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SJHC / Client Services/ Virtual Care Pathway-CHF/COPD


The Integrated Comprehensive Care (ICC) Program has been successfully operating within St. Joseph’s Health System (SJHS) and Niagara Health (NH) since 2012 for Thoracic, Cardiovascular, Hip and Knee replacement surgery as well as patients with Chronic disease (COPD and CHF). This innovative program provides seamless patient centered care by fully integrating the Hospital and Homecare Teams, providing the patient and caregiver with one point of contact, and enabling both Hospital and Homecare staff to access a single integrated digital health record. In addition to the current ICC program, all COPD/CHF patients within the Greater Hamilton Health Network catchment area can now access this evidenced based program virtually.

This program is primarily focused on education and self-management of patients 18 and older, utilizing current COPD and CHF materials, in alignment with clinical partners and organizations. Providing virtual education sessions and wellness checks on a weekly basis during the 60-day program, ensures the opportunity for proactive self-management and reinforcement of the education patients participate in. If you are healthcare provider and would like to refer a patient, please click the referral from link below.

Please click here to view or download our Community ICC CHF COPD Virtual Pathway Referral Form

Please click here to view or download our ICC CHF COPD Virtual Pathway Community Patient Handout

If you have any questions about the program please contact us at