Strategic Clinical Network Research Articles

Knowledge translation strategies used for sustainability of an evidence-based intervention in child health: a multimethod qualitative study

BackgroundSustainability of evidence-based interventions (EBIs) is suboptimal in healthcare. Evidence on how knowledge translation (KT) strategies are used for the sustainability of EBIs in practice is lacking. This study examined what and how KT strategies were used to facilitate the sustainability of Alberta Family Integrated Care (FICare)™, a psychoeducational model of care scaled and spread across 14 neonatal intensive care units, in Alberta, Canada.MethodsFirst, we conducted an environmental scan of relevant documents to determine the use of KT strategies to support the sustainability of Alberta FICare™. Second, we conducted semi-structured interviews with decision makers and operational leaders to explore what and how KT strategies were used for the sustainability of Alberta FICare™, as well as barriers and facilitators to using the KT strategies for sustainability. We used the Expert Recommendations for Implementation Change (ERIC) taxonomy to code the strategies. Lastly, we facilitated consultation meetings with the Alberta FICare™ leads to share and gain insights and clarification on our findings.ResultsWe identified nine KT strategies to facilitate the sustainability of Alberta FICare™: Conduct ongoing training; Identify and prepare local champions; Research co-production; Remind clinicians; Audit and provide feedback; Change record systems; Promote adaptability; Access new funding; and Involve patients/consumers and family members. A significant barrier to the sustainability of Alberta FICare™ was a lack of clarity on who was responsible for the ongoing maintenance of the intervention. A key facilitator to sustainability of Alberta FICare was its alignment with the Maternal, Newborn, Child & Youth Strategic Clinical Network (MNCY SCN) priorities. Co-production between researchers and health system partners in the design, implementation, and scale and spread of Alberta FICare™ was critical to sustainability.ConclusionThis research highlights the importance of clearly articulating who is responsible for continued championing for the sustainability of EBIs. Additionally, our research demonstrates that the adaptation of interventions must be considered from the onset of implementation so interventions can be tailored to align with contextual barriers for sustainability. Clear guidance is needed to continually support researchers and health system leaders in co-producing strategies that facilitate the long-term sustainability of effective EBIs in practice.

A48 PARENT-REPORTED HEALTH RELATED QUALITY OF LIFE CARING FOR CHILDREN WITH PEDIATRIC FEEDING DISORDERS IN ALBERTA

Abstract Background Children with pediatric feeding disorders (PFD), including those requiring tube feeding, need significant care. Caregiver burden includes time, cost, as well as worry over patient morbidity and mortality (1). This project used a validated health-related quality of life (HRQoL) tool for caregivers of children with PFD: the Feeding/Swallowing Impact Survey (FS-IS). The FS-IS has three subscales related to daily activities, worry, and feeding concerns, scored 1-5 with 5 being the most adverse. Prior studies have shown both the total sub-scale scores and the total score correlate with generic quality of life instruments for pediatric caregivers (2). Data was obtained from a provincial quality improvement initiative, the Alberta Provincial Pediatric Eating and Swallowing (PEAS) Project. Aims 1. To determine the HRQoL reported by caregivers of children with PFD in Alberta. 2. To determine if tube-feeding is associated with worse reported HRQoL. Methods Caregivers receiving feeding and swallowing services in Alberta were offered the opportunity to complete the FS-IS online or by phone at baseline and 12 months later. All demographic data was self-reported. Results In total 52 caregivers completed the surveys once and 16 at follow-up. Average baseline FSIS was 3.1 (range 1.2-4.7) and at follow up was 3.0 (range 1.5-4.2). There was no difference between the scores of those completing at both time points (p=0.78). At all time points, only 15% of the cohorts reported scores ≤2. As shown in Table 1, children who were tube-fed were older with a longer duration of PFD symptoms, however, HRQoL scores were not different to children not ever tube-fed. Conclusions Caregivers of children with PFD face challenges, which do not abate over time. Surprisingly, in our cohort, this is independent of the need for tube feeding and of the duration of PFD symptoms, although we acknowledge the small sample size of those who were never tube-fed. Longitudinal follow-up studies and strategies to improve quality of life are needed. * FS-IS Global Score (1=never to 5=almost always) Funding Agencies Alberta Health Services Maternal Newborn Child & Youth Strategic Clinical Network

Development of a Soft Tissue Knee Clinical Decision-Making Tool for Patients Presenting to Primary Point-of-Care Providers in Alberta, Canada.

