Ivey Health has been working with the Huron Perth Healthcare Alliance and the Southwestern Ontario Stroke Network to promote a new process for early supported discharge of stroke patients. This process aims to reduce hospital length of stay for mild to moderate stroke patients by providing in-home resources at the same level of intensity as the hospital. Outcomes from other jurisdictions have demonstrated the early supported discharge model to reduce adverse health outcomes, improve patient activities of daily living scores, and improve patient satisfaction, while reducing hospital length of stay and system costs. On June 18th 2018, Ivey Health launched the Early Supported Discharge (ESD) Stroke Program with Huron Perth Healthcare Alliance (HPHA). Ivey Health is continuing to assist and monitor the ESD Stroke Program at Stratford General Hospital, with 24 patients who have been through the program to date.
The current project examines how and when product recall impacts technological product innovation by the focal firm and its competitors. The empirical context of this study is the U.S. medical device industry. The data comprise nearly 100,000 medical device innovations (ranging from incremental to novel to radical) and about 35,000 recalls across nearly 3,000 product categories and 19 medical specialties, spanning more than 17,000 firms headquartered in 62 countries. The findings will provide evidence on innovation effects of product recall.
Researcher: Vivek Astvansh
Ivey Health and London’s Housing Development Corporation (HDC) have entered a one year agreement whereby Ivey Health will provide HDC with: health sector expertise and research to support housing-related research, funding proposals, and new initiatives; strategic support for a new HDC strategy; third-party verification of ongoing housing data analysis and reporting; and general support and health expertise for ongoing initiatives. This will enhance connections and involvement with the local London community, and will be instrumental in bridging the gap between health and social services.
In collaboration with the MINDS (Mental Health INcubator for Disruptive Solutions) and the MaRS Solutions Lab, the Centre is working on developing a proposal for a project that will have a positive impact on improving access to housing for transitional age who are experiencing mental health and addiction issues.
For more information, visit our website at https://www.mindslondonmiddlesex.ca/
Since 1980, Multimed has been internationally recognized for ingenuity, creativity, and vision in project development. We balance innovation with expertise, understanding the ever-changing climate in the academic and medical sectors. Multimed has established a large network of key players in the cancer and healthcare communities and it is our mandate to include the patient voice in all our endeavours, ultimately assisting in linking patients to potential new therapies, services and improved healthcare. The mandate of the Ivey International Centre for Health Innovation is to act as a catalyst for health system transformation by leading the adoption of a value-based health care decision-making process and contributing to systematic improvements in efficiency and effectiveness within health systems in Canada and internationally. The Centre’s research focuses on building a value-based health care system through the successful creation and implementation of innovative solutions.
The Ivey / Multimed partnership will seek to find innovative health delivery solutions and services which will result in sustainable value-driven results for patient consumers, and identify meaningful opportunities which will move the patient included concept forward in practical terms.
The Centre has partnered with Dr. Richard Kim on his project Pharmacogenomics Technologies and Patient-Centered Approaches for Enhancing Drug Safety and Effectiveness, which has been successfully funded by The Ontario Research Fund. The objective of this project is to demonstrate that Dr. Kim’s innovative Personalized Medicine-based health care model can be implemented hospital-wide and that the resultant integrated model is adoptable, cost-effective, and scalable for Ontario hospitals and beyond. In particular, the Centre will be leading the creation of a business plan and commercialization strategy for the wide-scale distribution of the model based on the varying needs of urban and rural health care facilities in Ontario and throughout Canada.
Ivey Health has recently formed a formal partnership with Value-Based Healthcare Canada, through the Conference Board of Canada. Ivey Health will be providing research and project management support over the next 8 months, as VBHC Canada establishes a series of provincial and national pilot projects implementing VBHC practices in hospitals. These pilot projects will involve the adoption of ICHOM standard outcome measure sets in multiple hospital sites, whose variable practices will then be evaluated and assessed based on patient outcomes in order to identify and scale best practices across systems.
In response to the increased prescribing of opioids in Ontario, the Centre for Effective Practice is trialing an academic detailing approach to prescription reduction. Under this model, one-on-one visits with providers are offered to deliver objective, balanced, evidence-informed information on best practices to optimize clinical care. For the last several months, Ivey Health has been engaged as the evaluation lead for this pilot project.
We examine performance-based payment contracts to promote the use of an optional diagnostic test for newly diagnosed cancer patients. Our work is inspired by three ongoing trends: tremendous increases in the cost of new advanced cancer drugs, development of new diagnostic tests to allow physicians to tailor treatment to patients, and changes in healthcare funding models that reward quality care. Our study suggests that advent of new diagnostic tests necessitates new reimbursement models. We also find that physicians should not use the test for all patients, even if the diagnostic test can be available for free. Furthermore, we demonstrate the importance of understanding the behavioral effects of physicians’ concerns about their treatment decisions by showing that the social welfare may increase from an increase in reputational concerns and altruistic behaviour of a provider.
