The Canadian Institutes of Health Research as Driver for

Patient-Oriented Research

Dr. Alain Beaudet, PresidentCanadian Institutes of Health Research

January 24, 2014

Canada excels in all health research sectors

Less Specialized World Average More Specialized

Specialization Index (SI)

Less

Impa

ct

W

orld

Ave

rage

Mor

e Im

pact

Aver

age

Rel

ativ

e C

itatio

ns (A

RC

)

Clinical Medicine

Biomedical Research

Biology Public Health and Health Services

Psychology and Cognitive Sciences

Source: The State of Science and Technology in Canada, 20122

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

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The Canadian health system does not perform as well

United-Kingdom

2nd

United States

7th

Netherlands

1st

Canada

6th

New-Zealand

5th

Germany

4th

Australia

3rd

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

Overall Ranking (2010)

1.00 - 2.33 2.34 - 4.66 4.67 to 7.00

Source: The Commonwealth Fund

Despite the excellence of the Canadian health research, Canada faces a challenge in turning this powerful information into high-quality and cost-effective care

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Health care spending is burgeoning without a concurrent increase in quality of care

Canada’s health care spending:

•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;

•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.

Total health care spending in Canada, 1975-2010

0

5

10

15

0

20

40

60

80

100

120

140

160

180

200

1975 1980 1985 1990 1995 2000 2005

% of G

DP

Health Sp

ending

 ($000,000)

YearTotal 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.

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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

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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 Awardshas been steadily declining

36 34 32 34 32 28 26 28 20

17 18 18 25 27

27 30 21

22

53 52 50

59 59 55 56

49

42

0

10

20

30

40

50

60

70

2004-05 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13

Num

ber o

f clin

icia

n sc

ient

ist a

war

ds

Phase 1 (Training Awards) Phase 2 (Salary Awards)

The structure and process required to obtain and integrate relevant evidence into clinical practice

IDENTIFYclinical gaps/challenges

ANALYZEexisting global and national health data

APPLY and evaluate

best practices on a pilot-

scale

ADOPTbest practices on a system-wide scaleFo

rmul

ate

Key

Que

stio

ns

Iden

tify

Bes

t Pr

actic

es

Mea

sure

O

utco

mes

Evaluate Outcomes to Optimize the Health System

Patient-Oriented Research

GENERATEnew data

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Canada has many STRENGTHS to realize this objective…

Exemplary medical

expertise

Excellence in data analysis

and generation

Integrated universal public health care system capable of adopting changes in practice

Extensive health

databases

Investments in health research infrastructure

IDENTIFY ANALYZE APPLY ADOPT

Iden

tify

Bes

t Pr

actic

es

Mea

sure

O

utco

mes

Evaluate Outcomes to Optimize the Health System

GENERATE

Form

ulat

eK

ey Q

uest

ions

10

…BUT, we are unable to realize previous investments due to current GAPS

Insufficient funding for data analysis,

generation and pilot studies

Lack of a coordinated mechanism to address health

priorities

Lack of evidence to reform the health

system

Increasing demand coupled with shortages in

talent*

Guideline development is

under-resourced and uncoordinated

Lack of a mechanism to link provincial resources

across the country

IDENTIFY ANALYZE APPLY ADOPT

Iden

tify

Bes

t Pr

actic

es

Mea

sure

O

utco

mes

Evaluate Outcomes to Optimize the Health System

GENERATE

Form

ulat

eK

ey Q

uest

ions

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.

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• 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.

Strategy for Patient-Oriented Research:Objectives

Shifting from a researcher-driven to a health provider/patient centered research agenda.

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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

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Establish local infrastructure: SUPPORT units

Research Networks are underpinned by local SUPPORT units that provide the resources and personnel to enhance evidence generation and integration.

Data ManagementBiostatistics and Methods SupportProject ManagementConsultation and Education

Data ManagementBiostatistics and Methods SupportProject ManagementConsultation and Education

Large International TrialsLarge International Trials

Systematic ReviewsSystematic Reviews

Biobanks and Translational MedicineBiobanks and Translational Medicine

Knowledge TranslationKnowledge Translation

CO

RE

FUN

CTI

ON

SSP

ECIA

LIZE

D

MO

DU

LES

SUG

GES

TED

SU

PPO

RT

UN

IT F

UN

CTI

ON

S

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.

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Develop a culture of collaboration:SPOR Networks

16

AB Support

UnitSK

Support Unit

MB Support

Unit

ON Support

Unit

QC Support

Unit Maritimes Support

Unit

Newfoundland and Labrador Support UnitBC

Support Unit

Yukon Support

Unit

Nunavut Support

UnitNWT 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

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

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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

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Bridging “valleys of death” between research and outcomes

Valley 1 Valley 2

Basic Biomedical Research

Clinical Science & Knowledge

Clinical Practice &

Health Decision Making

Translational Continuum

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