OSSU Research Centres and Initiatives



OSSU’s 14 Research Centres and 8 Research Initiatives offer world leading expertise in data access, methodological and research services, knowledge translation, clinical trials, capacity building and more. These organizations work together, and in concert with the Coordinating Centre, to provide Ontario’s health system stakeholders with the infrastructure, scientific knowledge and technical support needed to conduct patient-oriented research, and to inform and implement more effective health policy and clinical practices throughout the province.

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Research Centres

ossu-logo-01ahrcThe Applied Health Research Centre (AHRC) is an Academic Research Organization (ARO) at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital in Toronto, with expertise in clinical study design, pragmatic methodology, and biostatistics. The AHRC has experience managing more than 100 multi-site, national and international clinical trials, observational studies, and qualitative studies. The AHRC employs industry-leading web-based secure database technology, which incorporates advanced data validation and reporting tools. Through its service model, the AHRC is one of the only research organizations to offer a comprehensive services package – a true one-stop-shop for patient-oriented clinical research. The AHRC is committed to providing our partners with efficient and innovative strategies for clinical research that inform patient care and policy decisions. As a result of this approach, the AHRC has grown to be one of the largest academic research organizations in Canada.

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The Centre for Rural and Northern Health Research (CRaNHR) is an academic and applied health research centre at Laurentian University, Sudbury, Ontario. CRaNHR’s mandate is to conduct interdisciplinary research on rural health, with a focus on Indigenous and Francophone populations, to improve health services and access to health care in rural and northern communities and enhance understanding of the health care system.

CRaNHR supports health equity for rural and northern Ontarians through engagement that is responsive to the sex, gender, nationality, and cultural-linguistic diversity of local stakeholders and through collaboration with diverse local, regional, and international partners.

The Centre’s staff actively engage in capacity-building to develop new researchers, orient institutions to rural and northern contexts, promote data access and use, and support vulnerable populations in all consultation and research activities. The Centre also acts as one of the Leads for the Early Career Researcher Initiative.

CRaNHR provides timely, in-depth research and evaluation findings to participants, funders, and community stakeholders. The Centre employs multiple knowledge mobilization techniques that are responsive to specific needs of knowledge users and serve to facilitate the multi-directional flow of information among all partners. For instance, CRaNHR’s Research in FOCUS on Research series provides a 4-page reader-friendly bulletin to facilitate broad dissemination.

Patient-oriented studies, interventions, and knowledge mobilization activities are consistent with CRaNHR’s role as an academic and applied research centre. CRaNHR supports OSSU’s Francophone Initiative and leads support for the Métis and Inuit-Indigenous Initiative.

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Clinical Trials Ontario

Clinical Trials Ontario is a leading organization in the clinical trials community dedicated to strengthening, promoting, and capitalizing on Ontario’s competitive advantages for conducting high-quality clinical trials. We work collaboratively with industry, research institutes, patients and the public and other health innovation organizations to improve the clinical trials environment and attract investment to the province, while supporting the highest ethical and quality standards.

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Health System Performance Research Network

The Health System Performance Research Network (HSPRN) is a multi-university and multi-institutional network of Ontario researchers. We work closely with policy and provider decision makers, to find ways to improve management of the health system. Our network includes investigators, trainees and project staff. HSPRN researchers develop high quality evidence that is relevant to health system policy development and decision making for performance excellence. Our research focuses on specific target populations and related health system policy themes.

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Institute for Clinical Evaluative Sciences

As an OSSU research centre, ICES provides researchers, students and knowledge users with access to the largest and most comprehensive collection of health-related data in Ontario through ICES Data & Analytic Services (ICES DAS).

ICES DAS offers several types of services to researchers who receive funding from the public sector such as secure online access to research-ready, linked health administrative and clinical data, analytic tools including high-performance computing, and subject matter experts.

Public sector researchers are considered to be any of the following:

  • Researchers and students affiliated with a university, college, hospital or other institutions
  • Publicly-funded, not-for-profit health care agencies and research organizations
  • Policy makers
  • Other publicly funded knowledge users who require data or analytic services to support the development of evidence-informed policies and practices.  Services are also available for private sector researchers.

