Improvement Initiatives Noah Ivers MD PhD Family Physician, Family - - PowerPoint PPT Presentation

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Improvement Initiatives Noah Ivers MD PhD Family Physician, Family - - PowerPoint PPT Presentation

Scaling Up Promising Quality Improvement Initiatives Noah Ivers MD PhD Family Physician, Family Practice Health Centre and Scientist , Womens College Research Institute, Womens College Hospital Assistant Professor, Department of Family and


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Scaling Up Promising Quality Improvement Initiatives

Noah Ivers MD PhD Family Physician, Family Practice Health Centre and Scientist, Women’s College Research Institute, Women’s College Hospital Assistant Professor, Department of Family and Community Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto noah.ivers@wchospital.ca @noahivers

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The evidence-practice gap

Institute of Medicine of the National Academies, Best Care at Lower Cost: The Path to Continuously Learning Health Care in America, The National Academies Press, Washington, DC, 2012.

  • Ivers. Academy Health June 2016
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The learning health care system

  • Ivers. Academy Health June 2016

Ann Intern Med. 2012 Aug 7;157(3):207-10

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Learning across systems/projects?

  • Ivers. Academy Health June 2016
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Growing Literature, Stagnant Science?

  • Ivers. Academy Health June 2016

Evidence of “pilot-itis”:

Patient oriented initiatives:

182 RCTs of med-adherence strategies by 2013

Provider oriented initiatives:

140 RCTs of audit and feedback by 2010

Health services initiatives:

142 RCTs of diabetes QI strategies by 2011

Ivers et al. Cochrane 2012; Ivers et al. JGIM 2014; Tricco, Ivers, et al. Lancet 2012; Ivers et al. Systematic Reviews 2014; Nieuwlaat et al. Cochrane 2014

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Wanted: better implementation science

Causal inference & Causal explanation

  • JAMA. 2016;315(4):339-340.
  • Ivers. Academy Health June 2016
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Scaling-up: developing the science Scientific Research

contributes to generalizable knowledge by testing or developing theories or hypotheses, to draw conclusions applicable beyond the specific populations or situations being studied

Implementation Science Laboratories

partnering researchers with health systems seeking to both improve local initiatives and identify generalizable lessons about how to close the evidence-practice gap

  • Ivers. Academy Health June 2016
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Questions?

noah.ivers@wchospital.ca @noahivers

  • Ivers. Academy Health June 2016