Several barriers exist in Alberta, Canada to providing accurate and accessible diagnoses for patients presenting with acute knee injuries and chronic knee problems. In efforts to improve quality of care for these patients, an evidence-informed clinical decision-making tool was developed. Forty-five expert panelists were purposively chosen to represent stakeholder groups, various expertise, and each of Alberta Health Services' 5 geographical health regions. A systematic rapid review and modified Delphi approach were executed with the intention of developing standardized clinical decision-making processes for acute knee injuries, atraumatic/overuse conditions, knee arthritis, and degenerative meniscus. Standardized criteria for screening, history-taking, physical examination, diagnostic imaging, timelines, and treatment were developed. This tool standardizes and optimizes assessment and diagnosis of acute knee injuries and chronic knee problems in Alberta. This project was a highly collaborative, province-wide effort led by Alberta Health Services' Bone and Joint Health Strategic Clinical Network (BJH SCN) and the Alberta Bone and Joint Health Institute (ABJHI).

Consensus for a primary care clinical decision-making tool for assessing, diagnosing, and managing low back pain in Alberta, Canada.

Low back pain (LBP) is a common condition causing disability and high healthcare costs. Alberta faces challenges with unnecessary referrals to specialists and long wait times. A province-wide standardized clinical care pathway based on evidence-based best practices can improve efficiency, reduce wait times, and enhance patient outcomes. Implementing such pathways has shown success in other areas of healthcare in Alberta. This study developed a clinical decision-making pathway to standardize care and minimize uncertainty in assessment, diagnosis, and management. A systematic rapid review identified existing tools and evidence that could support a comprehensive LBP clinical decision-making tool. Forty-seven healthcare professionals participated in four rounds of a modified Delphi approach to reach consensus on the assessment, diagnosis, and management of patients presenting to primary care with LBP in Alberta, Canada. This project was a collaborative effort between Alberta Health Services' Bone and Joint Health Strategic Clinical Network (BJHSCN) and the Alberta Bone and Joint Health Institute (ABJHI). A province-wide expert panel consisting of professionals from different health disciplines and regions collaborated to develop an LBP clinical decision-making tool. This tool presents clinical care pathways for acute, subacute, and chronic LBP. It also provides guidance for history-taking, physical examination, patient education, and management. This clinical decision-making tool will help to standardize care, provide guidance on the diagnosis and management of LBP, and assist in clinical decision-making for primary care providers in both public and private sectors.

Community Group-Based Physical Activity Programs for Immigrant Older Adults: A Systematic Realist Review

Physical activity program interventions often lack sensitivity to the needs of older immigrant adults. The objective of this systematic realist review is to explain how, why, for whom, and under which circumstances community group-based physical activity programs work for immigrant older adults. The initial program theory was developed using prior research, team expertise, social cognitive theory, and knowledge user consultations. The program theory was tested and refined via a systematic review of the literature. Database searches were conducted in MEDLINE, EMBASE, CINAHL, Scopus, Cochrane Library, Sports Medicine and Education Index, and SPORTDiscus. A total of 22 sources of evidence met inclusion criteria and included intervention studies, systematic reviews, and a discussion paper. Intervention studies were appraised using the Mixed Methods Appraisal Tool. The final program theory constituted eight context–mechanism–outcome configurations that highlight the importance of facilitator characteristics, access to safe spaces, group dynamics, and social support. A limitation was the small number and variable quality of included evidence. Physical activity programs that target immigrant older adults must strengthen physical and psychological safety and maximize opportunities for role modeling and socialization. This research was supported by the Alberta Health Services Seniors Health Strategic Clinical Network and is registered in PROSPERO (ID#258179).

Personalising haemodialysis treatment with incremental dialysis for incident patients with end-stage kidney disease: an implementation study protocol

IntroductionIncremental dialysis is a personalised dialysis prescription based on residual kidney function that allows for the initial use of shorter duration, less frequent and less intense dialysis. It has been...

Lifestyle factors, substance use, and frequent recurrent headaches in youth: Data from a Canadian population-based observational study (S41.004)

