Innovation Fund Awards 2015

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For the first time, the Innovation Fund Provincial Oversight Committee has initiated “annual” awards. For 2015, 5 winners were selected in the following categories….

AWARD: SYSTEM COORDINATION, GUIDELINES, and EDUCATION
TO: Robert Gratton,
FROM: AMOSO (a city wide association of London Health Science Centre, St Joseph’s Healthcare, London, Western University and the Clinical Teachers Association at Western)
For: “Optimization of Patient Flow: Implementation of a Fast Track Assessment Pathway in Obstetrical Triage”

Dr. Rob Gratton (left) pictured with Dr. Michael Rieder, Chair of the AMOSO Innovation Fund Sub-Committee

Dr. Rob Gratton (left) pictured with Dr. Michael Rieder, Chair of the AMOSO Innovation Fund Sub-Committee

Obstetrical triage units faced with overcrowding, prolonged wait times, and limited resources will be able to use this new reliable obstetrical triage tool. The tool “OTAS” helps identify the patients’ level of need and directs priority assessment for pregnant women and the fetus, while lower need patients are directed to an efficient fast track care pathway. The success of this innovation has driven the creation of a National Obstetrical Triage Working Group to facilitate regional and national implementation, establish national research priorities, and to guide the continued refinement of OTAS to meet the needs of obstetrical triage units across the country. To standardize the implementation regionally and nationally, we are developing an OTAS Providers Course and an OTAS Instructors Course that will include principles and methodology to assess patient flow and guidelines for establishing fast track pathways for lower acuity patients. This innovation will improve patient care, reduce wait times overall, and may be useful as a guideline for triage in other emergency specialties.

AWARD: CANCER CARE AND MENTAL HEALTH
TO: Nicholas Power,
FROM: AMOSO (a city wide association of London Health Science Centre, St Joseph’s Healthcare, London, Western University and the Clinical Teachers Association at Western)
FOR: “Predicting drug resistance in metastatic renal cell carcinoma: Individualizing targeted therapy by xenografting patient tumors into chick embryos”

Dr. Nicholas Power (left) pictured with Dr. John Sangster, Chair of the AMOSO Governing Committee

Dr. Nicholas Power (left) pictured with Dr. John Sangster, Chair of the AMOSO Governing Committee

This project is testing a new method of personalizing drug therapy that depends less on static genetic changes and more on dynamic cancer biologic behavior. We have developed a “living laboratory” where tumors from individual patients are grown in a “surrogate” model using avian embryos that are high efficiency and very economical when compared to immunocompromised mice which are expensive and inefficient. Within weeks from harvesting the tumor, we can perform tests with a panel of available drugs and determine the response rates of each, essentially offering the best initial drug therapy to maximize patient benefit and minimize wasteful efforts on ineffective treatments. This project may not only improve patient care by speeding up decision-making for treatment options, but also will save time and money in the process. The impact may provide a watershed moment for personalizing drug therapy and optimizing cancer specific survival outcomes for not only kidney cancer patients, but provide a platform for translation to personalized medicine in many other cancers. The Project leads have already begun expanding their platform to other genitourinary cancers and plan to test a number of other tumor types, and are in the process of starting an investigator initiated trial using the results of the project.

AWARD: EVIDENCE- AND PATIENT-CENTRED CARE
TO: Nick Daneman
FROM: Sunnybrook Health Sciences Centre
FOR: “Bacteremia Antibiotic Length Actually Needed for Clinical Effectiveness (BALANCE): A Pilot Randomized Controlled Clinical Trial”

The BALANCE RCT will define a treatment duration paradigm for patients with bacteremia. If shorter course treatment (7 days) is non-inferior to longer course (14 days) this intervention will be simple to implement (no new technology) and sustainable (cheaper than existing standard of care). This will lead to more than 100,000 fewer days of antibiotic treatment, and more than $10 million in savings per year in Ontario drug acquisition costs alone. Downstream benefits will include reductions of C. difficile infections, antibiotic resistant pathogens, drug adverse events, and ICU/hospital lengths of stay. For future study, we are seeking larger scale funding for the main BALANCE trial of 7 versus 14 days treatment for bacteremia. This trial will require 3598 patients, across 38 Canadian ICUs, to test whether 7 day treatment is associated with a non-inferior 90 day mortality rate. Although this trial will cost $4 million, this will be offset quickly by drug acquisition cost-savings (estimated to be >$10 million/ year in Ontario alone), as well as much larger cost-savings related to reductions in C. difficile, antibiotic resistant pathogens, drug adverse events, ICU and hospital lengths of stay, and home care administration of antibiotic treatments.

