Impacts of CIHR-funded research: Health services delivery
[ Table of Contents ]Been to intensive care?
Don't forget your medications!
Overview
If you're a senior taking medication for chronic diseases, being in an intensive care unit can be dangerous to your long-term health, according to Dr. Chaim Bell of St. Michael's Hospital in Toronto. Dr. Bell studied a group of patients at Ontario hospitals and found that, when discharged from the intensive care unit, one-third had at least one of their medications unintentionally discontinued.
Impact
At the local level, Dr. Bell and his colleagues have developed an electronic discharge tool to assist in ensuring medication reconciliation and other aspects of care whose continuation needs to be ensured. The tool was published in October 2009, and Dr. Bell has already received indications of interest from many jurisdictions. In addition, as a result of Dr. Bell's and other's research, unintentional medication discontinuation is now a focus of Safer Healthcare Now!, an initiative to improve quality of care through medication reconciliation (formalized processes to ensure continuity of care). Medication reconciliation processes are now an accreditation requirement by Accreditation Canada for hospitals and long-term care facilities. Canada is also leading the medication reconciliation portion of an international quality of care initiative being led by the World Health Organization. Dr. Bell is involved in that work, as well as being a member of the medication reconciliation group of Safer Healthcare Now!
First Published
CIHR Health Research Results, 2006-07; updated 2009
Improving the delivery of health care in rural areas
Evidence in action
Overview
Delivering health services to scattered rural and remote populations is an ongoing challenge. Manitoba's The Need to Know Team, a collaboration of the Manitoba Centre for Health Policy, Manitoba's 10 rural and northern regional health authorities and Manitoba Health, conducts research relevant to these communities and works with regional health authorities to implement its findings.
Impact
Based on the research conducted by the Need to Know team, regional health authorities in rural and northern Manitoba have developed primary health-care centres and nursing homes, cervical cancer screening programs and regional injury prevention programs, as well as proposed changes to mental health services. The research also led to the development of a regional indicators atlas that is being used extensively in strategic planning..Arlene Wilgosh, former Manitoba Deputy Minister of Health says that over the years, the research reports have "influenced our decisions around resources." She cites 2004's mental health report and 2008's What Works? evaluation of programs and policies as particularly helpful. "They showed what the evidence is and how you can apply it," she says.
First Published
Evidence in action, acting on evidence: The CIHR Institute of Health Services and Policy Research Knowledge Translation Casebook, 2006
Helping patients steer their way through the health-care system
Tool provides guidance to patients with chronic diseases
Overview
Many bone and joint conditions are chronic diseases, requiring a lifelong commitment from patients to managing their health and ongoing interaction with an often-confusing health-care system. Dr. Peter Tugwell of the University of Ottawa, working with the Cochrane Collaboration, documented the types of skills patients need to effectively manage their conditions, including using health information to make decisions, communicating with others, clarifying values and priorities and negotiating their roles as patients. He developed the Effective Consumer Scale (EC-17) to measure how effective people are at dealing with their chronic condition and making decisions about their health care.
Impact
The EC-17 has been validated in Canada and Australia and groups in Argentina, Ireland, Norway, Sweden and Romania are also validating the scale in other languages.
First Published
CIHR Health Research Results, 2005-06; updated 2009
Setting wait times benchmarks
Research provides evidence for policy decisions
Overview
In response to widespread public concern over wait times, CIHR, in partnership with Canada's provincial/territorial ministers of health, funded research into wait times in three priority treatment areas: sight restoration, joint replacement and cancer.
Impact
The research informed the first set of wait times benchmarks set by provincial/territorial ministers of health in December 2005.
First Published
CIHR Institute of Health Services and Policy Research, Annual Report 2005-06
Mapping drug use in Canada
Atlas provides tool for policy makers
Overview
Prescription drug spending is the fastest-growing category of health-care spending in Canada, expected to account for 17.4% of health-care spending in 2008, up from 15% a decade ago. Provincial and territorial health officials have struggled to contend with the complex problem of controlling spiralling drug costs. Now, Dr. Steve Morgan of the University of British Columbia has provided an accurate picture of how drugs are being used across Canada. The Canadian Rx Atlas highlights differences in drug use in different parts of the country and breaks down the factors that drive drug spending.
Impact
The Atlas, currently in its second edition, is routinely used by researchers, professional associations, governments and media for information about drug expenditures in Canada. Earlier in 2009, western premiers cited the atlas in announcing their plans to pursue joint drug purchasing policies in the future.
First Published
CIHR Health Research Results, 2005-06; updated 2009
Promoting patient safety
The Canadian Adverse Events Study
Overview
In 2004, the first national study of patient safety in Canadian hospitals estimated that 7.5% of Canadian patients – or 185,000 of the almost 2.5 million medical and surgical admissions in Canada in 2000 – experienced an adverse event as a result of their care. This includes unintended injury or complication resulting in death, disability or prolonged hospital stay. The study, led by Drs. Ross Baker of the University of Toronto and Peter Norton of the University of Calgary, found that the majority of adverse events resulted in temporary disability or prolonged hospital stay, while 5% of patients who experienced adverse events were judged to have a permanent disability as a result. Adverse events were associated with death in 1.6% of patients. Close to 37% of adverse events in the study could have been prevented.
Impact
As a result of the Canadian Adverse Events Study and of activities conducted throughout the duration of the study, policy initiatives and education programs to enhance patient safety and minimize adverse events were developed by many professional organizations, including the Canadian Medical Associated and the Canadian Healthcare Association. The Canadian Council on Health Services Accreditation created a Patient Safety Advisory Group that includes Drs. Baker and Norton as members and that has helped to develop a set of patient safety goals and required organizational practices that were implemented in accreditation surveys beginning in 2006.
First Published
CIHR Institute of Health Services and Policy Research, Annual Report 2004-05; CIHR news release, May 24, 2004
Safe prescribing made simple
Computerized system reduces prescription drug errors
Overview
Anywhere from 5-23% of hospital admissions are due to drug-related illnesses. And, in many cases, errors occur because patients have different prescribing physicians and different dispensing pharmacies, leaving it up to patients themselves to manage their medications. Dr. Robyn Tamblyn of McGill University has developed an electronic prescribing and drug management system that gives Quebec physicians instant, computer-based access to a patient's drug, disease and allergy history and alerts them to potential prescribing problems. MOXXI, short for the Medical Office of the 21st Century, reduces the potential for human error by having physicians select drugs from an automated list and indicate the problem the drug is supposed to treat.
Impact
More than 200 physicians, nearly 80 pharmacies and, as of January 1, 2009, more than 68,000 patients in Quebec are participating in MOXXI, now in its third phase.
First Published
Research profile, May 2007; updated 2009
Assisting emergency room decisions
Rules help treat injuries more consistently
Overview
Emergency room physicians regularly see injuries to feet, ankles, knees, necks and brains. Knowing what tests to order and when can be a challenge. Dr. Ian Stiell of the Ottawa Hospital Research Institute has made it easier. He has developed the Ottawa Ankle and Knee Rules and the Canadian C-Spine and CT Head Rules to provide guidance to physicians.
Impact
The use of decision rules saves money and time and improves patient flow. The rules have been validated by more than 20 other studies worldwide, translated into several other languages and adopted worldwide. A recent survey found that 89% of Canadian emergency room physicians use the guidelines. As well, the Rules have been mentioned several times on the prime-time TV series "ER".
First Published
CIHR Health Research Results, 2003-04; updated 2009