Institute for Better Health Newsletter Volume 1 Issue 1

THE INSTITUTE FOR BETTER HEALTH | NEWSLETTER VOLUME 1 ISSUE 1

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INSIDE THIS ISSUE: PROJECT PROFILE

Engaging Patients in Creating a New Model of Care for Cataract Procedures

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SCIENTIST SPOTLIGHT

Sharyn Gibbins, NP PhD

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Q&A

Research Ethics Board

A MESSAGE FROM OUR LEADERSHIP Welcome to our first newsletter

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his quarterly publication will feature research work and happenings across Trillium Health Partners (THP) and the Institute for Better Health (IBH) to inform, activate and share the latest health research in our community.

community, using scientific expertise, innovative approaches and partnerships.

As I reflect on my one-year anniversary of coming to the IBH, I am reminded of what brought me here and continues to inspire me.

As the only full-service hospital serving the Mississauga community, we are able to truly take a population perspective in our research. As we work to create a new kind of health care, we need to consider the diverse perspectives in our community to truly understand the full spectrum of their needs. Through our research, we will continue to better understand how to serve our community.

The IBH is an embedded research institute within THP; aligned in priorities, partners and most importantly vision. The hospital’s executive leadership wholly embraces research as a means to learn, shape strategies and inform initiatives. Working with THP and our community, we are creating a new kind of health care for a healthier

At THP, there is a shared and strong desire to transform health care in meaningful ways.

With this in mind, the IBH is focused on services and systems-based research; discovering, implementing and evaluating practical solutions that will produce better outcomes for our community and for the health care system as a whole. We strive

to take a patient and family centered approach to everything we do. We are designing solutions that meet the needs, expectations and preferences of our patients, their families, providers and the community both inside and outside hospital walls.

I look forward to continuing to share our successes, learnings and growth with you as we develop our infrastructure, welcome research chairs and faculty and take on new research endeavours.

Sincerely,

Robert Reid, MD, MPH, PhD

OUR MISSION:

A new kind of health care for a healthier community using scientific expertise, innovative approaches and partnerships

OUR VALUES:

We are committed to enabling, producing and sharing meaningful research and innovation through compassion, excellence and courage

Compassion

Excellence

and inclusion of patients, providers and community

in using scientific evidence, system design and evaluation

Courage

to think differently - plan, try, fail, succeed, improve, share

OUR RESEARCH THEMES:

Quality - Health Services Implementation & Evaluation Examine how people, organizations and health systems work together to discover areas for improvement

Access - Patient & Provider Experience Designing solutions around the needs and preferences of patients, families and providers Sustainability - Models of Care Integration & Exploration Developing new models of delivering care that result in better practice, better outcomes and better experiences

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ROBERT REID MD, MPH, PhD Chief Scientist, Institute for Better Health Senior Vice-President Science, Trillium Health Partners

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obert Reid is internationally recognized for his  research developing and testing populationbased innovations in primary care delivery, prevention services and chronic care. He received his medical degree from the University of Alberta and completed a master of public health in epidemiology and a doctorate of health policy and management from the Johns Hopkins University.

Robert is best known for his work in developing and evaluating Group Health Cooperative’s pioneering patient-centred medical home in Seattle, Washington, which coordinated and streamlined team-based care to improve quality, patient experience and affordability. A fellow of the American College of Preventive Medicine, he has lectured nationally and internationally on the organization, financing and delivery of care from the Mayo Clinic, Kaiser Permanente, and Harvard to Ottawa, London and Auckland.

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ENGAGING PATIENTS IN CREATING A NEW MODEL OF CARE FOR CATARACT PROCEDURES

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t 84 years old, Violet* was living on her own and struggling to take care of herself. The clouding from her cataracts was so severe she had lost nearly all of her vision. With pre-existing health conditions, Violet was unable to find a doctor willing to perform the outpatient procedure that would replace her cloudy lens with a clear lens to restore her vision. After 4 years of unsuccessfully navigating the health care system and desperate for help, Violet came to the emergency department at Trillium Health Partners (THP). Within a week, Violet’s first cataract surgery was performed and several weeks later her second surgery had been performed, restoring the vision in both of her eyes and allowing her to regain her independence.

standardized measures for prioritization, it is not always available in a timely manner for those who need it most. Under the current model of care, a patient who is unable to work due to their cataract(s) may be waiting just as long, if not longer, than a patient whose cataract(s) has little impact on their daily life.

captures diverse patient stories. Patients of different ages, with varied vision loss and social supports, shared their experiences of living with cataract(s) and navigating the health care system. The video brings the patient voice into the panel’s decisionmaking process to help shape a more equitable and patient-centred model of care.

