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Digestive Health Strategic Clinical Network™ Transformational Roadmap 2017-2021

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AHS Vision: Healthy Albertans. Healthy Communities.

Together.

Our Vision: The best digestive health for all Albertans.

Our Mission: Innovate and collaborate to create a person-focused, high quality digestive health system through prevention, research, and best practices.

February 20, 2018

Digestive Health Strategic Clinical Network

Transformational Roadmap

2017-2021


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Table of Contents

A Word from our Leadership Team 3

Executive Summary 4 Summary Infographic 6 Introduction 7

About the Digestive Health SCN 7

Development of our Transformational Roadmap 2017 – 2021 8

Our Strategic Goals 9

Strategic Goal: Integrate Primary/Specialty Care 10

Strategic Goal: Deliver high quality, standardized digestive healthcare 12

Strategic Goal: Provide clinically appropriate and efficient care 14

Strategic Goal: Prevent Digestive Diseases 15

Our Principles 17

Our Enablers 19

Research and Innovation 21

Conclusion 23

Appendix A: Strategic Clinical Network Leadership and Core Committee Members 24

Appendix B: Glossary 26

Appendix C: References 31

November 1, 2017


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A Word from our Leadership Team

The Digestive Health Strategic Clinical Network™ (SCN™) is dedicated to achieving the best digestive health for all Albertans. This four year transformational roadmap is a dynamic and integrated plan that sets an ambitious collective vision for the future of digestive healthcare in Alberta. We have asked questions, analyzed data, and sought answers broadly on how to improve care and outcomes for people with or at risk for digestive diseases. With input from patients and families, physicians, front-line healthcare workers, researchers, administrators, community-based organizations, and policy makers, we have created a roadmap that outlines the SCN’s strategic goals and describes how these goals will be accomplished. The Digestive Health SCN’s goals are to: improve access to gastroenterology services for all Albertans and integrate the care delivered by primary care providers and specialty teams; support the delivery of high quality digestive healthcare and reduce variation across the province; ensure care is appropriate and efficient; and address the preventable causes of digestive diseases. Foundational to all of our activities will be a focus on patients and families and fostering a culture of inquiry, innovation, and quality improvement. This roadmap reflects the shared priorities of Alberta Health Services and the SCNs, and is well aligned with the AHS 2017-20 Health Plan. Thank you to our Core Committee for their exceptional passion, enthusiastic participation, and dedication to improving the lives of individuals with digestive health concerns. This is their vision and transformational roadmap for an improved future for digestive healthcare in Alberta. We look forward to sharing our progress with you in achieving that vision. The DHSCN is proud to be collaborating and aligning with our partners to lead a transformation in digestive healthcare, one that is driving quality, innovation, and value to achieve better outcomes for patients and families. We hope this roadmap will present you with the opportunity to engage with the Digestive Health SCN and become a part of that transformation. Many thanks to our past and future contributors, Louise and Sander

Sander Veldhuyzen van Zanten Louise Morrin Senior Medical Director Senior Provincial Director Digestive Health Strategic Clinical Digestive Health Strategic Clinical Network™ Network™ Alberta Health Services Alberta Health Services


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Executive Summary

Digestive disorders, which include any conditions affecting the digestive organs (e.g. esophagus, stomach, small and large intestines, liver, and pancreas), impact more than 2 million Albertans and cost the Canadian healthcare system $18 billion dollars annually, with rates for many of these disorders continuing to rise. The Digestive Health Strategic Clinical Network™ (SCN™) was launched in November 2016 to address key gaps in care and outcomes related to digestive healthcare across Alberta. SCNs are province-wide teams bringing together the experiences and expertise of healthcare professionals, researchers, administrators, government, communities, non-governmental organizations, and patients and their families to improve our healthcare system. SCNs are the mechanism through which Alberta Health Services empowers and supports physician and clinical leaders both within Alberta Health Services and the community to work with patients and their families to develop and implement evidence-informed, clinician-led, team-delivered health improvement strategies across Alberta. This transformational roadmap was developed through collaborative Core Committee meetings, surveys, and by engaging a variety of interested stakeholders who provided valuable guidance and input into the direction and activities for the SCN over the next four years. The vision of the Digestive Health SCN is “The best digestive health for all Albertans.” The mission statement, or how we will achieve this vision, is: “Innovate and collaborate to create a person-focused, high quality digestive health system through prevention, research, and best practices.” To reach this vision and mission, the Digestive Health SCN has identified four strategic goals to achieve over the next four years. These strategic goals are to:

1) Integrate Primary/Specialty Care approaches to digestive diseases and improve access

2) Deliver high quality, standardized digestive healthcare

3) Provide clinically appropriate and efficient care

4) Prevent digestive diseases

The Strategic Clinical Network has identified nine priorities under these strategic goals in order to focus the work. Priorities for Strategic Goal: Integrate Primary/Specialty Care approaches to digestive

diseases and improve access

1) Implement and monitor a complete, standardized provincial referral process and use

innovative models to improve access to care

2) Enhance support and resources for primary healthcare providers to manage digestive

diseases

3) Create a standardized wait time management system for consultations and endoscopic

procedures


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Priorities for Strategic Goal: Deliver high quality, standardized digestive healthcare