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INSPIRE – Primary Health Care OSSU

INSPIRE – Primary Health Care focuses on Primary Health Care (PHC) research, assisting Ontario researchers with primary health care-data platform access, specific research consultation, funding, stakeholder engagement, knowledge translation and exchange (KTE), capacity building opportunities and activities, and patient engagement resources.

INSPIRE-PHC provides:

  • consultations to all Ontario researchers and knowledge users on primary health care specific research methodology/processes;
  • capacity building courses and other opportunities for the next generation of primary health care researchers;
  • a Patient Engagement Resource Centre; and,
  • knowledge translation and exchange opportunities, events and research.

The program can offer: ideas for primary health care collaborators on research projects; knowledge translation and exchange and patient engagement expertise and advice; and, dissemination of information to a larger network of interdisciplinary primary health care related researchers and decision makers.

This Primary Health Care research resource is composed of a Pan-Ontario team of researchers working with a broader network of decision makers, trainees and researchers.

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The Knowledge Translation Program

The Knowledge Translation Program (KTP) works with researchers to develop a strategy to put knowledge into practice at both the clinical and policy levels. Our vision is to ensure high quality evidence reaches patients, health care providers and other decision-makers using effective strategies to improve quality of care. By focusing on the processes through which knowledge is effectively translated into changed decision making and using an equity-focused and inclusive approach, we play a critical role in improving patient care and strengthening the health system.

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McMaster Collaborative for Health & AgingThe McMaster Collaborative for Health and Aging is a coalition of researchers, trainees, and older adults and caregivers working together to improve the health and well-being of older Canadians by advancing patient-oriented health research on aging.  The Collaborative provides consultation and support, promotes training and mentorship, and facilitates partnerships and knowledge translation within three key areas: Science of engagement with older adults; Complex health interventions for older adults and caregivers; and Access and use of secondary data for healthy aging.  Activities within these areas of focus include 1) development of resources and provision of research support services for the engagement of patients, caregivers and the public in health research in aging; 2) development of resources, online learning modules, and provision of research support services for the co-design, implementation, evaluation, scale-up and spread of integrated, complex older adult-centred health interventions; 3) development of resources and provision of guidance to support access and use of Canadian Longitudinal Study on Aging and ICES-linked data.

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McMaster Health Forum

The McMaster Health Forum’s goal is to generate action on the pressing health-system issues of our time, based on the best available research evidence and systematically elicited citizen values and stakeholder insights. We aim to strengthen health and social systems – locally, nationally, and internationally – and get the right programs, services and products to the people who need them. The Forum works through a number of networks to accelerate its impacts on health and social systems, which includes Rapid-Improvement Support and Exchange (RISE), through which it supports rapid learning and improvement among Ontario Health Teams (OHTs).

RISE has four program objectives:

  1. logo-riseSupport rapid learning and improvement among OHTs (through learning and improvement collaboratives as well as through a coaching initiative)
  2. Deliver ‘on demand’ (or facilitate the delivery of) a suite of activities and products for OHTs (e.g., RISE jamborees and RISE briefs)
  3. Share tools and resources with OHTs (through the website, e-newsletter, webinars, Twitter, etc.)
  4. Support the province’s COVID-19 response (by preparing rapid evidence profiles and contributing to key COVID-END initiatives such as its guide to key COVID-19 evidence sources, horizon-scanning panel, and inventory of ‘best evidence syntheses).

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logo-ontariobraininstitute

The Ontario Brain Institute (OBI) is a not-for-profit institution that reflects the commitment of the government and people of Ontario to be a world leader in brain health. A different kind of Institute, we are pioneering an open-source, “team science” approach. OBI integrates the will, knowledge and resources that creates new connections across research, commercialization and care.

Supports we can provide:

  • Patient engagement in research;
  • Knowledge translation, exchange and implementation;
  • Data platforms: Data storage, management and curation; and,
  • Capacity building and career development: Internships and entrepreneurship support

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Ontario Child Health SUPPORT Unit

The Ontario Child Health SUPPORT Unit (OCHSU) – led by The Hospital for Sick Children (SickKids) and the Children’s Hospital of Eastern Ontario (CHEO) – provides methodological support to researchers to enhance the quality of and to build capacity in patient-oriented research in child health research across Ontario.

