influencing evidence-based practice and clinical ... · – ~ 9% of workforce – $21b/yr to...
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Influencing Evidence-based practice and
clinical innovation through a Provincial
Strategic Clinical Network
Presentation to ACC Rockies
March 20, 2013
Blair J. O’Neill MD FRCPC
Senior Medical Director, CVH + Stroke SCN, Alberta Health Services
Immediate Past President, Canadian Cardiovascular Society
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• Potential Conflicts
– Global End Point Adjudication Committees
• Pfizer
– Clinical Trial Support
• Pfizer
• Eli Lilly
• Merck
Cardiovascular Health and Stroke
Strategic Clinical Network
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The Landscape in 2013
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Evidence = Non-sustainable cost increases in Canada
1975 to 2010
• Expenditure increases = 3.5 fold
• Population increases = 1.5 fold
23.4M
people
34.2 M
people
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Why are we here? How do you compare?
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Are we getting the results?
Life Expectancy by Province
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As more is learned - the complexity of care increases (driving
waste + inefficiency)
Physician A
Agency F
Physician W Primary Care Group
Service 467
Service 311
For Profit Rehab.
Agency Y
Public Rehab.
Service 222
Service 1
Service 179
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Additional Challenges in Canada
Weather!
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Additional Challenges in Canada
Where people choose to live!
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•Area: 661,848 km (vs 130,448 km for MC)
•Pop: 3,645,257 (2011)
•Growth: 1.6 %
•Density: 5.1 persons/km
•81% Urban
•60% of pop in 5 cities
•30% of the population will be
seniors by 2030
Additional Challenges in Canada
Geography
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Changes are needed: Alberta as an
example
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Northern Lights
Alberta: 154.5
Source: Alberta Health and Wellness. 2003-2005.
LEGEND
270
205
140
Peace Country
Health Regions in Alberta 1992-2008 Age-Standardized Mortality Rate per 100,000 Pop.
262.7
184.6
Aspen 194.1
Capital 147.8
East Central 182.5
David Thompson 177.3
Calgary 145.9
Palliser 184.3
Chinook 163.5
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Northern Lights
Alberta: 154.5
Source: Alberta Health and Wellness. 2003-2005.
LEGEND
270
205
140
Peace Country
Health Regions in Alberta 1992-2008 Age-Standardized Mortality Rate per 100,000 Pop.
262.7
184.6
Aspen 194.1
Capital 147.8
East Central 182.5
David Thompson 177.3
Calgary 145.9
Palliser 184.3
Chinook 163.5
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Alberta Health Services
Formed 2008
One Health System
One Board
5 Zones formed in 2010
SCN’s formed in 2012
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Strategic Clinical Networks
Support to lead Provincial Improvement and Sustainability
• Phase One (established June, 2012)
– Obesity, Diabetes and Nutrition
– Seniors’ Health
– Bone & Joint
– Cardiovascular Health and Stroke
– Cancer
– Addiction & Mental Health
• Phase Two (TBA, 2013)
– Population Health and Health Promotion*
– Primary Care and Chronic Disease Management*
– Maternal Health
– Newborn, Child and Youth Health
– Neurological Disease, ENT and Vision
– Complex Medicine (current Respiratory Clinical Network + others TBD)
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• Facilitates collaboration, joint decision-making
and shared learning
• Promotes the use/uptake of clinical experience,
knowledge and research to reduce variation
and improve care
• Involve partners along a broad continuum in
planning, improving and innovating healthcare
services
Why Networks?
