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Peer-to-Peer Webinar Series: Success Stories in EIDM 2018 / Webinar #2

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There are many examples of evidence-informed decision making (EIDM) among public health professionals and organizations in Canada. However, there are limited mechanisms in place to facilitate the sharing of these stories within the public health community. The National Collaborating Centre for Methods and Tools (NCCMT) seeks to address this gap with an interactive, peer-led webinar series featuring a collection of EIDM success stories in public health.

These success stories will illustrate what EIDM in public health practice, programs and policy looks like across the country.

Join us to engage with public health practitioners across Canada as they share their success stories of using or implementing EIDM in the real world. Learn about the strategies and tools used by presenters to improve the use of evidence.

Featuring:

Sharing health information with community organizations to promote health equity
Dr. M. Mustafa Hirji and Cassandra Ogunniyi, Niagara Region Public Health & Emergency Services

To improve the sharing of local demographic and health outcome data to meet the needs of local priority populations, a project was undertaken to examine how to select, analyze and distribute data. Learn more about how this team worked to improve data sharing across local public health units and community partners.

Putting research in place: An innovative approach to decision support in Newfoundland and Labrador
Dr. Stephen Bornstein and Rochelle Baker, Newfoundland and Labrador Centre for Applied Health Research

The Newfoundland & Labrador Centre for Applied Health Research (NLCAHR) supports applied health research in Newfoundland and Labrador. Learn more about how the NLCAHR’s Contextualized Health Research Synthesis Program works with health system partners to prioritize health research needs, as well as synthesize and contextualize evidence for Newfoundland and Labrador.

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Peer-to-Peer Webinar Series: Success Stories in EIDM 2018 / Webinar #2

