Strategies for Patient Oriented Research: The PEI Primary and Integrated Healthcare

Innovation Network

March 16th, 2017 W.J. Montelpare

What is the SPOR PIHcI Network?

•  SPOR: Strategies for Patient-Oriented Research •  PIHcIN: Primary and Integrated Healthcare

Innovation Network

•  Potential to develop both a physical and virtual environment for new ways of thinking about healthcare across a variety of cohorts and health conditions.

PEI PIHcI Network History

•  Developmental Phase (2014/15)- increasing awareness and engaging stakeholders/partners

•  General meeting of stakeholders April 2015. About 40 in attendance.

•  Over 50 individuals on the PIHcIN member list

•  Submission of proposal for Operating Grant to establish PIHcIN (August 2015)

•  CIHR, Health PEI and Medical Society of PEI funding approved (Oct-November 2015)

National Focus: 12 Networks with Tri-partite Leads

Clinical Dr. Peter Mckean Gov’t/Policy Mark Spidel, HPEI

Research Dr. William Montelpare, UPEI

Current PEI Tri-partite Leads

Objectives of the Network

•  To develop and sustain effective alliances between research, health and other partners to conduct patient-engaged research;

•  To create a practice-based learning and research network integrating horizontal

and vertical care with a rapid assessment component using administrative and new data and focusing on scaling-up to improve care and reduce healthcare costs;

•  To conduct research to assess the impact, cost-effectiveness, comparative

efficiency and scalability of existing and new innovative, integrated primary health care delivery models (focus on patients with complex needs and vulnerable cohorts across the lifespan);

Objectives of the Network cont’d

•  To conduct research on upstream prevention strategies to prevent chronic disease,

reduce exacerbations and complications from these diseases, and reduce preventable health care system utilization (e.g. enhanced COPD care, cardiac rehab, birth cohort, pre-diabetes);

•  To provide evidence to support the provision of patient-centred care that is based on patient values and needs and is responsive to economic, social and cultural differences; and

•  To work with the Maritime SPOR Support Unit to build research capacity of students,

researchers, primary care and the broader health system and other community partners.

Patient Engagement is Critical to our Mandate

•  A primary tenet of the SPOR PIHcI Network is that there will be patient engagement-involvement at every stage of the research process

•  This means that we will have patients working with us from the initial development of the research initiative through to the delivery of final reports and into the process of knowledge translation

•  A second critical tenet of the SPOR PIHcI Network is to develop Inter-professional education across the multiple stakeholders that make up the network partnership.

•  Our goal is to make explicit within our

professional culture: Collaboration, Engagement, Innovation, Integration, and practices that are Evidence-Informed.

Critical Tenets cont’d

PEI PIHcI Network Operational

Management Committee

 

Links to MSSU

Links to Atlantic PIHcI Networks (NB, NS, NL)

Links to National SPOR Networks

Critical PIHcIN Linkages

PEI Strategies for

Patient Oriented Research

Building Capacity

Trained Students

Stakeholders

Research Ready

Fostering Engagement

Input

Citizens

Patients

Healthcare providers

Researchers

Policy Makers

Driving Collaborative

Research

Reports

Articles

Infograms

Newsletters

New Healthcare Models

Create a Communication

Network

Knowledge Translation

Health Literacy

National and International

linkages

e-access

Relevant Questions

Skilled Participants

Informed evidence-based

recommendations

Understanding and Uptake

Improved Health

outcomes for Islanders in a sustainable healthcare

system!

The 10 Essentials of CIHR-SPOR PIHcIN

1  Tri-partite leadership (science, policy, clinical) (✔)

2.  Strategic scope: (i) individuals with complex care needs across the life course, showing capacity to evolve the network's scope over time to include age groups from children to older adults (☐); and (ii) multi-sector integration of upstream prevention strategies and care delivery models (✔)

3.  Engagement of key stakeholders across the care continuum in primary and integrated care re-design (☐)

4.  Citizen/patient/family engagement (☐)

5.  Capacity for rapid monitoring, evaluation, feedback (linkages with SUPPORT Units) (✔)

6.  University partnerships to develop primary and integrated health care research capacity (✔)

7.  Capacity to implement and evaluate e-Health solutions that could improve the cost-effectiveness of care delivery (☐)

8.  Geographic scope: Coverage of practices and patients (☐)

9.  Linkage to CBPHC Innovation Teams (☐)

10.  Partnership funding (1:1 for infrastructure award and research priorities) (☐)

KEY: accomplished (✔) developing (☐) to be developed (?)

The Maritime SPOR Support Unit (MSSU)

•  Members of the network continue to sit on the committees of the MSSU and participate in MSSU working groups and subcommittees.

•  Network involvement in the MSSU has strengthened the

partnership and future collaborative opportunities between the PEI PIHcI Network and the MSSU.

•  It is expected that such activities will continue and in so doing will develop the appropriate framework for rapid cycle evaluation and establishment of common metrics and measurement strategies.

Secure Data Repository

•  The PIHcI Network is a founding partner in the development of a patient data management plan upon which the provincial data repository is being created.

