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Influencing Evidence-based practice and

clinical innovation through a Provincial

Strategic Clinical Network

Presentation to ACC Rockies

March 20, 2013

Blair J. O’Neill MD FRCPC

Senior Medical Director, CVH + Stroke SCN, Alberta Health Services

Immediate Past President, Canadian Cardiovascular Society

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• Potential Conflicts

– Global End Point Adjudication Committees

• Pfizer

– Clinical Trial Support

• Pfizer

• Eli Lilly

• Merck

Cardiovascular Health and Stroke

Strategic Clinical Network

The Landscape in 2013

Evidence = Non-sustainable cost increases in Canada

1975 to 2010

• Expenditure increases = 3.5 fold

• Population increases = 1.5 fold

23.4M

people

34.2 M

people

Why are we here? How do you compare?

Are we getting the results?

Life Expectancy by Province

As more is learned - the complexity of care increases (driving

waste + inefficiency)

Physician A

Agency F

Physician W Primary Care Group

Service 467

Service 311

For Profit Rehab.

Agency Y

Public Rehab.

Service 222

Service 1

Service 179

Additional Challenges in Canada

Weather!

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Additional Challenges in Canada

Where people choose to live!

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•Area: 661,848 km (vs 130,448 km for MC)

•Pop: 3,645,257 (2011)

•Growth: 1.6 %

•Density: 5.1 persons/km

•81% Urban

•60% of pop in 5 cities

•30% of the population will be

seniors by 2030

Additional Challenges in Canada

Geography

Changes are needed: Alberta as an

example

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Northern Lights

Alberta: 154.5

Source: Alberta Health and Wellness. 2003-2005.

LEGEND

270

205

140

Peace Country

Health Regions in Alberta 1992-2008 Age-Standardized Mortality Rate per 100,000 Pop.

262.7

184.6

Aspen 194.1

Capital 147.8

East Central 182.5

David Thompson 177.3

Calgary 145.9

Palliser 184.3

Chinook 163.5

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Northern Lights

Alberta: 154.5

Source: Alberta Health and Wellness. 2003-2005.

LEGEND

270

205

140

Peace Country

Health Regions in Alberta 1992-2008 Age-Standardized Mortality Rate per 100,000 Pop.

262.7

184.6

Aspen 194.1

Capital 147.8

East Central 182.5

David Thompson 177.3

Calgary 145.9

Palliser 184.3

Chinook 163.5

Alberta Health Services

Formed 2008

One Health System

One Board

5 Zones formed in 2010

SCN’s formed in 2012

Strategic Clinical Networks

Support to lead Provincial Improvement and Sustainability

• Phase One (established June, 2012)

– Obesity, Diabetes and Nutrition

– Seniors’ Health

– Bone & Joint

– Cardiovascular Health and Stroke

– Cancer

– Addiction & Mental Health

• Phase Two (TBA, 2013)

– Population Health and Health Promotion*

– Primary Care and Chronic Disease Management*

– Maternal Health

– Newborn, Child and Youth Health

– Neurological Disease, ENT and Vision

– Complex Medicine (current Respiratory Clinical Network + others TBD)

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• Facilitates collaboration, joint decision-making

and shared learning

• Promotes the use/uptake of clinical experience,

knowledge and research to reduce variation

and improve care

• Involve partners along a broad continuum in

planning, improving and innovating healthcare

services

Why Networks?

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• Improve population health

• Ensure continuous quality improvement

• Incorporate research that impacts patients

• Focus on patient outcomes

• Design more accessible care

• Develop appropriate clinical practices

• Make patient safety a priority

• Ensure value for money

Provincial Mandate of AHS/SCN’s

18 Initial SCN Goal:R&D, Innovate, Eliminate ‘Waste’ and Reinvest Resources

To improve Quality and Create a Sustainable System

$$$$

A Successful and Sustainable

Formula for Quality Health Care

SCN’s as an integral component of Alberta Innovation and Research &

Development

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Health is a global business:

Improving Prevention, Health, and

Health Care Quality and Sustainability

Alberta has major competitive advantages

Our Provincial Approach is unique

Our Health system is unique

Our Universities are aligned

Our R and D structure is unique

Health/Energy/Environment/Food

Health generates major economic value

MANY industries related to health

Major Supply chains (drugs/lab /repairs)

Health Human Resources

Rapid and low cost access to high

quality health data = a key

Health and Health Care Health is a Big Business: Comparison to oil patch

OIL + GAS + MINING

• >150,000 employed

– ~ 7% of workforce

– $79B/yr to Alberta’s GDP

• ~ 27.6% of Alberta’s GDP

• Oil sands

– ~21,000 jobs

– >$3.7B/yr in royalties

– $100B in provincial and municipal

taxes over 25 years

• R and D

– ~$1B/year on R and D (2010)

HEALTH + HEALTH CARE

• >190,000 employed

– ~ 9% of workforce

– $21B/yr to Alberta’s GDP

• ~ 7.6% of GDP (health care alone)

• Health Care

– 100 hospitals ~100,000 public jobs

– Every dollar spent on public health

care generates 21.7 cents in taxes

and import duties (Conf. Board – 2013)

• ~ $2.5B/year in Alberta in taxes/duties

• Plus private health care businesses

• R and D

– ~$ 478M/year (in 2008)

• Included ~$75M/year in biotech

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Health and Health Care Health is a Big Business: Comparison to oil patch

OIL + GAS + MINING

• >150,000 employed

– ~ 7% of workforce

– $79B/yr to Alberta’s GDP

• ~ 27.6% of Alberta’s GDP

• Oil sands

– ~21,000 jobs

– >$3.7B/yr in royalties

– $100B in provincial and municipal

taxes over 25 years

• R and D

– ~$1B/year on R and D (2010)

HEALTH + HEALTH CARE

• >190,000 employed

– ~ 9% of workforce

– $21B/yr to Alberta’s GDP

• ~ 7.6% of GDP (health care alone)

• Health Care

– 100 hospitals ~100,000 public jobs

– Every dollar spent on public health

care generates 21.7 cents in taxes

and import duties (Conf. Board – 2013)

• ~ $2.5B/year in Alberta in taxes/duties

• Plus private health care businesses

• R and D

– ~$ 478M/year (in 2008)

• Included ~$75M/year in biotech

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SCNs need to align ‘top to bottom’

SCN’s need to engage academics with Health Care System

Patients

Policy Makers/Payers

Providers

Administrators

Researchers

For Researchers

Integrate the four pillars of health research research networks to connect, analyze, innovate and export

Basic research Clinical research

Health systems research Prevention, Population and

Public Health research

For the System Overall – Will be Able to

Address

Translational Gaps in Research Uptake

Knowledge to Practice Continuum

Biomedical

Research Clinical

Science &

Knowledge

Clinical

Practice &

Health Decision

Making

Community

Based

Practice

Gap 1

Gap 2

Gap 3

The Researcher

New

Knowledge

Users of Knowledge

On the same team

The ‘Knowledge Translation Networks’ of all-time with engaged end-users (clinical, policy, public, etc)

Highly Qualified People = Key collecting and analyzing linked data

Highly Qualified People = Key collecting and analyzing linked data

Biggest Opportunity #1 comparative effectiveness data will define value for $$

Biggest Opportunity #2 data to inform personalized medicine

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/

documents/digitalasset/dh_132382.pdf

30 ....................and MANY OTHERS

SCN’s Can bring many key partners together

as the interface to the Health System

Strategic Clinical Networks: Bringing

Science and Best Practices Together to

Define Next Practices integrate to innovate

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Stars are aligned - now