<h3>Objective:</h3> To assess the association between lifestyle factors, substance use, and frequent recurrent headaches in youth. <h3>Background:</h3> We hypothesized that higher odds of frequent headaches would be associated with several lifestyle factors and frequent substance use in youth. <h3>Design/Methods:</h3> This was an observational study of youth aged 5–17 using data from a population-based health survey (2019 Canadian Health Survey on Children and Youth). Headache frequency was dichotomized as ‘about once a week or less’ or ‘&gt;once a week’ (defined as frequent recurrent headaches). Logistic regression was used to quantify the association between frequent headaches and meal schedules, prolonged screen exposure (≥21h in past week), physical activity (≥60 minutes/day), chronotype, frequent substance use (alcohol ≥1/week, binge drinking ≥5 times in past month, daily smoking, daily e-cigarettes, daily cannabis), and exposure to daily smoking in the household, unadjusted and adjusted for age and sex. Design effects were addressed using bootstrap replicate weighting. <h3>Results:</h3> There were 4,978,370 youth (weighted sample size) (mean age=10.9 years, 48.8% females) and 6.1% had frequent headaches. Age and female sex were associated with frequent headaches (OR=1.31, 95%CI=1.28–1.34, and 2.39, 95%CI=2.08–2.75, respectively). In models adjusted for age/sex, the odds of frequent headaches decreased with meal regularity (OR=0.90, 95%CI=0.89–0.92) and increased with later chronotype (OR=1.10, 95%CI=1.05–1.15) and excess screen exposure (OR=2.97, 95%CI=1.53–5.77); there was no significant association with physical activity. In adolescents 12–17 years old, frequent headaches were associated with alcohol use (OR=3.50, 95%CI=2.18–5.62), binge drinking (OR=5.52, 95%CI=2.95–10.32), smoking cigarettes (OR=3.81, 95%CI=1.91–7.62), using e-cigarettes (OR=3.10, 95%CI=2.29–4.20), and cannabis use (OR=3.59, 95%CI=2.0–6.45). Smoking inside the house was associated with higher odds of frequent headaches in youth of all ages (OR=2.00, 95%CI=1.23–3.27). <h3>Conclusions:</h3> Lifestyle factors (meal irregularity, late chronotype, and prolonged screen exposure) were significantly associated with frequent headaches in a large sample of Canadian youth. Frequent substance use was associated with frequent headaches in adolescents. <b>Disclosure:</b> The institution of Dr. Orr has received research support from Alberta Children’s Hospital Research Institute. The institution of Dr. Orr has received research support from Canadian Institutes of Health Research. Dr. Orr has received publishing royalties from a publication relating to health care. Dr. Orr has a non-compensated relationship as a Associate Editor with Headache: The Journal of Head and Face Pain that is relevant to AAN interests or activities. Dr. Orr has a non-compensated relationship as a Editorial Board with Neurology that is relevant to AAN interests or activities. Ms. Nilles has received research support from French Gilles de la Tourette Association. Ms. Nilles has received research support from Owerko Centre of Alberta Children’s Hospital Research Institute. Ms. Nilles has received research support from Assistance Publique - Hôpitaux de Paris. Dr. Patten has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Canadian Psychiatric Association. Dr. Patten has received publishing royalties from a publication relating to health care. Jeanne Williams has nothing to disclose. The institution of Dr. Pringsheim has received research support from Maternal Newborn Child and Youth Strategic Clinical Network. The institution of Dr. Pringsheim has received research support from Owerko Center of Alberta Children’s Hospital Research Institute. The institution of Dr. Pringsheim has received research support from Canadian Institutes of Health Research. The institution of Dr. Pringsheim has received research support from Public Health Agency of Canada.

The Association Between Gender Minority Identity and Functional Tic-Like Behaviors During the COVID-19 Pandemic (P11-11.013)

<h3>Objective:</h3> To examine how gender minority (GM) identity relates to etiological factors and health outcomes in functional tic like behaviours (FTLB). <h3>Background:</h3> GM people experience stigma-related stressors which may result in gender dysphoria, a condition associated with higher rates of depression, anxiety, disability, and lowered quality of life. During the COVID-19 pandemic, we observed a rise in FTLB which appeared to occur disproportionately in GM people. <h3>Design/Methods:</h3> Patients aged 11–25 years with FTLB (n= 34) were age and assigned sex-matched to Tourette Syndrome (TS [n= 21]), and healthy controls (HC [n=21]). Groups completed self-report measures and a clinical neuropsychiatric interview that investigated demographics, quality of life, disability, loneliness, neuropsychiatric disorders, social interaction anxiety, social phobia, vulnerable attachment, distress tolerance, pandemic experiences, suggestibility, family functioning, and social media use. Validated measures of gender dysphoria and GM stress and resilience were not included. <h3>Results:</h3> 41.2% of FTLB patients disclosed a GM identity as compared to 9.5% of TS and 14.3% of HC (p=.013). GM identity was significantly related to total disability (p=.017), anxiety (p=.033), depression (p=.005), social phobia (p=.037), social interaction anxiety (p=.028), lower psychological quality of life (p=.010) and self-reported worsening mental health during the pandemic (p=.022) across subgroups. An interaction between GM identity/diagnostic group indicated GM HC reported lower distress tolerance than cisgender HC (p=.027). All other relationships and interactions were non-significant. Regression analyses indicated the gender identity/disability and diagnostic group/disability relationships were strongly and nearly identically mediated by anxiety and depression (p&lt;0.001). <h3>Conclusions:</h3> Although validated measures of gender dysphoria were not included, our study results suggest greater disability from anxiety and depression may have increased the clinical presentation of GM patients with FTLB during the COVID-19 pandemic, as compared to their cisgender peers and controls. <b>Disclosure:</b> Dr. Martino has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Martino has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Merz Pharma Canada Ltd.. Ms. Berg has nothing to disclose. Dr. L’Erario has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ohio State University, University of Colorado, Sacred Heart University, The LOFT LGBT Community Center . Dr. L’Erario has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Weiss Law. Dr. L’Erario has received publishing royalties from a publication relating to health care. The institution of Dr. Pringsheim has received research support from Maternal Newborn Child and Youth Strategic Clinical Network. The institution of Dr. Pringsheim has received research support from Owerko Center of Alberta Children’s Hospital Research Institute. The institution of Dr. Pringsheim has received research support from Canadian Institutes of Health Research. The institution of Dr. Pringsheim has received research support from Public Health Agency of Canada.

