Download The Canadian Institutes of Health Research as Driver for Patient

The Canadian Institutes of
Health Research as Driver for
Patient-Oriented Research
Dr. Alain Beaudet, President
Canadian Institutes of Health Research
January 24, 2014
Clinical Medicine
Average Relative Citations (ARC)
Biology
Public Health and Health
Services
Psychology and
Cognitive Sciences
Biomedical Research
Less Impact
World Average
More Impact
Canada excels in all health research sectors
Less Specialized
World Average
More Specialized
Specialization Index (SI)
Source: The State of Science and Technology in Canada, 2012
2
It is particularly competitive in clinical subfields
Health subfields in which Canada ranks best in the world
Sub‐field
Field
Impact
Rank
General & Internal Medicine
Clinical Medicine
3.93
1
Anatomy & Morphology
Biomedical Research
2.38
1
Dermatology & Venereal Diseases
Clinical Medicine
2.24
1
Gastroenterology & Hepatology
Clinical Medicine
2.09
2
Anesthesiology
Clinical Medicine
1.87
2
Orthopedics
Clinical Medicine
1.49
2
Medical Informatics
Information & Communication Technologies
1.33
2
Urology & Nephrology
Clinical Medicine
1.67
3
Surgery
Clinical Medicine
1.49
3
Speech‐Language Pathology & Audiology
Public Health & Health Services
1.39
3
Source: Council of Canadian Academies, September 2012
3
The Canadian health system does not perform as well
Despite the excellence of the Canadian health research, Canada faces a challenge in turning
this powerful information into high-quality and cost-effective care
Netherlands
United-Kingdom
Australia
Germany
New-Zealand
Canada
United States
Overall Ranking
(2010)
1st
2nd
3rd
4th
5th
6th
7th
Quality Care
2
3
4
5
1
7
6
Access
1
2
6.5
3
4
5
6.5
Efficiency
3
1
2
5
4
6
7
Equity
1
2
4
3
6
5
7
1.00 - 2.33
Source: The Commonwealth Fund
2.34 - 4.66
4.67 to 7.00
4
Health care spending is burgeoning without a
concurrent increase in quality of care
•Is expected to grow at a rate
faster than Canada’s economy,
outpacing inflation and population
growth;
•Typically consumes 40% of
provincial budgets and will
account for half of all spending
within the next few years2.
200
15
180
160
140
10
120
100
80
% of GDP
•Reached an estimated $183.1
billion in 20091, which represents
an estimated 11.9% of Canada’s
gross domestic product (GDP) in
2009, a jump from 10.8% of GDP
in 2008;
Total health care spending in Canada, 1975-2010
Health Spending ($000,000)
Canada’s health care spending:
5
60
40
20
0
0
1975
1980
1985
1990
1995
2000
2005
Year
Total Health Spending
Total Health Spending as a Percentage of GDP
Health care spending is spiraling out of
control and we have little information
on how to curb costs while offering
high quality care
1. Canadian Institute for Health Information (CIHI) (www.cihi.ca).
2. The Globe and Mail. (2010) A health-care challenge to Canada.
5
Challenges
•As many as 50% of patients do not get treatments of proven effectiveness
and up to 25% get care that is not needed or potentially harmful
• Research and innovation are too often disconnected from patients and
decision makers’ needs
•We are virtually unable to quantify how current health research spending
affects or improves patient outcomes
•There are still insufficient systematic analytical approaches to identify and
synthesize existing best evidence and translate these findings into clinical
practice
•We need greater capacity to generate new evidence, if required, to
ultimately support decision-makers
6
On average, physicians spend 1.7 hours a week
on research activities
Average weekly work hours - excluding on-call activities
Source: 2010 National Physician Survey: National Results (Survey updated 2013)
7
The number of CIHR Clinician Scientist Awards
has been steadily declining
Number of clinician scientist awards
70
59
60
53
52
50
17
40
55
56
50
49
25
18
59
27
27
18
42
30
21
22
30
20
36
34
32
34
32
28
10
26
28
2010-11
2011-12
20
0
2004-05
2005-06
2006-07
2007-08
Phase 1 (Training Awards)
2008-09
2009-10
Phase 2 (Salary Awards)
2012-13
The structure and process required to obtain and
integrate relevant evidence into clinical practice
APPLY and
evaluate
best practices
on a pilotscale
Measure
Outcomes
ANALYZE
existing global
and national
health data
Identify Best
Practices
IDENTIFY
clinical gaps/
challenges
Formulate
Key Questions
Patient-Oriented Research
ADOPT
best practices
on a systemwide scale
GENERATE
new data
Evaluate Outcomes to Optimize the Health System
9
Canada has many STRENGTHS
to realize this objective…
Exemplary
medical
expertise
APPLY
Measure
Outcomes
ANALYZE
Extensive
health
databases
Identify Best
Practices
IDENTIFY
Excellence in
data analysis
and generation
Formulate
Key Questions
Investments in
health research
infrastructure
ADOPT
GENERATE
Evaluate Outcomes to Optimize the Health System
Integrated universal public
health care system capable of
adopting changes in practice
10
…BUT, we are unable to realize previous investments
due to current GAPS
ANALYZE
Insufficient funding
for data analysis,
generation and pilot
studies
APPLY
Guideline
development is
under-resourced and
uncoordinated
Measure
Outcomes
Increasing
demand coupled
with shortages in
talent*
Identify Best
Practices
IDENTIFY
Formulate
Key Questions
Lack of a coordinated
mechanism to
address health
priorities
ADOPT
GENERATE
Evaluate Outcomes to Optimize the Health System
Lack of a mechanism to
link provincial resources
across the country
Lack of evidence to
reform the health
system
11
A proposed mechanism
• The goal is to develop a national mechanism that coordinates talent and
expertise across the country, and to ask critical questions most relevant to
Canadians, conduct pilot-scale studies and monitor and evaluate the impact.
