Concurrent session II: The learning cycle

Thursday, March 8, 1:30 – 2:30 pm
Salon E
Chair: Sabrina Wong, UBC Centre for Health Services and Policy Research

Using network science to understand the knowledge translation pathways that support evidence informed decision making in learning health systems

Presenting author: Krista English, UBC Institute for Resource, Environment and Sustainability

Evidence-informed public policy has demonstrated positive outcomes for populations. Within the health sector, evidence-informed decision-making (EIDM) is a continuous process and suggests that knowledge generated from scientific research will support better policy, and knowledge translation (KT) is intended to facilitate this process. This interdisciplinary strategy uses network science to understand the KT pathways in a learning health system that supports EIDM in both the global and provincial context.

The discipline of epidemiology has embraced network science for quantitatively describing the transmission dynamics of communicable diseases in a population. Infectious diseases and knowledge translation alike, are contagious phenomena, whose transmission pathways can be mapped on a network. Many aspects of KT involve complex social processes fundamentally embedded in relationships and there is compelling evidence to suggest that a group’s success in solving complex problems is primarily related to the quality of relationships individuals form. Networks, comprised of nodes and edges, uniquely illuminate the importance and variability of this connectivity for understanding the holistic structure of these interpersonal networks.

Two applications are used to demonstrate the usefulness of network science for understanding complex health systems issues. At the macro- level, bibliometric analyses are used to understand the global trends in health policy and systems research (HPSR) over the past two and a half decades. The resulting network analysis demonstrates the evolution in international collaboration within HPSR over time. At the micro-level, a “Research to Policy Survey” was conducted in a public health agency with an embedded policy support research mandate. The survey captured the informal interpersonal networks among employees and these results were used to demonstrate the complex pathways along which research knowledge flows within the organization.

These concepts are used to understand KT as a contagion phenomenon in a learning environment that uses evidence to inform health policy. Both macro and micro applications enhance our understanding of the new metrics available which may facilitate knowledge flow for EIDM, improving organizational learning in support of quality improvement, client care and systems transformation.

Changing primary care performance measurement: Honey, we need to talk

Presenting author: Carol Mulder, Association of Family Health Teams of Ontario

Co-authors: Ross Kirkconnell, Allan Macpherson

Objective: Learn about what it takes to change performance measurement in primary care by doing it.

Background: The Association of Family Health Teams of Ontario (AFHTO) voluntarily launched an ongoing performance measurement process called “Data to Decisions” (D2D) in 2014, to achieve the organization’s strategic direction to improve care and demonstrate value of team-based, patient-centered comprehensive primary care. D2D included a novel composite measure of quality based on what matters to patients, providers and the system. The 6th iteration was released in Sep 2018.

Approach: Developmental evaluation using an action research approach. Operational documents (minutes, performance reports, conversations via email etc) were considered. The experience of primary care teams was described using template analysis, from which emerged enablers for participation and changes to make subsequent iterations of D2D easier and/or more meaningful.

Results: D2D was considered successful based on high and sustained voluntary participation (66% of members over 6 iterations), increasingly frequent conversations about QI and performance, increased EMR maturity and finally, persistent demonstration of Starfield’s observation that higher quality primary care is related to lower healthcare system cost.

AFHTO’s experience suggested that conversations were both the vehicle and data source for supporting and learning from the experience of D2D. Among these learnings was an awareness of divergence in the perceived priority of D2D and the capacity for problem-solving. The experience of members also pointed to enablers for performance measurement such as the strength of relationships and a philosophy of getting started in small safe ways. Notably, the novel composite measure of quality was not apparently a driver for participation even though it was instrumental in demonstrating that higher quality is related to lower cost.

Conclusion: Conversations are both a means and an end in efforts to improve performance measurement. Conversations supported the philosophy of getting started with small steps with an overt intention to learn and change the NEXT small step. This, in turn, facilitated ongoing voluntary participation and evolution towards an increasingly meaningful measurement process. All of which is to say that when it comes to performance measurement in primary care, “Honey, we NEED to talk!”

Connecting the dots: How an innovation hub can foster health system transformation

Presenting author: Candice Ashley Pollack, AGE-WELL National Innovation Hub

Canadians have engaged in an incredible amount of work in health research, yet the research-implementation gap in our country is up to 14 years. Meanwhile, policymakers are addressing some of the most complex socioeconomic challenges in our history without access to or knowledge of the cutting-edge solutions already out there. We call this the knowledge translation gap, and it is perhaps one of the greatest barriers to health system transformation in Canada.

In this presentation, we will share the vision of the AGE-WELL APPTA National Innovation Hub, and discuss the emerging model of innovation hubs as connecting points between researchers and policymakers in the context of Canada’s aging population. More specifically, we will examine the role that an innovation hub can play in promoting learning health systems through knowledge translation and knowledge exchange, and provide a taste of innovations to come in the field of health policy as it relates to aging.

Assessing the feasibility of payable outcome measures in digital health: The case of youth mental health

Presenting author: Mark Embrett, Canada Health Infoway

Co-authors: Simon Hagens

Objectives: New funding arrangements that promote payable outcomes promote innovation in learning health systems. Digital health solutions for youth mental health may provide an opportunity assess payable outcomes. To determine impactful digital health solutions for youth with mental health issues we assessed:

  • Digital health solutions suited for payable outcome research;
  • Outcomes for designing outcomes based funding models; and
  • The opportunities and challenges of outcome based funding

Approach: We engaged in an iterative, collaborative approach between social innovation experts, health researchers, mental health experts, and patients to conduct:

  • Literature review and needs assessment of the youth with mental illness population in Canada;
  • Environmental scan of digital health solutions for youth with mental illness;
  • Outcome analysis for measuring social impact for targeted populations
  • Development of an assessment tool to evaluate potential of digital health solutions in Canada

Results: Target populations focused on those with high need and high demand for digital health solutions due to barriers to access current health system services. To best organize the complexity of approaches to youth mental health we categorized the continuum of care into four domains: (1) promoting healthy development for all children and youth, (2) preventing disorders for all those at risk, (3) providing effective treatments for all those with established disorders, and (4) coordination of care. The environmental scan helped identified over 30 potential digital health services. Potential outcome domains were categorized as clinical, psychosocial, health system usage, satisfaction and health system process. Chosen outcome measures focused on patient reported outcome measures and health system indicators. Selection criteria included categories of health system alignment, cost of delivery, reach& access, capacity, health system potential, evidence of effectiveness, user/patient experiences, funder interest, and partnership networks.

Conclusion: To determine payable outcomes for youth mental health required careful alignment of population needs, demanded solutions, and evidence based outcomes before choosing a service and funder. The process described in this study provides guidance for how payable outcomes may promote innovative solutions.