Leveraging Technology to build a Comprehensive Infrastructure to Support the Implementation of Evidence-Based Practices in Health Care Systems

Despite considerable investments in health research in Ontario, a significant gap remains between evidence and health care policy and practice, costing millions to the health care system, and to the wellbeing of Ontarians. Translating research evidence into programmatic change has proved challenging on many levels, including structural, organizational, and temporal.  Learning health systems have been posed as a possible solution however, the evidence around how to effectively promote and facilitate this process is still relatively limited.

The Nicotine Dependence Services at CAMH has leveraged technology to create a learning health system based on Dr. Friedman’s three components: afferent, efferent and scale and the Interactive Systems Framework for Dissemination and Implementation.  Specifically it has:
1. Created synthesis of scientific knowledge such as:
a. Built and evaluated computerize clinical decision support system that guides practitioners into proving evidence based interventions by following clinical guidelines.
b. Built a platform that allows for collaborative care to be provided
2. Built capacity in the system by:
a. Having an online program in evidence-based tobacco dependence treatment that is useful across disciplines and diverse health service settings
b. Creating a virtual collaborative care model where information and education can be shared with healthcare providers, clients and their families
3. Delivered our interventions by:
a. Sharing a portal that our partners working in primary care sites and addiction agencies across Ontario can use to provide smoking cessation treatment directly to Ontario smokers in their communities.
b. Creating a web-based virtual platform to support a virtual collaborative care model that allowed health coaches to provide treatment recommendations to youth with early psychosis to address smoking, physical activity and nutrition to decrease their cardiometabolic risk factors.

Over 4,980 practitioners from 6 provinces, over 15 disciplines, and 812 organizations have been trained in tobacco cessation since the projects initiation in 2006. One hundred and sixty-one Family Health Teams (FHTs) (87%); 56 Community Health Centers (CHCs) (76%); 68 Addiction Agencies (34%); and 32 Public Health Units (PHUs) (100%) have partnered with the NDS and have implemented care pathways for smokers in their practice.
In addition we have tested the feasibility of engaging patients and healthcare providers to use a virtual collaborative care model which allows us to reach people who otherwise would not have access to specialists and treatment resources.

In this workshop we will share our experience building a learning health system that:
1. Builds on a comprehensive knowledge translation framework (ISF)
2. Leverages technology (CDSS, virtual platform)
3. Ensures that data is collected, analyzed (afferent phase) and that analysis are shared back into the system, solutions to change practices are tested (efferent phase), and promising results are scaled up
This system has been successful in treating over 253,000 smokers, as well as testing the feasibility of a virtual care team for a population that has been described as hard to reach and treat.


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