Ike, along with Institute for Better Health (IBH) Scientist, Morgan Lim, PhD and their team are working to develop an Electronic Cataract Appropriateness and Prioritization System (eCAPS) that would standardize the way patients with cataracts are referred and triaged for surgery. eCAPS would provide physicians with standardized measurement tools for the assessment of

“We want patients and experts to be engaged in the design process to ensure we create a new model of care that truly meets the needs of both patients and providers,” says Dr. Lim. “eCAPS will be tested locally in Mississauga first, but if successful, we believe it can be used across Ontario, Canada and even globally, to standardize cataract care and other elective surgeries.”

“We want patients and experts to be engaged in the design process to ensure we create a new model of care that is designed to truly meet the needs of both the patient and provider.”

- Morgan Lim, PhD Violet says the surgery was life-changing, “I live alone and I couldn’t cook, I couldn’t read, I kept falling. It was very hard for me and I had to wait a long time for the surgery.”

Cataracts primarily develop through aging and thereby greatly affect seniors, one of the fastest growing and most vulnerable populations.

A global leader in ophthalmology, Ike Ahmed, MD, Division Head of Ophthalmology at THP, says stories like Violet’s are far too common. “In Ontario, the demand for cataract surgery is high and expected to increase as our population ages,” says Ike. “We are rethinking the model of care for cataracts with patients in mind, to create a system that includes the prioritization of patients based on need and appropriateness.”

Cataract surgery is the most commonly performed procedure in Ontario, yet costs and wait times vary drastically across the province1. Surgical removal of a cataract is effective, but with high demand and lack of

cataract(s) and act as an electronic interface between the hospital booking system, the wait time information system and clinic offices. eCAPS will not only help identify patients who are appropriate for cataract surgery, but also provide physicians with measurement tools to assess the impacts cataract(s) has on a patient’s quality of life to more appropriately prioritize and schedule patients, ensuring timely access for patients in greatest need of surgery.

An expert panel, comprised of ophthalmologists, optometrists and general practitioners, has been engaged to inform the creation of the standardized measurement tools. The panel has expertise in optical care and cataracts; however, they recognize the barriers in truly understanding the impact cataract(s) have on a patient’s quality of life. Barriers like time constraints, effective communication and power dynamics between patients and providers.

To better inform the panel, the research team conducted qualitative interviews with cataract(s) patients and compiled a video that

Violet was able to regain her independence, security and vision through cataract surgery.

There are many patients like Violet waiting to receive this life changing surgery. By identifying and prioritizing appropriate surgeries, patients will be given greater access to quality care. *Name has been changed for patient confidentiality.

Ontario Vision Strategy Task Force. A Vision for Ontario: Strategic Recommendations for Ophthalmology in Ontario. 2013.

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Project Update The expert panel is in the final phase of rating the criteria to be included in the cataract surgery appropriateness and measurement tool. The project has reached a major milestone with the start of patient recruitment, continuing over the next several months.

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SCIENTIST SPOTLIGHT SHARYN GIBBINS, NP, MN, PhD Director, Professional Practice Chair, Trillium Health Partners’ Research Ethics Board

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r. Sharyn Gibbins knows firsthand the impact frontline staff can have when they use research to improve care at the bedside. Sharyn began her career caring for the smallest and most fragile patients as a nurse in neonatology. She quickly noticed a gap between knowledge and practice.

“Health care providers gain valuable insights caring for patients,” says Sharyn. “To improve patient care on a larger scale, this knowledge needs to be shared. Research can do this.”

Determined to improve the health and care of her patients, Sharyn pursued research in neonatal pain and nutrition. A four-time recipient of esteemed Canadian Institute for Health Research (CIHR) funding, her body of work has transformed the way we care for preterm infants across the country.

