On Nov 17 2016, at the Innovation Fund Showcase 2016: Innovation, Integration, and Implementation, the Innovation Fund Provincial Oversight Committee announced its 2016 Award Winners.
Here are the Award winning project Titles and Project Leads and a few short highlights about their successful and innovative projects:
Cancer Care Award:
Dr. Peter Lovrics, Hamilton Academic Health Sciences Organization
The evaluation of a LHIN4 practice guideline for completion axillary lymph node dissection in breast cancer surgery
Highlights:
Recent evidence form the ACOSOC Z0011 trial and dissemination of a LHIN4 regional guideline for completion axillary node dissection (cALND) were associated with a marked decrease in cALND after positive sentinel node biopsy (SNB), even among some cases recommended to receive cALND by the guideline. Practice patterns for SNB, cALND and nodal radiation changed significantly over the study time period. We found there was good compliance overall in this locally developed guideline and that patient age and nodal characteristics were important in decision-making for cALND. Physician interviews found that physicians from all disciplines perceived that the GL helped to unify care within the region and improve communication between specialties and with patients concerning cALND.
Miriam Tsao on behalf of Peter Lovrics
Cardiovascular and Stroke Care Award:
Dr. David Birnie, University of Ottawa Heart Institute
Pacemaker and Defibrillator Surgery without Interruption of Anticoagulation BRUISE CONTROL
Highlights:
1. Transformation: How will the project transform health care delivery.
The project has and is widely regarded as being the definitive project in the world in this area. Immediately we changed practice at our center. The study results are a triple win i.e to continue anti-coagulation has much better outcomes for patients, patients much preferred it and it is much cheaper. The Health Economic analysis showed substantial savings for the health care system both because of a reduction in complications and also because continuing warfarin is much cheaper than bridging with heparin. Also the results of our study has wider implications for patients having temporary interruption of anti-coagulation to undergo other types of surgery or procedures. Physicians have begun to explore performing other procedures and operations without interruption of warfarin. Case series have shown low bleeding complications with coronary angiography and stenting, minor head and neck surgey, urological procedures, colonoscopic polypectomy, hand surgery, vascular surgery, joint injections and aspirations, and hip and knee replacements.
2. Adoptability: Can the project be adopted by other centres to improve outcomes?
We have received multiple emails/verbal communications that the study has changed practice at many centers in Canada and elsewhere in the world. It has also been pivotal in changing best practice guidelines worldwide
3.Outcome: Will the results obtained convince other institutions to adopt the new approach?
It already has see 2. above
Chronic Care and Patient-Centred Care Award:
Homer Yang, The Ottawa Hospital
Post Op Home Monitoring after Joint Replacement (POHM)
Highlights:
Post-op 30-day readmissions, re-operations, and Emergency Department (ED) visits currently are 5 – 13%. With early discharge, patients are often unsure of signs or symptoms (S+S), resulting in extra ED visits for minor S+S or delayed repatriation in major complications. POHM monitors vital signs (VS) and pain scores via remote wireless connectivity and a smartphone. Results show a continuity of care; excellent patient satisfaction with early or same day discharge; reduced ED visits for minor S+S; and could expedite repatriation in serious complications. Preliminary cost analysis showed savings and patients felt secure after early discharge. The technology and care paths are validated as a reliable acute care tool. Negotiations with OTN for partnership and scalable implemention are on-going.
Homer Yang
Emergency and Critical Care Award:
André Carlos Amaral, Sunnybrook Health Sciences Centre
Therapeutic Alliance in the ICU: Enhanced Information to Facilitate Decision-Making
Highlights:
Transformation: We expect processes of care related to communication and decision-making to improve.
Adaptability: We expect that many parts of our website will be used in other hospital settings, and the locally specific parts of the website will be easily adaptable at other institutions.
Outcomes: We expect that patient and family outcomes will improve.
André Carlos Amaral
Mental Health and Geriatric Care Award:
Simone Vigod, Women’s College Hospital
Risk of Readmission to Acute Psychiatric Units in Ontario: A Gender-based Analysis
Highlights:
Our major output was a validated clinical risk prediction index to identify psychiatric inpatients at risk for early rehospitalisation, the READMIT scale (Vigod et. al., Psych Res, 2015). We are now licensing READMIT to major U.S.-based health care organizations for integration into their behavioural health systems in an effort to identify patients at risk for 30-day readmission so as to deliver targeted interventions that reduce this risk, and meet the U.S. Affordable Care Act qulity standards. To support implementation, I also led a systematic review on transitional care interventions to reduce readmission risk cited > 50 times (Vigod et al, Brit J Psych 2013), work on quality of care indicators for the MOHLTC mental health strategy and on a project measuring mental health performance across Canadian provinces to help improve mental health care delivery in Canada.
Simone Vigod
Patient Safety and Quality of Care Award:
Sukhbir Singh, The Ottawa Hospital
Planned Early Discharge After Laparoscopic (PEDAL) Hysterectomy Study: A Pilot Prospective Observational Study
Highlights:
Hysterectomy is one of the most common surgical procedures performed in Canada. With over 40 000 cases/year, there is an opportunity to provide meaningful interventions for large scale change. Presently most hysterectomies are done by laparotomy and result in a 3 day stay in hospital. Laparoscopic hysterectomy (LH) offers a shorter length of stay (LOS), less pain and quicker return to normal activity.
Is it possible to provide better surgical care for patients while reducing costs to the health care system? We decided to challenge the status quo and proposed a Same Day Discharge (SDD) program for laparoscopic hysterectomy.
The findings of this pilot study confirm that SDD is possible, safe and results in high satisfaction for patients who undergo LH. Sharing this knowledge may result in a dramatic decrease in LOS and convert a classic inpatient surgery to a day procedure with the benefits of reduced hospital resource utilization.
Calvin Thompson on behalf of Sukhbir Singh
Technology: e-Solutions and Telemedicine Award:
Alexander Logan, Mount Sinai Hospital and University Health Network
Harnessing mobile health technology to personalize the care of chronic kidney disease patients
Highlights:
Self-management has been advocated as a way for patients to cope with the challenges of living with complex chronic illnesses. However, to be effective and sustainable self-care activities need to be integrated into the overall goals of care. Our team developed a smartphone-based, self-management system that incorporates key elements of the chronic care model. It automatically tracks patient-directed activities between clinic visits, provides personalized feedback responses in real time and populates a readily accessible, secure web-based clinical dashboard with patient-derived data to aid clinical decision-making and generate alerts for patients and their care team when pre-defined thresholds are crossed or critical changes occur. In our pilot study the system was well-accepted and improved knowledge, health behaviours and clinical outcomes of chronic kidney disease patients. Our system, built from commercial products to minimize cost, is easily adaptable to any set of chronic conditions.
Alexander Logan
Women and Children Award:
Orlando da Silva, Academic Medicine Organization of Southwestern Ontario
Maternal Education about Infant Nutrition
Highlights:
Increased “any” breastfeeding : 72.7% vs. 54% p<0.001
MAVINS use correlated with breastfeeding duration p <0.001
Positive effect of usage on maternal satisfaction with MAVINS p<0.001
Mean age of solid food introduction : 5.5 months
65% of mothers rated their satisfaction with MAVINS as either “mostly” or “completely” satisfied
“Your comment was very very informative, thank you! I’ve been looking all over Google for different information and just summed it all up in one comment, hopeffuly some of this does help”. (MAVINS user in response to IBCLC moderator response)
Orlando da Silva