Ontario's Program Research Articles

Impact of Unrestricted Access to Pregabalin on the Use of Opioids and Other CNS-Active Medications: A Cross-Sectional Time Series Analysis.

Access to pregabalin via Ontario's public drug insurance program was expanded to an unrestricted model on April 1, 2013, from a prior authorization model. This study aims to identify the effect of expanded access on the rate of pregabalin use by publicly insured persons and to assess the characteristics of new patients initiating pregabalin following this expanded access. We conducted a cross-sectional time series analysis using the linked health administrative records of residents of Ontario, Canada, with public drug coverage who were dispensed a prescription for pregabalin between April 1, 2006, and December 31, 2014. A total of 108,047 publicly insured persons were dispensed pregabalin over the study period. The overall rate of pregabalin use increased from 1.0 per 1,000 individuals in Q1 of 2013 to 22.0 per 1,000 individuals in Q4 of 2014. Musculoskeletal (81.6%) and neurological (68.1%) conditions were the most prevalent diagnoses in patients who initiated pregabalin following the expansion of access. Past and concomitant use of opioids, nonsteroidal anti-inflammatory drugs, and antidepressants was also common in this population. Formulary changes in Ontario have led to expanded access to pregabalin, which may have led to an increase in off-label use of these products and potential patient risk associated with concomitant use of pregabalin with central nervous system-depressing drugs.

Developing leading indicators from OHS management audit data: Determining the measurement properties of audit data from the field

IntroductionOHS management audits are one means of obtaining data that may serve as leading indicators. The measurement properties of such data are therefore important. This study used data from Workwell audit program in Ontario, a Canadian province. The audit instrument consisted of 122 items related to 17 OHS management elements. The study sought answers regarding (a) the ability of audit-based scores to predict workers' compensation claims outcomes, (b) structural characteristics of the data in relation to the organization of the audit instrument, and (c) internal consistency of items within audit elements. MethodThe sample consisted of audit and claims data from 1240 unique firms that had completed one or two OHS management audits during 2007–2010. Predictors derived from the audit results were used in multivariable negative binomial regression modeling of workers' compensation claims outcomes. Confirmatory factor analyses were used to examine the instrument's structural characteristics. Kuder–Richardson coefficients of internal consistency were calculated for each audit element. ResultsThe ability of audit scores to predict subsequent claims data could not be established. Factor analysis supported the audit instrument's element-based structure. KR-20 values were high (≥0.83). ConclusionsThe Workwell audit data display structural validity and high internal consistency, but not, to date, construct validity, since the audit scores are generally not predictive of subsequent firm claim experience. Audit scores should not be treated as leading indicators of workplace OHS performance without supporting empirical data. Practical applicationsAnalyses of the measurement properties of audit data can inform decisionmakers about the operation of an audit program, possible future directions in audit instrument development, and the appropriate use of audit data. In particular, decision-makers should be cautious in their use of audit scores as leading indicators, in the absence of supporting empirical data.

How effectively does the full-day, play-based kindergarten programme in Ontario promote self-regulation, literacy, and numeracy?

ABSTRACTThis study investigated the effectiveness of the Full-Day Early Learning Kindergarten (FDELK) programme, which integrates play-based learning and team teaching, in promoting 32,027 kindergarteners’ self-regulation (SR), literacy, and numeracy outcomes. Outcome measures derived from teacher reports of students’ school readiness in the Early Development Instrument were analysed in separate hierarchical regression analyses that controlled for individual and school-level characteristics. Results revealed essentially no benefit for students participating in the FDELK programme when compared to peers in Half-Day Kindergarten (HDK) or Alternate-Day Kindergarten programmes. Being older, female, and in higher socio-economic status schools with a history of higher achievement predicted more positive SR, literacy, and numeracy outcomes. Findings suggest the FDELK programme requires improvement. Play-based learning programmes, such as the FDELK, might be enhanced by incorporating evidence-based guidelines and goals for play, reducing class sizes to more effectively scaffold learning, and revising curriculum expectations to include a greater focus on SR, literacy, and numeracy skills.

