ECHO Ontario Skin and Wound Cohort B - Cycle 1 (January 11th - March 1st 2023) Cycle 2 (April 12th - May 31st 2023)

Background Information

**Open to all Healthcare Professionals across Ontario

Project ECHO (Extensions for Community Health Outcomes) Ontario Skin and Wound offers evidence-based mentorship and case-based learning on skin and wound care at no cost to Ontario health care providers. Project ECHO is based on a Hub and Spoke model. A resource team (Hub) comprising of physicians, nurses and allied health providers provide community partners (Spokes), with guidance on patients with complex skin and wound care needs. Spokes are comprised of health care professionals from across the province interested in expanding their knowledge in wound care. Continuing Medical Education (CME) credits will be rewarded to physicians and education credits awarded to non-physicians.

A Spoke can be one or more health providers gathered at a (n):

- Family Health Team
- Indigenous Health Centre or a Community Health Centre
- Long-Term Care Home
- Hospital

- Nursing Clinic

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* 1. The ECHO sessions will be delivered in 2 cycles, each cycle comprising of 8 weekly sessions. Select the cycle (s) you are interested in attending (one or both cycles can be selected).

Cycle 1: Lower leg (venous, other) and foot ulcers common in persons with diabetes (neuropathic/ischemic/others)

Cycle 2: Pressure injuries, malignancies, inflammatory, ulcers and post surgical wounds

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* 2. What is your first and last name?

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* 3. What is your email address?

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* 4. What is your telephone number?

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* 5. What is the name of your Clinic/Organization?

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* 6. What City/Town/Village is your Clinic/Organization based in?

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* 7. What is the postal code of your clinic/organization?

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* 8. Which LHIN/Region(s) do you perform skin and wound care in Ontario?

Central

Central East

Central West

Champlain

Erie St. Clair

Hamilton Niagara Haldimand Brant

Mississauga Halton

North East

North Simcoe Muskoka

North West

South East

South West

Toronto Central

Waterloo Wellington

Not Sure

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* 9. What is your profession?

Other (please specify)

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* 10. What is your area of practice specialty or expertise e.g. pediatrics, complex care, geriatrics?

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* 11. What is your primary practice setting?

Family Health Team

Community Health Centre

Indigenous Health Access Centre

Nurse Practitioner Led Clinic

Primary Care Solo Practice

Home Care Provider

Home Care Clinic

Nursing Station

Community Hospital

Academic Hospital

Long Term Care

Other (please specify)

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* 12. Including yourself, how many team members would be joining you on these ECHO sessions?

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* 13. Select All of the Following Priority Areas that Apply to Your Organization

Urban (communities within and in close proximity to cities)

Rural (communities with a population of less than 30,000 that are greater than 30 minutes away in travel time from a community with a population of more than 30,000)

Remote (without year-round road access, or which rely on a third party (e.g. train, airplane, ferry) for transportation to a larger centre)

Northern

Working Towards Forming an Inter-professional Team or Already Within an Inter-Professional Team

Caring for Indigenous People

Caring for other Vulnerable Populations e.g. housing insecure

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* 14. Are you interested in attending future Virtual Boot Camps for additional skills development?

Yes, I am interested in learning more about Virtual Boot Camps

No, I am not interested at this time

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* 15. Our statement of collaboration for ECHO Ontario Skin and Wound requests attendance at 6 or more out of 8 sessions (Wednesdays 2-4 pm). You would also need to present 1 case during the cycle

Agree

Cannot commit to this cycle

Your application for Project ECHO Cohort B has been received. You will receive a reply on Wednesday January 4, 2023 .

Thank you for your support.