  1. 1. Follow us @nccmt Suivez-nous @ccnmo Peer-to-Peer Webinar: Success Stories in EIDM Webinar 2 - Featuring: Sharing health information with community organizations to promote health equity Dr. M. Mustafa Hirji and Cassandra Ogunniyi, Niagara Region Public Health & Emergency Services Putting research in place: An innovative approach to decision support in Newfoundland and Labrador Dr. Stephen Bornstein, Pablo Navarro, and Rochelle Baker, Newfoundland & Labrador Centre for Applied Health Research November 28, 2018 1:00 – 2:30 PM EST
  2. 2. Follow us @nccmt Suivez-nous @ccnmo 2 Housekeeping Use Chat to post comments and/or questions during the webinar • ‘Send’ questions to All (not privately to ‘Host’) Connection issues • Recommend using a wired Internet connection (vs. wireless), • WebEx 24/7 help line • 1-866-229-3239 Participant Side Panel in WebEx Chat
  3. 3. Follow us @nccmt Suivez-nous @ccnmo 3 After Today Presentation slides (in English and French) and a video recording (in English) will be posted. These resources will be available at: http://www.nccmt.ca/capacity- development/webinars/previous-webinars
  4. 4. Follow us @nccmt Suivez-nous @ccnmo 4 How many people are watching today’s session with you? Poll Question #1 a. Just me b. 1-3 c. 4-5 d. 6-10 e. >10
  5. 5. Follow us @nccmt Suivez-nous @ccnmo 5
  6. 6. NCC Infectious Diseases Winnipeg, MB NCC Methods and Tools Hamilton, ON NCC Healthy Public Policy Montreal, QC NCC Determinants of Health Antigonish, NS NCC Aboriginal Health Prince George, BC NCC Environmental Health Vancouver, BC 6
  7. 7. Registry of Methods and Tools Online Learning Opportunities WorkshopsVideo Series Public Health+ Networking and Outreach NCCMT Products and Services 7
  8. 8. Follow us @nccmt Suivez-nous @ccnmo The EIDM Casebook • Collection of success stories in public health • Available at http://www.nccmt.ca/impa ct/eidm-casebook 8
  9. 9. Follow us @nccmt Suivez-nous @ccnmo 9 Presenters Dr. M. Mustafa Hirji Niagara Region Public Health & Emergency Services Cassandra Ogunniyi
  10. 10. A Locally Driven Collaborative Project (LDCP) 10
  11. 11. Speakers Dr. M. Mustafa Hirji, MD MPH FRCPC Medical Officer of Health & Commissioner (Acting) Niagara Region Public Health & Emergency Services Cassandra Ogunniyi, PhD, MSocSci, BA Strategic and Health Equity Initiatives Coordinator Niagara Region Public Health & Emergency Services 11
  12. 12. Presentation Outline We will discuss the LDCP's: • Objectives • Phases • Results • Impact Assessment • Lessons Learned 12
  13. 13. Disclaimer • This project is funded by Public Health Ontario • The views expressed in this presentation are those of the project team and do not necessarily represent the views of Public Health Ontario 13
  14. 14. Participating Local Public Health Agencies • Kingston, Frontenac and Lennox & Addington Public Health (KFL&A) • Leeds, Grenville and Lanark District Health Unit (LGLDHU) • Niagara Region Public Health (NRPH) • North Bay Parry Sound District Health Unit (NBPSDHU) • Ottawa Public Health (OPH) • York Region Public Health (YRPH) 14
  15. 15. Project Team • Allison Branston (NRPH) • Andrew Hendriks (OPH) • Clare Mak (KFL&A) • Elaine Murkin (LGLDHU) • Ellen Wodchis (NRPH) • Kaelan Moat (McMaster) • Karen Graham (NBPSDHU) • Marty Mako (NRPH) • Marjan White (OPH) • Matthew Tenenbaum (McMaster/UofT) • Nicole Andruszkiewicz (NRPH) • Sinéad McElhone (NRPH) • Shailee Tanna (NRPH) • Tanis Brown (LGLDHU) • Tanya Scarapicchia (PHO) • Tina Leung (YRPH) 15 • Carolynne Gabriel, Middlesex-London Health Unit Library – literature search • Community partners – survey, dialogue and pilot
  16. 16. Health Equity Public Health Social Services OthersCHCs Local Advocacy Groups 16
  17. 17. LDCP Objective • Identify best practices to select and analyze key behavioural and health outcome data and how to distribute the data to local community partners to enable them to advance health equity for the populations they serve 17
  18. 18. Short term goals • Understand community partners’ preferred types of data and methods of distribution • Identify barriers, possible solutions and implementation considerations in data sharing and use among community partners • Determine ways in which community partners could use population health data provided to them by LPHAs 18
  19. 19. Long term goals • Enable community partners to successfully reduce health inequities • Increase data sharing initiatives between LPHAs and their local community partners • Develop community partners’ understanding of the role of public health for data sharing • Increase understanding among LPHA staff of the data needs of their community partners 19