1) Develop and implement provincial clinical pathways for patients to improve disease

prevention, management, and continuity of care

2) Address unwarranted clinical variation and improve quality of care for endoscopy

procedures

3) Standardized education and support for patients, families, and providers

Priorities for Strategic Goal: Provide clinically appropriate and efficient care

1) Improve appropriateness of testing and therapies

Priorities for Strategic Goal: Prevent digestive diseases

1) Prevent chronic liver disease through better identification and management of preventable

causes of this disease

2) Decrease incidence of C. difficile in acute care facilities

The Digestive Health SCN has developed seven Principles that provide the foundation for the

Network and will serve as the basis for establishing and achieving our strategic goals. These

principles are:

Patient and family focus

Engagement and collaboration

Culture of quality

Standardized, evidence-based approaches

Sustainability

Research and innovation

Healthcare equity

Five key Enablers have also been identified that are essential to the success of the Digestive

Health SCN. These Enablers are:

Information technology and quality data

Patient and provider education

Clinical pathways

Performance measurement

Communication

By focusing on the strategic goals, priorities, principles, and enablers described throughout this

document, digestive healthcare in Alberta will be more integrated, of higher quality, and more

clinically appropriate. This will result in improved patient outcomes, and bring us closer towards

achieving the SCN’s vision of the best digestive health for all Albertans.


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Introduction

Strategic Clinical Networks™ (SCNs™) are province-

wide teams bringing together the experiences and

expertise of healthcare professionals, patients and

families, researchers, government, administrators,

communities, and non-governmental organizations to

improve our healthcare system. To achieve this, SCNs

are responsible for generating innovation, implementing

best evidence into practice, and utilizing change

management strategies to improve the quality of care

and outcomes and ensure long-term sustainability and

success of all initiatives. They also build capacity with

and within operations, using local improvements to drive

system innovation.

As a major stakeholder in health service delivery, the

work of the SCNs is aligned with Alberta Health

Services’ (AHS’) four foundational strategies, and the

quadruple aim approach (Figure 1). SCNs are the

mechanism through which AHS empowers and supports physician and clinical leaders both within AHS

and the community to work with patients and their families to develop and implement evidence-

informed health improvement strategies across Alberta.

About the Digestive Health SCN

The Digestive Health SCN™ was officially launched on November 18,

2016 as the fourteenth SCN. It is comprised of a Leadership Team and

a Core Committee, which has representation from a wide-range of

multi-disciplinary stakeholders across the province with a keen interest

in digestive health. A complete list of our Leadership Team and Core

Committee can be found in Appendix A.

The scope of our work includes all digestive diseases, all liver diseases,

and cancers of the digestive system across the lifespan. A number of

project teams and working groups are being formed and will be responsible for the development and

implementation of priority projects aligned with the Digestive Health SCN’s strategic goals and

priorities.

Figure 1: AHS' Four Foundational Strategies

As an SCN, we are here to: ask questions, find

answers, inspire change, and

transform the healthcare

system.


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Development of our Transformational Roadmap 2017 – 2021

Figure 2: Development of our Transformational Roadmap


Our Strategic Goals

Integrate Primary / Specialty Care Approaches to Digestive Diseases and Improve Access

Deliver High Quality, Standardized Digestive Healthcare

Provide Clinically Appropriate and Efficient Care

Prevent Digestive Diseases


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WHAT

Strategic Goal: Integrate Primary/Specialty Care approaches to digestive diseases and improve access

Our Priorities: Implement and monitor a complete, standardized provincial referral process and use innovative

models to improve access to care

Enhance support and resources for primary healthcare providers to manage digestive diseases

Create a standardized wait time management system for consultations and endoscopic

procedures

WHY

Currently available resources are inadequate to meet the demand for investigations and care

of patients referred for specialty gastroenterology care, leading to ever-increasing wait times

and unacceptable limitations to access1.

Triage processes and wait times vary across the province by reason for referral, with urgent

referrals prioritized to be seen first while non-urgent referrals may wait up to two years1.

Demand is expected to increase as the number of people living with chronic digestive diseases

continues to rise. The estimated number of referrals to Gastrointestinal (GI) services in the

Edmonton Zone alone exceeds 40,000 annually2.

The vast majority of referrals processed in Alberta remain outside of any electronic

management system, with little transparency into wait times, priority allocation (triage), and

endoscopy allocation, as these are determined individually/privately1. The different systems

have resulted in safety incidents as referrals are lost or misplaced and the patient is not seen

within the appropriate timeframe.

Strategies to improve access to GI services have been implemented in many sites/programs

across Alberta. For example, innovations

such as Central Access and Triage, Specialist

Link, and Primary Care Clinical Pathways in

the Calgary Zone resulted in a 43% reduction

in routine referrals between 2014 and 20161.

The GI Provincial Referral Guide has

recently been completed and is ready for

implementation across the province.

Did you know?

The Canadian Association

of Gastroenterology

recommended wait time for

consultation and endoscopy

for indications FIT positive,

rectal bleeding, and iron

deficiency anemia is 8

weeks3. Currently in Alberta,

less than half of patients are

meeting this criteria.


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HOW Improve collaboration and integration between primary and

specialty care to ensure patients are better supported in their

medical home.