Symptom severity, impairment and health outcomes in patients with Functional Tic Like Behaviours (P11-11.011)

<h3>Objective:</h3> To quantitatively understand symptom severity, impairment, and health outcomes of patients with functional tic-like behaviours (FTLB) compared to Tourette Syndrome (TS) and healthy controls (HC). <h3>Background:</h3> Functional tic-like behaviors (FTLB) are a previously rare form of functional movement disorder that rose in incidence during the COVID-19 pandemic. Patients report significant disruptions in daily functioning. <h3>Design/Methods:</h3> As part of a larger data set, patients aged 11–25 years with FTLB (n= 34) were age and sex-matched to TS (n= 21), and healthy controls (HC) (n=21). Groups completed online self-report measures and a clinical neuropsychiatric interview that investigated quality of life, disability, loneliness, suicidality, depression, anxiety, social interaction anxiety, social phobia, current and peak tic-severity, and family functioning. Two-tailed group differences were Bonferroni corrected. <h3>Results:</h3> Compared to HC and TS, FTLB patients endure higher levels of total disability (p=.037), self-care disability (p=.019), disability related to participation in life activities such as school and work (p=.013), depression (p=.011), and suicidality (p&lt;.001). 61.8% of FTLB patients reported school absence that ranged up to 65% of the time (Mean=20.88%, SD=22.25). FTLB had higher current phonic tic severity (p=.048), and peak motor and phonic tic severity (p&lt;.001; p&lt;.001) than TS. FTLB experience lower quality of life in the physical, psychological, and environmental domains (p=.015; p=.031; p=.042) and significantly higher social interaction anxiety (p=.004), social phobia (p&lt;.001), and loneliness (p=.038) compared to HC. TS and FTLB reported similar levels of tic related impairment, anxiety, and social anxiety/phobia. Family functioning was not significantly different between groups. <h3>Conclusions:</h3> FTLB are a highly disabling disorder that severely impacts quality of life, social and adaptive functioning, and mental health. Comparable levels of social anxiety, loneliness, and tic related impairment in TS and FTLB may be due to social apprehension in response to common negative reactions to tics and tic-like behaviors. <b>Disclosure:</b> Ms. Berg has nothing to disclose. The institution of Dr. Pringsheim has received research support from Maternal Newborn Child and Youth Strategic Clinical Network. The institution of Dr. Pringsheim has received research support from Owerko Center of Alberta Children’s Hospital Research Institute. The institution of Dr. Pringsheim has received research support from Canadian Institutes of Health Research. The institution of Dr. Pringsheim has received research support from Public Health Agency of Canada. Dr. Martino has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Martino has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Merz Pharma Canada Ltd..

Substance misuse in adults with primary tic disorders (P12-11.012)