OCHSU support includes:

  • Methodological Support Services:
    • Health Economics, Clinical Research Design and Analysis.
  • Using Data for Real World Clinical Research
    • eMR Data Platforms: EPIC integration and Research Data Warehouse
    • Inventory of Child Health Datasets (N>100)
    • Clinical Research Data Management:
      • REDCap Instance Support
      • Project Support – database development, data set organization & cleaning, Case Report Form development, data formatting and coding).
  • Patient and Family Engagement in Child Health Research:
    • Raising Awareness of Patient-Oriented Research in Child Health via seminars and webinars
    • Training in Patient-Oriented Research in Child Health via the PORCCH Curriculum:
      • Research 101 (parts 1 and 2) developed for patients and families
      • Patient Engagement 101 (parts 1 and 2) developed for researchers
    • Consultation on Patient and Family Engagement – incorporation of the patient and family perspective in child health research via grant review, document review, and matching patient partners with researchers
    • Leadership in Patient-Oriented Research in Child Health:
      • Family Leader Coordinator (Research) – CHEO
      • Patient & Family Engagement Coordinator (Research) – SickKids
      • Family Leader Program
      • Family Advisory Networks

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Ontario Drug Policy Research Network

The Ontario Drug Policy Research Network (ODPRN) is a network of researchers and drug policy-makers across Ontario that aims to respond rapidly to the need for high-quality, timely, relevant and scientifically rigorous research to support drug policy decisions. The network’s core mandates are to generate scientifically sound evidence related to real-world drug utilization, safety, effectiveness, and costs of drugs in Ontario, and to develop partnerships for cross-provincial comparisons of drug safety and utilization. The ODPRN also aims to focus its research agenda on priority areas identified by patients and the general public through meaningful engagement, consultation, collaboration, and integration of patients and citizens throughout its entire research process.

Description of services:

  • Generate rapid research evidence for drug policy-makers and other knowledge users to inform and evaluate drug policy-related decisions.
  • Support engagement with individuals with lived experience, a Citizen’s Panel, and external drug policy stakeholders to facilitate integration of varied perspectives and feedback into research.
  • Develop knowledge translation tools (e.g., research summariesinfographics, interactive dashboards and maps) to communicate findings to relevant stakeholders (including patients, policy-makers and clinicians).
  • Provide training for students and patients interested in drug policy and drug safety research.

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ottawamethodscentre

The Ottawa Methods Centre (OMC), a sub-unit of the Ottawa Hospital Research Institute, provides expert methods consultation to researchers, decision-makers, and other key stakeholder across Ontario and who are engaged in patient-oriented research. We offer a range of services including providing nose-to-tail support from grant and protocol development, through study implementation, to data analysis and knowledge translation. We offer support for a range of patient-oriented research approaches including:  real world clinical trials, statistical consultation, data management and big data analytics, qualitative methods including consensus approaches, health economics, knowledge syntheses, and knowledge translation and evidence implementation. Our robust infrastructure of services includes a specific focus on patient engagement wherein we offer training, mentorship, and conduct specialized methods research.

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Women’s College Hospital: Women’s XchangeThe Sex and Gender+ Research Support Service is a research knowledge translation and capacity-building initiative within Women’s College Hospital that advances and supports the integration of an intersectional sex and gender lens (SGBA+) in health research in Ontario and beyond. Our aim is to aid principal investigators, patient partners and other team members, in considering how to effectively integrate sex, gender and other determinants of health in their studies – from the initial research question through knowledge translation and dissemination. We develop presentations and educational materials to enhance the quality of research studies through SGBA+, as well as publications for academic and general audiences. Study consultation and proposal review through a sex and gender lens are available on a cost-recovery basis.

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Research Initiatives

Understanding how to implement a new initiative can help increase the uptake, impact, and sustainability of your work. The Office of Spread and Scale (OSS), a multi-disciplinary team from the Women’s College Hospital in Toronto, can help. Our team provides coaching and consultation services to help you plan for sustainability, spread, and scale by incorporating principles of implementation science into project plans and grant proposals. We also have expertise in digital health, and can help you to consider sustainability, spread and scale within your digital health evaluations.

Our team holds expertise in:

  • implementation science
  • sustaining, spreading and scaling effective interventions
  • evaluation
  • health services research
  • health equity
  • digital health
  • dissemination
  • strategic communications
  • public policy

Guided by the values of collaboration, health equity, and evidence-informed decision-making, the OSS prioritizes patient-oriented research and application of practices likely to achieve impact.

