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

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.

Karen Palmer
karen.palmer@wchospital.ca