Researchers: Salar Ghamat, Gregory S. Zaric, Hubert Pun
The development of a microsimulation model of alcohol consumption to determine if pharmacological and/or psychosocial interventions are cost-effective for reducing alcohol consumption in the general Canadian population, and in underserved populations.
Researchers: Estefania Ruiz-Vargas, Gregory S. Zaric
We use dynamic programming to model ambulance systems. Our model can potentially assist ambulance dispatchers to proactively avoid states at which most, or all, of scheduled ambulances are busy by taking appropriate actions timely. Possible actions that we consider are: Calling in additional ambulances from neighbouring cities, expediting the service, and repositioning available ambulances following a desired compliance table. The objective is to maximize the expected proportion of time that the system spends in states with low utilizations by using reward functions that penalize being in high-utilization states. We use a detailed simulation model to validate our results.
Project Manager: Amir Rastpour, Gregory S. Zaric
The Centre is currently working with the Fowler Kennedy Sports Medicine Clinic to develop a new strategic growth plan, examining potential options such as site relocation and establishing an out-of-hospital surgical centre. By connecting key stakeholders within the London and Ontario health care sector, and examining best practices from comparator organizations across the globe, the Centre is leading this research to develop a replicable model for establishing centres of clinical excellence across Canada.
The Centre has collaboration with the South-West Local Health Integration Network (SW-LHIN), the Asthma Research Group Inc. (ARGI), and the Ontario Lung Association to conduct a health economic analysis as it relates to the implementation of the ARGI clinical and digital point of service system for the chronic obstructive pulmonary disease (COPD) program in the SW-LHIN. The intent of the ARGI COPD program will be to align with the Patients First priorities including patient and provider experience, quality and digital health in order to sustain program access across the SW LHIN, decreasing acute care utilization and improve patient’s experience and quality of life.
In partnership with Ontario’s Ministry of Government and Consumer Services, the Centre is leading a global search for best practices in health sector supply chain management. Involving participants from across Canada, the United States, the United Kingdom, Australia, and Finland, this study is pooling together the best policies and practices. This research is focused on the specific health system challenges of driving product standardization and categorization, clinician engagement, and public sector back office reform. Ultimately, the findings from this study will promote effective and informed decision making for our provincial supply chain strategy and knowledge sharing between health system stakeholders.
In highly congested hospitals, it may be common for patients to overstay at Intensive care units due to unbalanced downstream capacity. Step-down beds, also known as Level 2 beds, have become an increasingly popular and cheaper alternative to deal with this delicate issue. We developed a discrete event simulation model that estimates Level 2 bed needs for a university hospital (LHSC). The model innovates by simulating the daily Death/Stay/Step-down stochastic routine at the ICU based on nursing workload scoring, i.e. NEMS. We show our model provides a useful, more realistic framework for bed capacity panning in hospitals.
Researchers: Felipe Rodrigues, Gregory S. Zaric, David Stanford, Judy Kojlak, Fran Priestap, Claudio Martin
The Centre recently completed a research study for Health Canada and MEDEC examining models for global supply chain standards in Canada. Supply chain management and optimization has become a priority area for global health systems due to increasing complexity of healthcare supply chains and the availability of IT solutions capable of automated supply chain management and advanced analytics. Initiatives to promote the efficiency and effectiveness of materials management have been largely motivated by cost savings, but are reaping multiple benefits including promoting patient safety, reducing medical errors, and promoting patient outcomes measurement and tracking. As health systems are becoming increasingly globalized, particularly related to multi-national device manufacturers, ensuring that all health system product data systems are aligned and interoperable is becoming increasingly important. One approach to managing this challenge is the adoption of global standards which ensure that data systems are using the same terminology and technology so that processes can be standardized internationally. In the healthcare industry, there are two key standards types to identify product information: (1) unique device identification (UDI) standards, which standardize product labelling and barcode information; and (2) nomenclature standards, which standardize how devices are named and categorized. Our recent report entitled Models for Global Supply Chain Standards examined global policy models for both UDI and nomenclature standards, and through interviews with leaders from the medical device industry, government regulators, hospital purchasing departments, and shared services organizations, made key recommendations for developing supply chain standards across Canada.
