We asked, you answered

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1 We asked, you answered an innovative method to sourcing answers to pressing health policy and health care questions CAHSPR 2016 Panel Discussion Canada Health Infoway

2 Our Panel Erika Yates Senior Research Project Manager Institute for Clinical Evaluative Sciences Tracy Johnson Director, Health System Analysis and Emerging Issues Canadian Institute for Health Information (CIHI) Chi-Ling Joanna Sinn PhD Candidate School of Public Health and Health Systems, University of Waterloo Greg Horne National Lead, Healthcare SAS Yoshiko Nakamachi ASP Lead, Program Manager Sinai Health System - University Health Network Antimicrobial Stewardship Program Simon Hagens - Moderator Director, Benefits Realization Canada Health Infoway Canada Health Infoway

3 Data Impact Challenges 13 Questions 64/77 days 51 submissions 41 judges Canada Health Infoway 2016 imaginenationchallenge.ca

4 Submission Example: How Often do Patients Receive Repeat Lab Tests Within 90 Days? 90 Day Duplication Rate Scope of exams Geographic /population scope Sample size % All outpatient All of Ontario 114 Million tests Timeframe Feb 2014 Apr Range: 11.5%-14.3% Average: 13.3% (30257/227768) Outpatient tests for LDL, HbA1c, TSH and HB Large primary care organization (Ontario) 0.23 Million tests % Hospital outpatient Large hospital pathology lab (Nova Scotia) 4 Range: 0%-7.1% Average: 6.0% (179534/ ) HCV, syphilis and HIV % Inpatient and outpatient for 24 common tests All of British Columbia Calgary 4.30 Million tests 2.98 Million tests 1.4 Million people Jan-Dec Abnormal results range: 20%-50% Normal results range: 5%-20% Canada Health Infoway 2016 Outpatient tests for HbAc1, TSH, and K All of Ontario 1.75 million Jul 2013 June

5 Yoshiko Nakamachi ASP Lead, Program Manager Sinai Health System - University Health Network Antimicrobial Stewardship Program Canada Health Infoway

6 CRACKING THE VAULT ON ANTIMICROBIAL DATA Yoshiko Nakamachi Program Manager, Antimicrobial Stewardship Program Sinai Health System - University Health Network ASP CAHSPR panel on Canada Health Infoway s Data Impact Challenge II May 11, 2016

7 Institute for Clinical Evaluative Sciences Team CASPAR Consortium of Antimicrobial Stewardship Programs Against Resistance

8 CCIS Ontario s Critical Care Information System Institute for Clinical Evaluative Sciences

9 What is the Reduction in Antimicrobial Use in Hospitals with Antimicrobial Stewardship Programs (ASP)? Before ASP After ASP 14% Institute for Clinical Evaluative Sciences

10 Greg Horne National Lead, Healthcare SAS Canada Health Infoway

11 Chi-Ling Joanna Sinn PhD Candidate School of Public Health and Health Systems, University of Waterloo Canada Health Infoway

12 Team interraiders (of the lost data) What portion of older adults (65+) have been L-R: prescribed Raquel Betini, benzodiazepine PhD(c), Sophie Hogeveen, or other PhD(c), sedativehypnotics for insomnia, agitation, or delirium? Chi-Ling Joanna Sinn, PhD(c), Byung Wook Chang, PhD, John Hirdes, PhD, Luke Turcotte, PhD(c)

13 Data source (Canadian Institute for Health Information University of Waterloo) RAI MDS 2.0 in the Continuing Care Reporting System RAI Home Care in the Home Care Reporting System From , proportion of persons with insomnia, agitation, or delirium receiving anxiolytics or hypnotics in Long-Term Care in Complex Continuing Care in long-stay Home Care* *Insomnia not measured in RAI Home Care

14 Erika Yates Senior Research Project Manager Institute for Clinical Evaluative Sciences Canada Health Infoway

15 Answering Data Impact Challenge Questions at the Institute for Clinical Evaluative Sciences CAHSPR CONFERENCE 2016 WEDNESDAY, MAY 11, 2016 ERIKA YATES Institute Institute for Clinical for Clinical Evaluative Evaluative Sciences Sciences