<h3>Objective:</h3> To estimate prevalence of substance use disorder (SUD) in adults with tics and characterize relationship with sex, age, psychiatric comorbidities and tic severity. <h3>Background:</h3> There are few data regarding SUD in adults with tics. One Swedish population-based study reported a high SUD-prevalence (15.9%) in people with Tourette syndrome (Virtanen et al, 2020). <h3>Design/Methods:</h3> From our Calgary and Paris Adult Tic Registry, we included adults with primary tic disorders who answered to the Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) Tool for substance use screening. For alcohol, tobacco, and cannabis, SUD was possible if the TAPS score was 2+. For illicit and prescription drugs, we used a cut-off of 1+ to identify problem use. We compared the prevalence of possible SUD in our cohort with the Swedish study’s results (Z-test). We looked for associations between possible SUD and age, sex, psychiatric comorbidities and tic severity using logistic/linear regression. <h3>Results:</h3> We included 139 participants (122 with Tourette syndrome; mean age: 32.5 years; 64.0% males; 53.2% Canadian, 46.8% French). A total of 28/139 (20.2%) had possible SUD for alcohol, 16/139 (11.5%) for tobacco and 15/139 (10.8%) for cannabis. For other substances: 7/139 (5.0%) were likely to have a problem use with cocaine/crack/methamphetamine, 1/139 (0.7%) with heroine, 1/139 (0.7%) with opioids, 11/139 (7.9%) with sedative drugs and 1/139 (0.7%) with stimulants for attention deficit/hyperactivity disorder (ADHD). Prevalences of possible overall-SUD (37%) and alcohol-SUD were higher than in the Swedish cohort (p=0.0142 and p&lt;0.00001). Total tic severity score was higher in people with possible SUD (p=0.017). Depression and anxiety were significantly associated with possible cannabis-related SUD (OR=3.5 and OR=7.2 respectively). Age, sex, comorbid ADHD and obsessive-compulsive disorder were not significantly associated with possible SUD. <h3>Conclusions:</h3> Thirty-seven % of adults with tic disorders have possible SUD related to alcohol, tobacco or cannabis, and require further diagnostic assessment. <b>Disclosure:</b> Ms. Nilles has received research support from French Gilles de la Tourette Association. Ms. Nilles has received research support from Owerko Centre of Alberta Children’s Hospital Research Institute. Ms. Nilles has received research support from Assistance Publique - Hôpitaux de Paris. Dr. Roze has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for merz. Dr. Roze has received personal compensation in the range of $500-$4,999 for serving as a Consultant for orkyn. Dr. Roze has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for elivie. Dr. Roze has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for allergan. Dr. Roze has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Orkyn. Dr. Roze has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for elivie. Dr. Roze has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Aguettant. The institution of Dr. Roze has received research support from merz. The institution of Dr. Roze has received research support from Orkyn. Dr. Roze has received research support from elivie. The institution of Dr. Roze has received research support from allergan. The institution of Dr. Roze has received research support from fondation desmarest. The institution of Dr. Roze has received research support from everpharma. Dr. Roze has received research support from AMADYS. The institution of Dr. Roze has received research support from ADCY5.org. The institution of Dr. Roze has received research support from agence nationale de la recherche. The institution of Dr. Roze has received research support from société française de médecine esthétique. The institution of Dr. Roze has received research support from dystonia medical research foundation. Andreas Hartmann has nothing to disclose. Dr. Worbe has nothing to disclose. The institution of Mr. Bendetowicz has received research support from Fondation Recherche Médicale. Dr. Szejko has nothing to disclose. Mrs. SERARI has nothing to disclose. Julian Fletcher has nothing to disclose. Dr. Martino has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Martino has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Merz Pharma Canada Ltd.. The institution of Dr. Pringsheim has received research support from Maternal Newborn Child and Youth Strategic Clinical Network. The institution of Dr. Pringsheim has received research support from Owerko Center of Alberta Children’s Hospital Research Institute. The institution of Dr. Pringsheim has received research support from Canadian Institutes of Health Research. The institution of Dr. Pringsheim has received research support from Public Health Agency of Canada.

Etiological factors associated with functional tic-like behaviours during the COVID-19 pandemic (P11-11.015)

<h3>Objective:</h3> To explore the hypothesized etiological factors affecting the functional tic like behaviour (FTLB) cohort that emerged since the onset of the pandemic. <h3>Background:</h3> FTLB are a form of functional movement disorder resembling Tourette Syndrome (TS) that surged in prevalence during the SARS-COV-2 pandemic. Exposure to tic-related social media content, pandemic stressors, and comorbid neuropsychiatric disorders are factors hypothesized to contribute to the sudden increase in FTLB. <h3>Design/Methods:</h3> FTLB patients (n= 34) age/sex matched with TS (n = 21), and healthy controls (HC) (n=21) completed self-report measures and a clinical neuropsychiatric interview that investigated social media use, suggestibility, distress tolerance, demographics, attachment style, SARS-COV-2 related experiences, family history, family functioning, loneliness, and neuropsychiatric comorbidities. Group differences were Bonferroni corrected. <h3>Results:</h3> FTLB had higher levels of depression (p &lt;.001), suicidality (p &lt;.001), panic disorder (p=.029), and were more likely to gender identify as trans/non-binary/genderfluid (p =.013) than TS and HC. Compared to HC, FTLB patients experienced higher levels of anxiety (p =.005), vulnerable attachment (p =.004), agoraphobia (p=.016), borderline personality traits (p =.004), psychotic symptoms (p =.049), ADHD (p =.035), neuropsychiatric family history (p &lt;.001), pandemic related sleep disturbance (p=.002) and loneliness (p =.038). FTLB reported poorer pandemic school performance compared to TS (p=.043). FTLB and HC were more likely to first learn about tics through social media than TS. Suggestibility, distress tolerance, family functioning, exposure to tic-related content on social media, time spent online, social media integration and comparison, and most pandemic experiences tested were not significantly different. Distress tolerance posed the only significant interaction between group and gender identity in HC. <h3>Conclusions:</h3> Neuropsychiatric comorbidities emerged as the strongest etiological factor related to FTLB. The insignificant direct relationship between FTLB to tic-related content on social media may be due to ubiquitous exposure to tic-content suggesting the influence of social media is mediated by unexplored factors. <b>Disclosure:</b> Ms. Berg has nothing to disclose. The institution of Dr. Pringsheim has received research support from Maternal Newborn Child and Youth Strategic Clinical Network. The institution of Dr. Pringsheim has received research support from Owerko Center of Alberta Children’s Hospital Research Institute. The institution of Dr. Pringsheim has received research support from Canadian Institutes of Health Research. The institution of Dr. Pringsheim has received research support from Public Health Agency of Canada. Dr. Martino has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Martino has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Merz Pharma Canada Ltd..