AWARD: CARDIOVASCULAR, EMERGENCY, AND CRITICAL CARE
TO: Lisa Mielniczuk
FROM: University of Ottawa Heart Institute
FOR: “Heart Failure Telelink: Using Interactive Voice Response Technology to improve Patient Outcomes”

Interactive voice recognition (IVR) technology uses speech recognition to deliver phone calls every 2 weeks to assess HF symptoms, offer additional educational material, offer medication information, receive self-care information from the system and track readmission and satisfaction at the end of the 3 month follow-up. The technology is easy to use with any type of phone system, has a broad reach into remote rural communities and requires minimal resources to implement. To date, the Heart Institute (HI) in partnerships with the Champlain LHIN community hospitals, has applied the use of a Heart Failure (HF) discharge tool for over 1000 patients from community hospitals in 2013-14 & the follow-up of 72 HF patients referred to the HI for daily Telehome Monitoring (THM). In 2015 the HI successfully implemented the expansion of the Acute Coronary syndrome IVR program to 4 community hospitals following 154 patients to date. Lessons learned from this expansion will be applied to the expansion of the Heart Failure IVR program to the community for improved self-care, communication with primary care physicians and collaboration between sectors as well as improved outcomes such as decreased readmission. This project aims to improve patient care and self-care, reduce readmission rates, and increase access to follow-up care in remote areas. This provides a multidisciplinary team for improved quality of life and better outcomes. The innovation can be easily exported to any health care organization across many sectors. It can be easily adapted to include transitional care follow-up at 48 hours after discharge as well as other chronic diseases such as diabetes. Last year the HI added a diabetes follow-up component to the ACS, cardiac surgery and HF patient populations with a diabetes nurse specialist addressing issues raised by the system, and preliminary results are promising.

AWARD: TECHNOLOGICAL INNOVATIONS
TO: Lakshmikumar Venkat Raghavan
FROM: University Health Network
FOR: “Measurement of cerebrovascular reactivity using BOLD-MRI combined with precise controlled changes in carbon dioxide. Is this a new brain stress test?”

Dr. Lakshmikumar Venkat Raghavan (left) receives the 2015 Innovation Fund Award in the category TECHNOLOGICAL INNOVATIONS from Dr. Paul Tenenbein, Chair, MSH UHN AMO Innovation Fund Sub-Committee.

2015 AWARD – Technological Innovation

Dr. Lakshmikumar Venkat Raghavan (left) receives the 2015 Innovation Fund Award in the category TECHNOLOGICAL INNOVATIONS from Dr. Paul Tenenbein, Chair, MSH UHN AMO Innovation Fund Sub-Committee.

“In our project we have a shown that the precise targeting of CO2 in combination with BOLD-MRI can be used as a non-invasive “brain stress test” to identify patients at risk for stroke. This technique can be adopted as a routine clinical test in the diagnosis, treatment and prognosis of patients who are at risk of stroke and those with suspected cerebral blood flow abnormalities.”

Cerebrovascular reactivity (CVR), defined as a change in cerebral blood flow in response to a vasoactive stimulus, reflects the vascular reserve capacity of cerebral vessels. Impaired CVR has shown to be an important prognostic marker for stroke. However, no CVR method has been widely adopted to assess the risk for stroke and for clinical management. This project developed a non-invasive method of mapping CVR using a precise targeting of CO2 and Blood oxygen level dependent (BOLD) MRI to identify patients at risk for stroke and to monitor the effect of treatments. In an innovative use of existing techniques, this study showed that the precise targeting of CO2 in combination with BOLD-MRI, provide a feasible, non-invasive and reproducible measure of CVR. This combined technique may be complementary in identifying patients with poor cerebrovascular reserve at risk for stroke and thus constitute a “Brain Stress Test”. This technique can be adapted for routine clinical test in the diagnosis, treatment and prognosis of patients who are at risk of stroke and those with suspected cerebral blood flow abnormalities. This test stands to improve patient care and lower the burden of care on our hospital system.

For information about these award-winners and their projects, please inquire through their Governance Organizations, which can be accessed on the main “ABOUT US” page: https://ifpoc.org/about-us/

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