Grant: Project Grant

A learning healthcare system looks for ways to use the tools it already has to greater effect. Ideally, this means integrating research into everyday healthcare interactions - varying how we do things, seeing what works best, and moving down that path. Unfortunately, integrating such evaluations into usual care is challenging. Research can be expensive, require on-site research personnel, and introduce work-flow disruptions that discourage providers from participating. Our solution is to expand the role of a provincial health data steward to take over the tasks clinicians and researchers usually need to perform to facilitate a research project. A health data steward holds information produced during the normal course of care needed to run the healthcare system (e.g. reasons for hospitalization, diagnoses given, drugs prescribed). Instead of being a passive recipient and analyzer of such data, a data steward can also become an active research coordinator by identifying eligible participants, allocating them to a treatment group, advising providers who to work with, tracking outcomes that matter, determining when a study can end, and analyzing the data. Such projects can be seamlessly integrated into everyday care very inexpensively, with minimal workflow disruption, and no need for on-site research personnel. Our goal is to demonstrate how a provincial health data steward can coordinate a large clinical trial - a trial that explores whether older adults with "polypharmacy" (many medications) have better health outcomes if the doses and number of those medications are minimized. This trial will take place in the offices of over 300 Alberta community family physicians, enrol roughly 1,500 seniors >= 80 years of age with >= 6 daily medications, and be the first such trial large enough to detect differences in mortality, or loss of independence. Although this approach to prescribing is already recommended care, better evidence is needed to push the practice forward.