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There and Back Again: An HTA Analyst’s Tale of
Evidence-Informed Decision Making
Daniel Grigat, MA
HTA Analyst, Knowledge Translation
Research, Innovation, and Analytics
Alberta Health Services
CADTH, April 2014
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Presentation Objectives
HTA in the Alberta Context
Stories of success
and challenges
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11.21
8.73
7.68
5.92
4.29
5.53
0
2
4
6
8
10
12
South Zone Calgary Zone Central Zone Edmonton Zone North Zone Best Large RHA/Zone (Central West LHIN,
ONT)
Ris
k-A
dju
ste
d R
ate
(p
er
1,0
00
)
Source = CIHI CHRP
5-Day In-Hospital Mortality Following Major Surgery - 2010/11
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Presentation Objectives
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Strategic Clinical Networks
• Multidisciplinary (Researchers, Clinicians, Support Units,
Policy-Makers, Patients)
• Evidence-Based
• Strategic and Innovative
• Accessibility (reduce variation in care)
• Sustainability (Choosing Wisely)
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Strategic Clinical Networks 1. Addiction & Mental Health
2. Obesity, Diabetes and Nutrition
3. Emergency
4. Cancer
5. Cardiovascular and Stroke
6. Bone & Joint Health
7. Seniors Health
8. Critical Care
9. Surgery
10. Respiratory
11. Primary Care and Chronic Disease
12. Maternal, Newborn and Youth Health
13. Kidney
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HTA Partners (IHE, UofA, UofC)
From Micro to Macro: The Alberta Health
Technologies Decision Process
Alberta Advisory
Committee on
Health Technologies
AHW Health Technologies
Policy Unit
Screening
Sub-Committee
Executive
Team/
Minister
AHS
AH
Strategic
Clinical
Networks
Assessing System Needs Assessing Technology and Policy Development Decision/implementation
From Alberta Health
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Evidence-Based Decision Making
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Knowledge to Action Cycle
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Clinical Opportunity Identification
Evidence Synthesis
Evidence-informed Decision Making
Implementation and Evaluation
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Clinical Opportunity Identification
Evidence Synthesis
Frequent Users of Emergency Medical Services
Complex High Needs Users
Rapid Reviews: Patient Profiles, Case Management
Lack of: clarity, clear intervention, coordination with other
efforts or agencies, cost benefits
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Clinical Opportunity Identification
Evidence Synthesis
Edmonton Inner City Health Research & Education Network
Multi-disciplinary Case Management for inner-city persons
Evidence: existing RR, update SR, new RR
Next Steps: Funding, Implementation and Evaluation
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Evidence Synthesis
Policy
Diabetic Foot Care Pathway
How do we prevent, identify, and treat diabetic foot ulcers?
PICO (wound care, orthopaedics, contact casting)
Policy Implications: uninsured services
Barrier: clinical independence, comfort with orthopaedics, fear
of policy process
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Evidence Synthesis
Policy
Repetitive Transcranial Magnetic Stimulation
Treatment Resistant Major Depressive Disorder
ECT: invasive (safety, access), stigmatized (acceptability)
Promising evidence but unanswered questions on optimal use
Next Steps: Policy, Implementation, Evaluation
Barriers: Time Frame
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Bariatric Surgery
HTA: treatments for obesity, surgery 5-10 year outcomes
Current provision of service 0.5%.
Barriers: funding, OR management, surgeon support / late
engagement, HTA didn’t answer clinical optimization questions
Next Steps: Surgery SCN, answer optimization questions
Evidence-informed Decision Making
Implementation and Evaluation
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Enhanced Recovery After Surgery
Evidence-based CPGs.
Barriers: resistance to practice change (e.g. anaesthesiology)
KT: Leadership Support, Clinical Champions, Clinical
Informatics, Targeted Training Programs, Robust Evaluation
Next Steps: Scale Up, Test Implementation Strategies
Evidence-informed Decision Making
Implementation and Evaluation
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Lessons Learned
Stakeholders must be engaged from the public to the front
lines to universities to the Minister
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Lessons Learned
Translation is continuous and iterative: Clinical Need ->
Research Question(s) -> Policy Implications -> Operational
Options -> Clinical Need
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Lessons Learned
Problems require a lot of definition before solutions are
sought
If I had one hour to save the
world I would spend fifty-five
minutes defining the problem
and only five minutes finding
the solution.
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Lessons Learned
Funding frameworks tend to drive the conceptualization of
problems (from Dens to HTR to PRIHS)
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Lessons Learned
Time Matters – evidence is often sought too late in the
process, more structured planning is required, clinical time
and policy time are out of sync
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Lessons Learned
Consideration of policy options should include clinical
experts, research experts, and the persons who will be tasked
with implementing directives
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Lessons Learned
Knowledge Translation and change management is hard
work. Change does not happen by emailing CPGs or issuing
directives.
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Acknowledgements Dr. Ulrich Wolfaardt, Dr. Don Juzwishin, Barbara
Hughes, Rosmin Esmail
Strategic Clinical Networks: Obesity Diabetes
Nutrition; Addiction and Mental Health;
Emergency; Cancer
Ministry of Alberta Health
Dr. Gabrielle Zimmerman and CADTH
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Questions and Comments?
Clinical Opportunity Identification
Evidence Synthesis
Evidence-informed
Decision Making
Implementation and Evaluation