Planned Health Links for Scarborough – Renate Crizzle


The planned changes in the way health care is delivered in Ontario are moving forward.  Part of the plan is to integrate services provided by the various types of health organizations.  There are presently three integration strategies being pursued by the Central East Local Health Integration Network (CE LHIN) to which Scarborough belongs: (1) Hospitals and Community Health Services Integration, (2) Small Rural Northern Hospital Transformation, and (3) Creation of Health Links.  So, what exactly is a Health Link?


Health Links are a new model of care planning and care delivery at the clinical level where all health service providers in a community, including primary care, hospitals, Long Term Care and community care are working together to best treat the patient.  Participation in Health Links is voluntary on the part of providers. The onus is for the providers to collaborate and develop co-ordinated care plans for the patient at lower cost by preventing unnecessary visits to Emergency Departments or extended hospital stays.  Primary care involvement is mandatory, and one of the providers will act as the co-ordinator of the Link.  The Link will have Information sharing systems among its providers.  The Health Links will report to their LHIN.   The initial focus will be on patients with high needs, for instance a person with severe heart failure and chronic obstructive pulmonary disease who has early dementia.  Health Links support the LHIN’s goal of Community First.


Factors determining Health Links include: (1) Patterns of referral between primary health care to specialist care (based on data developed by the Institute for Clinical Evaluation Sciences). (2) Simplicity of administration, i.e. creation of the fewest possible Health Links to enable effective collaboration and integration. (3) Manageable size to ensure physician engagement and relevance.  (4) Standardization and efficiency without the creation of unmanageable geographic and complex networks.


The CE LHIN has divided Scarborough into two areas for the purpose of establishing Health Links: (1) Scarborough South and (2) Scarborough North.  Here is some interesting information provided by the LHIN.


Scarborough South Health Link

Total Population                                               451,045

Emergency Dept. visits per 1,000 population       419.6

Admissions per 1,000 population                         50.1

# of Primary Care Physicians per 1,000 pop.        0.4

High Users                                                        4750

Total Inpatient (acute) High Users                       1197

Total Ambulatory (ED) High Users                        3894

Admissions                                                        57.0%

Emergency Department                                      62.3%


LHIN funded Health Service Providers (Not Exclusive)   

The Scarborough Hospital – General

Centenary (RVHS)

Central East CCAC

Pinewood & Destiny Manor Addictions (Lakeridge Health)

Yee Hong Centre for Geriatric Care

Carefirst Seniors & Com. Serv. Assoc.

Momiji Health Care Society

TAIBU Community Health Centre

TransCare Community Support Services

Scarborough Centre for Healthy Communities

St. Paul’s L’Amoreaux Centre


Potential Primary Health Care Partners

(FHG = Family Health Group, FHO = Family Health Organization)

Scarborough Medical FHO

Neilson (FHO)

Rouge Valley FHO

Surrey FHG

East GTA (FHG)

East GTA Sixth FHO

One-Stop Medical Centre FHG

22 other FHG/FHO’s


Scarborough North Health Link


Total Population                                                 176,772

Emergency Dept. visits per 1,000 population         327.5

Admissions per 1,000 population                           45.0

# of Primary Care Physicians per 1,000 pop.          0.7

High Users                                                         1852

Total Inpatient (acute) High Users                         468

Total Ambulatory (ED) High Users                         1209

Admissions                                                         36.6%

Emergency Department                                       31.0%


LHIN funded Health Service Providers (Not Exclusive)

The Scarborough Hospital Birchmount

Central East CCAC

Pinewood & Destiny Manor Addictions

Scarb. Centre for Healthy Communities

Yee Hong Centre for Geriatric Care

Hong Fook

Carefirst Seniors & Comm. Serv. Assoc.

St. Paul’s L’Amoreaux Centre

TransCare Comm. Support Serv.

Momiji Health Care Society


Potential Primary Health Care Partners

North East Scarborough FHO

Bridlewood Medical Clinic FHG

Comprehensive Care Group

East GTA First FHO


Scarborough FHO

Agincourt FHG

14 other FHG/FHO/s


In summary, a Health Link is an integrated model of care that focuses on the chronic needs of the complex patient population.  Working in partnership with patients, care givers, primary care providers and specialists, a Health Link tries to shift the care of these chronic conditions into the community rather than to hospitals.  Patients in a Health Link should encounter higher co-ordination and self-direction in their care.


Your local CARP chapter will keep their eyes on future developments in the integration process.  If you have any particular concerns, please forward them to [email protected].