Develop standardized referral processes based on best

evidence and implement these broadly.

Collaborate with primary care stakeholders to develop and

implement innovative care models and clinical pathways to

support primary care and increase access to underserviced

areas, including outreach to rural and remote communities.

Work with the Access Improvement team to implement Alberta

Netcare eReferral (advice request and consult request), creating

a common referral management platform for gastroenterology

services across the province.

Work with the Alberta Coding and Access Targets System (ACATS) team to expand utilization

of their wait time management solution to include endoscopy procedures.

MEASURING SUCCESS

Increased number of gastroenterology sites participating in eReferral.

Increased number of referring providers utilizing eReferral Advice Request.

• Increase in number of avoided gastroenterology consults (based on Advice Request utilization and outcomes).

Reduction in wait time for gastroenterology consults at sites participating in eReferral.

Decreased wait times for endoscopy procedures.

Primary care providers are supported to manage their patients’ digestive diseases in a

variety of situations, including: prior to specialist consultation, in lieu of specialist

consultation, and after specialist consultation.

Did you know?

After implementing eConsult in Ottawa,

70% of cases did not require a face-to-face specialist

visit, and in 40% of cases, an

unnecessary referral was

avoided4.

“As a family physician, I know that the digestive system is long and complex. Accessing healthcare for the digestive system ideally should not be long and complex, yet challenges exist in the current system that affect our patients' healthcare journey. I joined the Digestive Health Strategic Clinical Network because I saw that there was a need for innovative solutions to address access, continuity of care, and management of digestive health concerns within a patient's medical home, and in the specialty care system. I am also passionate about disease prevention, and saw an opportunity to be involved in preventative health at the system level. Prior to joining, I was told that the gastroenterologists involved in the Digestive Health SCN were highly motivated to hear what family physicians have to say, and that has certainly been the case so far, but what has impressed me the most is that the patient experience has been front and centre throughout. I am confident that, with such an inclusive approach, the Digestive Health SCN will help Alberta lead the way in providing high quality digestive healthcare."

- Dr. Julia Carter, Family Physician and DHSCN Core Committee Member


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WHAT

Strategic Goal: Deliver high quality, standardized digestive healthcare

Our Priorities: Develop and implement provincial clinical pathways for patients to improve disease prevention,

management, and continuity of care

Address unwarranted clinical variation and improve quality of care for endoscopy procedures

Standardized education and support for patients, families, and providers

WHY In 2015, the prevalence of Inflammatory Bowel Disease (IBD) in Alberta was 0.67%, among

the highest worldwide5, and is expected to increase to ~1% by 20306.

There are marked disparities in access to care in rural and small urban sites where there is

limited access to a full range of gastroenterology services7.

The prevalence of Irritable Bowel Syndrome (IBS) is rising. The self-reported prevalence in

Canada was 2.4% in 2007-20088 and rose to 3.2% in 20149. This is an underestimation of the

actual prevalence given as few as 30% of patients consult a physician regarding IBS10 and there

is under diagnosis of IBS in the presence of established criteria11.

IBS puts considerable strain on healthcare resources, incurring a significant financial burden,

and accounts for up to 50% of gastroenterology consultations12.

There is a lack of standardized care for IBS due to the availability of a wide range of treatments

with varying effectiveness13.

While excellent educational resources for a variety of

GI disorders are available throughout the province,

these resources are not standardized or available to

all Albertans or clinicians, nor have they been

developed for all digestive diseases.

Across the province, there are multiple versions of

patient materials with variation in content and advice.

In the Edmonton Zone alone, there were 37 different

patient handouts being used across the zone on how

to prepare for a colonoscopy.

Endoscopy is performed at 65 sites across the

province. Over 315,000 endoscopy procedures were

performed in Alberta in 2016-1715. There is no

province-wide approach to endoscopy quality.

Did you know?

Inflammatory Bowel Disease (IBD) is expected

to impact ~1% of Albertans by 20306, a prevalence

among the highest worldwide, and costs ~$2.8

billion in direct and indirect costs in Canada

each year14.


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The Alberta Colorectal Cancer Screening Program endorses the adoption of the Canada-

Global Rating Scale (C-GRS©) for all sites performing screening colonoscopy within Alberta

and is seeking organizational support to mandate this standard province-wide. This quality

improvement program improves quality of care and enhances the patient experience.

To date, 19 of 52 sites in Alberta are using the C-GRS© to assess the quality of their endoscopyprocesses and procedures.

HOW

Collaborate with primary care providers to adapt existing or develop new clinical pathways for

digestive disorders. The initial focus will be on primary care oriented pathways.

Clinical pathways for more complex digestive diseases, such as IBD and liver disease, that

span the care continuum, will be developed and implemented for

conditions where there is significant variation in care and outcomes across the province.

In partnership with the Alberta Colorectal Cancer Screening Program, we will develop and

implement a strategy to improve the quality of endoscopy care, which includes broad

implementation of the C-GRS©.

Work with clinical experts across the province to develop and strengthen the information

provided to Albertans on digestive diseases, using MyHealth Alberta as a platform for

information that is accurate, peer-reviewed, and evidence-based.