  20. 20. Project Timeline 20 Phase One Survey of Community Partners Literature Review In-Person Deliberative Dialogue
  21. 21. Methods • Survey: ▫ Sample - 401 community partners ▫ Partners had existing relationships with 6 LPHAs ▫ 25% Response Rate – 99 respondents 21
  22. 22. Methods • Literature Search: ▫ Supported by librarian ▫ Search constructs (health equity, public health, KTE, data, community partners) ▫ Medline, Embase, CINHAL ▫ Total 12 articles used: 9 grey literature, 3 systematic reviews (2229 citations reviewed) 22
  23. 23. Methods • Deliberative Dialogue: ▫ Evidence brief 1. Problem (barriers in data sharing and use) 2. Options to solve the problem 3. Implementation considerations ▫ Merit review of evidence brief ▫ Participants selected from interested survey respondents ▫ McMaster Health Forum facilitated ▫ Dialogue summary 23
  24. 24. Results: Evidence Brief & Dialogue 24 • Capacity limitations across organizations • Lack of a universal data sharing strategy • Lack of a supportive work structure for data sharing • Lack of familiarity with ethical processes to share data Barriers • Provide interpreted data • Enhance data sharing networks • Provide assistance with capacity-building • Develop universal methods for data sharing Potential Solutions
  25. 25. Project Timeline 25 Phase Two Pilot Sharing Data Feedback & Evaluation Develop a Guidebook for LPHAs
  26. 26. Process for Data Sharing 26 Evaluation & Collaboration Provide Data Consultation Identify Partners
  27. 27. Step 1: Identify Partners 27 • Findings indicate importance of trust • Collaborate based on common areas of focus • Community partners may also self-identify by requesting data from LPHAs
  28. 28. Step 2: Conduct Consultation 28 • Shared goals • Common understanding of data • LPHA capabilities and community partner needs • Types of data requested: ▫ Demographics ▫ Health outcomes
  29. 29. Step 3: Provide Data 29 • Data considerations: ▫ Ownership ▫ Privacy ▫ Data sharing agreements • Comparisons between local and regional and/or provincial data is valuable
  30. 30. Step 4: Evaluation & Collaboration 30 • Connect with community partners over time to conduct evaluation at multiple times • Work with partners to use the data collaboratively • To address the social determinants of health • Use the data for program planning • Advocacy • Raise awareness
  31. 31. Pilot Methods • Pilot: ▫ 3 local community organizations in Niagara Region ▫ Initial consultation ▫ Briefing document with summarized data & interpretation ▫ Evaluation  Satisfaction  Usefulness  Capacity to use 31
  32. 32. Pilot Results & Evaluation • Feedback on Data Received ▫ “Comprehensive” ▫ Appreciated local data compared to regional/provincial data ▫ All partners interested in future data sharing initiatives • Data Use for Impact on Health Equity ▫ To identify potential new clients ▫ To evaluate their services ▫ Provides “leverage” to apply for funding 32
  33. 33. Guide for Data Sharing 33 Purpose • Outlines the processes of engaging in data sharing to improve health equity at the local level Who is This Guide For? • Local Public Health Agency (LPHA) staff to share data with their local community partners
  34. 34. Impact Assessment 34 Objectives 1) Evaluate how data provided to community partners affects their work on health equity issues 2) Evaluate how the guide can assist LPHAs with sharing data with their local community partners
  35. 35. Impact Assessment Methods 35 • Conduct evaluation interviews with the pilot organizations at 6 and 12 months post pilot • Send survey to LPHA staff to assess the guide’s content and usability • Conduct in-person and over the phone interviews with LPHA staff approximately 6 months after the survey
  36. 36. Lessons Learned – Worked Well 36 • Consulting with community partners • Hosting a deliberative dialogue • Having a diverse LDCP team from across Ontario
  37. 37. Lessons Learned – Done differently 37 • Consulting with other LPHAs • Increasing the time frame • Engaging in a longer pilot
  38. 38. Thank you! 38
  39. 39. Questions? 39
  40. 40. Follow us @nccmt Suivez-nous @ccnmo 40 Your Comments/Questions • Use Chat to post comments and/or questions • ‘Send’ questions to All (not privately to ‘Host’) Chat Participant Side Panel in WebEx
  41. 41. Follow us @nccmt Suivez-nous @ccnmo 41 Presenters Dr. Stephen Bornstein Rochelle Baker Newfoundland & Labrador Centre for Applied Health Research Pablo Navarro
  42. 42. CHRSPPutting Research in Place An innovative approach to decision support in Newfoundland & Labrador NCCMT Peer-to-Peer Webinar Series: Success Stories in Evidence-Informed Decision Making November 28, 2018 Dr. Stephen Bornstein Director, NL Centre for Applied Health Research
