July 5, 2019
Dr. Niven Receives Two CIHR Grants
Please congratulate Dr. Niven on receiving two CIHR grants.
Catalyst Grant: SPOR Innovative Clinical Trials
Healthcare systems need to more consistently incorporate findings from research into patient care. Gaps between what we know through research and what we do in daily care of patients (knowledge-practice gaps) result in underuse of helpful tests and treatments and overuse of unhelpful ones. Given the amount of research that needs to be incorporated into patient care, and the limited success existing methods have had doing so, new methods for closing these knowledge-practice gaps are needed. This is especially important for patients admitted to intensive care units (ICUs) where multiple expensive, potentially risky tests, and treatments are used to save lives. Decision-makers for ICUs in Alberta have asked us to develop new methods for improving the use of helpful tests and treatments and reducing the use of the unhelpful ones for patients admitted to ICUs. In response to this challenge, we have designed a system composed of key personnel and organizations within Alberta that is capable of more efficiently using helpful tests and treatments and stopping unhelpful ones. We refer to this as a learning healthcare system. However, before we can incorporate this learning healthcare system into our current healthcare system, many of its components require testing and evaluation. The project described in this application proposes to test one component of our system by trying to efficiently decrease unnecessary use of an unhelpful treatment provided to patients admitted to ICUs in Alberta. The treatment is prescription of a blood product called albumin to patients that need intravenous fluids. Research clearly shows that albumin is not helpful for most patients, but costs 40 time the amount of the alternative treatment (standard intravenous fluids). For most patients, its use unnecessarily exposes patients to blood products and constitutes unnecessary healthcare spending. Albumin is thus an excellent treatment to use as the test case for our learning health care system.
Abstract: Healthcare systems need to more consistently incorporate findings from research into patient care. With the amount of research in the current medical literature, and limited resources available to apply this research, some research findings should be given higher priority over others. This is especially important for patients admitted to intensive care units (ICUs) where multiple expensive, potentially risky tests, and treatments are used to save lives. In a review of ICU research, we identified 14 medical practices that high-quality research suggests are beneficial among ICU patients, and 21 practices that are of no benefit. Decision-makers for ICUs in Alberta have asked us to use this list of 35 ICU practices to develop a method that can both determine from within a list of current research which ICU care practices should be given greater priority for use or removal from patient care, and allows for annual updating of the list by being responsive to new research. We plan to do this in 4 connected steps, guided by a governing group consisting of patients, researchers, and healthcare providers. First, we will develop a method that enables our review of ICU research to be continuously updated in response to new research. Second, using electronic health data, we will determine predicted outcomes and costs associated with changes in use of each practice. Third, we will survey a national group of healthcare providers and former ICU patients and their family members to rank priorities for practice change. Fourth, we will present the results of steps 1-3 to decision-makers in Alberta to determine which patient care practices will be targets for practice change in Alberta ICUs. This work is important because it will help improve care in ICUs, and potentially contribute to future improvements in other areas of healthcare through development of a strong, widely applicable, sustainable approach for incorporating high-quality science into the care of patients admitted to ICUs.