Improving the Uptake of Transcatheter Aortic Valve Replacement in Ontario.

Abstract

BackgroundThe rising costs of healthcare delivery globally and the increasing research production rate create immense opportunities for implementing novel and more effective medical interventions that significantly benefit patient outcomes. However, the successful uptake of medical innovations is complex and often extremely contextual based on many sociopolitical and economic factors. These barriers to implementation can delay or derail new practices, procedures, products, and pharmaceuticals. Understanding the barriers to the successful implementation of medical innovations and the best practices and strategies to mitigate them is an extremely important area for translational research in health sciences.This study examines the barriers and potential challenges in implementing medical innovations and the possible preemptive measures that can be addressed early to increase the use of life-saving medical innovations. We consider the importance of appropriate, timely, and user-defined implementation techniques as a critical component of the successful uptake of medical innovations and use the uptake of transcatheter valve replacement therapy (TAVR), which is an alternative life-saving intervention for patients at risk for surgical complications, in Ontario, Canada as the practical case study of the challenges and potential instructive opportunities to establish best practices for systematic and effective innovation uptake.MethodologyIn addition to contextual and informal investigations, a small pilot survey of decision-makers across the University of Toronto-affiliated teaching hospitals helped compare and contrast the barriers to medical innovation uptake (in the literature) with the suggested barriers to the successful implementation of TAVR. This study looks primarily at the role of funding, physician preference, clinical guidelines, and patient comorbidities as decision-making factors contributing to TAVR uptake. The study also explores how the differences and similarities of TAVR uptake related to the decision-making factors above can help develop recommended strategies to address future implementation barriers.ResultsWe observed that the decision-makers across the surveyed institutions refer patients with intermediate to high risk for surgery for TAVR. Funding and physician preference were identified as possible barriers to TAVR uptake, with underlying comorbidities of patients being a primary decision determinant for TAVR referral. Physician preferences were based on multiple factors such as clinical judgment, patient comorbidities, clinical guidelines, knowledge, TAVR, and surgical valve replacement skills.ConclusionsTo the best of our knowledge, this study is one of the first to use the Toronto Translational Thinking Framework to assess an innovative treatment uptake in the Ontario healthcare system. Although the study sample size was 11 and did not reflect the views of all decision-makers regarding TAVR use in Ontario, the survey reflected participants who directly make decisions regarding TAVR use, strengthening the credibility of the survey results. The insights from this study are intended to inform both the continued implementation of TAVR and to contribute to a broader field of investigation that aims to identify and operationalize the principles and best practices of translational research that may contribute to the efficacy of implementing other medical innovations in Ontario hospitals and beyond.