  43. 43. • About us /the Newfoundland & Labrador Context Stephen Bornstein • The CHRSP Method: “What will work here?” Pablo Navarro • Feedback & Uptake Rochelle Baker • Lessons Learned Stephen Bornstein Overview
  44. 44. About NLCAHR • Funding from Department of Health/ Memorial University • Builds capacity for applied health research • Addresses priority health research needs • Encourages the use of research evidence in healthcare
  45. 45. The Challenge: bringing evidence to policy and practice Research Users: “How can we locate the best scientific evidence (as one input among many) to support our decision making? How can we obtain evidence that addresses our unique challenges and capacities?” Researchers: “How can we get scientific evidence into the hands of decision makers in a form they will appreciate and use?” Everywhere, researchers and research users face the problem of effective collaboration: This challenge is particularly evident in a place like Newfoundland & Labrador.
  46. 46. The Newfoundland & Labrador Context
  47. 47. Demographics
  48. 48. Population Health Diabetes Obesity Smoking Chronic Disease
  49. 49. • Highest mental health hospital separations in Canada: – 235.3/100,000 vs. 79.3/100,000 national average • Prevalence of dementia is high and projected to rise: – 8,600 currently diagnosed – 18,000 by 2030 Mental Health
  50. 50. Access to Healthcare Labrador Grenfell Health: 104 AC Beds: 3 health centres; 2 hospitals Western Health: 268 AC Beds: 3 health centres; 2 hospitals Central Health: 253 AC Beds: 9 health centres Eastern Health: 836 AC Beds; (350 in HSC): 4 health centres; 5 hospitals Newfoundland and Labrador acute care facilities and catchment areas (representing sixty-minute driving time to the facility)
  51. 51. Healthcare Challenges • Population health challenges • Access challenges • Services for key demographics: – Geriatric patients – Chronic disease patients – Mental health patients – Indigenous peoples • Health human resources: – Rural primary care physicians – Specialists, particularly in ST&R – Allied health workers (OT, PT, etc.)
  52. 52. Decision-making Challenges • Decision makers lack analytic and policy capacity • Decision makers tend to ignore generic evidence • These problems are very apparent in NL but likely arise in other places, too.
  53. 53. The Solution? Contextualized Synthesis and iKT • Contextualized An iKT program to support evidence-based healthcare policy in Newfoundland & Labrador • Health • Research • Synthesis • Program CHRSP looks at local conditions to figure out what will work here.CHRSP synthesizes the best available research evidence.
  54. 54. CHRSP Projects Evidence in Context (EIC) Reports are fully contextualized syntheses of high quality SR evidence 1. Exercise Interventions in LTC 2. Reducing Acute Care Length of Stay 3. Prevention and Screening for Type 2 Diabetes 4. Supporting the Independence of Persons with Dementia 5. Troponin Point-of-Care Testing 6. Agitation and Aggression in Residents with Dementia in LTC 7. Fall Prevention for Seniors in Institutional Healthcare Settings 8. Community-Based Service Models for Seniors 9. Telehealth for Specialist-Patient Consultations 10. Updated Evidence on Rural Dialysis Services 11. Age-Friendly Acute Care 12. Hyperbaric Oxygen Therapy for Difficult Wounds 13. Chronic Disease Management 14. Youth Residential Treatment 15. Reuse of Single-Use Medical Devices 16. Childhood Overweight and Obesity 17. PET-CT in Newfoundland and Labrador 18. Options for Dialysis Services in Rural and Remote NL TOPICS |2018-2019 • De-Prescribing Medications • Palliative Care Experiences • High-Risk/ Low-Volume Obstetrics & Pediatric Services • Advance Care Paramedics in Rural Settings Reports in Progress: 19. Barriers & Facilitators to Care Transitions 20. Evidence Update: Hyperbaric Oxygen Therapy for treating wounds
  55. 55. A More Rapid Report Rapid Evidence Reports (RER) are completed in 30 days to provide an evidence overview for quicker decisions (or in cases where the SR evidence is not robust): 1. Preschool Screening 2. Chronic Disease & Palliative Care 3. Mental Health Units in Acute Care Facilities 4. Digital Surveys for Patient Feedback 5. Reducing Wait Times for Outpatient Services 6. Health Promotion Strategies: Healthy Dietary Habits 7. Ambulatory Care Services for Patients with Chronic Heart Failure 8. Flu Vaccination for Healthcare Workers in Newfoundland and Labrador 9. Mobile Mental Health Crisis Intervention 10. Safe Patient Handling Programs and Injury Prevention
