ARTIC + Quality Standards: Spreading Quality Care

ARTIC + Quality Standards: Spreading Quality Care

By Dr. Joshua Tepper and Michelle Noble

Earlier this year, Globe and Mail health writer André Picard wrote a column about innovation in health care. “One of the most frustrating traits of the Canadian health-care system is its failure to recognize and embrace success,” he began. “Imagine if we took all our successful local innovations and pilot programs and actually implemented them on a larger scale,” he wrote later.

In Ontario, spreading innovation in health care is not something to be imagined. It is actually taking place.

ARTIC (Adopting Research to Improve Care) is a partnership between Health Quality Ontario and the Council of Academic Hospitals of Ontario (CAHO), and is one of the only Canadian programs focused exclusively on accelerating the spread of proven health care.

In the past year alone, ARTIC has improved the health of Ontarians by:

  • Expanding the use of primary care Memory Clinics by supporting the implementation of 17 clinics in rural, remote and underserviced communities across Ontario to improve care for patients with memory problems associated with dementia. They provide training for family medicine teams and professionals, meaning patients can receive appropriate care closer to home.
  • Reducing emergency room visits and improving care and the patient experience for up to 2,000 patients annually with opioid or alcohol addiction by supporting META:PHI (Mentoring, Education, and Clinical Tools for Addiction: Primary Care-Hospital Integration). The program has developed rapid access addiction medicine clinics in seven communities where opioid supports are much needed. They integrate care received in emergency departments and hospitals, primary care and front-line community services, enabling patients to seamlessly transition to a rapid access clinic and then, once stable, to a primary care provider. ARTIC and the Ministry of Health and Long Term Care are now supporting the further expansion of the clinics in communities across Ontario.
  • Expanding the use of a proven new tool that provides patients with clear and easy-to-understand instructions to help them manage their care after being discharged from hospital. A report by Ontario’s Avoidable Hospitalization Expert Panel in 2011 found communication of discharge instructions by hospitals to patients was often poor, in part because patients did not understand medical terms or were too stressed at the time of discharge to absorb critical information. Co-developed by patients and health care providers, PODS (Patient Oriented Discharge Summary) is being adopted in 27 hospitals and will benefit approximately 50,000 patients in the first year of its expanded use. If you are interested in adopting PODS at your hospital, contact ARTIC.

ARTIC will continue this important work in 2018. ARTIC has just issued a new call for proposals for high-impact clinical interventions or practice changes that are proven to work and are ready to spread across the province.

What is unique about this year’s call is that proposals are being sought for proven interventions or practice changes that align with Health Quality Ontario quality standards. Quality standards outline for clinicians and patients what quality care looks like and focus on conditions or topics where there are large variations in how care is delivered, or where there are gaps between the care provided in Ontario and the care patients should receive.

Based on the best available evidence, the standards are intended to enable critical conversations between patient and health care professional by providing them with tailored guidance to make them more comfortable and knowledgeable about the relevant condition.

To date, quality standards are been developed for a wide range of conditions including dementia, heavy menstrual bleeding, hip fracture, major depression, palliative care, opioid prescribing for both acute and chronic pain, and for the treatment of opioid use disorder.

To be eligible for ARTIC funding, proposed clinical interventions or practice changes must have already been proven and successfully implemented in at least one site, and must have involved patients and families in the development of the initiative and plans for its future spread. How patients are involved is a key criteria in assessing project proposals.  If you have or know of an intervention that’s ready to be spread across Ontario, we encourage you to apply.

As André Picard noted in his article, too often successful health innovations are piloted at one organization but never spread further. ARTIC is solving that problem by successfully seeding innovative projects in communities across Ontario, thereby providing quality care to patients and families.

 

Dr. Joshua Tepper is President and CEO of Health Quality Ontario and Michelle Noble is the Executive Director of the Council of Academic Hospitals of Ontario.

 

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Can computers help unlock the mysteries of the brain?

Can computers help unlock the mysteries of the brain?

This story was originally published by Sean O’Malley, Senior Media Relations Specialist and co-host of the CAMH Podcast, on the CAMH website

There is perhaps no better way to illustrate how much the world of mental health research has changed in the 20-year history of CAMH than to look at the work being done today by Dr. Sean Hill’s team at the Krembil Centre for Neuroinformatics.

Consider what happened in 1997, the year before CAMH was created. That was when Deep Blue, a supercomputer created by IBM, defeated the world’s best chess player Gary Kasparov, marking a seminal event in the history of our relationship with technology. Today, the free chess app on my smart phone could probably beat Deep Blue.

For fans of the dystopian Terminator movie franchise, Deep Blue’s victory over Team Human signaled the beginning of the end for humanity as we know it.

But for young scientists like Dr. Hill, it raised the same question he had been asking since he tried his first PC at the age of eight: how much smarter could we make these machines? Could we make them smart enough to unlock the mysteries of the brains of the people who created them?

