Locating EPIC/PHSI in a Sea of Acronyms

(CNN; CIHR-PHSI; EPIC; EPIC/PHSI)

Shoo K. Lee, MBBS, FRCPC, PhDDirector, Canadian Neonatal Network™

Scientific Director, iCAREProfessor of Pediatrics, University of Alberta

EPIC/PHSI Training WorkshopNovember 9 & 10, 2006

Toronto Ontario

ObjectivesObjectives

• Overview CNNTM

• Overview CIHR

• Overview EPIC/PHSI

• Locate EPIC/PHSI in CNN and CIHR

Canadian Neonatal Network™

(CNN)

Background of CNNBackground of CNN Founded in 1995 Multidisciplinary researchers 30 hospitals & 16 universities across Canada

All 30 tertiary NICUs in Canada

Standardized NICU database CNN researchers have published extensively in

peer-reviewed journals and made many presentations at scientific conferences

Objective of CNNObjective of CNN

To conduct leading, innovative, To conduct leading, innovative, collaborative research leading to collaborative research leading to improvements in neonatal-perinatal health improvements in neonatal-perinatal health and the quality of healthcare in Canada and the quality of healthcare in Canada and internationally.and internationally.

Structure of CNNStructure of CNN

Canadian Neonatal Network™Canadian Neonatal Network™

Network Coordinating CentreEdmonton

Network Coordinating CentreEdmonton Participating InstitutionsParticipating Institutions Steering CommitteeSteering Committee

Project CoordinatorAireen Wingert

Database ManagerJack Yeung

Data AnalystKate Zhang

Knowledge BrokerDavid S Thompson

Project CoordinatorAireen Wingert

Database ManagerJack Yeung

Data AnalystKate Zhang

Knowledge BrokerDavid S Thompson

Site Investigator

Individual Membership

Data Abstractor

Site Investigator

Individual Membership

Data Abstractor

6 elected members

set Network/database policies ensure Network goals are met

6 elected members

set Network/database policies ensure Network goals are met

Kingston

CNN SitesCNN Sites

Vancouver

New Westminster

Victoria

EPIC/PHSI Sites--25

CalgaryRegina

Saskatchewan

Winnipeg

LondonHamilton

Ottawa

Toronto

SherbrookeMontréal

Québec City Moncton

St. John’s

Fredericton

HalifaxSt. John

Kingston

CNN Sites--30

Canadian Institute of Health Research

(CIHR)

CIHRCIHR

CIHR Mandate"To excel, according to internationally accepted standards of scientific excellence, in the creation of new knowledge and its translation into improved health for Canadians, more effective health services and products and a strengthened Canadian health care system."

CIHR - Partnerships for Health System CIHR - Partnerships for Health System Improvement (PHSI)Improvement (PHSI)

• The purpose of this initiative is to support teams of researchers and decision-makers interested in conducting applied health research useful to health system managers and/or policy makers over the next two-to-five years.

• EPIC/PHSI funded for $100,000 x 3 years

CIHR and Knowledge TranslationCIHR and Knowledge Translation

• Knowledge translation is the exchange, synthesis and ethically-sound application of knowledge - within a complex system of interactions among researchers and users - to accelerate the capture of the benefits of research for Canadians through improved health, more effective services and products, and a strengthened health care system

• EPIC/PHSI is built upon knowledge translation

Evidence-based PracticeEvidence-based PracticeIdentification and ChangeIdentification and Change

(EPIC)(EPIC)

EPIC/PHSIEPIC/PHSI

Evidence-based Practice Evidence-based Practice Identification and Change (EPIC)Identification and Change (EPIC)

Scientific method for quality improvement

Innovation - 3 pillars:

1. Evidence-based Uses published research literature

2. Variations in outcomes for targeted intervention Use data to identify practices associated with variations in outcomes

3. Combined expertise Uses a national network of clinicians and experts to share expertise and

experience

A template that is generalizable to all NICUs

Create culture of continuous quality improvement and evidence-based practice and change

EPIC-I Results: Group A (NIT)EPIC-I Results: Group A (NIT)

NIT(intervention group)

24.1%

17.1%

21.5%

12.5%

15.6% 16.4% 15.8% 15.5%13.1%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

baseline Oct03-Dec03

Jan04-Mar04

Apr04-Jun04

Jul04-Sept04

Oct04-Dec04

Jan05-Mar05

Apr05-Jun05

Jul05-Sept05

Quarter

Percen

tag

e o

f N

I (ever in

fected

)NIT (control group)

32.7%

28.3%

38.0%

28.2% 28.3%

33.0%29.5% 29.5%

32.2%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

baseline Oct03-Dec03

Jan04-Mar04

Apr04-Jun04

Jul04-Sept04

Oct04-Dec04

Jan05-Mar05

Apr05-Jun05

Jul05-Sept05

Quarter

Pe

rce

nta

ge

of

CL

D

EPIC-I Results: Group B (CLD)EPIC-I Results: Group B (CLD)CLD (intervention gruop)

31.5%28.9% 30.0%

28.2% 28.5% 27.8%25.3%

27.4%

21.7%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

baseline Oct03-Dec03

Jan04-Mar04

Apr04-Jun04

Jul04-Sept04

Oct04-Dec04

Jan05-Mar05

Apr05-Jun05

Jul05-Sept05

Quarter

Pe

rce

nta

ge

o

f C

LD

CLD (control grup)

17.8%

13.7%15.0%

10.0%

12.4% 12.8%

10.1%8.0% 7.1%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

baseline Oct03-Dec03

Jan04-Mar04

Apr04-Jun04

Jul04-Sept04

Oct04-Dec04

Jan05-Mar05

Apr05-Jun05

Jul05-Sept05

Quarter

Percentage of N

I (ever in

fected)

EPIC-I Results: Group C (Controls)EPIC-I Results: Group C (Controls)control group (Non-EPIC group)

37.85%

31.54% 30.61%

38.98% 40.60%

29.17%31.94%

36.56%35.71%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

baseline Oct-Dec03

Jan-Mar04

Apr-Jun04

Jul-Sept04

Oct-Dec04

Jan-Mar05

Apr-Jun05

Jul-Sept05

Quarter

Percentage of B

PD

babie

s

control group (Non-EPIC group)

12.3%

6.0%

14.5%16.0%

13.7%

7.2%

11.8%10.3%

14.0%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

baseline Oct03-Dec03

Jan04-Mar04

Apr04-Jun04

Jul04-Sept04

Oct04-Dec04

Jan05-Mar05

Apr05-Jun05

Jul05-Sept05

Quarter

Perc

enta

ge o

f N

I(ever

infe

cte

d)

EPIC-I ConclusionsEPIC-I Conclusions

• EPIC is effective at reducing NI and BPD in the NICU

• Interventions targeting one outcome may affect other outcomes

• EPIC may be more effective and less costly at improving quality of care than traditional CQI methods

EPIC/PHSI ObjectivesEPIC/PHSI Objectives

• Test the generalizeability of EPIC

• Determine the sustainability of EPIC

• Establish and evaluate a national system to support NICU quality improvement efforts based on EPIC