Effective Pain Management in Preterm Infants

While in hospital, sick and preterm infants undergo numerous painful procedures with no reliable pain measures. Along with coinvestigator, Bonnie Stevens, PhD, Research Scientist, Sick Kids, they identified sucrose as an effective pain management tool in preterm babies. This groundbreaking discovery has been widely adopted as best practice across Ontario. They are currently focused on the dissemination and uptake of their findings to help the broader health care community understand how to assess and manage pain based on the most current evidence. Trillium Health Partners (THP) is one of the participating sites in this phase of the study, helping translate new evidence into practice.

Nutritional Interventions

Nutrition is critical to the healthy development of preterm infants. Sharyn and Co-Investigators, Sharon Unger, MD, Neonatologist, Mount Sinai Hospital, and Deborah O’Connor, PhD, Dietitian, Sick Kids have greatly contributed to the body of research showing that the nutrients provided by breast milk improves the health of preterm or low birthweight babies, protecting them against life-threatening illnesses, serious infections and other complications related to preterm birth. This team of researchers introduced donor milk to neonatal units in Ontario, Nova Scotia and British Columbia. They are currently looking at school age children to evaluate the outcomes of children who received donor milk.

Advancing Research at Trillium Health Partners

Sharyn brings her expertise to THP, leading the Research Ethics Board (REB) and introducing new learning opportunities to professional staff. “Sharyn has been instrumental in permeating research into the culture of THP, a key enabler for quality improvement in health care,” says Kathryn Hayward-Murray, Chief Nursing Executive and Senior Vice-President Patient Care Services, THP. “Her passion and expertise inspire and empower others to participate in research and make meaningful contributions to improve patient care.”

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As Director of Professional Practice, Sharyn was instrumental in the development of Partners in Research, an interprofessional practice-based research course tailored to THP staff in partnership with the Institute for Better Health and McMaster University. The three-year program has recently graduated its first cohort.

During her three-year term as Chair of THP’s REB, Sharyn has made significant enhancements to the board’s operations.

With an increase in studies processed through the REB, they have continued to improve their review time and find efficiencies. Membership has expanded to include a more diverse review board, including the addition of a community member. Sharyn has also introduced an academic mandate, requiring members to complete educational training and participate in academic discussions at meetings.

Sharyn is a leading scientist who conducts and inspires research that is transforming patient care at THP and beyond.

THP would like to recognize and thank Sharyn as outgoing Chair of the REB for her strong leadership and dedication over the past three years. With her expertise and oversight the REB has advanced its operations and diversity at the table. Sharyn’s work as REB Chair is a true testament to her commitment to improve health through research and innovation.

RESEARCH Q&A Do you have a question about research? Want to know more about the IBH? Ask us at IBH@trilliumhealthpartners.ca What is the Research Ethics Board or ‘REB’?

Trillium Health Partners’ (THP) Research Ethics Board (REB) is an independent body established by and accountable to the hospital’s Board of Directors to independently protect the rights and welfare of human research subjects.

The REB ensures all research involving human subjects meets the most current and highest ethical and scientific standards and is in compliance with the applicable legislation, guidelines, policies and regulations. The REB is comprised of staff and community member subject matter experts in the areas of ethics, privacy, clinical research and clinical practice, along with commmunity member representation.

The REB is mandated to approve, reject, propose modifications to, or terminate any proposed or ongoing research involving human subjects.

Research involving human subjects means any use of an individual’s (living or not living) data and/or responses to interventions, stimuli or questions to answer a research question. This includes research involving human remains, cadavers, tissues, biological fluids, embryos and fetuses.

Why is REB approval required?

It is a mandatory step in the research process. The REB ensures studies being conducted within or under the auspices of THP are ethical and that the rights, welfare and privacy of participants are protected.

As an organization that is eligible to receive Canadian Institutes of Health Research (CIHR) funding, all research conducted within, by or in collaboration with THP must be in compliance will all Tri-Council Policies – this includes REB approval.

The Tri-Council Policy is a joint policy for the ethical conduct of research involving humans of Canada’s three federal research agencies: the Canadian Institutes of Health Research (CIHR), the Natural Sciences and Engineering Research Council of Canada (NSERC), and the Social Sciences and Humanities Research Council of Canada (SSHRC).