Co-developing patient and family engagement indicators for health system improvement with healthcare system stakeholders: a consensus study

ObjectiveTo develop a set of patient and family engagement indicators (PFE-Is) for measuring engagement in health system improvement for a Canadian provincial health delivery system through an evidence-based consensus approach.DesignThis...

Omicron, Long-COVID, and the Safety of Elective Surgery for Adults and Children: Joint Guidance from the Therapeutics and Guidelines Committee of the Surgical Infection Society and the Surgery Strategic Clinical Network, Alberta Health Services

Background: Active and recent coronavirus disease 2019 (COVID-19) infections are associated with morbidity and mortality after surgery in adults. Current recommendations suggest delaying elective surgery in survivors for four to 12 weeks, depending on initial illness severity. Recently, the predominant causes of COVID-19 are the highly transmissible/less virulent Omicron variant/subvariants. Moreover, increased survivability of primary infections has engendered the long-COVID syndrome, with protean manifestations that may persist for months. Considering the more than 600,000,000 COVID-19 survivors, surgeons will likely be consulted by recovered patients seeking elective operations. Knowledge gaps of the aftermath of Omicron infections raise questions whether extant guidance for timing of surgery still applies to adults or should apply to the pediatric population. Methods: Scoping review of relevant English-language literature. Results: Most supporting data derive from early in the pandemic when the Alpha variant of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) predominated. The Omicron variant/subvariants generally cause milder infections with less organ dysfunction; many infections are asymptomatic, especially in children. Data are scant with respect to adult surgical outcomes after Omicron infection, and especially so for pediatric surgical outcomes at any stage of the pandemic. Conclusions: Numerous knowledge gaps persist with respect to the disease, the recovered pre-operative patient, the nature of the proposed procedure, and supporting data. For example, should the waiting period for all but urgent elective surgery be extended beyond 12 weeks, e.g., after serious/critical illness, or for patients with long-COVID and organ dysfunction? Conversely, can the waiting periods for asymptomatic patients or vaccinated patients be shortened? How shall children be risk-stratified, considering the distinctiveness of pediatric COVID-19 and the paucity of data? Forthcoming guidelines will hopefully answer these questions but may require ongoing modifications based on additional new data and the epidemiology of emerging strains.

Creating Value Through Learning Health Systems: The Alberta Strategic Clinical Network Experience.

Design, implementation, and evaluation of effective multicomponent interventions typically take decades before value is realized even when value can be measured. Value-based health care, an approach to improving patient and health system outcomes, is a way of organizing health systems to transform outcomes and achieve the highest quality of care and the best possible outcomes with the lowest cost. We describe 2 case studies of value-based health care optimized through a learning health system framework that includes Strategic Clinical Networks. Both cases demonstrate the acceleration of evidence to practice through scientific, financial, structural administrative supports and partnerships. Clinical practice interventions in both cases, one in perioperative services and the other in neonatal intensive care, were implemented across multiple hospital sites. The practical application of using an innovation pipeline as a structural process is described and applied to these cases. A value for money improvement calculator using a benefits realization approach is presented as a mechanism/tool for attributing value to improvement initiatives that takes advantage of available system data, customizing and making the data usable for frontline managers and decision makers. Health care leaders will find value in the descriptions and practical information provided.