  56. 56. Our Latest Format Snapshot Reports were launched in 2017 to provide a jurisdictional scan of policies, practices, and interventions that have been implemented elsewhere in Canada, or globally, to help decision makers assess options that might be suitable for adaptation in Newfoundland & Labrador. These reports can become the impetus for more in-depth study, as an EIC or an RER. 1. Remote Patient Monitoring 2. Home Dialysis 3. Rural Psychiatry Services 4. Health Risk Assessments for School-Aged Children & Youth
  57. 57. The CHRSP seven-step method 3. Build the research team 2. Set priorities 1. Ask the health system 5. Place the evidence in context 7. Report the findings 6. Identify implications for decision makers CHRSP involves Health System Partners every step of the way: from topic selection to dissemination. 4. Synthesize & Appraise the evidence
  58. 58. 1. Ask the Health System Every year, CHRSP asks its health system partners for topic submissions. From across the province, these partners tell us what issues require evidence to inform pending health policy decisions. 2. Set Priorities CHRSP collaborates with health system partners to refine an annual list of Research Questions, based on priority, feasibility, and availability of quality evidence. Step 2 results in a short list of priority topics CHRSP Health & Community Services Children, Seniors & Social Development Step 1 results in a long list
  59. 59. 3. Build the Research Team CHRSP research teams include diverse perspectives and expertise, from both knowledge producers and knowledge users, a process known as Integrated Knowledge Translation. Team Leader: Subject Expert Consultants: Decision-makers and administrators, frontline service providers, patients, caregivers, other stakeholders NLCAHR: CHRSP Researchers Academics: Local experts and health economists (as required) Health System Leader: CEO or Deputy Minister The Research Team’s first job is to refine the research question
  60. 60. 4. Synthesize the Evidence Search Strategy Critical Appraisal Synthesis Search for: • Systematic Reviews • Primary studies not captured in Systematic Review literature Filter evidence: • Up-to-date • On topic Critically appraise evidence: • AMSTAR* / Downs & Black Rating • Assess limitations • CHRSP Evidence Rating System Synthesize evidence: • Extract data with PICOS* framework • Identify/interpret convergent/divergent findings *AMSTAR = Assessment of Multiple Systematic Reviews | ** PICOS- Population Intervention Comparison Outcome Setting
  61. 61. The CHRSP Evidence Rating System Data • Enter SR Metrics (Quality & Quantity): AMSTAR/ PICOS/ Unique Studies Analysis • Formulate a decision tree of all possible combinations • Yield a formula for evidence rating Rating • Five evidence ratings: very strong, strong, moderate, weak, and very weak. The RESULT? A consistent description of the evidence. 4B. APPRAISAL
  62. 62. CHRSP tailors its syntheses to the Context of Newfoundland & Labrador CHRSP interprets findings in context CHRSP identifies contextual factors Labrador-Grenfell Health Central Health Eastern Health CHRSP asks: Will it work here? Contextual factors may have an impact on health outcomes and cost effectiveness ↓ 5. Place the evidence in Context Population Service design/location Health Human Resources Service organization & delivery Other system factors Economics  Political factors
  63. 63. 6. Identify the Implications The Team Leader & CHRSP researchers interpret the evidence in context. The Team identifies key implications for local decision makers. An EXTERNAL REVIEWER validates the findings.
  64. 64. Meetings & Workshops Reports in various formats: • Evidence in Context, RER, Snapshot Reports • Full studies • Summaries • Online reports Dissemination & Uptake Feedback & Follow-up 7. Report the Findings
  65. 65. Has CHRSP informed decisions? After a report has been published, we ask our partners: Was this report useful/relevant to your organization? If so, how? If the report was not useful or relevant, tell us why not and how it might have been improved. Health system feedback about the usefulness and relevance of CHRSP products has been overwhelmingly positive. See report online: https://www.nlcahr.mun.ca/CHRSP/2018_CHRSP_FEEDBACK.pdf YES!!
  66. 66. Samples: Feedback & Uptake Mobile Mental Health Crisis Intervention: Study informed the Department of Health and Community Services policy to implement the Memphis Model of mental health crisis intervention in NL. Home Dialysis Snapshot: The Home Based ‘enabling’ strategies (HBT Open House and assisted self-care) identified in this report were deemed appropriate for implementation within Eastern Health. Managing Agitation and Aggression in LTC Residents with Dementia: This report supported the continuation of a pilot project and then the province-wide implementation of the Music & Memory Program in Long-Term Care in NL. Fall Prevention for Seniors in Institutional Healthcare Settings: Results of this study were used to support a review of the existing falls prevention program and inform province-wide enhancements to these policies.
