VIRTUAL CARE & DIGITAL HEALTH EVALUATION
Digital Eye Screening for People Living with Diabetes
Despite the recommendation for people living with diabetes to have annual eye screening, roughly 400,000 Ontarians with diabetes have not had their eyes screened in the last two years. Diabetic Retinopathy (DR) is the leading cause of blindness among working age people. WIHV, working with partners at University Health Network (UHN) and South Riverdale Community Health Centre (SRCHC), have launched a new study using tele-ophthalmology to improve DR screening. The project aims to identify the interventions that have the greatest potential to increase screening rates across Ontario. To learn more about DR screening visit www.eyescreening.ca
COPD Self-Monitoring Technology
The Connected Health Kit from Cloud DX is a remote monitoring device created to help COPD patients better manage and treat their condition from the comfort of their home. WIHV and its partners Markham Stouffville Hospital, Cloud DX and Closing the Gap Healthcare, implemented and rigorously evaluated the technology during a pilot project to determine how it could best provide value to patients with COPD, a common lung disease. The evaluation demonstrated overall positive patient experience and provided lessons learned for the hospital on developing effective remote monitoring programs. As a result, Markham Stouffville Hospital has purchased several new Connected Health Kits for its patients.
Mental Health Peer Support through Big White Wall
In 2015, WIHV and the Ontario Telemedicine Network (OTN) collaborated in evaluating Big White Wall, an online anonymous community for people with mental health challenges. Big White Wall offers participants a range of evidence-based treatment strategies for mental illness and addiction, including education, peer support, self-assessment and artistic self-expression. As part of its rigorous evaluation, WIHV conducted a randomized control trial with a nested study, as well as a qualitative realist evaluation to examine acceptability, effectiveness, and cost-effectiveness of Big White Wall for mental health self-management and peer support. Our findings have been published in BMC Psychiatry and the Journal of Medical Internet Research (JMIR).
Innovative Integrated Care Globally
Working with researchers at the University of Toronto’s Institute for Health Policy, Management and Evaluation (IHPME), WIHV surveyed 30 innovative integrated care programs for patients with complex needs in 11 countries. Our team developed a survey tool, collected and interpreted the data to create briefs about the design features of each program and their policy context. Through this initiative with the Commonwealth Fund, our team was able to leverage best practices globally to gain better insight into how new models of care can better support patients with complex needs.
Toronto Neighbourhood Care Initiative
Under our current health system, socially and medically complex patients often face difficulties receiving continuity of care. The Neighbourhood Care Initiative is an integrated care pilot project in 10 neighbourhoods across Toronto that is developing highly-coordinated, patient-centred models of care. Teams are made up of home and community care organizations, social service agencies and primary care partnerships. WIHV is conducting a multi-year developmental evaluation of the initiative.
Low-Value Care with Choosing Wisely Canada
Up to 30 per cent of tests, treatments, and procedures done in Canada are potentially unnecessary. Choosing Wisely Canada is a national initiative taking action against low-value healthcare. WIHV works as the measurement and evaluation lead of Choosing Wisely Canada, where our research involves quantifying rates of overuse and assessing the impact of low-value care on patient outcomes. These findings are contributing to the development and implementation of solutions to improve quality of care. In a recent study, published in JAMA Open, we found that, within Ontario, there was a small group of “frequent users,” comprised of roughly 18 per cent of all primary care physicians in the province, ordering over 32 per cent of low-value screening tests.
The Ontario Healthcare Implementation Laboratory
Working with multiple provincial organizations and agencies, WIHV is leveraging data to evaluate large-scale quality improvement activities in the health system. Currently, the team is investigating the role of family doctors in improving opioid prescribing practices. We have found that there is a clear opportunity for better intervention strategies targeting family physicians, in order to more effectively support them in managing patients’ with a high-risk opioid prescription. Our initial findings have been published in BMC Family Practice and Annals of Family Medicine.
Proactive, Personalized Postpartum Mental Healthcare (P3MH)
Mental health symptoms are very common in new parents, affecting close to 20 per cent of mothers and at least 10 per cent of fathers. When these symptoms progress to severe levels, they can become more difficult to treat. Our study uses software that integrates with electronic medical records and delivers secure email to engage parents in assessing their mental health symptoms. Online surveys are sent on behalf of family doctors and are used to support the development of a tailored care plan that includes customized resources for both patients and family physicians. The study is taking place at 5 family health teams across the greater Toronto area. We are currently enrolling patient participants.
P3MH is a part of WIHV’s Proactive, Personalized Self-Management & Decision Support (PPDS) program. Read More
Screen While You Wait: Physical Activity
We know that exercise is an effective way to improve health. Yet, only 18 per cent of adults get the recommended amount each week. For this study, patients at WCH’s Family Practice Health Centre completed an online survey, which was used to support the development of a tailored care plan, including the provision of an “exercise prescription” and a toolkit with online and community-based resources. The Screen While You Wait study demonstrated that digital tools can provide patients with tailored resources to improve healthy behaviours. Study findings have been published in Canadian Family Physician and the Journal of Medical Internet Research.
Screening While You Wait 2: Tobacco and Alcohol Use
The best approach to reducing substance use involves routine screening, short discussions with clinicians, and offering people tailored resources to help them. Unfortunately, primary care providers often do not screen or provide evidence-based interventions to their patients. Building on the first iteration of Screen While You Wait, patients at WCH’s Family Practice will be emailed a secure link to a survey with question assessing their substance use and other important contextual factors prior to an upcoming, non-urgent appointment. Results will be summarized in their chart and an automatic notification will be sent to their doctor when that occurs. If the survey reveals concerns, both parties will receive a package of tailored resources for further care through an innovative website. This study is currently underway at WCH Family Practice.
Both Screen While You Wait studies are a part of WIHV’s Proactive, Personalized Self-Management & Decision Support (PPDS) program.