World Federation of Athletic Training and Therapy World Congress 2022 Peer-Reviewed Track Abstracts, May 5–7, 2022, Winnipeg, Manitoba, Canada

World Federation of Athletic Training and Therapy World Congress 2022 Peer-Reviewed Track Abstracts, May 5–7, 2022, Winnipeg, Manitoba, Canada

Strategic Clinical Network Teams Improve Effectiveness, Team and Leadership Processes and Inputs: Theory-Based Longitudinal Survey.

Strategic Clinical Networks (SCNs) in Alberta include multidisciplinary teams that work toward health system innovation and improvement; however, what contributes to team effectiveness is unclear. This theory-informed longitudinal survey (n = 826) evaluated team effectiveness within SCNs and predictors of effectiveness. Satisfaction, inter-team relationships and seven predictors including team inputs and team and leadership processes improved over two years. Attitudinal outputs were predicted by the same factors over time, whereas performance outputs were predicted by different factors. This innovative study emphasizes that SCN teams and their effectiveness evolve over time and that team-based research can refine network evaluations.

Scale and spread of quality improvement initiatives for bronchiolitis management in Alberta emergency departments

Background: Acute viral bronchiolitis is among the most common illnesses seen in the emergency department (ED) and is the leading cause of infant hospitalization in Canada. Practice guidelines do not recommend routine use of certain diagnostic tests and medications in managing bronchiolitis, yet prior studies suggest that low-value interventions are routinely administered to patients with bronchiolitis. Successful implementation of quality improvement at the Alberta Children’s Hospital suggested that low-value interventions and tests can be improved. Yet, practice variation and potential opportunities to improve bronchiolitis management are likely present in EDs in urban and rural settings.&#x0D; Implementation: The project is a collaboration between the Maternal Newborn Child and Youth Strategic Clinical Network (MNCY SCN), the Improving Health Outcomes Together Team (IHOT), and Physician Learning Program (PLP) under the umbrella of the AHS Ernst &amp; Young Clinical Appropriateness Theme recommendations to expand and scale initiatives to reduce unnecessary tests to improve patient safety. A provincial Bronchiolitis Steering Committee, led by two Physician Initiative Leads, was formed to guide the project and implementation at 16 facilities across Alberta.&#x0D; Site implementation includes two key aspects:&#x0D; &#x0D; Audit &amp; Feedback (A&amp;F) – review practice data, facilitated discussion with clinicians, and identify enablers and barriers to practice change&#x0D; Site Specific Implementation Plan – options for sites include use of posters, tools, resources; utilization of ConnectCare (order sets); and staff and physician education&#x0D; &#x0D; Qualitative interviews with site-champions will provide perspectives and feedback on enablers and barriers to change. Discussions from the A&amp;F sessions, in addition to the qualitative interviews will be coded and analyzed based on the Consolidated Framework for Implementation Research and Theoretical Domains Framework.&#x0D; Resources required included clinical leads, project management, data/dashboards, educational posters, updated order sets, and a central location for staff and physician to access bronchiolitis materials (via SharePoint).&#x0D; Evaluation Methods: The primary objective of the study is a reduction of chest x-ray utilization. Chest x-rays utilization can be readily obtained from administrative data at all sites in the project. Secondary measures include medications (PIN) and respiratory viral testing. There is strong evidence to support that medications and respiratory viral testing do not impact bronchiolitis management. The project addresses patient safety and outcomes by reducing the use of low-value interventions and tests in the ED and enables resources to be directed towards evidence-based care. As ConnectCare is phased into all facilities across Alberta, additional metrics will be incorporated into reports and updates to participating sites.&#x0D; Results: The first phase of the project took place from September to November 2021, with rollout to six facilities (four EDs and two inpatient units). A total of 151 physicians attended the audit and group feedback sessions. Site-specific planning sessions and qualitative interviews with site-champions are planned, and the next phase of the project will continue with spread and scale to regional EDs (n=5), urban (n=2) and rural (n=4) locations in fall 2022. &#x0D; Advice and Lessons Learned: &#x0D; &#x0D; The partnership with MNCY SCN, PLP, IHOT, and two Clinician Leads has been beneficial for establishing a team-based multi-disciplinary approach to address needs as they arise and the ability to work together with site champions.&#x0D; Identifying and collaborating with site champions is necessary for establishing relationships and trust prior to conducting audit and feedback sessions and addressing practice change. Site champions understand the contextual factors of their facility and how to best utilize enablers or address barriers for practice change. Initiation of these working relationships need to take place months before implementation and ideally develop through existing networks.&#x0D; Timing and flexibility are crucial for successful implementation. Rescheduling launch dates, adjusting session time, validating data, and adjusting to external factors such as delays in ConnectCare rollouts and pressures on the healthcare system brought on by the COVID-19 pandemic were experienced in the planning and initiating phases of the project. These lessons will be carried forward as we plan for the second part of spread and scale in Fall 2022.&#x0D;

What are the respiratory health research priorities in Alberta, Canada? A stakeholder consultation

ObjectiveThe Respiratory Health Strategic Clinical Network (RHSCN) was launched to facilitate respiratory and sleep health through implementation of innovative, patient-centred, evidence-informed coordinated services in Alberta. In collaboration with project partners,...

