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Background The Canada-Global Rating Scale (C-GRS) is a web-based, patient centered endoscopy quality improvement tool. It assesses the quality of the services an endoscopy unit provides in two dimensions: clinical quality and the quality of the patient experience. It also allows each endoscopy unit to choose priority areas for future QI activities. Scores are submitted twice a year to a centralized website by the local endoscopy site’s C-GRS working group. Uptake of the C-GRS in Alberta has been historically poor with only 22/50 sites submitting a C-GRS survey in 2016. A provincial C-GRS project team was formed in 2018 to spearhead provincial implementation of the C-GRS. Alberta Health Services approved a C-GRS policy in 2020 mandating regular use of the C-GRS in all provincial endoscopy units. Aims The purpose of this project is to describe a process of focused C-GRS implementation using Innovation Learning Collaborative (ILC) methodology. Methods An ILC is a process meant to drive clinical pathway practice changes to achieve system-wide improvements. Inter-professional teams meet at least three times over a 12–18 month period at Learning Sessions to share successes, learnings, resources and data. A balanced scorecard (Figure 1) is used to track C-GRS progression and regression. Action Period meetings are held in between the Learning Sessions to help build collaboration and support the teams. Results The first of three in-person ILC Learning Sessions was successfully held on November 29, 2019. 37 out of 50 sites in Alberta attended. Each site committed to working on up to 6 C-GRS descriptors during the course of the ILC. An updated scorecard is provided after each C-GRS cycle. An average of 25 sites attended Action Period meetings to report on progress and to share learnings with other sites. 44 endoscopy sites submitted a follow-up C-GRS survey in the spring 2020 cycle (an increase of 22 from 2016). 84% of sites demonstrated improvement with the average number of items improved at 5.1 Conclusions Use of ILC methodology with a balanced scorecard approach can achieve system level improvement within a relatively short time frame. Funding Agencies None

Background Proton pump inhibitors (PPIs) are among the most commonly prescribed drugs in Canada. They are effective for several upper GI-disorders, have a very favorable safety profile and therefore there are few barriers to prescribing. Concern about overuse of PPIs has been growing. Many patients do not need long term treatment. Patients starting PPI should receive short term therapy (e.g. 8 weeks) and if they respond the need for long term therapy needs to be determined. The usual starting dose is once a day for most indications. Evidence suggests a lack of ongoing indication for PPI in 40–55% of primary care patients.There are economic implications of overuse of PPIs. Public drug spending on PPIs in Canada totaled $288.3 million of $13.5 billion spent in 2017. Aims To analyze prescribing data for all PPI prescriptions in Alberta for the years 2017–18 and 2018–19 and 2019–2020, to document number of prescriptions >60 days, the number of new versus repeat prescriptions, proportion of new prescriptions at a greater than 1x daily dose, the proportion of prescriptions written by primary care physicians and to estimate the number of prescriptions targetted for deprescribing. Methods Data were obtained anonymously from the Pharmaceutical Information Network (PIN) database from community based pharmacies in Alberta. PPIs were identified using DIN numbers. Prescribed dose and duration were obtained, as well as data on repeat prescriptions. The number of prescriptions that could be targeted for deprescribing was also estimated. Results The results are shown in table 1. More than 10% of the population receives a prescription each year. Of these 25–31% were new prescriptions and 69–75% were refills. The percentage of patients who were prescribed PPIs for more than 60 days was 26–28%. Furthermore, 23% of all prescriptions had a defined daily dosage greater than the recommended standard dose of once a day therapy for most indications.75% of all prescriptions are written by family physicians. Conclusions Prescription rates of PPIs are very high in Alberta and 75% of patients are on longer term therapy. There likely is significant overprescribing of PPIs, estimated to be up to 40% of patients filling PPI prescriptions in Alberta. This represents a significant avoidable medication and system burden and patient costs. The starting dose of new prescriptions is also high, despite the fact that for most indications the daily dose should be 1x a day. A 20% reduction in prescribing would save at least $ 9 million in Alberta. A deprescribing project has been initiated by the Digestive Health Strategic Clinical Network, a multi-stakeholder network, which addresses important GI issues in Alberta. Funding Agencies None

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Background:The recently developed GRS-Canada is a validated instrument whose implementation leads to improved quality and patient experience of colonoscopy. The GRS-C has two dimensions dealing with clinical quality and quality of the patient experience. Both have ratings for 6 different categories resulting in a total of 12 dimensions for the "total" GRS-C score. The GRS-C has four grading levels, going from D, the lowest level, to level A, the highest. In order to reach a certain level all questions in each domain need to be answered positively. 18 months ago the GRS was introduced in seven of the eight hospital sites where endoscopy is performed in the Edmonton Zone: University of Alberta Hospital, Royal Alexandra, Grey Nuns, Misericordia, Sturgeon, Leduc and Fort Saskatchewan. The 8 th hospital WestView recently also started. Aims: The aim is to get all sites up to an A level over the next four years. Here we report on how scores improved as a result of an integrated QA program that was launched. Methods: The CAG website created for online submission of the GRS and associated improvement process was used to enter scores. This was done once every year. Results:As can be seen marked improvements were seen in 6 of the 7 hospitals all of whom have been actively working on the project for at least 1 year. In many dimension there was improvement from a D level to a C. One site was unchanged and an eighth site is just starting. Patient surveys have been started which will further help improve scores over time. Conclusions: Important improvements were seen in GRS-Canada scores in Edmonton Zone endoscopy units using an integrated QA program. The program was supported by a project manager.