MEASURING SUCCESS

Reduced variation in care and outcomes for Albertans with digestive disorders.

All sites that perform endoscopy in Alberta are using the C-GRS© and have quality

improvement initiatives underway.

Improved endoscopy quality indicators.

Standardized digestive health related educational materials are universally accessible and

meet the information needs of Albertans

"It was an honour to be asked to join the Digestive Health SCN Core Committee. After decades of working towards improvement of quality of GI care within our zone, it is very refreshing to participate in thoughtful discourse in a room with individuals who have such a great mix of vision, passion, pragmatism, and varying life and occupational experiences related to gastrointestinal disease. Also, the ability to tap resources that produce evidence-based data to guide our deliberations will result in the crystallization of vision into more effective outcomes for our patients. What a very nice group of people! I am confident that patients in this province will ultimately receive improved care, going forward, through this process of collaboration."

- Dr. Dave Koegler, Gastroenterologist and DHSCN Core

Committee Member


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WHAT

Strategic Goal: Provide clinically appropriate and efficient care

Our Priority:

Improve appropriateness of testing and therapies

WHY

Up to 30% of selected medical tests and therapies are not clinically indicated, resulting in

increased costs to the healthcare system and exposure of patients to risk16.

There is a high prevalence of use and overuse of Proton Pump Inhibitors (PPIs). Pantoprazole

was the fifth most common drug prescribed in 2012, with more than 11 million prescriptions

dispensed in Canada17. Spending on PPIs by public drug programs (excluding Quebec and

the territories) totalled $249.6 million of the $7.8 billion spent on prescription drugs by these

programs in 201318.

Chronic use of PPI’s is problematic, with studies showing a lack of documented ongoing

indication for between 40% and 65% of hospitalized patients19.

The Canadian Association of Gastroenterology’s Choosing Wisely recommendation is: don’t

maintain long-term PPI therapy for gastrointestinal symptoms without an attempt to

stop/reduce PPI at least once per year in most patients20.

Inappropriate and inconsistent use of the Fecal Immunochemical Test (FIT) stool test for colon

cancer screening outside the target population continues to be a problem across Alberta21.

Colorectal Cancer Screening Clinical Practice Guidelines recommend asymptomatic

individuals aged 50-74 who are at average risk complete a FIT test every 1-2 yrs22.

Colon cancer screening using the FIT will lead to colon cancer diagnosis in 3.7% of

patients2

“As a Patient Advisor on the Core Committee for the Digestive Health SCN, I have been able to share my experiences and knowledge, not just with Digestive Health, but with the Alberta Health System. It has been an insightful experience to see the process that goes into designing policy and strategic goals and truly invaluable to be able to provide feedback and participate as the patient voice within those conversations. It’s a challenging position, but the chance to help improve those suffering from Digestive Health diseases and illnesses makes it incredibly rewarding."

- Amy van Engelen, Patient Advisor, DHSCN Core Committee Member and PaCER (Patient and Community Engagement Research) Graduate


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HOW We will partner with Pharmacy Services, the Physician Learning Program, and other SCNs to

develop and implement an appropriate prescribing strategy for PPIs.

In collaboration with the Alberta Colorectal Cancer Screening program, we will develop and

implement approaches to improve appropriateness of FIT testing.

MEASURING SUCCESS

Reduced prescriptions for PPIs.

Increased appropriateness of FIT testing.

WHAT

Strategic Goal: Prevent Digestive Diseases

Our Priorities: Prevent chronic liver disease through better identification and management of preventable

causes of this disease

Decrease incidence of C. difficile in acute care facilities

WHY

Digestive diseases account for an annual cost of $18 billion dollars

per year in Canada due to healthcare costs and lost productivity23.

By preventing the onset and progression of diseases related to the

digestive system, we can decrease the impact these diseases have

on patients, families, clinicians, and our healthcare system.

It is estimated that one in 10 Canadians, or more than three million

people, has some form of liver disease24.

The most common forms of liver disease – viral hepatitis, fatty liver

disease, and liver cancer – are all on the rise.

Did you know? Digestive

disorders impact more than 2

million Albertans, and rates for

many of these disorders are on

the rise23.

"In my current role as the manager of ambulatory care at the QE II, I am responsible for the Endoscopy program and the IBD and Hepatology Clinics. As a core team member of the Digestive Health Strategic Clinical Network, I am excited to build great networking opportunities and to learn from other’s successes as we strive to improve our patients’ healthcare experience. Through the work of this SCN, I look forward to working to standardize and advance our approach to optimal care for every one of our North Zone digestive health patients."

- Tracey Parsons, Manager, Ambulatory Care, QEII Hospital and DHSCN Core Committee Member


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Death from liver disease in Canada increased by 30% from 2000-2008 and is expected to

rise further in the future25.

Hepatitis C Virus infection hospitalization costs increased by an average of 41% per year

in the Calgary Zone from 2000-200426. These costs are continuing to rise and aren’t

expected to peak until 2020-203027.

Non-Alcoholic Fatty Liver Disease (NAFLD) is the most common cause of liver disease25,

is directly related to obesity, and impacts approximately 1/3 of Albertans28.

Hospital-acquired Clostridium difficile infection (CDI) increases healthcare costs four-fold

which translates into additional costs of $100 million dollars annually in Canada29.