•  An important outcome in the SPOR initiative is the establishment of a mechanism for data access that was drafted in collaboration with and approved by Health PEI.

•  This formalized policy guarantees confidentiality and security at all levels of data operations in SPOR activities.

Agency / Partner

Project Title Timeline

CIHR Quick Strike (I)

Children with Complex Healthcare Conditions NPI: Shelley Doucet

July 2015 In progress

CIHR Quick Strike (II)

Creation of a Comprehensive Health Profile of Children in NB & PEI and Development of Intra-Provincial Population-Based Birth Cohorts: NPI: Carole Tranchant

December 2015

CIHR Project Scheme PEI / NB / NS

Creating HeAlthy Transitions in MaRitimE Families/Créer des transitions SAINES chez les familles des Maritimes: The CARE/SAINES Study NPI: WJM

October CIHR Project Grant 2016

Network Project I (Health PEI)

MAAP-PEI: Models and Access to Primary Care Providers in PEI (replication of NS Study) NPI: Emily Marshall

October CIHR Project Grant 2016

Network Project II (Health PEI)

Family Physician Abuse by Patients Seeking Controlled Substances PEI (replication of NB Study): Peter McKean and Health PEI

Ongoing development

Network Project III CHANCES

Understanding Epigenetic development – CHANCES

Ongoing development

Current Research Initiatives

Agency / Partner Project Title Timeline

Network Project IV NS, NB, PEI, Quebec, MB AB, UBC

Comparative Policy Analysis Grant: NPI Jeannie Haggerty - McGill

2017-2018

Network Project V UPEI Clinic Workers Compensation Board

Establishing the Baseline Measures For Concussion And Providing Evidence For Return To Work/Play Decisions

April 2016-17

Network Project VI (Health PEI)

COPD – Enhanced (January 2016 Pilot) Jan 2017 full program

Ongoing delivery

Network Project VII (Health PEI)

Cardiac Rehabilitation (ongoing development) Jan 2017 full program

Ongoing delivery

Network Project VIII (Health PEI)

Neonatal Abstinence Syndrome (in development) Ongoing development

Network Project IX (CIHR-NS/NB/PEI)

Integrating end of life care to help people stay in the community: the essentials for success.

Dec 2016: SPOR Knowledge synthesis grant

Current Research Initiatives cont’d

Human Resources

•  Post Doctoral Fellowship (QS I & QSII)

•  PhD Student Researchers across the Maritimes

•  Research Associate (FT)

•  Network Coordinator

•  Graduate students

•  MN, MN-NP, MSc, MAHSR, PhD

•  Undergraduate Summer Students

The Goal To enhance access and delivery of primary

healthcare locally, regionally, and nationally…

The challenge is that projects must have matching funding at a 1:1 level

A community based primary health care clinic at UPEI

Optimizing space and capital to enhance community based primary

health care and provide opportunities for learning

Current Health Status of Islanders

•  Islanders have higher than national average rates of –  Obesity –  Heavy drinking –  Inactivity

•  Less likely to consume recommended amounts of fruits and vegetables per day

•  One in three Islanders have at least one chronic disease •  One in five have hypertension •  One in 18 (over age 20) have diabetes •  Aging population will mean growth in chronic disease •  47% of Islanders age 50-64 are pre-frail and 29% are frail •  43% of those age 65 and over are pre-frail and 43% are

frail (CCHS, CHO, 2014)

Health Care Utilization

•  Aging population and high rates of chronic disease and multi-morbidity

•  High rates of ER visits and hospital

admissions for potentially preventable health conditions

•  Higher rates of hospitalizations for Ambulatory Care Sensitive Conditions than national average

Ambulatory Care Sensitive Conditions

485 480*

497*515*

326320

302 299

200

250

300

350

400

450

500

550

2007/08 2008/09 2009/10 2010/11

Rateper100,000

ACSCRatesinPrinceEdwardIslandandCanada2007/08to2010/11

PEI Canada

We have a physical home on the UPEI Campus

We are developing a space for Patient Oriented Research in the lower level of the Steel Building on the UPEI campus

In the clinic we can develop programs to pursue the potential benefits of the PEI PIHcIN with patients

Access to Research Expertise

Evidence to drive practice/policy

Testing new innovations

and upstream prevention

Support for existing program areas (HI Unit,

Evaluation) Enhance access to PEI

data

Respond to research interests of staff,

clinicians, residents

Build research capacity.

Staff training and education

Align research with Strategic

Plan

At UPEI we have the academic infrastructure for healthcare and patient oriented research

Graduate students in research (M.Sc.)

Dietetics

Interns Graduate students in Nursing (MN)

Nurse Practitioner program

Main Objective

•  To create an environment that will foster enhanced learning opportunities for students while enabling care for selected primary care initiatives.

The punch line is to create an environment that will help to move ideas from the what if we did this -- to the what happens when we do this stage

Thank-you

Questions?

Contact me

Principal Researcher Professor William J. Montelpare, Ph.D. Margaret and Wallace McCain Chair in Human Development and Health Department of Applied Sciences, Faculty of Science University of Prince Edward Island (902) 620-5186 wmontelpare@upei.ca