London’s Healthcare Materials Management Services (HMMS) is currently undergoing a transformative shift in its supply chain processes, transitioning from a traditional push model of supply chain (projection-driven) to a pull supply chain (demand-driven) for all of London Health Sciences Centre. The Centre is working with HMMS, providing project steering and developing a best practices guide to share the learnings from this initiative with other hospitals across Canada. Unique to this approach is its low-cost nature – while many supply chain transformation projects require heavy IT investment, HMMS’ strategy achieves many of the same outcomes (point-of-use data capture, SSO asset management, accurate case costing, standardized physician preference items, and automatic requisitioning) without relying on expensive software solutions. The findings from this study will help other hospitals and health care organizations, regardless of budget, reap the benefits associated with supply chain transformation effectively.
The Centre is leading a national study examining how organizations across Canada are currently embedding patient-reported outcomes in the decision-making process for material purchases. Traditional hospital tendering processes are most often conducted at a distance from the patient. Hospital clinical teams or procurement leaders set minimum performance criteria, and vendors are incentivized only to reach those criteria. In an effort to enhance value-based procurement, many procurement departments are beginning to involve patients in the tendering process through patient-reported outcome testing. Patient-reported outcome tendering has the opportunity for hospitals to improve patient outcomes and reduce costs by making procurement decisions based on the total cost of care rather than price alone. This research will encourage collaboration and sharing of resources/knowledge across the system so that a shared set of best practices can be adopted as system stakeholders are ready. The study is currently being funded by the Ministry of Government and Consumer Services.
Facilitated by the Health Care group at MaRS, the project pairs health care providers (generally hospitals) with vendors who are early stage customers to bring new and innovative solutions to market. The goal is to use Design Thinking to develop solutions that transfer to practice better. Dr. Darren Meister is investigating best practices for the improvement of this approach to procurement for possible broader adoption in the health sector.
Ivey Health has recently completed a shared services assessment for eight local hospital corporations. Our team worked with local hospital leadership and IT system experts to design a shared services model for the region that would meet the specific needs of each participating hospital site. After reviewing relevant literature, selected case studies, and local hospital interviews and data collection, our recommended model was presented to system leadership. Our findings recommend a separate spin-off enterprise comprised of functional expertise from multiple participating hospitals, with options for scaling to other hospitals or community health organizations.
The Centre has entered into a collaborative partnership with the London Health Sciences Centre. The projects undertaken through this collaboration will be focused on health system improvements that are strategically aligned with both parties and enable patients to experience greater value from the health system. Currently, this partnership has projects in two areas care:
1. Stroke rehabilitation: Currently, Ontario’s rehabilitation system struggles to provide accessible and comprehensive care to patients recovering from stroke. To address this challenge, this project suggests a vision for a more patient-focused system that incorporates the use of health information technology, proper incentives, and greater accountability to improve the quality and efficiency of care.
2. Care for patients with infectious complications from Injection Drug Use. The objective for the project focused on patients with infectious complications from Injection Drug Use is to create a more timely and integrated system that incorporates community-based services to address acute and ongoing medical needs, as well as social psychological, spiritual and personal wellness needs.
Ivey Health is working on a project to support the implementation of London’s Community Mental Health and Addictions Strategy (CMHAS) that was published in November 2017. This 11-month contract will focus on the following deliverables from the CMHAS:
- Create governance structure to align MH&A services
- Focus and align existing collaborative forums, tables and initiatives
- Develop London Asset Map of MH&A services across all funders
- Reinforce and coordinate a central, single door for information about local assets
- Communicate MH&A services across providers, agencies, and the public
- Open and build communication channels
To Learn More: - https://getinvolved.london.ca/CMHAS
The objective of the proposed research was to develop a unified efficiency metric that can be used across CCO’s 15 cancer treatment centres. This metric facilitates the creation of benchmarks and allows for straightforward comparison between the centres, given their differing sizes in administrative and medical staff, and operational capacities. Data Envelopment Analysis (DEA) was the selected methodology, populated with financial and operational data to determine a relative efficiency score for each centre, with a focus on the radiation treatment areas. Wait time data, recurrence rates, and mortality rates from 2012 to 2016 were calculated from records provided by CCO. Common among top performing cancer centres is their low to average revenues and expenses compared to their peers, low to average available machine hours, and average to high machine utilization. These centres achieve good results with fewer monetary resources available to them. What our analysis has shown is that other measures, aside from wait times, will assist in identifying more specific areas of improvement for each centre, as well as quantify the improvement needed for a centre to achieve 100% relative efficiency.
Ivey Health, London Health Sciences Centre, the Schulich School of Medicine and Dentistry’s Department of Epidemiology and Biostatistics, and Western’s Faculty of Information and Media Studies have received a grant from the London Community Foundation to map Middlesex County’s Mental Health and Addiction services. The funding has been provided under the Isabel Hodgkinson Fund for medical research and will be used to conduct a social network analysis of services in the area.
The project aims to deliver:
- An inventory of MH&A services.
- A Social Network Map outlining partnerships and strength of relationships among local services.
- Feedback to participating programs about opportunities to improve their connectivity.