Grant: Operating Grant: SPOR Innovative Clinical Trial Multi-Year Grant

Up to 30% of tests and treatments given to patients are not needed. This can lead to significant inconvenience and harms for these patients without any benefit. It also wastes money for patients and the health system. Choosing Wisely Canada (CWC) is engaging patients and health professionals to fix this problem. CWC has made 280 recommendations about tests and treatments that should be avoided in certain situations. But these are still happening because it is not an easy thing to change health care processes. Implementation science aims to understand the underlying reasons for health care processes and to develop and test potential solutions to improve them. This project links CWC, patient and health system partners in three provinces with leading Canadian implementation scientists to develop and test solutions for two important topics: x-rays/CT/MRI scans that are not needed for patients with low-risk back pain; and pre-operative tests that are not needed for patients having low-risk surgery. In each province, we will do preliminary studies to make sure we fully understand the different reasons for unnecessary care. Then we will develop targeted solutions using insights from behavioural and system science that support both health professionals and patients to make informed decisions about whether these tests are needed. We will test these solutions in experiments. Some health organisations (either family practices for low back pain imaging or hospitals for pre-operative testing) will receive the solution and some will not. We will determine who gets the solution using an approach similar to flipping a coin to ensure that health organisations that receive or do not receive the solution are similar. We are working with the Canadian Institute of Health Information to use the data already collected routinely to measure whether the solution worked. If our solutions work, we will engage our partners to spread and scale them across Canada.