Moving Guidelines into Action: A Report from Cancer Care Ontario’s Event Let’s Get Moving: Exercise and Rehabilitation for Cancer Patients

The need for an improved understanding of the rehabilitation services landscape in Ontario and for promotion of Cancer Care Ontario’s newly developed Exercise for People with Cancer guideline brought Cancer Care Ontario’s Psychosocial Oncology and Survivorship Programs together to host a knowledge translation and exchange event. The primary objectives of the event were to understand recommendations from Cancer Care Ontario’s new exercise guideline, to discuss key considerations and determine strategies for the implementation of the guideline recommendations, and to explore the current state and future directions of cancer rehabilitation in Ontario. The event was attended by 124 stakeholders, including clinicians, allied health care professionals, administrators, patients, community partners, and academics representing each of the 13 regional cancer programs in Ontario. Attendees participated in two small-group activities that focused on determining the best approach for implementing the guideline recommendations into practice and discussing current barriers and the future state of cancer rehabilitation in Ontario. The activities allowed for networking and collaboration between attendees. The event provided an opportunity for the Psychosocial Oncology and Survivorship Programs to learn about the types of goals and plans that could be feasible in implementing the guideline in each region, and about ways to prioritize gaps in access to rehabilitation services and the types of implementation strategies that might be used to address the gaps. Overall, attendees were highly satisfied with the event, and the findings are being used to help inform research and practice activities with respect to guideline implementation and rehabilitation practice.

New vehicle feebates

AbstractNew vehicle feebate programs encourage improved fleet‐wide vehicle fuel efficiency; yet analyses of these policies have been limited to ad hoc proposals. In this paper, we exploit an extensive, multi‐year dataset which includes more than 16 million observations to evaluate the welfare implications of a long‐standing vehicle feebate program in the Canadian province of Ontario. We: (1) show that second‐best optimal feebates can be written as a function of new vehicle Pigouvian taxes; (2) find that Ontario's feebate program was welfare‐enhancing relative to a no feebate scenario but that a second‐best optimal benchmark would have yielded additional welfare while reducing fleet‐wide emissions; and (3) find that Ontarian consumers responded asymmetrically to fees versus rebates.

Pediatric Insulin Pump Therapy: Reflecting on the First 10 Years of a Universal Funding Program in Ontario.

We evaluated the universal funding program for pediatric insulin pumps in Ontario by examining the dynamics underlying patterns of pump use and adverse events using population-based health administrative data available at the Institute for Clinical Evaluative Sciences (ICES), supplemented by other data. We found that (1) pump use has increased steadily since 2006 with variation across centres and disparity in use by socioeconomic status; (2) pump discontinuation is uncommon; (3) physicians value pump therapy in numerous ways that provide important insights into patterns of uptake; and (4) the safety profile of pump therapy is, in general, very good; however, individuals of lower socioeconomic status are at an increased risk of acute diabetes complications, most frequently diabetic ketoacidosis. This comprehensive mixed-methods evaluation reveals the need to understand and intervene to reduce social disparities in the use and adverse outcomes of technologies used for diabetes management.

Baccalaureate nursing students’ confidence on patient safety

High rates of patient safety events led to media attention and litigation that sparked the patient safety movement. Gaining awareness of nursing students’ confidence levels on patient safety will reveal their perceptions of their competency. A quantitative descriptive cross-sectional method was employed. The Health Professional Education in Patient Safety Survey was used to determine how 458 baccalaureate nursing students from two nursing programs in Ontario, Canada rate their confidence levels on patient safety. Nursing students are the most confident on Clinical Safety topics and least confident on topics related to Human and Environmental Factors and Culture of Safety. Overall, they are more confident in the classroom than in the clinical settings with fourth year students expressing lower degrees of confidence on many of the areas. Education programs need to reinforce patient safety and educate students on their responsibilities to protect patients/clients. Programs need to target strategies to reduce student fears, promote error reporting, and system improvements.

Patient safety in practical nurses' education: A cross-sectional survey of newly registered practical nurses in Canada