It is estimated that approximately 3000 Albertans are impacted by CDI each year, leading to

about 30-50 deaths yearly30.

For patients with Recurrent CDI (RCDI),

Fecal Microbiota Transplantation (FMT) has

been shown to be the most effective therapy

(success rate > 80%) and the most cost

effective treatment31,32,33,34,35.

A timely FMT, offered after the 3rd episodeof RCDI, has been shown to reducehealthcare spending by approximately$30,000 per patient36.

Figure 3: The Fecal Microbiota Transplantation Team receiving the 2017 President’s Excellence Award for Outstanding Achievement in Innovation and Research Excellence from AHS President and CEO Dr. Verna Yui, (front row, fourth from left).

HOW We will work with stakeholders to implement effective policies and screening, diagnostic,

and treatment options to address the preventable causes of liver disease.

In partnership with researchers, Infection Prevention & Control and gastroenterologyclinicians, and clinical operations, we will develop strategies to improve antimicrobialstewardship, reduce in-hospital transmission of CDI, and operationalize effective andtimely treatment strategies for recurrent CDI.

MEASURING SUCCESS

Decrease in CDI and its associated costs in Alberta’s acute care facilities.

Decrease in incidence of chronic liver disease.

Increase in appropriate screening for liver diseases.

“The Digestive Health Strategic Clinical Network was created as a vehicle to deliver the best digestive healthcare possible to Albertans; including better quality, better outcomes, and better value. The mandate for the DHSCN is to help focus resources on what patients need, to help develop and support local models of patients care, and then effectively transfer them across Alberta. In essence, the DHSCN is designed to enhance innovative healthcare delivery by using the input of patients alongside scientific evidence and expertise of frontline providers. I look forward to seeing many improvements supported by this network.”

- Dr. Mark Swain, Hepatologist, Head of the Calgary Division of Gastroenterology, and DHSCN Core Committee Member


Our Principles

Our guiding principles provide the foundation for our work and are the basis for establishing and achieving our strategic goals



Culture of quality


Sustainability


Healthcare equity


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From conception through to implementation and evaluation, our initiatives will be centered on the

needs, priorities, and experiences of patients and their families. We recognize that we can only focus

on these needs by involving patient advisors throughout the process.


We will engage the broader digestive health community across the continuum of care, including

primary healthcare and end of life care, and spectrum of age (including children and the elderly) and

seek input in all stages of an initiative’s cycle – from planning to implementation to evaluation and

sustainability. We know that to be successful, we must collaborate with a wide variety of

stakeholders, including front-line providers, researchers, government, other SCNs, and patients and

families. Our approach to stakeholder engagement will be articulated in a Communications and

Engagement Plan, to be developed in fall 2017.

Culture of quality

We will foster a culture of quality improvement, based on the six dimensions of quality (as defined by

the Health Quality Council of Alberta), to achieve safe, effective, patient-centred, timely, efficient,

and equitable digestive healthcare.


We will endeavor to minimize provincial variations in practice; ensuring practice is based on current

scientific knowledge and best available evidence, while taking into account local context and the

needs and preferences of patients and families.

Sustainability

We are committed to optimal use of limited healthcare resources to drive a sustainable system of

digestive healthcare based on quality.


We will foster and support research throughout the digestive health community by building and

embedding evidence into our practice, and actively supporting knowledge creation and translation.

We will lead a culture of innovation to improve outcomes, where innovation is any evidence-

informed, value-added service, device, technology, or model of care.

Healthcare equity

We will promote equitable access and fairness in the distribution, quality, production, and control of

healthcare resources for all communities and Albertans.


Our Enablers

Our enablers are the elements we need to focus on as an SCN in order to achieve success in our strategic goals



Clinical pathways

Performance pathways

Communication


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Quality outcomes and improvement will be achieved by using information technology to measure

and record reliable, provincially consistent data that we will use to drive change and monitor impact.


Evidence-based provincially consistent patient education, knowledge translation, and multi-

disciplinary provider education strategies will be employed to support uptake of all SCN initiatives.

Clinical pathways

The Digestive Health SCN will help design, evaluate, and utilize clinical pathways consisting of

evidence-informed, patient-centred interdisciplinary care to help patients affected by digestive

diseases achieve optimal health outcomes.

Performance Measurement

Performance measurement, based on reliable provincially consistent data, is required to improve the

quality of decisions made regarding priorities for digestive healthcare improvement, the evaluation of

improvement initiatives, and the sustainability of positive outcomes.

Communication

Digestive Health SCN initiatives will incorporate strategies to optimize communication between

providers, and between patients and providers, to ensure that information is accessible throughout

the patient’s journey, and thereby improve the delivery and integration of digestive healthcare and

health outcomes.

Did you know?

Specialist Link in

Calgary receives ~40

calls per month, many

of which avoid

unnecessary

consultation.