• In order to achieve this goal, CIHR has developed with its partners a
National Strategy for Patient-Oriented Research (SPOR).
• The vision for SPOR is to “Improve health outcomes and enhance patients’
health care experience through integration of evidence (research output) at
all levels in the health care system.”
• The objective of SPOR is to better integrate research and care, and
develop a culture of evaluation, dissemination and uptake of health
innovations, in partnership with federal, provincial and territorial
stakeholders.
12
Strategy for Patient-Oriented Research:
Objectives
• Supporting and promoting comparative effectiveness research to evaluate the
benefits and harms of current therapeutics and practices;
• Developing implementation science to investigate and address major
bottlenecks (e.g. social, behavioral, economic, management) that impede
effective practice change;
• Strengthening clinical research to increase our capacity to evaluate health
innovations (preventative, diagnostic, therapeutic; drugs, practices, devices);
• Fostering evidence-informed health care by bringing innovative diagnostic and
therapeutic approaches to the point-of-care so as to ensure greater quality,
accountability and accessibility of care;
• Involving decision-makers, clinicians and patients throughout the research
process to ensure translation of health innovations into practice.
Shifting from a researcher-driven to a health provider/patient centered
research agenda.
13
Strategy for Patient-Oriented Research:
Core elements
Support for People and Patient‐Oriented Research and Trials (SUPPORT) Units
SPOR Networks
Training and capacity development
Improving the clinical trials environment
Patient engagement
14
Establish local infrastructure:
SUPPORT units
CORE
FUNCTIONS
Data Management
Biostatistics and Methods Support
Project Management
Consultation and Education
Large International Trials
SPECIALIZED
MODULES
SUGGESTED
SUPPORT UNIT FUNCTIONS
Research Networks are underpinned by local SUPPORT units that provide the
resources and personnel to enhance evidence generation and integration.
Systematic Reviews
Biobanks and Translational Medicine
Knowledge Translation
 Integrated within a local
clinical/care setting.
 Provides communities with
access to expertise and
resources (i.e. core functions
and specialized modules).
 Enhances attraction and
retention of talent to
communities.
 Creates linkages with health
centres (from tertiary hospitals
to primary care centres), and
national and international
health stakeholders.
15
Develop a culture of collaboration:
SPOR Networks
Yukon
Support
Unit
Nunavut
Support
Unit
NWT
Support
Unit
BC
Support
Unit
AB
Support
Unit
SK
Support
Unit
Newfoundland
and Labrador
Support Unit
MB
Support
Unit
ON
Support
Unit
QC
Support
Unit
Maritimes
Support
Unit
SPOR Networks represent national collaborations of decision-makers, health
professionals, health researchers, patients and other stakeholders to generate
research evidence and innovations designed to improve patient health and
health care systems
16
Develop the talent pool for Patient-Oriented Research
• Train more health professionals in health-oriented research
• Mentor, develop and support careers of clinician-researchers
• Train more non-clinicians with advanced degrees in core
research methodology
• Re-engineer career training and salary awards to build
capacity in patient-oriented research for individuals aligned with
patient-oriented research units
17
Improve clinical trials environment
The Canadian Clinical Trials Coordinating Centre (CCTCC) is being
developed by CIHR, Rx&D and ACAHO to:
• Measure, monitor and market clinical trial performance
improvements
• Leverage existing work on accreditation, harmonization and
streamlining ethics reviews and common contracts
• Develop a ‘database of registries’ and consider a national patient
recruitment strategy
• Adopt common Standard Operating Procedures (SOPs), training
and certification
• Optimize intellectual property protection policy and SR&ED Tax
Credits
• Attract international investments in clinical trials through the
management of a concierge (storefront) service for investors
18
Bridging “valleys of death”
between research and outcomes
Valley 1
Basic Biomedical
Research
Valley 2
Clinical Science
& Knowledge
Clinical
Practice &
Health Decision
Making
Translational Continuum
19