BackgroundPractical nurses have experienced an increasing scope of practice, including an expectation to care for complex patients and function on interdisciplinary teams. Little is known about the degree to which patient safety principles are addressed in practical nursing education. PurposeTo examine self-reported patient safety competencies of practical nurses. DesignA cross-sectional online survey (July 2014) and face-to-face interviews (June 2015). SettingOntario, Canada. ParticipantsSurvey participants were practical nurses newly registered with the College of Nurses of Ontario between January 2012 and December 2013. Interview participants were faculty and students in a practical nursing program in Ontario. MethodsSurvey respondents completed the Health Professional Education in Patient Safety Survey online. Self-reported competencies in various patient safety domains were compared between classroom and clinical settings. Faculty members were interviewed about educational preparation of practical nurses and students were interviewed to provide insight into interpretation of survey questions. ResultsThe survey response rate was 28.4% (n=1104/3883). Mean domain scores indicated a high level of confidence in patient safety competence (<4.0/5.0). Confidence was highest in respondents registered with the College of Nurses of Ontario >2years and in those who obtained their education outside of Canada. Faculty believed their approach to teaching and learning instilled a deep understanding of the limits to practical nurse autonomous practice. ConclusionsPractical nurses were confident in what they learned about patient safety in their educational programs. The high degree of patient safety competence may be a true reflection of practical nurses understanding of, and comfort with, the limits of their knowledge and, ultimately, the limits of their individual autonomous practice. Further exploration as to whether the questionnaire requires additional modification for use with practical nurse populations is warranted. However, this study provides the first examination of practical nurses' perspectives and perceptions about patient safety education.

Variation in Access to Kidney Transplantation Across Renal Programs in Ontario, Canada.

In the United States, kidney transplant rates vary significantly across end-stage renal disease (ESRD) networks. We conducted a population-based cohort study to determine whether there was variability in kidney transplant rates across renal programs in a health care system distinct from the United States. We included incident chronic dialysis patients in Ontario, Canada, from 2003 to 2013 and determined the 1-, 5-, and 10-year cumulative incidence of kidney transplantation in 27 regional renal programs (similar to U.S. ESRD networks). We also assessed the cumulative incidence of kidney transplant for "healthy" dialysis patients (aged 18-50 years without diabetes, coronary disease, or malignancy). We calculated standardized transplant ratios (STRs) using a Cox proportional hazards model, adjusting for patient characteristics (maximum possible follow-up of 11 years). Among 23 022 chronic dialysis patients, the 10-year cumulative incidence of kidney transplantation ranged from 7.4% (95% confidence interval [CI] 4.8-10.7%) to 31.4% (95% CI 16.5-47.5%) across renal programs. Similar variability was observed in our healthy cohort. STRs ranged from 0.3 (95% CI 0.2-0.5) to 1.5 (95% CI 1.4-1.7) across renal programs. There was significant variation in kidney transplant rates across Ontario renal programs despite patients having access to the same publicly funded health care system.

The Risk of Acute Rejection Following Kidney Transplant by 25-Hydroxyvitamin D and 1,25-Dihydroxyvitamin D Status: A Prospective Cohort Study.

Background:Prediction of acute kidney transplant rejection remains imperfect despite several known risk factors. There is an increasing appreciation of the potential importance of the vitamin D pathway in immunological disease and transplantation.Objective:The purpose of this study was to determine the association of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D with acute rejection.Design:This was a prospective cohort study.Setting:Three academic adult kidney transplant programs in Ontario, Canada, were chosen.Patients:All consecutive adult patients at the 3 institutions who received a solitary kidney transplant, were able to provide written informed consent, and planned to be followed at the same center post-operatively were included.Measurements:Serum concentration of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D were measured at baseline, 3, and 6 months post-transplantation. Acute rejection was classified using Banff criteria.Methods:The co-primary outcome was the association between 25-hydroxyvitamin D or 1,25-dihydroxyvitamin D and time to first occurrence of biopsy-proven acute rejection (BPAR) within the first year after kidney transplantation. Cox proportional hazards models were fitted taking into account the time-varying nature of serum concentrations of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D.Results:From 556 screened patients, data on 327 kidney transplant recipients are included. First BPAR occurred in 54 (16.5%) patients. In adjusted Cox proportional hazards models, the serum concentration of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D was not associated with acute renal transplant rejection (hazard ratio 1.00; 95% [confidence interval] CI, 0.87-1.14, per 10 nmol/L increase, and hazard ratio 0.97; 95% CI, 0.84-1.12, per 10 pmol/L increase, respectively).Limitations:Given the observational design, we cannot rule out the possibility of residual confounding that limited our ability to detect a clinically significant effect of vitamin D metabolites on acute rejection.Conclusions:A low serum concentration of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D is not associated with an increased risk of acute kidney transplant rejection following kidney transplantation.

Utilisation of home-based physician, nurse and personal support worker services within a palliative care programme in Ontario, Canada: trends over 2005-2015.

