Optimal geographic placement of integrated community health services centres: with a focus on health equity and sustainability

Ontario's long-standing surgery wait-times issue has worsened during the COVID-19 pandemic. Establishing Integrated Community Health Services Centres (ICHSCs), which are stand-alone facilities that provide publicly funded, low-complexity day surgeries, may be a viable mitigation strategy that will alleviate pressures on the hospital and shorten surgical wait times. Recent legislation passing in Ontario (Bill 60) has demonstrated an appetite to pursue ICHSCs, but to our best knowledge, there is a gap in knowledge regarding where to place such facilities, how to structure them and their impact on patients, Canadian healthcare, and the environment. We will study these gaps using existing datasets from Ontario with a national stakeholder engagement. This study brings together seasoned healthcare leaders, physicians, patients, and other stakeholders to comprehensively assess the potential creation of ICHSCs in Ontario and nationally. Statistical analyses will be performed related to three aims: 1) identify the optimal locations for new ICHSCs; 2) measure impacts of ICHSCs on surgical care delivery (e.g., reducing wait times), population health (e.g., reducing mortality), and health equity for marginalized populations (e.g., recent immigrants and rural residents); and 3) quantify the environmental impact of ICHSCs in terms of organizational lifetime carbon footprint. We will engage national stakeholders throughout the study to devise policy recommendations that could aid ICHSC planning in Ontario and contribute to a general evaluation/decision-making framework for other jurisdictions. Findings of this study will provide actionable insights to inform patient-centred ICHSC planning that is also equitable and sustainable, to advance the well-being of the general population and those who have been historically underserved, in Ontario and beyond.