'Initiative de recherche des contacts dans le cadre de la lutte contre la COVID-19 de Santé publique Ontario a été mise sur pied dans l'objectif de centraliser l'effectif. Mobilisant des ressources humaines d'organisations fédérales et provinciales, ce programme a permis de faire les appels initiaux et de suivi aux contacts étroits de cas de COVID-19 exposés à un risque élevé. Grâce à des critères bien établis pour les soumissions au programme, à l'uniformisation des scripts et à la simplification du processus de gestion des données, un grand volume d'appels a pu être traité. RéSULTATS: Durant les 23 mois de l'Initiative, 33 des 34 bureaux de santé publique y ont eu recours. Ce sont ainsi plus d'un million d'appels à des contacts étroits qui ont pu être faits. L'Initiative a permis d'atteindre les objectifs en s'adaptant au contexte pandémique en constante évolution et de mettre en œuvre un nouveau système de gestion des renseignements provinciaux sur la COVID-19. Ses grandes forces sont la rapidité, le volume et l'efficacité de l'utilisation des ressources. Elle a été particulièrement utile dans les cas d'exposition en milieu scolaire, permettant d'offrir du soutien à la levée des mesures sanitaires et d'aider à la réaffectation des ressources des bureaux de santé publique pendant la campagne de vaccination. CONSéQUENCES: Si l'on envisage de réutiliser ce modèle, il importe de tenir compte des forces et des faiblesses du programme pour qu'il cadre avec les besoins futurs de soutien en matière de capacité de mobilisation. Les leçons tirées de cette initiative pourraient s'avérer pertinentes pour la planification de cette capacité.

Virtual learning collaboratives to improve urine culturing and antibiotic prescribing in long-term care: controlled before-and-after study.

BACKGROUND: Urine culturing practices are highly variable in long-term care and contribute to overprescribing of antibiotics for presumed urinary tract infections. The purpose of this study was to evaluate the use of virtual learning collaboratives to support long-term care homes in implementing a quality improvement programme focused on reducing unnecessary urine culturing and antibiotic overprescribing. METHODS: Over a 4-month period (May 2018-August 2018), 45 long-term care homes were self-selected from five regions to participate in virtual learning collaborative sessions, which provided an orientation to a quality improvement programme and guidance for implementation. A process evaluation complemented the use of a controlled before-and-after study with a propensity score matched control group (n=127) and a difference-in-difference analysis. Primary outcomes included rates of urine cultures performed and urinary antibiotic prescriptions. Secondary outcomes included rates of emergency department visits, hospital admission and mortality. An 18-month baseline period was compared with a 16-month postimplementation period with the use of administrative data sources. RESULTS: Rates of urine culturing and urinary antibiotic prescriptions per 1000 resident days decreased significantly more among long-term care homes that participated in learning collaboratives compared with matched controls (differential reductions of 19% and 13%, respectively, p<0.0001). There was no statistically significant changes to rates of emergency department visits, hospital admissions or mortality. These outcomes were observed with moderate adherence to the programme model. CONCLUSIONS: Rates of urine culturing and urinary antibiotic prescriptions declined among long-term care homes that participated in a virtual learning collaborative to support implementation of a quality improvement programme. The results of this study have refined a model to scale this programme in long-term care.