With health system restructuring in Canada and a general preference by care recipients and their families to receive palliative care at home, attention to home-based palliative care continues to increase. A multidisciplinary team of health professionals is the most common delivery model for home-based palliative care in Canada. However, little is known about the changing temporal trends in the propensity and intensity of home-based palliative care. The purpose of this study was to assess the propensity to use home-based palliative care services, and once used, the intensity of that use for three main service categories: physician visits, nurse visits and care by personal support workers (PSWs) over the last decade. Three prospective cohort data sets were used to track changes in service use over the period 2005 to 2015. Service use for each category was assessed using a two-part model, and a Heckit regression was performed to assess the presence of selectivity bias. Service propensity was modelled using multivariate logistic regression analysis and service intensity was modelled using log-transformed ordinary least squares regression analysis. Both the propensity and intensity to use home-based physician visits and PSWs increased over the last decade, while service propensity and the intensity of nurse visits decreased. Meanwhile, there was a general tendency for service propensity and intensity to increase as the end of life approached. These findings demonstrate temporal changes towards increased use of home-based palliative care, and a shift to substitute care away from nursing to less expensive forms of care, specifically PSWs. These findings may provide a general idea of the types of services that are used more intensely and require more resources from multidisciplinary teams, as increased use of home-based palliative care has placed dramatic pressures on the budgets of local home and community care organisations.

Evaluation of the effect of an audit and feedback reporting tool on screening participation: The Primary Care Screening Activity Report (PCSAR)

Participation in cancer screening is critical to its effectiveness in reducing the burden of cancer. The Primary Care Screening Activity Report (PCSAR), an electronic report, was developed as an innovative audit and feedback tool to increase screening participation in Ontario's cancer screening programs. This study aims to assess its impact on patient screening participation.This study used a retrospective cohort design to evaluate the effectiveness of the 2014 PCSAR on screening participation in Ontario's three screening programs (breast, cervix and colorectal). The 3 cohorts comprised all participants eligible for each of the programs enrolled with a primary care physician in Ontario. Two exposures were evaluated for each cohort: enrollment with a physician who was registered to receive the PCSAR and enrollment with a registered physician who also logged into the PCSAR. Logistic regression modelling was used to assess the magnitude of the effect of PCSAR on participation, adjusting for participant and physician characteristics.Across all three screening programs, 63% of eligible physicians registered to receive the PCSAR and 38% of those registered logged-in to view it. Patients of physicians who registered were significantly more likely to participate in screening, with odds ratios ranging from 1.06 [1.04;1.09] to 1.15 [1.12;1.19]. The adjusted odds ratios associated with PCSAR log-in were 1.07 [1.03;1.12] to 1.18 [1.14;1.22] across all screening programs.Implementation of the PCSAR was associated with a small increase in screening participation. The PCSAR appears to be modestly effective in assisting primary care physicians in optimizing cancer screening participation among their patients.

The innovation of Ontario full-day kindergarten educator teams: have they reproduced the split systems of care and education?

ABSTRACTThis study investigated the implementation of a full-day kindergarten programme in Ontario, Canada. Key to the implementation of this programme has been a new kind of educator team consisting of a certified teacher and a registered early childhood educator and a complementary partnership in which each team member contributes equally. Our research examined team members’ perceptions and practices related to their roles and responsibilities. Findings suggest that the care work for which early childhood educators are disproportionally responsible is accorded less value and status than the work of educating children. Implications of these findings are discussed in relation to the care/education split, the social reproduction of care work and social inequities.

A randomized wait-list control trial to evaluate the impact of a mobile application to improve self-management of individuals with type 2 diabetes: a study protocol.