  67. 67. Feedback & Uptake continued… Age-Friendly Acute Care: Report was used to support the opening of NL’s first Acute Care of the Elderly (ACE) unit in 2017. Youth Residential Treatment: This report was instrumental in the planning and design of two new YRT Centres in NL – the report was referenced in planning meetings to inform guidelines for target populations, models of care, and facility design. Reuse of Single-Use Medical Devices: Report was used to review and revise province-wide policy on the reuse of single-use devices PET-CT in Newfoundland and Labrador: Report informed purchase of NL’s first PET-CT scanner. Options for Dialysis Services in Rural and Remote NL: Report used to inform new dialysis options in rural NL, including home-based modalities and clinic design.
  68. 68. CHRSP Highlights • Integrated KT • Contextualization • Uptake and Impact • New Developments: • Adaptation for other Canadian provinces • Patient & Caregiver Advisory Council
  69. 69. • Pull works better than “push.” Studies proposed and prioritized by decision makers get more health system attention and better uptake. • Relationships matter: it is crucial to build/maintain relationships with partners and to involve them fully in the process. The smaller scale of the health system in NL has been helpful in this regard. • Contextualizing the results for use in local settings makes reports more useful and relevant to knowledge users. • Contextualization is complicated but developing a template to structure contextualization interviews is helpful. Lessons
  70. 70. • Combining local and external expertise is an important feature of the program– an “outside” viewpoint can be helpful. • Teams that involve researchers and decision makers can effectively integrate KT. • Working quickly and communicating effectively are appreciated by the health system. • CHRSP can be adapted for use in other jurisdictions with similar characteristics and needs. Recent 3-province CIHR proposal. Lessons
  71. 71. Evidence in Context THE CONTEXTUALIZED HEALTH RESEARCH SYNTHESIS PROGRAM www.nlcahr.mun.ca/CHRSP
  72. 72. Follow us @nccmt Suivez-nous @ccnmo 72 Your Comments/Questions • Use Chat to post comments and/or questions • ‘Send’ questions to All (not privately to ‘Host’) Chat Participant Side Panel in WebEx
  73. 73. Follow us @nccmt Suivez-nous @ccnmo Share your story! • Are you using EIDM in your practice? We want to hear about it! • Email us: nccmt@mcmaster.ca • Need support for EIDM? Contact us for help! • Email us: nccmt@mcmaster.ca • We typically respond within 24 business hours 73
  74. 74. Follow us @nccmt Suivez-nous @ccnmo 74 Your Feedback is Important Please take a few minutes to share your thoughts on today’s webinar. Your comments and suggestions help to improve the resources we offer and plan future webinars. The short survey is available at: https://surveys.mcmaster.ca/limesurvey/index.php/726768? lang=en
  75. 75. Follow us @nccmt Suivez-nous @ccnmo 75 Join us for our next webinar Webinar 3 - Featuring: Knowledge broker training for evidence-informed decision making: Building capacity in public health Lori Greco and Dr. Megan Ward, Region of Peel Public Health Making evidence-informed decisions about the Alberta Public Health well-child visit: The art and the science Farah Bandali and Maureen Devolin, Alberta Health Services Date: December 6, 2018 Time: 1:00 – 2:30pm EST Register at: https://health-evidence.webex.com/health- evidence/onstage/g.php?MTID=e346bac6e7d012e5de7793e92689 7d127
  76. 76. Follow us @nccmt Suivez-nous @ccnmo Webinar Series from NCCMT http://www.nccmt.ca/capacity-development/webinars • Spotlight on Methods and Tools • Topic-Specific Methods and Tools • Online Journal Club • Peer-to-peer Webinars 76
  77. 77. Follow us @nccmt Suivez-nous @ccnmo Funded by the Public Health Agency of Canada | Affiliated with McMaster University Production of this presentation has been made possible through a financial contribution from the Public Health Agency of Canada. The views expressed here do not necessarily reflect the views of the Public Health Agency of Canada.. For more information about the National Collaborating Centre for Methods and Tools: NCCMT website www.nccmt.ca Contact: nccmt@mcmaster.ca

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