CAMH podcast with Dr. Sean Hill neuroinformatics
Dr. Sean Hill, Director of CAMH’s Krembil Centre for Neuroinformatics and CAMH podcast co-hosts Dr. David Goldbloom and Sean O’Malley discuss the past, present and future of neuroinformatics.

Yes, Dr. Hill began coding when he was eight, inspired by something called a TRS-80 that his older brother’s high school had purchased at a local Radio Shack and let his brother bring home to their family farm in rural Maine.

“In the winter when it was cold and dark…there was this whole new world you could discover in a box,” says Hill. “To me it was an opportunity to be incredibly creative.”

From a neuroscience perspective, the answer to 8-year-old Sean Hill’s question about computers and the brain increasingly appears to be ‘yes’ in a way we could only have imagined in CAMH’s early days. And that could have profound implications for how we diagnose and treat mental illness in the future.

“We saw in 2005 that by 2025, a supercomputer would be built that could simulate brain circuitry the scale of the human brain,” says Dr. Hill in the latest episode of the CAMH Podcast.

That prediction ended up being off but not by much – that supercomputer is now expected to be ready in the next two years.

Just in time for Dr. Hill to apply that technology breakthrough to his work at CAMH.

After devoting much of his career to this intersection between computers and neuroscience, most recently at the prestigious Blue Brain Project in Switzerland, what most excites Dr. Hill about coming to CAMH is that he can now apply the theoretical power of big data to the flesh and blood world of patient care.

 

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CAMH is one of Ontario’s 23 research hospitals that contribute to a healthier, wealthier, smarter province. Look for other RESEARCH SPOTLIGHT posts on our Healthier, Wealthier, Smarter blog or join the conversation about why health research matters for Ontario on Twitter, using the hashtag #onHWS.

Healthy Aging: 100 Years of Research and Care at Baycrest

Healthy Aging: 100 Years of Research and Care at Baycrest

“I just plough through, that’s something I learned from my mom. Just plough through,” says Barbara Schechter, a young caregiver featured in CBC’s recent documentary, The Caregivers Club, which takes an intimate and compassionate look at the lives of four caregivers and their loved ones living with dementia. The families are also part of the Baycrest Health Sciences community in Toronto.

With three young children and a full time job, Barbara is also a caregiver for her mother. “The only thing that gets you through the day is how you’re going to manage and how you’re going to make your mom safe,” says Barbara in the documentary.

There are currently 564,000 Canadians living with dementia, and that number is expected to double by 2031. As Canada’s population ages, more and better care is needed.

Baycrest Health SciencesThat’s what drives the researchers at Baycrest Health Sciences.

Baycrest is ranked as one of the most research-intensive hospitals in Canada and is a member of the Council of Academic Hospitals of Ontario, which represents Ontario’s research hospitals. Research hospitals play a unique and vital role in Ontario’s health system, providing advanced patient care services, training the healthcare workforce, and conducting leading-edge research to discover tomorrow’s care today. They generate the expertise and evidence to drive change as system leaders, building a healthier, wealthier, smarter Ontario.

And Baycrest is doing just that. Its Rotman Research Institute is among the world’s top research institutes in cognitive neuroscience.  The Centre for Aging and Brain Health Innovation, led by Baycrest Health Sciences, helps to accelerate brain health and aging solutions. Together, Baycrest is advancing dementia care for patients locally and globally, discovering better ways to diagnose, prevent and treat dementia and other brain disorders.

Research at Baycrest is part of a continuous cycle, where foundational brain research leads to clinical testing, which leads to innovations supporting healthy aging, which leads to more questions about the fundamental mechanisms of the brain.

Is my memory normal? At-home assessments and iPad apps  

Early detection and prevention of memory problems and cognitive impairment is a major area of focus at Baycrest. Cogniciti, a digital health company led by Baycrest researchers, is empowering adults to assess their memory in the comfort of their own homes. Free, private and clinically researched, the digital brain health assessment has helped more than 60,000 adults answer the question, “Is my memory normal or should I see my doctor?”

Test-takers age 40 and up solve a series of evidence-based puzzles, including shape matching, face and name matching, and a number-letter alternating test. Based on performance, they receive a memory report and may be advised to connect with their family doctor for next steps in care.  Through the brain health assessment, Cogniciti provides researchers access to a rich pool of interested volunteers to help advance memory research.

Another initiative accelerating research into Alzheimer’s and dementia treatments is Baycrest’s work with the Toronto Dementia Research Alliance (TDRA). The Sam and Ida Ross Memory Clinic at Baycrest is the initial pilot site for the newly developed Toronto Cognitive Assessment (TorCA), which utilizes an iPad to capture anonymous patient information and pools it onto a secure, research recruitment database that will be shared amongst TDRA memory clinics. This data will allow scientists to widen their pool of research subjects and easily identify and recruit consenting subjects who match the criteria for their dementia studies.