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• Improve population health
• Ensure continuous quality improvement
• Incorporate research that impacts patients
• Focus on patient outcomes
• Design more accessible care
• Develop appropriate clinical practices
• Make patient safety a priority
• Ensure value for money
Provincial Mandate of AHS/SCN’s
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18 Initial SCN Goal:R&D, Innovate, Eliminate ‘Waste’ and Reinvest Resources
To improve Quality and Create a Sustainable System
$$$$
A Successful and Sustainable
Formula for Quality Health Care
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SCN’s as an integral component of Alberta Innovation and Research &
Development
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Health is a global business:
Improving Prevention, Health, and
Health Care Quality and Sustainability
Alberta has major competitive advantages
Our Provincial Approach is unique
Our Health system is unique
Our Universities are aligned
Our R and D structure is unique
Health/Energy/Environment/Food
Health generates major economic value
MANY industries related to health
Major Supply chains (drugs/lab /repairs)
Health Human Resources
Rapid and low cost access to high
quality health data = a key
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Health and Health Care Health is a Big Business: Comparison to oil patch
OIL + GAS + MINING
• >150,000 employed
– ~ 7% of workforce
– $79B/yr to Alberta’s GDP
• ~ 27.6% of Alberta’s GDP
• Oil sands
– ~21,000 jobs
– >$3.7B/yr in royalties
– $100B in provincial and municipal
taxes over 25 years
• R and D
– ~$1B/year on R and D (2010)
HEALTH + HEALTH CARE
• >190,000 employed
– ~ 9% of workforce
– $21B/yr to Alberta’s GDP
• ~ 7.6% of GDP (health care alone)
• Health Care
– 100 hospitals ~100,000 public jobs
– Every dollar spent on public health
care generates 21.7 cents in taxes
and import duties (Conf. Board – 2013)
• ~ $2.5B/year in Alberta in taxes/duties
• Plus private health care businesses
• R and D
– ~$ 478M/year (in 2008)
• Included ~$75M/year in biotech
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Health and Health Care Health is a Big Business: Comparison to oil patch
OIL + GAS + MINING
• >150,000 employed
– ~ 7% of workforce
– $79B/yr to Alberta’s GDP
• ~ 27.6% of Alberta’s GDP
• Oil sands
– ~21,000 jobs
– >$3.7B/yr in royalties
– $100B in provincial and municipal
taxes over 25 years
• R and D
– ~$1B/year on R and D (2010)
HEALTH + HEALTH CARE
• >190,000 employed
– ~ 9% of workforce
– $21B/yr to Alberta’s GDP
• ~ 7.6% of GDP (health care alone)
• Health Care
– 100 hospitals ~100,000 public jobs
– Every dollar spent on public health
care generates 21.7 cents in taxes
and import duties (Conf. Board – 2013)
• ~ $2.5B/year in Alberta in taxes/duties
• Plus private health care businesses
• R and D
– ~$ 478M/year (in 2008)
• Included ~$75M/year in biotech
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SCNs need to align ‘top to bottom’
SCN’s need to engage academics with Health Care System
Patients
Policy Makers/Payers
Providers
Administrators
Researchers
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For Researchers
Integrate the four pillars of health research research networks to connect, analyze, innovate and export
Basic research Clinical research
Health systems research Prevention, Population and
Public Health research
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For the System Overall – Will be Able to
Address
Translational Gaps in Research Uptake
Knowledge to Practice Continuum
Biomedical
Research Clinical
Science &
Knowledge
Clinical
Practice &
Health Decision
Making
Community
Based
Practice
Gap 1
Gap 2
Gap 3
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The Researcher
New
Knowledge
Users of Knowledge
On the same team
The ‘Knowledge Translation Networks’ of all-time with engaged end-users (clinical, policy, public, etc)
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Highly Qualified People = Key collecting and analyzing linked data
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Highly Qualified People = Key collecting and analyzing linked data
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Biggest Opportunity #1 comparative effectiveness data will define value for $$
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Biggest Opportunity #2 data to inform personalized medicine
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/
documents/digitalasset/dh_132382.pdf
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30 ....................and MANY OTHERS
SCN’s Can bring many key partners together
as the interface to the Health System
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Strategic Clinical Networks: Bringing
Science and Best Practices Together to
Define Next Practices integrate to innovate
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Stars are aligned - now