OHIL
Ontario Health Implementation Laboratory
Objective:
The Ontario Health Implementation Laboratory (OHIL) working in partnership with provincial organizations, including Health Quality Ontario (HQO), Public Health Ontario (PHO) and Cancer Care Ontario (CCO), aims to evaluate system-wide quality improvement activities such as audit and feedback. OHIL seeks to maximize the impact of existing partner initiatives, and advance implementation research, while emphasizing patient engagement, knowledge translation and exchange, as well as capacity building.
OHIL currently features two streams of work focusing on the following topics:
- Improving Antibiotic Prescribing
-
Improving Opioid Prescribing
- Details on past streams of work can be found below.
Improving Antibiotic Prescribing: Antibiotics are prescribed more often than necessary, leading to avoidable short-term harms for patients as well as contributing to antimicrobial resistance at both the patient and population-level. We will carry out a series of trials testing the design of an audit and feedback (A&F) report provided to primary care (PC) physicians working in the province of Ontario in order to identify the most effective A&F for reducing inappropriate antibiotic prescribing.
Primary Care, Pragmatic Cluster Trials and Process Evaluations
- Project Link: n/a
- Funded By: Canadian Institutes of Health Research (CIHR)
- Partner Links: Health Quality Ontario; Public Health Ontario
- Study Summary:
- Population – PC physicians in Ontario receiving Health Quality Ontario (HQO) feedback reports
- Intervention – Testing the design of feedback in the form of HQO feedback reports
- Comparator – Standard versus an ‘enhanced’ (e.g., personalized message and action plan) feedback report
- Outcome – Metrics presented within feedback reports (e.g., the number of antibiotic prescriptions dispensed)
- Setting – PC in Ontario
- Publications: n/a
- Study Contact:
Michelle Simeoni
Research Coordinator, WCRI
Women’s College Hospital
Phone: 416-323-6400 ext. 5368
Improving Opioid Prescribing: With the heightened awareness of risks associated with opioids, increasing attention is focused on safely managing patients with chronic non-cancer pain who are taking opioids, especially those taking high doses. We will evaluate two large-scale interventions that aim to encourage safer opioid prescribing practices in primary care (PC).
Observational Trial and Process Evaluation
- Project Link: n/a
- Funded By: Canadian Institutes of Health Research (CIHR)
- Partner Links: The Centre for Effective Practice; Health Quality Ontario
- Study Summary:
- Population – PC physicians in Ontario receiving Health Quality Ontario (HQO) feedback reports and/or academic detailing services from the Centre for Effective Practice
- Intervention – Two voluntary opioid-related supports – feedback reports and/or academic detailing services delivered by a trained detailer
- Comparator – Receipt of feedback reports and/or academic detailing services
- Outcome – Metrics presented within the feedback reports and/or covered during the detailing service (e.g., high risk opioid prescriptions in PC patients)
- Setting – PC in Ontario
- Publications: n/a
- Study Contact:
Catherine Reis
Research Coordinator, WIHV
Women’s College Hospital
catherine.reis@wchospital.ca
PAST STREAMS OF WORK
Audit & Feedback (A&F): Health Quality Ontario (HQO) provides ‘practice reports’ to all physicians working in nursing homes (MyPractice Long Term Care Reports) and working in primary care (MyPractice Primary Care Reports). These reports provide ‘feedback’ regarding performance on key quality indicators based on an ‘audit’ of relevant administrative databases. OHIL works with HQO in a variety of ways to optimize the impact of these Practice Reports.
A) Long-Term Care Factorial Trial, Baseline Time Series and Process Evaluation
- Project Link: https://clinicaltrials.gov/ct2/show/NCT02979964
- Funded By: Ontario SPOR Support Unit (OSSU)
- Partner Links: Health Quality Ontario
- Study Summary:
- Population – Long-term care (LTC) physicians in Ontario receiving Health Quality Ontario (HQO) feedback reports
- Intervention – Testing the design and delivery of feedback in the form of HQO feedback reports
- Comparator – Differing framing and comparators of feedback reports
- Outcome – Metrics presented within the feedback reports (e.g., antipsychotic prescribing for LTC residents with no history of psychosis)
- Setting – LTC in Ontario
- Publications:
- Testing feedback message framing and comparators to address prescribing of high-risk medications in nursing homes: protocol for a pragmatic, factorial, cluster-randomized trial
- Public reporting of antipsychotic prescribing in nursing homes: population-based interrupted time series analyses
- Effectiveness of confidential reports to physicians on their prescribing of antipsychotic medications in nursing homes. (in progress)
- A mixed-methods multiple-behaviour investigation of goal prioritization in long-term care physicians receiving audit and feedback to address high risk prescribing. (in progress)
- Study Contact:
Catherine Reis
Research Coordinator, WIHV
Women’s College Hospital
catherine.reis@wchospital.ca
B) MyPractice Primary Care Reports Redesign and Patient Engagement to Prioritize Quality Indicators
- Project Link: None
- Funded By: Ontario SPOR Support Unit (OSSU)
- Partner Links: Health Quality Ontario
- Study Summary:
- Approaches to prioritizing quality indicators to feature in the feedback reports provided to primary care (PC) physicians; and
- How a user-centered design process could inform the format and presentation of PC feedback reports
- Publications:
- Engaging Patients to Select Measures for a Provincial Primary Care Audit and Feedback Initiative (in progress)
- Redesigning Feedback Reports for Use in Primary Care: Evaluating a User-Centered Design Approach (in progress)
- Study Contact:
Catherine Reis
Research Coordinator, WIHV
Women’s College Hospital
catherine.reis@wchospital.ca
Quality Based Procedures (QBPs): Quality Based Procedures are a component of Ontario’s Health System Funding Reform. As defined by the Ministry of Health (2016), QBPs are “specific groups of patient services that offer opportunities for health care providers to share best practices that will allow the system to achieve even better quality and system efficiencies.” QBPs are similar in some, but not all, respects to international attempts to encourage standardization of care and improve efficiency through patient-based (also known as activity-based) funding reforms.
- Project Link: None
- Funded By: Ontario SPOR Support Unit (OSSU)
- Partner Links: None
- Study Summary:
The QBP-related work involves mixed methods and multiple phases; we will undertake a concurrent formative evaluation of both implementation and effectiveness. The study goals are two-fold:
- Understand how QBPs are being rolled out on the ground in Ontario hospitals compared to how QBPs were intended to be implemented, and how best to implement QBPs province-wide, across clinical contexts and settings, to enable achievement of their intended goals in Ontario;
- Understand the effects of QBPs on specific outcomes of interest
- Publications:
- Study Contact:
Karen Palmer
karen.palmer@wchospital.ca