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The Fairness is Excellence initiative can help ensure health research promotes equity or fairness. We can provide researchers with advice on how to conduct research that promotes health equity and how to ensure the research enterprise is itself equitable. We can help connect researchers with a supportive community centred advancing health equity through events and by facilitating collaborations. Our equity framework explains principles and practices for promoting equity in patient-oriented research, and the equity-related requirements for researchers working with the Ontario SPOR Support Unit.

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The First Nations Research and Data Management initiative (FNRDMI) is mandated by the Chiefs of Ontario (COO). COO is the political forum and secretariat for collective decision-making, action, and advocacy for the 133 First Nations communities located within the boundaries of the province of Ontario.  FNRDMI is dedicated to promoting First Nations’ health and wellbeing through meaningful research, strong data platforms, and adherence to the principles of OCAP®, which specifies First Nations Ownership, Control, Access and Possession of First Nations data and information.

The primary focus for the FNRDMI is capacity building, in a manner that strengthens First Nations patient oriented research efforts and aligns with national instruments such as: a)  the Royal Commission on Aboriginal People (RCAP) b) the United Nations Declaration on Indigenous People (UNDRIP); and c)initiatives such as the Truth and Reconciliation (TRC) recommendations. Capacity building in this regard necessitates recognizing and advancing patient-oriented research in the context of First Nations rights, issues specific to health equity, and data sovereignty.

FNRDMI seeks the evolvement of the First Nations health research agenda through community based input; expansion of alliances, collaborations, and partnership, and the strengthening of data platforms through exploration in data governance and relationship protocols

Selected Publications

  • Campbell, R. J., Sutherland, R., Khan, S., Doliszny, K. M., Hooper, P. L., Slater, M.,& Green, M. E. (2020). Diabetes-induced eye disease among First Nations people in Ontario: a longitudinal, population-based cohort study. CMAJ open8(2), E282.
  • Chu, A., Han, L., Roifman, I., Lee, DS., Green, ME., Jacklin, K., Walker, J., Sutherland, R., Khan, S., Frymire, E., Tu, J., Shah, B. (2019) Trends in cardiovascular care and event rates among First Nations and other people with diabetes in Ontario, Canada, 1996-2015. CMAJ, 191 (47): doi: https://doi.org/10.1503/cmaj.190899.
  • Kapral, M., Shah, B., Green, M,, Porter, J., Griffiths, R., Frymire, E., Slater, M., Jacklin, K., Sutherland, R. & Walker, J. (2020). Hospital admission for stroke or transient ischemic attack among First Nations people with diabetes in Ontario: a population-based cohort study. CMAJ open8(1), E156.
  • Shah, B. R., Slater, M., Frymire, E., Jacklin, K., Sutherland, R., Khan, Walker, J. & Green, M.. (2020). Use of the health care system by Ontario First Nations people with diabetes: a population-based study. CMAJ open8(2), E313.
  • Slater, M., Green, M. E., Shah, B., Khan, S., Jones, C. R., Sutherland, R., Jacklin, K., & Walker, J. D. (2019). First Nations people with diabetes in Ontario: methods for a longitudinal population-based cohort study. CMAJ open7(4), E680.
  • Slater, M., Jacklin, K., Sutherland, R., Jones, C., Blind, M., Warry, W., & Walker, J. (2020). Understanding aging, frailty, and resilience in Ontario First Nations. Canadian Journal on Aging/La Revue canadienne du vieillissement, 1-6.
  • Vélez, M. P., Slater, M., Griffiths, R., Shah, B. R., Sutherland, R., Jones, C, Jacklin, K., Walker, J. & Green, M.. (2020). Diabetes during pregnancy and perinatal outcomes among First Nations women in Ontario, 2002/03–2014/15: a population-based cohort study. CMAJ open8(1), E214.
  • Walker, J., Andrew, M., Bronskill, S.,  Smylie, J., Warry, W., Henry, D., Loft, D., Jones, C., Sutherland, R., Blind, M., Slater, M., Pitawanakwat, K., Mecredy, G.,&  Jacklin, K. (2019).  Ontario First Nations Aging Study: Overview and Report.
  • Walker, J., Lovett, R., Kukutai, T., Jones, C., & Henry, D. (2017). Indigenous health data and the path to healing. Lancet390(10107), 2022-2023.
  • Walker, J., Pyper, E., Jones, C., Khan, S., Chong, N., Legge, D., Schull, M., & Henry, D. (2018). Unlocking First Nations health information through data linkage. International Journal of Population Data Science3(1). Doi : https://doi.org/10.23889/ijpds.v3i1.450
  • Walker, J., Rowe, R., & Jones, C. (2018). Describing the process of ethical conduct of research in an Ontario-wide First Nations diabetes research project. CMAJ190(Suppl), S19-S20.
  • Walker, J., Slater, M., Jones, C., Shah, B., Frymire, E., Khan, S., Jacklin, K. & Green, M. E. (2020). Diabetes prevalence, incidence and mortality in First Nations and other people in Ontario, 1995–2014: a population-based study using linked administrative data. Cmaj192(6), E128-E135