BackgroundManagement of diabetes through improved glycemic control and risk factor modification can help prevent long-term complications. Much diabetes management is self-management, in which healthcare providers play a supporting role. Well-designed e-Health solutions targeting behavior change can improve a range of measures, including glycemic control, perceived health, and a reduction in hospitalizations.MethodsThe primary objective of this study is to evaluate if a mobile application designed to improve self-management among patients with type 2 diabetes (T2DM) improves glycemic control compared to usual care. The secondary objectives are to determine the effects on patient experience and health system costs; evaluate how and why the intervention worked as observed; and gain insight into considerations for system-wide scale-up. This pragmatic, randomized, wait-list-control trial will recruit adult participants from three Diabetes Education Programs in Ontario, Canada. The primary outcome is glycemic control (measured by HbA1c). Secondary outcomes include patient-reported outcomes and patient-reported experience measures, health system utilization, and intervention usability. The primary outcome will be analyzed using an ANCOVA, with continuous secondary outcomes analyzed using Poisson regression. Direct observations will be conducted of the implementation and application-specific training sessions provided to each site. Semi-structured interviews will be conducted with participants, healthcare providers, organizational leaders, and system stakeholders as part of the embedded process evaluation. Thematic analysis will be applied to the qualitative data in order to describe the relationships between (a) key contextual factors, (b) the mechanisms by which they effect the implementation of the intervention, and (c) the impact on the outcomes of the intervention, according to the principles of Realist Evaluation.DiscussionThe use of mobile health and virtual tools is on the rise in health care, but the evidence of their effectiveness is mixed and their evaluation is often lacking key contextual data. Results from this study will provide much needed information about the clinical and cost-effectiveness of a mobile application to improve diabetes self-management. The process evaluation will provide valuable insight into the contextual factors that influence the application effectiveness, which will inform the potential for adoption and scale.Trial registrationClinicaltrials.gov NCT02813343. Registered on 24 June 2016 (retrospectively registered).Trial Sponsor: Ontario Telemedicine Network

Cost-effectiveness of Wait Time Reduction for Intensive Behavioral Intervention Services in Ontario, Canada

Earlier access to intensive behavioral intervention (IBI) is associated with improved outcomes for children with severe autism spectrum disorder (ASD); however, there are long waiting times for this program. No analyses have been performed modeling the cost-effectiveness of wait time reduction for IBI. To model the starting age for IBI with reduced wait time (RWT) (by half) and eliminated wait time (EWT), and perform a cost-effectiveness analysis comparing RWT and EWT with current wait time (CWT) from government and societal perspectives. Published waiting times were used to model the mean starting age for IBI for CWT, RWT, and EWT in children diagnosed with severe ASD who were treated at Ontario's Autism Intervention Program. Inputs were loaded into a decision analytic model, with an annual discount rate of 3% applied. Incremental cost-effectiveness ratios (ICERs) were determined. One-way and probabilistic sensitivity analyses were performed to assess the effect of model uncertainty. We used data from the year 2012 (January 1 through December 31) provided from the Children's Hospital of Eastern Ontario IBI center for the starting ages. Data analysis was done from May through July 2015. The outcome was independence measured in dependency-free life-years (DFLYs) to 65 years of age. To derive this, expected IQ was modeled based on probability of early (age <4 years) or late (age ≥4 years) access to IBI. Probabilities of having an IQ in the normal (≥70) or intellectual disability (<70) range were calculated. The IQ strata were assigned probabilities of achieving an independent (60 DFLYs), semidependent (30 DFLYs), or dependent (0 DFLYs) outcome. Costs were calculated for provincial government and societal perspectives in Canadian dollars (Can$1 = US$0.78). The mean starting ages for IBI were 5.24 years for CWT, 3.89 years for RWT, and 2.71 years for EWT. From the provincial government perspective, EWT was the dominant strategy, generating the most DFLYs for Can$53 000 less per individual to 65 years of age than CWT. From the societal perspective, EWT produced lifetime savings of Can$267 000 per individual compared with CWT. The ICERs were most sensitive to uncertainty in the starting age for IBI and in achieving a normal IQ based on starting age. This study predicts the long-term effect of the current disparity between IBI service needs and the amount of IBI being delivered in the province of Ontario. The results suggest that providing timely access optimizes IBI outcomes, improves future independence, and lessens costs from provincial and societal perspectives.