Photo Credit: Edmonton University Hospital Foundation


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Research and Innovation

The Digestive Health SCN recognizes Alberta’s well-developed research landscape. As outlined by

our Scientific Office’s six pillars of activity in Figure 4 below, our Scientific Director (Dr. Gil Kaplan)

and Assistant Scientific Director (Dr. Susan Jelinski) partner directly with researchers to increase

communication and collaboration, support and

champion research projects, increase capacity for

research in the health system, and translate

knowledge generated from research into the clinical

setting. Through 2017-2021, we will continue to

work collaboratively with research teams across the

province to identify knowledge gaps aligned to the

priorities of the SCN and bring more research into

practice.

Figure 4: Six Pillars of Activity of the SCN Scientific Offices

Did you know?

The Scientific Office created the Alberta IBD Surveillance cohort,

the first of its kind in the province. This allows us to track incidence, prevalence, healthcare utilization, variation in care, and outcomes for Albertans with IBD.


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The Digestive Health SCN has developed a research plan outlining our research goals and the role

the SCN will have in research and innovation for digestive health, and our accountabilities in relation

to research and innovation underway in Alberta. Our Scientific Office has initiated an annual Seed

Grant competition, awarding grant funds to researchers to complete research projects and

systematic reviews related to the SCN’s priorities. Another major priority is to focus on data

liberation to support the development of provincial cohorts of digestive diseases that can be used

by the Digestive Health SCN to inform evidence-based decision making and to track outcomes

overtime. For example, the Scientific Office created the Alberta IBD surveillance cohort that allows

us to track incidence, prevalence, healthcare utilization, variation in care, and outcomes for

Albertans with IBD.

Did you know?

The SCN Scientific Office partners directly with researchers to increase communication and

collaboration, support and champion research projects, increase capacity for research in the health

system, and translate knowledge generated from research into the clinical setting.

"I am excited to be part of the Digestive Health SCN and to work with such passionate and enthusiastic people in the area of digestive health. The challenges faced by healthcare today are complex and require innovation and new ways of doing things. I believe that the Digestive Health SCN can be instrumental in the translation of research into the clinical environment which in turn will improve health outcomes for patients. Collaborations between many different individuals are necessary to identify common obstacles and to induce positive changes. I am proud to be part of the Digestive Health SCN and to contribute to the transformation of digestive healthcare in Alberta."

- Dr. Karen Madsen, Clinical Researcher and DHSCN Core Committee Member


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Conclusion

The strategies identified in this four year Transformational Roadmap will push Alberta to a

leadership position within Canada in the prevention and management of digestive diseases. By

focusing on the strategic goals and priorities described throughout this document, we are

confident we will be delivering care that is integrated, high-quality, and clinically appropriate,

and ultimately improving patient outcomes. We look forward to working together with our

network members to meet the challenges and opportunities ahead.

“Digestive health involves complex systems that are difficult for patients, such as myself, to understand and navigate. I feel privileged to provide a patient voice in association with a group of medical professionals dedicated to improving care within the Digestive Health SCN. I believe that the group will ultimately provide improved patient care through more uniform practices and attention to the patient perspective.”

- Brendan Murphy, Patient Advisor and DHSCN Core Committee Member


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Appendix A: Strategic Clinical Network Leadership and Core

Committee Members

SCN Leadership and Core Committee Members as of: October 2017

Name Title

Leadership Team

Dr. Sander Veldhuyzen van Zanten

Senior Medical Director

Louise Morrin Senior Provincial Director

Leanne Reeb Executive Director

Jessica McLarty Manager

Dr. Gilaad Kaplan Scientific Director

Dr. Susan Jelinski Assistant Scientific Director

Core Committee

Amy van Engelen Patient Advisor

Barb Kathol Senior Program Officer, CIS

Brendan Murphy Patient Advisor

Dr. Brennan Walters Head of Gastroenterology, Misericordia Hospital

Dr. Chris Sikora Medical Officer of Health

Dr. Christian Turbide Gastroenterologist

Clare McCabe Woodrow IBD Nurse

Dr. Clarence Wong Provincial Physician Lean, Colon Cancer Screening

Dr. Dan Sadowski Director, Division of Gastroenterology, UofA

Deon Druteika Clinical Practice Lead – Pharmacy

Derek Drager Patient Advisor

Dr. Diana Mager Associate Professor UofA, Clinical Nutrition

Dr. Doug Simmonds Gastroenterologist, Red Deer

Dr. Hien Huynh Director, Pediatric Gastroenterology

Holly Knight Director, Health Professions Strategy & Practice

Jennifer Coulthard Executive Director, Outpt Medicine, Allied Health, Transition Units & Neuro Rehab , Foothills Medical Centre

Jennifer Courtney Unit Manager, Medicine

Dr. Jessica Abraham General Surgeon, Medicine Hat

Jodi Glassford Director, Access Improvement

Jon Ashmead Patient Advisor


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Dr. Julia Carter Family Physician

Karen Hamilton Patient Advisor

Dr. Karen Madsen Director - CEGIR

Dr. Kerri Novak Gastroenterologist; QA/QI Medical Lead, Calgary Zone

Kim Kostiuk Executive Director, Ambulatory Care, Emergency, Endoscopy & Ophthalmology (Edmonton Zone)

Dr. Leah Gramlich Gastroenterologist, AHS Provincial Medical Advisor Nutrition Services