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  • Cindy Owl, Knowledge Translator/Coordinator, (416) 597-1266

The Métis and Inuit-Indigenous Initiative is led by OSSU’s northern Research Centre, the Centre for Rural and Northern Health Research (CRaNHR). The Initiative supports the development of, and enhanced capacity for POR among Métis and Inuit stakeholders, communities and researchers. CRaNHR supports cross cutting POR needs that are sensitive to equity, diversity and inclusion, and Métis and Inuit-led visions for knowledge co-creation and translation.

The Initiative’s activities support: Indigenous-driven POR capacity building for Métis and Inuit stakeholders and trainees; enhanced capacity for Métis and Inuit-led research and information/data management; connections between Métis and Inuit stakeholders and other SPOR entities; Métis and Inuit-led components for a learning health system and patient partnership; and Métis and Inuit-Indigenous representation in OSSU’s governance structure.

CRaNHR acts as the coordinating point of contact for the Initiative, and guiding support efforts is explicit recognition of the inherent sovereignty of Indigenous communities with full right of self-governance and self-determination.

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To address the growing need for mental health and addictions patient-oriented research in Ontario, existing resources and expertise in Ontario has been organized into a network of supports culminating in a Mental Health and Addictions Research Initiative. This new initiative will provide infrastructure, expertise and support to people engaged in mental health and addictions patient-oriented research. It will work with existing resources within and outside the mental health and addictions sector to promote knowledge transfer and exchange of evidence generated by the OSSU-supported research. With the establishment of the Mental Health and Addictions Centre of Excellence, including its alignment with the Mental Health and Addictions Division within the Ministry of Health, there will be opportunities for the research supported by this new initiative to have a direct input into the development of mental health policy.

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Ontario Francophone Communities Research Initiative (OFCRI) is a representative consultative group of researchers and health planners from across the province.  The OFCRI can support the advancement and integration of Francophone communities in patient-oriented research (POR) by identifying challenges and priorities for Francophone health in Ontario. The Initiative provides support by linking researchers with relevant resources to integrate a Francophone component to their study, developing and disseminating research support tools, and consolidating evidence for informed decision making. The Initiative also seeks to expand collaboration among Francophone researchers in the province of Ontario and broaden Francophone POR across provinces/territories in Canada. Specifically, the OFCRI can:

  1. assist with incorporating and analysing data related to the needs of Francophone communities;
  2. facilitate incorporating Francophone patient representatives in all aspects of research projects;
  3. ensure research participation and findings are available to a wider audience;
  4. validate French training modules or frameworks and e) participate in the development of large-scale research projects.

The OFCRI is based at l’Institut du Savoir Montfort. For more information and French resources, please visit; https://savoirmontfort.ca/.(OFCRI specific page is forthcoming)