Rituximab in Lymphoma and Chronic Lymphocytic Leukaemia: A Practice Guideline

Rituximab is the first monoclonal antibody to be approved for use by the US Food and Drug Administration in cancer. Its role in the treatment of non-Hodgkin lymphoma, including chronic lymphocytic leukaemia (CLL), has evolved significantly. We aimed to systematically review and update the literature on rituximab in lymphoma and CLL, and provide evidence-based consensus guidelines for its rational use. Validated methodology from the Cancer Care Ontario Program in Evidence-based Care was used. A comprehensive literature search was completed by a methodologist from the Hematology Disease Site Group of Cancer Care Ontario. Data were extracted from randomised controlled trials of rituximab-containing chemotherapy regimens for patients with lymphoma or CLL. Fifty-six primary randomised controlled trials were retrievable and met all inclusion criteria. Clinically important benefits in progression-free survival or overall survival were seen in the following settings: (i) addition of rituximab to combination chemotherapy for initial treatment of aggressive B-cell lymphomas, including diffuse large B-cell lymphoma, Burkitt lymphoma and HIV-related lymphoma with CD4 count ≥50/mm3; (ii) addition of rituximab to combination chemotherapy for initial and subsequent treatment of follicular lymphoma and other indolent B-cell lymphomas; (iii) use of rituximab maintenance in patients with indolent B-cell lymphomas who have responded to chemoimmunotherapy; (iv) addition of rituximab to fludarabine-based chemotherapy or chlorambucil for initial treatment of CLL. The consensus opinion of the Hematology Disease Site Group is that rituximab is recommended for these indications.

The Best Laid Plans: Educational Pathways of Adult Learners in Toronto

In this paper, we examine the post‑secondary plans and attainment of adult learners in Toronto, Ontario. We first describe the population of adult learners in Canada’s largest city, describing how they are largely made up of immigrants who use the continuing education adult day programs at the Toronto District School Board to upgrade their skills. We hypothesize that the adult day schools are a stepping stone for entering post‑secondary programs in Ontario and find that the vast majority of students surveyed indicated that they wished to pursue college or university. However, an administrative data set demonstrates that only a fraction of these students successfully confirmed an offer of college or university admission at a later date. We discuss this disconnect between the plans and later‑life attainment of adult learners, noting how this particular population is much different demographically than traditional high‑school students.

Investigating the within-herd prevalence and risk factors for ketosis in dairy cattle in Ontario as diagnosed by the test-day concentration of beta-hydroxybutyrate in milk

A large-scale observational study was conducted to estimate the within-herd prevalence and cow-level risk factors for ketosis in dairy cattle in herds that participate in a dairy herd improvement association (DHIA) program in Ontario, Canada.

Optimizing emissions targets for residential recycling programmes: Why 'more' is not necessarily better with respect to diversion.

This study highlights the economic and environmental challenges of recycling in Ontario, specifically examining the effect of attempting to increase the emissions target for the province's household recycling programme. The findings from the cost model analysis found that Ontario's Blue Box programme reduces overall carbon emissions by approximately 1.8 million tonnes every year. This study also found that targeting specific materials for recovery could result in a scenario where the province could improve both overall diversion and emissions offsets while reducing material management costs. Under our modelled scenario, as the tonnes of greenhouse gases (GHGs) avoided increases, the system cost per tonne of GHG avoided initial declines. However, after avoiding 2.05 million tonnes of GHGs, the system cost/tonne GHG avoided increases. To achieve an emissions target in excess of 2.05 million tonnes, the province will have to start recycling higher cost non-core materials (composite materials, other plastics, etc.).

Poster ‐ 27: Incident Learning Practices in Ontario

Purpose:The Radiation Incident and Safety Committee (RISC), established and supported by Cancer Care Ontario (CCO), is responsible for advising the Provincial Head of the Radiation Treatment program on matters relating to provincial reporting of radiation incidents with the goal of improved risk mitigation.Methods:The committee is made up of Radiation Incident Leads (RILs) with representation from each of the 14 radiation medicine programs in the province. RISC routinely meets to review recent critical incidents and to discuss provincial reporting processes and future directions of the committee. Regular face to face meetings have provided an excellent venue for sharing incident learning practices. A summary of the incident learning practices across Ontario has been compiled.Results:Almost all programs in Ontario employ an incident learning committee to review incidents and identify corrective actions or process improvements. Tools used for incident reporting include: paper based reporting, a number of different commercial products and software solutions developed in‐house. A wide range of classification schema (data taxonomies) are employed, although most have been influenced by national guidance documents. The majority of clinics perform root cause analyses but utilized methodologies vary significantly.Conclusions:Most programs in Ontario employ a committee approach to incident learning. However, the reporting tools and taxonomies in use vary greatly which represents a significant challenge to provincial reporting. RISC is preparing to adopt the National System for Incident Reporting – Radiation Therapy (NSIR‐RT) which will standardize incident reporting and facilitate data analyses aimed at identifying targeted improvement initiatives.