A100 A PROVINCIAL APPROACH TO ASSESSING ENDOSCOPY PATIENT EXPERIENCE ENHANCES SITE PARTICIPATION AND CANADA-GLOBAL RATING SCALE COMPLIANCE

BackgroundThe Canada-Global Rating Scale (C-GRS) is a web-based, patient centered endoscopy quality improvement tool. It assesses the quality of services a unit provides in two dimensions: clinical quality and patient experience. Endoscopy units submit results to the Canadian Association of Gastroenterology twice a year. In Alberta, units receive an A, B, C or D grade for each of the 12 C-GRS Items and a C-GRS score.The C-GRS promotes that patient feedback is sought annually. Patient feedback is important because it informs practice improvement opportunities. However, survey creation, distribution, analysis and reporting can be time consuming and costly for an endoscopy unit and is a potential barrier to participation.AimsThe purpose of this quality improvement project is to demonstrate how a provincial infrastructure, which includes coordination, management and reporting of an endoscopy patient satisfaction survey, can enhance provincial endoscopy unit survey participation and facilitate C-GRS compliance.MethodsThe Digestive Health Strategic Clinical Network (DHSCN), the Alberta Colorectal Cancer Screening Program and Primary Data Support (PDS) collaborated on the Provincial Endoscopy Patient Experience Survey (PEPES) in 2019. An existing paper survey was adapted to meet the needs of the 50 endoscopy units in AB with the addition of an electronic version. Education about the PEPES process was provided via a webinar and site visits. Each unit was responsible for distribution of the surveys to their patients. PDS coordinated the paper survey process and the DHSCN managed the electronic survey submissions. Paper survey results were merged with electronic PEPES data. A summary report was provided to units and shared with each AHS Zone Endoscopy Executive Leadership Team.ResultsProvincially coordinated implementation of the PEPES fosters compliance with C-GRS criteria. Participating endoscopy units were able to achieve at minimum 9 C-GRS descriptors and improve their C-GRS score in the following 7 of the 12 C-GRS Items: consent, comfort, equality, booking, privacy, aftercare and feedback.Initial enrollment in the PEPES increased with the onset of provincial coordination (Figure 1). However, subsequent participation was negatively impacted by COVID-19 as many endoscopy units in AB were required to decrease their capacity and redeploy staff.ConclusionsA provincially coordinated approach to the management of an endoscopy patient experience survey is an effective way to enhance site participation and improve C-GRS scores. Units can focus on actioning survey results, rather than the burden of survey administration. Future work includes comparison of results across sites allowing for potential provincial equity issues to be addressed. Funding AgenciesNone

Consensus for a primary care clinical decision-making tool for assessing, diagnosing, and managing shoulder pain in Alberta, Canada

BackgroundShoulder pain is a highly prevalent condition and a significant cause of morbidity and functional disability. Current data suggests that many patients presenting with shoulder pain at the primary care level are not receiving high quality care. Primary care decision-making is complex and has the potential to influence the quality of care provided and patient outcomes. The aim of this study was to develop a clinical decision-making tool that standardizes care and minimizes uncertainty in assessment, diagnosis, and management.MethodsFirst a rapid review was conducted to identify existing tools and evidence that could support a comprehensive clinical decision-making tool for shoulder pain. Secondly, provincial consensus was established for the assessment, diagnosis, and management of patients presenting to primary care with shoulder pain in Alberta, Canada using a three-step modified Delphi approach. This project was a highly collaborative effort between Alberta Health Services’ Bone and Joint Health Strategic Clinical Network (BJH SCN) and the Alberta Bone and Joint Health Institute (ABJHI).ResultsA clinical decision-making tool for shoulder pain was developed and reached consensus by a province-wide expert panel representing various health disciplines and geographical regions. This tool consists of a clinical examination algorithm for assessing, diagnosis, and managing shoulder pain; recommendations for history-taking and identification of red flags or additional concerns; recommendations for physical examination and neurological screening; recommendations for the differential diagnosis; and care pathways for managing patients presenting with rotator cuff disease, biceps pathology, superior labral tear, adhesive capsulitis, osteoarthritis, and instability.ConclusionsThis clinical decision-making tool will help to standardize care, provide guidance on the diagnosis and management of shoulder pain, and assist in clinical decision-making for primary care providers in both public and private sectors.