How do I know if I need to submit to the REB? A study requires REB approval if: a) There are human participants; and/or b) There is analysis of personal information, personal health information and/or human biological materials from living or deceased individuals.

Often there is confusion as to whether a project is classified as research, quality improvement or innovation. If you are uncertain, contact the REB and they will provide clarification. If you are conducting human subjects research and do not apply for REB approval, research findings cannot be published, minimizing the impact of your work.

What do I need to submit to the REB? • Complete appropriate application form(s) • Research protocol – objectives, design, methodology, statistical considerations, and organization of a research study • Informed consent forms (if applicable) • Data collection forms (if applicable) • All supplemental material (e.g., questionnaires, assessment tools) • Budget In addition, other supplemental material necessary for the decision process should be provided, such as advertisements for recruitments.

When do I need to submit to the REB? You must submit to the REB and receive approval for all research that involves human participation or subject matter before research activity can begin.

Where do I submit to the REB? Applications are located on the Research Ethics Board page of THP’s website.

All submissions should be sent to: THPREB@trilliumhealthpartners.ca

A Research Ethics Board Coordinator can answer your questions about submitting to the REB at THPREB@trilliumhealthpartners.ca

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NEWS & EVENTS We would like to take the opportunity to recognize the following accomplishments and research activities.

THP Scientist Receives FedFev Grant Andrew Feifer, MD, MPH, Urological Oncologist and Surgeon, THP, has been awarded funding from FedDev Ontario’s Investing in Commercialization Partnerships for NED (No Evidence of Disease). The grant is awarded to hospital-based scientists to develop and commercialize new technologies with potential to manage chronic disease and provide Canadians with better, more precise health services delivered at a lower cost. In collaboration with University Health Network, Andrew has developed a personalized application for prostate cancer survivors to promote self-care and support providers with timely information about their patients’ health. Please join us in congratulating Andrew!

IBH Scientist Receives The Associated Medical Services Phoenix Fellowship Grant Seema Marwaha, MD, MEd, Clinician Scientist, IBH, Medical Internist, THP, has been awarded the Associated Medical Services (AMS) Pheonix Fellowship Grant to support her research in enabling compassionate care through storytelling. The AMS is a Canadian Foundation focused on compassionate care and championing the voice of patients and families. Each year, 6-10 of these fellowships are awarded to individuals to drive research work forward that aligns with their mandate. Please join us in congratulating Seema!

IBH Scientist Receives Canadian Institutes of Health Research Award Ian Zenlea, MD, MPH, Clinician Scientist, IBH, Paediatric Endocrinologist, THP, has been granted the Canadian Institute of Health Research (CIHR) Embedded Clinician Researcher Salary Award for a research program aimed at redesigning the care model for youth with obesity. This grant is awarded to a researcher who conducts transformative research and provides scientific leadership in improving the patient experience, outcomes and quality of life. Ian is one of 11 successful applicants from across Canada.

Please join us in congratulating Ian! Inaugural Maria Racioppo Scholarship for Integrative Care Established THP Foundation is introducing a new scholarship opportunity for staff whose day-to-day roles contribute to the experience, care and safety of patients, but who do not provide direct patient care and are not professional staff. The scholarship will provide dedicated research and innovation time to devote towards the contribution and support of an IBH project. The successful candidate will join the IBH in early 2017.

IBH Research Rounds - Merging Clinical, Research, Education and Entrepreneurship: How the Biomedical Zone Drives Patient-Centred Innovation in Health Thursday, December 8, 2016 - 12:00 p.m. - 1:00 p.m Live at Mississauga Hospital J-Wing Auditorium, 100 Queensway West, Mississauga, ON

Linda Maxwell, MD, MBA is a head and neck surgeon, as well as the founding and managing director of the Biomedical Zone, a Ryerson University and St. Michael’s Hospital joint partnership, whose core mission is to develop technology-focused early-stage companies delivering solutions to real-world health care problems. Linda will be joined Swift Medical, presenting Swift Wound XL, that uses machinevision and data analytics to solve operational, administrative and compliance challenges of wound care.

Registration is not required and all are welcome to attend. 1.0 CME credit.