16 Answering Data Impact Challenge questions at ICES With house rules in place, invitation to participate extended Teams created, proposals written and submitted Proposals adjudicated Privacy requirements fulfilled Analysis and reporting completed Recognition at outset that clear organizational approach required to enable participation Guiding principles Proposals driven by research staff from across the ICES network Proposals subject to internal review and adjudication Submissions subject to privacy requirements Investment (funding for staff time) provided by ICES (25 hours per team)

17 Answering Data Impact Challenge questions at ICES Data Challenge I (May 2015) Data Challenge II (Dec 2015) Internal review 14 proposals 11 teams (27 research staff and 15 scientists) 10 data challenge questions 4 proposals 4 teams (15 research staff and 6 scientists) 3 data challenge questions Responses submitted 9 proposals 8 teams (26 research staff and 7 scientists) 7 data challenge questions 3 proposals 3 teams (11 research staff and 5 scientists) 3 data challenge questions Results Western π rates (First Place Award) Avengers (Runner Up Award) ICES Western (Best Answer, Judges Choice Awards) Team BUGS (Best Answer, Speed Bonus Awards) Ontario Opioid Investigators (Best Answer Award) Experience Enabled and limited by data holdings Internal process affected speed of submissions Duplication of effort needed consideration Feedback and debrief process helpful

18 Tracy Johnson Director, Health System Analysis and Emerging Issues Canadian Institute for Health Information (CIHI) Canada Health Infoway

19 CAHSPR Panel Discussion Judging the Data Impact Challenge Submissions Canadian Institute for Health Information May 11 th, 2016 Institute for Clinical Evaluative Sciences

20 Setting the stage Timing: July 20 th receive judging package from Infoway August 12 th completed judging of assigned submissions Number of assigned submissions: 5-7 per judge Estimated time commitment: minutes/submission for 2 3 hours in total Judging/Scoring criteria: Speed Quality Institute for Clinical Evaluative Sciences 20

21 Award Criteria Data Quality 20 points total Data Sources 5 points Are the data sources appropriate? Are relevant limitations are identified and described? Point s Weak Strong Analysis Quality- 15 points Is the analytical approach and outcomes of interest clearly described and appropriate? Is the interpretation of the results insightful and based on results reported? Is answer is solid enough to affect policy-making or decisions for the health system or clinical practice? Point s Weak Strong Institute for Clinical Evaluative Sciences

22 Award Criteria Representativeness 20 points How relevant is the submission to a defined population or patient group (pan-canadian or specific patient/population sub-group or health care setting/context)? How wide is the geographic scope (e.g. local, provincial territorial)? Are data from different settings considered (e.g. primary care alone, primary and acute care, all sectors)? Is the scope of clinical tests/drug/procedures/patients included in the study sample appropriate and sufficiently representative? Point s Weak Strong Innovation 10 points To what extent is the analysis innovative? Does it : leverage underutilized data sources? combine data sources? streamline processes (e.g. speed of ethics requirements or approvals)? inform underlying healthcare policy/practice issue? Point s Weak Strong Institute for Clinical Evaluative Sciences

23 Recommendation Operationalization Outcome CIHI Results to date Don t do imaging for lower-back pain unless red flags are present Low back pain patients who have a CT, MRI or X-ray within 6 months of a physician visit 30% of low back pain patients in AB have at least one scan Don t routinely perform preoperative testing (such as chest x-rays, echocardiograms or cardiac stress tests) for patients undergoing low-risk surgery. Chest x-ray, ECG, Echo or stress test in the 60 day prior to select list of low risk procedures (Ophthalmology, endoscopy or other) 18-35% of patients having a low risk procedure have a preoperative test depending on province (AB, SK and ON) and low risk procedure Do not use antipsychotics as a firstline intervention for insomnia in children and youth Use of low dose (below indicated treatment threshold) Quetiapine in children (5-24) ~200/100,000 children filled a low dose quetiapine prescription (BC, SK, MB) Rate has increased from 2008 to 2012 Don t do screening mammography for average risk women aged % women who report having a mammography scan in the past two years, without mention of risk factors Approximately 22% women aged received a screening mammogram despite having an average risk Don't routinely obtain head computerized tomography scans in hospitalized patients with delirium in the absence of risk factors Institute for Clinical Evaluative Sciences Patients with a CT scan and a diagnosis of delirium in same hospitalization 23 23% of hospitalized delirium patients in ON have a head CT without indication

24 Institute for Clinical Evaluative Sciences

25 Discussion Canada Health Infoway