Selected Publications

  • Batista R, Prud’homme D, Rhodes E, Hsu A, Talarico R, Reaume M, Guérin E, Bouchard L, Desaulniers J, Manuel D, Tanuseputro P. Quality and Safety in Long-Term Care in Ontario: The Impact of Language Discordance. J Am Med Dir Assoc. 2021 Jan 9:S1525-8610(20)31056-2. doi: 10.1016/j.jamda.2020.12.007. Online ahead of print.
  • Riad K, Webber C, Batista R, Reaume M, Rhodes E, Knight B, Prud’homme D, Tanuseputro P. The impact of dementia and language on hospitalizations: a retrospective cohort of long-term care residents. BMC Geriatr. 2020 Oct 8;20(1):397. doi: 10.1186/s12877-020-01806-2.
  • Reaume M, Batista R, Talarico R, Rhodes E, Guerin E, Carson S, Prud’homme D, Tanuseputro P. The impact of hospital language on the rate of in-hospital harm. A retrospective cohort study of home care recipients in Ontario, Canada. BMC Health Services Research. 2020; 20: 340.
  • Reaume M, Batista R, Talarico R, Guerin E, Rhodes E, Carson S, Prud’homme D, Tanuseputro P. In-hospital patient harm across linguistic groups: A retrospective cohort study of home care recipients. J Patient Saf. 2020; Published Ahead of Print.
  • Sanou, B., Beaudoin, M., Gauthier, A.P., Chomienne, M-H., Prud’homme, D., & Kpazai, G. Processus de développement d’une trousse d’accompagnement pour l’examen médical des nouveaux arrivants francophones : un exemple de coopération. Diversity of Research in Health Journal. 2020; 3; 84-96.
  • Toal-Sullivan, D., Lemonde, M., Gauthier, A.P., Dahrouge, S. Theoretical and practical considerations for the adoption of a lay navigator training program in primary care. Health Educ J. 2020; https://doi.org/10.1177/0017896920959364.
  • Dahrouge, S., Gauthier, A.P., Chiocchio, F., Presseau, J., Kendall, C., Lemonde, M., Chomienne, M-H., Perna, A., Toal-Sullivan, D., Devlin, R.A., Timony, P., & Prud’homme, D. (2019). Access to resources in the community through navigation: A feasibility study protocol. JMIR Research Protocols. 8(1):e11022.
  • Dahrouge, S., James, K., Gauthier, A.P., Chiocchio, F. Engaging patients to improve equitable access to community resources. Can Med Assoc J. 2018; 190 (Suppl 1):S46-S47.
  • Guerin E, Batista R, Hsu AT, Gratton V, Chalifoux M, Prud’homme D, Tanuseputro P. Does end-of-life care differ for Anglophones and Francophones? A Retrospective Cohort Study of Decedents in Ontario, Canada. J Palliat Med. 2019; 22: 274-81.
  • Batista R, Prud’homme D, Hsu AT, Guérin E, Bouchard L, Rhodes E, Talarico R, Desaulniers J, Manuel D, Tanuseputro P. The health impact of living in a nursing home with a predominantly different spoken language. J Am Med Dir Assoc. 2019; 20: 1649-51.

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The Public and Patient Engagement Collaborative (PPEC) was established in 2011. Led by Dr. Julia Abelson of McMaster University, the PPEC’s research and service activities focus on the role of patients and publics in health system policy making and health research, with a specific focus on the evaluation of these efforts. The PPEC are leaders in the area of patient engagement evaluation. The Public and Patient Engagement Evaluation Tool (PPEET) developed by the PPEC has been used by health system organizations and research teams internationally to evaluate their patient engagement activities. The PEEC is currently developing a tool to evaluate the impact of patient engagement across the Ontario health system. The PPEC also continues to provide consultation and support to other research teams and health system groups who are implementing and evaluating their engagement activities. For Phase II of the OSSU, the PPEC will be supporting a Community of Practice for patient engagement research and the development of supports related to engaging and partnering with diverse populations.

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The Training and Capacity Development Initiative (TCDI) of the Ontario SPOR SUPPORT Unit, supports the building of capacity across Ontario on the conduct and use of patient-oriented research for patients, practitioners, policy makers and managers, and researchers.

The TCDI acts as a clearing house of information on capacity building programs, through a Compendium with all of the current training programs and resources available throughout Ontario. The Masterclass on Patient-Oriented Research has run numerous times both in person and virtually and has helped to train over 100 participants from all stakeholder groups on advanced POR methodologies, understandings and skills. The Patient Engagement Resource Centre (PERC) provides POR resources, guides, articles and consultations in Ontario. The PERC website has had over 1700 unique visitors. Trillium PHC Research Day, a collaborative event held annually to showcase the work of over 100 early-career researchers, patients and policy makers. Finally, the TCDI sponsored 7 POR online training programs spread across Ontario focused for different stakeholder groups and sectors of the healthcare system; these are online and available to all. Collectively, the programs have reached over 1700 stakeholders, spread across Ontario and Canada. (187 words)

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