Accelerated Canadian AppliCation of Evidence to Practice Through Monitoring of Outcomes Research team Endeavour (ACCEPT-MORE)
Dr. Peter Liu, University of Ottawa Heart Institute
Karen Tu, Institute for Clinical Evaluative Sciences
Sheldon Tobe, Sunnybrook Health Sciences Centre
Jack Tu, Institute for Clinical Evaluative Sciences
Janusz Kaczorowski, Université de Montréal
Kori Kingsbury, Cardiac Care Network of Ontario
Mary Lewis, Heart & Stroke Foundation
Angelique Berg, Hypertension Canada
Vascular diseases and complications such as heart failure account for suffering of over 4 million Canadians, and cost the health system over $30 billion per year. Heart failure (HF) is now the most rapidly rising cardiovascular chronic disease.
This ACCEPT-MORE team proposal aims to address the Theme I goals of the Canadian Vascular Network (CVN) program in closing the gap between evidence and practice, and to improve outcomes of vascular disease and its complications. This team proposal aims to link the original individual projects during Phase 1 of CVN into an integrated platform with a closed loop for continuous innovation, monitoring of process and identification of gaps. This will help to accelerate evidence to practice, and to compare system based interventions across jurisdictions.
Specifically, the ACCEPT-MORE proposal will (1) Enhance and evaluate the guideline developmental process by engaging knowledge users and patient participants using C-CHANGE guidelines v3 ; and to improve implementation tool design (algorithm vs target based) by testing out the new C-CHANGE-Heart Failure guideline implementation tools; (2) Enhance and expand the monitor processes of care quality indicators developed during Phase 1 in linked primary electronic medical records (EMR) program EMRALD, to incorporate both the cardiovascular (CV) risk intervention and heart failure treatment effectiveness monitoring; and (3) Systematic data linkage of EMRALD, ICES, drug and community resources utilization and outcomes to determine prevalence of risk factors and heart failure in the community, surveillance of their change, adherence to guidelines and identify residual gaps in care.
The ACCEPT-MORE proposal builds on the accomplishments in phase I of CVN. The phase I project collated the models of vascular care across Canada (Liu), together with international literature (Kaczorowski). Phase I projects also included the development of a set of validated quality indicators for evidence-based practice, and baseline prevalence of risk factors (Jack Tu); and the successful linkage of a series of EMRs in the primary care settings that allowed extraction of information related to quality indicators, processes of care, treatments and targets (Karen Tu).
The ACCEPT-MORE accelerated knowledge to practice platforms will also incorporate heart failure in addition to CV risk factor management. Heart failure and particularly HF with preserved ejection fraction (HFpEF) is associated with high mortality and hospitalization, and results from longstanding diabetes and hypertension. The most effective therapy for HFpEF to date involves aggressive risk factor management, and its prevention through risk factor intervention.
This proposal also takes into account of the recently completed CVN international review, which recommended further integration of the platforms, and take advantage of big data analysis to identify key gaps in the current practice patterns. We are encouraged to engage broader stakeholders, including patients and policy makers.
The ACCEPT-MORE proposal is also timely, in that C-CHANGE-Heart Failure guidelines are ready for publication. In addition, provincial heart failure strategies are being rolled out across Canada, the ACCEPT- MORE platforms are ideally suited for monitoring practice and tracking outcomes.