Grant: Partnerships for Health System Improvement (PHSI)

<html> <body>We showed that advances in medical and surgical therapy have led to a 57% increase in the adult congenital heart disease (ACHD) population over the last decade. By 2010, an estimated 250,000 Canadians had congenital heart disease (CHD) of which ~70% were adults. We have also shown that ACHD patients have a life-long disease burden with hospitalization rates for congestive heart failure (CHF) rising in Canada and the US. Recently, we demonstrated for the first time, that referral to specialized ACHD centres saves lives. Nonetheless, despite such benefits we also showed that less than one third of ACHD patients across Canada benefit from such care. <br>Thus, in this research proposal we make a strong case for the need to bridge the gap between evidence and practice. We have engaged the Institute national de sant&eacute; publique du Qu&eacute;bec, the Institute national d&rsquo;excellence en sant&eacute; et en services sociaux and the 3 supra-regional centres in Qu&eacute;bec that deliver specialized ACHD care. We propose a collaborative integrated knowledge translation (iKT) plan that will be implemented within each R&eacute;seaux universitaire int&eacute;gr&eacute; de sant&eacute; to accelerate referrals of high-risk patients to specialized ACHD clinics. <br> <br> <em><strong>Our overarching goal</strong></em> is to guide judicious allocation of resources by identifying high-risk patients who are most likely to benefit from specialized services. In this submission, we turn our attention to patients at risk for CHF hospitalization. With <em><strong>aim 1</strong></em>,we will develop a clinically relevant 1-year risk prediction model by point system for CHF hospitalization to inform accelerated referral. With <em><strong>aim 2</strong></em> we will determine the lifetime risk and impact of specialized ACHD care on CHF mortality. With <em><strong>aim 3</strong></em> we will promote an understanding of the problem (need for referral) and the proposed solution (use of the risk score) to guide accelerated referral of patients at high risk for CHF hospitalization to specialized ACHD clinics in Qu&eacute;bec.<br> <br>The project will employ <em><strong>quantitative and qualitative methods</strong></em>. For <em><strong>aim 1</strong></em><strong>,</strong> a retrospective cohort-design will be used to estimate the 1-yr <em>absolute risk</em> of CHF hospitalization. This will be combined with r<em>elative risks</em> obtained from case control clinical data that will be used to assign points based on the <em>&#x03b2;</em> coefficients. To <em>validate the prediction model</em>, we will use the split-sample cross-validation methodology. For <em><strong>aim 2</strong></em><em>,</em> the cumulative incidence of CHF will be calculated using the Practical Incidence Estimators methodology, and a time-to-event Cox model will measure the effect of CHF on mortality; results will be stratified by exposure to specialized ACHD. For <em><strong>aim 3</strong></em>, we will put in place a hierarchy of knowledge transfer strategies to engage knowledge users within each RUIS. The iKT impact will be measured using quality improvement methodology. Qualitative analysis of semi-structured interviews will be analyzed using grounded theory to explore drivers of referral in thematic domains. <br> <br> <em><strong>In sum</strong></em><strong>,</strong> our combined experience makes this submission feasible and timely. Using singular data sources, we propose a study that will generate a new body of evidence for targeted referrals in a growing population of ACHD patients requiring specialized care. We anticipate that knowledge gained on effective models of care delivery will be transferable to the delivery of specialized ACHD care in other provinces and to models of care for populations with life-long conditions.</body> </html>