Dr. Linda Slocombe Lead, Calgary pan-PCN Group

Lindsay Steward Manager, Edmonton North PCN

Lisa Westin Case Manager, Gastroenterology, Med. Specialty Clinics, RDRH

Lorna Driedger Director, Nutrition Services, Calgary Zone

Lynn Goughnour Director, Patient Care Surgery, Chinook Regional

Dr. Mark Swain Head, Division of Gastroenterology and Hepatology, Calgary

Michelle Carbonneau Nurse Practitioner, Cirrhosis Care Clinic

Dr. Naseem Hoque Gastroenterologist

Peter Campbell Alberta Health Policy Advisor

Dr. Puneeta Tandon Director, Cirrhosis Care Clinic; Associate Professor of Medicine, UofA

Ralph Ennis-Davis Patient Care Manager, Endoscopy, Edmonton Zone

Dr. Rick Ward Family Physician; Medical Director, Primary Care

Sandra Owen Senior Planner, AHS Primary Care

Dr. Smitha Yaltho Family Physician

Steve Lucas Program Manager, Operative, Endoscopic & Recovery Services, GNCH

Dr. Steven Heitman Head, Colon Cancer Screening Clinic

Tracey Parsons Unit Manager, QEII Hospital

Dr. Yolande Westra Physician, Internal Medicine, Grand Prairie

Business Support Team

Darryl Lacombe Senior Consultant, Engagement & Patient Experience

Jessica Lamb Senior Consultant, Engagement & Patient Experience

Dr. Stafford Dean Senior Program Officer, Analytics

Stewart Lee HTA Analyst

Susan Miskiman Business Relationship Partner, Clinical Services IT

Susan Sobey-Fawcett Senior Planner

Terry Baker Senior Consultant, SCNs


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Appendix B: Glossary

Alberta Innovates (formerly Alberta Innovates Health Solutions)

A provincially-funded Corporation tasked with delivering on the research and innovation priorities of the Government of Alberta. In the health sector, Alberta Innovates provides leadership for Alberta’s health research and innovation enterprise by directing, coordinating, reviewing, funding, and supporting health research and innovation. Working with its many partners in the health system, Alberta Innovates ensures that health research achieves innovation in care, policy, and practice, and that the needs of patients and clinicians influence research.

Antimicrobial Stewardship

Antimicrobial stewardship is an interdisciplinary activity that promotes optimal antimicrobial therapy including assessment of the need for antimicrobials, and if antimicrobials are needed, the appropriate selection, dosing, route and duration of antimicrobial therapy.

Appropriateness Health services are relevant to user needs and are based on accepted or evidence based practice. Appropriateness refers to the collaboration between the patient and the healthcare provider to determine the care respects the needs and preferences of the patient and is supported by evidence-informed practice.

Best Evidence

Best evidence, also known as primary evidence, usually denotes an original writing, which is considered the most reliable proof for the existence and/or content for a particular topic (e.g., Gastroenterology and Hepatology). Best evidence is usually found in clinically relevant research that has been conducted using sound methodology. It is one of the components in Evidence Based Practice, the other two being clinical expertise and patient preferences and values.

Best Practice Systematically developed statements of recommended practice in a specific clinical or healthy work environment area, that are based on best evidence, and are designed to provide direction to practitioners and managers in their clinical and management decision-making.

Canada-Global Rating Scale (C-GRS)

The Global Rating Scale (GRS) is a web-based survey tool that offers a comprehensive, systematic approach to the measurement of endoscopy quality to assess the quality of the colonoscopy service and patient experience. The self-assessment tool can be used to help teams in endoscopy units to prioritize and create action plans targeting specific quality improvement initiatives. The C-GRS© examines 12


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items related to clinical quality and the quality of the patient experience:

Consent process including patient information

Safety

Comfort

Quality of the procedure

Appropriateness

Communicating results

Equality of access

Timeliness

Booking and choice

Privacy and dignity

Aftercare

Ability to provide feedback

Change Management Change management is the process, tools, and techniques to manage the people side of change to achieve the required business outcome. Change management incorporates the organizational tools that can be utilized to help individuals make successful personal transitions resulting in the adoption and realization of change.

Cirrhosis Cirrhosis represents a diffuse liver disease characterized by structurally abnormal nodules of liver cells surrounded by fibrosis.

Clinically Indicated

A complex term encompassing appropriate patient treatment/intervention based on, but not limited to:

i. the clinician’s unique body of knowledge and expertise;

ii. a patient’s clinical presentation; iii. the cost of treatment; iv. the scientific merit to the treatment/intervention (e.g.,

scientifically supported clinical pathways); and, v. ethics.

Clinical Pathway A description of evidence-informed, clinician recommended interdisciplinary care to help a patient with a specific health condition or concern move progressively toward optimal health outcomes.

Clinician A physician or other healthcare provider who is involved in the treatment and observation of patients, as distinguished from one engaged in research.

Digestive Diseases

Ailments affecting the digestive organs (e.g. esophagus, stomach, small and large intestines, liver, and pancreas).

Digestive Health

Any action or activity that would affect the improvement, maintenance, and/or prevention of the overall functioning of the digestive health system.


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Digestive System Consists of the digestive tract and other abdominal organs that play a role in digestion such as the liver and pancreas. The system, or group of organs, that break down food in order to absorb its nutrients into the body.