The TorCA is a sensitive tool that can identify patients at risk of dementia earlier. The assessment not only informs research on detection of memory-related conditions, it also saves costs for the health system and saves patients from having to pursue unnecessary cognitive tests.

Currently, Ontario patients concerned with cognitive impairment receive assessments from specialists. The TorCA iPad app is a game changer, allowing any health care professional to assess patients upfront and determine whether they need to pursue a more lengthy and resource intensive neuropsychology exam. The hope is that this tool will soon be clinically available across TDRA hospital sites within Toronto – and beyond— free of charge.

Getting a glimpse into a brain with dementia

What if you could detect the minute changes that occur in the brain Alzheimer's transcranial stimulationover the course of a person’s life? Researchers at Baycrest are getting the chance to do just that by using magnetic resonance imaging (MRI) to study the aging brain, including brains with very early dementia.

Cognitive tests, similar to the Toronto Cognitive Assessment, led Dr. Rosanna Olsen and her team to wonder whether physical differences could be detected in the brains of healthy adults who scored poorly compared to those who scored well.

Her cross-sectional study found that people who scored lower on cognitive tests had a smaller “memory region” of the brain – the same region that is first affected in Alzheimer’s disease. This finding has allowed researchers to use both memory region brain measures and low cognitive test scores as biomarkers (a biological flag) for Alzheimer’s disease, which is a big step forward for the detection and prevention of dementia.

Innovative treatment for older adults with depression and Alzheimer’s disease

Up to 70% of people living with Alzheimer’s disease also suffer from depression, which does not typically respond to standard antidepressant treatments. Dr. Linda Mah and Dr. Jed Meltzer are using a non-invasive procedure called transcranial magnetic stimulation (TMS) to reduce symptoms of depression in older adults with Alzheimer’s.

TMS uses magnetic fields to stimulate or inhibit neurons in the brain. Although TMS is approved as a treatment for depression, researchers are aiming to treat other neurologic and psychiatric conditions. Drs. Mah and Meltzer will evaluate the effects of TMS on both mood and memory in Alzheimer’s patients who also suffer from clinical depression. For Alzheimer’s patients, this could mean tapping into brain stimulation to treat their symptoms.

Patient and family care driving research

Research at Baycrest goes both ways. Not only is evidence informing how clinicians, occupational therapists, personal support workers and volunteers care for Baycrest clients, but researchers are also evaluating services to ensure high quality care and support.

Baycrest dementia arts therapyThe Road to Connection program is a great example of this. It’s an arts-based program that brings together caregivers and their partners with dementia for creative sessions and discussion. The program empowers dementia patients to tap into their creative skills while serving as a support group for caregivers.  On top of that, the program gives caregivers an opportunity to celebrate their partners through the art they have created and come away with a shared, meaningful experience.

“We could come back together at the end of the day with something for both of us,” said one caregiver participating in the program. “There aren’t many programs like this one that allow caregivers to meet and share without leaving loved ones behind.”

Baycrest researchers are evaluating the Road to Connection program with the hope of duplicating it across other sites within the Baycrest community and in Ontario.

Baycrest researchers have evaluated and helped redesign volunteer programs to improve resident engagement in Baycrest’s long-term care facility, the Apotex Centre. The Program for Leisure Engagement for Active and Spontaneous Experiences (PLEASE) is an evidence-based model that trains volunteers to work one-on-one and in small groups with residents, when they ask the simple question, “What do you want to do today?” The evaluation found that the PLEASE program enhanced the abilities and personhood of residents – more smiling, talking and engagement. Researchers are also exploring the use of volunteer visits to help older adults with dementia preserve or improve their thinking abilities.

This work helps long-term care homes incorporate cost-effective programs to improve care for residents with dementia and create new roles for volunteers working with older adults.

A century of excellence in complex care, research and training

The world’s population is aging rapidly, and Baycrest has the expertise to deliver proactive solutions. Now in its centennial year, Baycrest has spent 100 years pioneering the science of health and aging.

Baycrest provides compassionate, specialized care, conducts cutting-edge cognitive neuroscience research, commercializes innovative solutions, and trains the next generation of health care professionals with the skills needed to support and respond to the diverse and complex needs of older adults.

As a global leader, Baycrest’s work is contributing to a healthier, wealthier, and smarter future for Ontario and beyond.

 

Why does health research matter to us? We know that it generates new discoveries, better care, and greater efficiency all while contributing to our knowledge-based economy. That’s how it makes Ontario healthier, wealthier and smarter today. Investing in research hospitals will help us continue building a healthier, wealthier, smarter Ontario. Discover more health research and patient stories by signing up for our monthly newsletter or joining the #onHWS conversation on Twitter.

Group feature photo was taken during CAHO’s Healthier, Wealthier, Smarter Field Trip to Baycrest Health Sciences. Read our other Healthier, Wealthier, Smarter Field Trips here.