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PUBLICATIONS This is a collection of some of the recent journal articles IBH and THP staff and professional staff have published.

Reid RJ. 2016. “Embedded Research in the Learning Health System.” Healthcare Papers 16 (Special Issue): 30-35.

Buist DSM, Chang E, Handley M, Pardee R, Gundersen G, Cheadle A, Reid RJ. 2016. “Primary Care Clinicians’ Perspectives on Reducing Low-Value Care in an Integrated Delivery System.” The Permanente Journal ;20(1):41-46.

Marwaha S, Lorv B, Heneleit S, Iroanyah N. 2016. “GET POKED: Comparing an Incentive-Based Flu Campaign with Vaccinate-or-Mask Policies to Boost Influenza Vaccination Rates Among Healthcare Workers.” Healthcare Quarterly, 18(4): 73-79.

Enright KA, Krzyzanowska MK. “Benefits and pitfalls of using administrative data to study hospitalization patterns in patients with cancer treated with chemotherapy.” J Oncol Pract. 2016 Feb;12(2):140-1. doi: 10.1200/ JOP.2015.008482.

Popovic M, Campos-Möller X, Schlenker MB, Ahmed II. “Efficacy and safety of femtosecond laser-assisted cataract surgery compared with manual cataract surgery: a meta-analysis of 14 567 eyes.” Ophthalmology. 2016 Aug 15. pii: S0161-6420(16)30607-8. doi: 10.1016/j.ophtha.2016.07.005.

McDonald JC, du Manoir JM, Kevork N, Le LW, Zimmermann C. “Advance directives in patients with advanced cancer receiving active treatment: attitudes, prevalence, and barriers. Support Care Cancer.” 2016 Oct 7. doi: 10.1007/ s00520-016-3433-6 Shulman RW, Kalra S, & Jiang JZ. “Validation of the sour seven questionnaire for screening delirium in hospitalized seniors by informal caregives and untrained nurses”. BMC geriatrics, 16(1), 1. 2016 Feb 15. doi: 10.1186/s12877016-0217-2 Nahas S, Feigenberg T, Park S. “Feasibility and safety of same-day discharge after minimally invasive hysterectomy in gynecologic oncology: A systematic review of the literature”. Gynecol Oncol. 2016 Jul 27. pii: S00908258(16)30984-2. doi: 10.1016/j.ygyno.2016.07.113.

Sikaneta T, Wu G, Abdolell M, Ng A, Mahdavi S, Svendrovski A, Tu T, Mercer T, Tong MK, Oreopoulos DG, Tam PW. “The trio trial - a randomized controlled clinical trial evaluating the effect of a biocompatible peritoneal dialysis solution on residual renal function”. Perit Dial Int. 2016 Jun 9. pii: pdi.2015.00090 Swartz RH, Bayley M, Lanctôt KL, Murray BJ, Cayley ML, Lien K, Sicard MN, Thorpe KE, Dowlatshahi D, Mandzia JL, Casaubon LK, Saposnik G, Perez Y, Sahlas DJ, Herrmann N. “Post-stroke depression, obstructive sleep apnea, and cognitive impairment: Rationale for, and barriers to, routine screening”. Int J Stroke. 2016 Jul;11(5):509-18. doi: 10.1177/1747493016641968. Epub 2016 Apr 12.

Fotouhi Ghiam A, Dawson LA, Abuzeid W, Rauth S, Jang RW, Horlick E, Bezjak A. “Role of palliative radiotherapy in the management of mural cardiac metastases: who, when and how to treat? A case series of 10 patients.” Cancer Med. 2016 Jun;5(6):989-96. doi: 10.1002/cam4.619. Epub 2016 Feb 16.

Ilyas F, Singh H, Anand N, Ahmed II. “Intraocular pressure rise in the course of peginterferon alpha-2a, ribavirin, and boceprevir therapy for hepatitis C.” Can J Ophthalmol. 2015 Dec;50(6):e112-4. doi: 10.1016/j.jcjo.2015.08.013.

To submit news, events and publications, contact: IBH@trilliumhealthpartners.ca.

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CONNECT WITH US AT IBH@TRILLIUMHEALTHPARTNERS.CA OR TRILLIUMHEALTHPARTNERS.CA/RESEARCHANDINNOVATION