Endoscopy Endoscopy is a procedure in which a physician uses specialized instruments to view and operate on the internal organs and vessels of the body. It allows the doctor to view inside the body without making large incisions. An endoscope is a flexible tube with an attached camera that allows the doctor to see.

Evidence-Based Practice (EBP)

It is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It is the integration of: (a) clinical expertise/expert opinion, (b) external scientific evidence, and (c) client/patient/caregiver perspectives to provide high-quality services reflecting the interests, values, needs, and choices of the individuals we serve.

Evidence-informed Using evidence to identify the potential benefits, harms, and costs of any intervention and also acknowledging that what works in one context may not be appropriate or feasible in another.

Fecal Immunochemical Test (FIT)

The Fecal Immunochemical Test (FIT) is a screening test for colon cancer. FIT detects blood in your stool.

Fibrosis The thickening and scarring of connective tissue, usually as a result of injury.

Gastroenterology The medical subspecialty that deals specifically with the investigation, diagnosis, and management of disorders of the digestive system including the pancreas and liver.

Gastrointestinal (GI)

Adjective referring collectively to the stomach and small and large intestines. The commonly used abbreviation for gastrointestinal is GI.

Healthcare Equity

Healthcare equity refers to the distribution and quality of healthcare resources, including the accessibility, acceptability, and appropriateness of health services. It also implies justice or fairness in the production and control of healthcare resources.

Hepatologist A specialist who diagnosis and treats disorders of the liver, pancreas, gall bladder, and biliary tree. It is a sub-specialty of gastroenterology, which studies the digestive systems as a whole.

Hepatology Hepatology is the branch of medicine that incorporates the study of liver, gallbladder, biliary tree, and pancreas as well as management of their disorders.

Innovation A device, drug, technique, method, system, or a service procured from outside an organization or developed within, with ideally clear evidence of its added value over existing approaches.


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Knowledge Translation A dynamic and iterative process that includes the synthesis, dissemination, exchange and ethically sound application of knowledge to improve health, provide more effective health services and products, and strengthen the healthcare system.

Pan-SCN Concepts or initiatives that are applicable or of interest to multiple Strategic Clinical Networks.

Partnership for Research and Innovation in the Health System (PRIHS)

A partnership between Alberta Innovates (AI) and Alberta Health Services (AHS) that provides a partnered funding opportunity targeting high impact research activities within the SCNs that align with the priorities identified in the Alberta Health Research and Innovation Strategy and the AHS Health Plan. PRIHS supports networks of health researchers and clinical practitioners to reassess potentially inefficient activities within the health system and identify sustainable solutions to improve overall quality of care and value for money in the health system.

Patient-and Family-Centered Care

Patient - and family-centered care sees patients and families as integral members of the healthcare team, and encourages their active participation in all aspects of care, including as partners in planning, implementation and evaluation of existing and future care and services.

Person-focused

A popular term for healthcare and social services which reflect the individual’s unique preferences, values and needs, identified and agreed upon in partnership with the physician.

Proton Pump Inhibitors (PPIs)

A group of drugs whose main purpose is the prolonged reduction of the production of gastric acid.

Quadruple Aim

AHS' approach to achieve four key objectives: 1. Improve patient and family experiences. 2. Improve patient and population health outcomes. 3. Improve the experience and safety of our people. 4. Improve financial health and value for money.

Quality The Health Quality Council of Alberta (HQCA) defines quality within the Alberta Quality Matrix for Health framework, which includes six quality dimensions:

1. Acceptability 2. Accessibility 3. Appropriateness 4. Effectiveness 5. Efficiency 6. Safety.

Quality Improvement A continuous process which includes identifying issues and opportunities, applying well thought out and often innovative solutions, and then learning from the process and resulting outcomes.


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Referral The act of referring someone or something for consultation, review, or further action:

The directing of a patient to a medical specialist by a primary care physician.

A person whose case has been referred to a specialist doctor or a professional body.

Strategic Clinical Networks (SCNs)

Networks developed by Alberta Health Services comprised of people who are passionate and knowledgeable about specific areas of health, challenging them to find new and innovative ways of delivering care that will provide better quality, better outcomes, and better value for every Albertan.

Strategic Goals Strategic goals determine the long range direction of the DHSCN based on their mission and vision. Each strategic goal’s name reflects what the DHSCN wants to change in order to better meet their mission and help resolve strategic targets identified through stakeholder consultation and engagement.

Sustainability Incorporation of measures intended to ensure the ongoing maintenance of initiatives once project funding has ended.

The Scientific Office of the Digestive Health Strategic Clinical Network

Includes the Scientific Director and the Assistant Scientific Director of the SCN. It leads the promotion, adoption, and diffusion of innovation as well as the creation and use of evidence to drive decision making in digestive health. The six pillars of activity are:

1. Knowledge Translation 2. Advancing Research Knowledge 3. Building Partnerships for Research 4. Research Facilitation 5. Research Capacity Building and Training 6. Research Prioritization

Transformational Roadmap (TRM)

The strategic plan of a Strategic Clinical Network that outlines how they will transform healthcare over a three -four year time period. Includes vision and mission statements, foundational principles, enablers of success, and strategic goals with corresponding priorities.


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