Using an Integrated Knowledge Translation (IKT) Approach to Enable Policy Change for Electronic Consultations in Canada

Liddy, Clare; Moroz, Isabella; Joschko, Justin; Horsley, Tanya; Kovacs, Katharina; Kossey, Sandi; Mitera, Gunita; Keely, Erin

doi:10.12927/hcpol.2018.25551

Cited by 8 publications

(18 citation statements)

References 13 publications

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“…These dimensions were highly aligned with the initial themes identified in the familiarisation step and relevant to our research question. We expanded the framework dimensions to include 'patients' based on our previous work, where active participation of patient partners transitioned the discussions and policy recommendations for the national spread and scale-up of eConsult from provider-centred to patientcentred thinking [14]. The initial codebook was established by applying the themes that emerged in the familiarisation phase to the Charif et al [17] framework.…”

Section: Discussionmentioning

confidence: 99%

“…The meeting served as a follow-up to an initial policy-focused meeting the National eConsult Policy Think Tankthat took place in Ottawa on 5 December 2016. The Think Tank yielded specific, actionable recommendations regarding provincial and national policy related to eConsult, particularly in the areas of interjurisdictional licensing, payment, privacy, quality assurance and regulation [14].…”

Section: Settingmentioning

confidence: 99%

“…Next, participants attended small group sessions facilitated by multiple eConsult leaders, which focused on issues relevant to national expansion. The afternoon portion consisted of two sets of small group sessions -(1) 'tabletop sessions', which focused on the experiences, knowledge and tools necessary to spread and scale eConsult, and (2) 'hot topicspolicy briefs', during which participants debated the key policy issues summarised in the five policy briefs arising from the 2016 Think Tank [14,15]. The meeting concluded with a panel of eConsult national leaders' reflections on the day.…”

Section: Settingmentioning

confidence: 99%

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Key factors for national spread and scale-up of an eConsult innovation

Moroz

Archibald

Bréton

et al. 2020

Health Res Policy Sys

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Background: Expanding healthcare innovations from the local to national level is a complex pursuit requiring careful assessment of all relevant factors. In this study (a component of a larger eConsult programme of research), we aimed to identify the key factors involved in the spread and scale-up of a successful regional eConsult model across Canada. Methods: We conducted a constant comparative thematic analysis of stakeholder discussions captured during a full-day National eConsult Forum meeting held in Ottawa, Canada, on 11 December 2017. Sixty-four participants attended, representing provincial and territorial governments, national organisations, healthcare providers, researchers and patients. Proceedings were recorded, transcribed and underwent qualitative analysis using the Framework for Applied Policy Research. Results: This study identified four main themes that were critical to support the intentional efforts to spread and scale-up eConsult across Canada, namely (1) identifying population care needs and access problems, (2) engaging stakeholders who were willing to roll up their sleeves and take action, (3) building on current strategies and policies, and (4) measuring and communicating outcomes. Conclusions: Efforts to promote innovation in healthcare are more likely to succeed if they are based on an understanding of the forces that drive the spread and scale-up of innovation. Further research is needed to develop and strengthen the conceptual and applied foundations of the spread and scale-up of healthcare innovations, especially in the context of emergent learning health systems across Canada and beyond.

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Section: Discussionmentioning

confidence: 99%

Section: Settingmentioning

confidence: 99%

Section: Settingmentioning

confidence: 99%

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Key factors for national spread and scale-up of an eConsult innovation

Moroz

Archibald

Bréton

et al. 2020

Health Res Policy Sys

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“…35 In an effort to overcome these obstacles, we applied an integrated knowledge translation strategy that culminated in a National eConsult Policy Think Tank, which convened experts and stakeholders from 9 Canadian provinces/territories. 36 It is our hope that these efforts will support the further expansion of the service to new jurisdictions across Canada.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the Generalizability of an eConsult Service through Implementation in a New Health Region

Liddy¹,

Moroz²,

Mihan³

et al. 2019

J Am Board Fam Med

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Introduction: Excessive wait times for specialist care are a significant issue in many countries. Electronic consultation (eConsult) services have demonstrated the ability to improve access to specialist care. In this article, we evaluated the implementation of a successful eConsult service in a new jurisdiction to test its generalizability.Methods: We used a multimethod approach to evaluate the Champlain Building Access to Specialists through eConsultation eConsult service's implementation in the South East Local Health Integration Network of Ontario, Canada. Our quantitative analysis drew on use data collected automatically by the service and survey responses completed between February 1, and June 15, 2017. For our qualitative analysis, we conducted a thematic analysis of 3 focus groups with primary care providers and specialists participating in the pilot study.Results: Forty-nine out of the potential 219 primary care providers in Kingston submitted 301 cases to 24 specialty groups during the study period. Monthly case volume grew from 15 in February to 90 in May. The most frequently requested specialties included dermatology (n ‫؍‬ 59), cardiology (n ‫؍‬ 27), and gastroenterology (n ‫؍‬ 26). Specialists responded in a median of 2 days, and a referral was originally contemplated but ultimately avoided in 40% of cases. Providers spoke positively of the service, citing high levels of satisfaction, enhanced collegiality, increased trust, and improved patient flow.Conclusions: Adoption of the eConsult service in the South East Local Health Integration Network was successful. The service exceeded all adoption targets, and the number of completed cases demonstrated a consistently upward trend, suggesting continued growth beyond the study's duration. The service's rate of adoption, high levels of satisfaction, and use data similar to other regions all demonstrate eConsult's generalizability. (J Am Board Fam Med 2019;32:146 -157.)

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“…Patient representatives are an important part of eConsult’s decision-making team, and inclusion of patient voices has been a cornerstone of the service’s process of evaluation and dissemination of knowledge 15. However, this study did not draw on direct patient data but instead relied on the aggregate use of data and survey responses from PCPs.…”

Section: Methodsmentioning

confidence: 99%

Supporting the spread and scale-up of electronic consultation across Canada: cross-sectional analysis

et al. 2019

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ObjectiveTo examine the process of implementing an electronic consultation (eConsult) service and evaluate its impact along key metrics outlined by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework.DesignCross-sectional study.SettingClinics using eConsult in four provinces across Canada: Alberta, Manitoba, Quebec and Newfoundland and Labrador.ParticipantsAll eConsult cases submitted in four participating provinces were included.InterventionThe eConsult service is a secure online application that allows primary care providers and specialists to communicate regarding a patient’s care. We measured the impact using system utilisation data and mandatory close-out surveys completed at the end of each eConsult.Main outcome measuresImplementation progress and impact were examined using the five categories outlined by the RE-AIM framework: reach, effectiveness, adoption, implementation and maintenance.ResultsFour provinces provided data from different periods, ranging from 4 years (Alberta) to 10 months (Manitoba). Total cases completed ranged from 96 (Manitoba) to 6885 (Alberta). Newfoundland had the largest menu of available specialties (n=35), while Alberta and Quebec had the smallest (n=22). The most frequently requested groups varied across provinces, with only endocrinology appearing in the top five for all provinces. The average specialist response time ranged from 3 days (Manitoba) to 16.7 days (Alberta). Between 54% (Newfoundland) and 66% (Manitoba) of cases resulted in new or additional information. Primary care providers avoided completing referrals they had originally considered in 36% (Newfoundland) to 53% of cases (Manitoba), while only between 27 % (Quebec) and 29% (Newfoundland) of cases resulted in a referral. In every province, services demonstrated higher rates of usage in their last quarter of data than their first.ConclusionseConsult was successfully implemented in four new provinces across Canada. Implementation strategies and scope varied, but services demonstrated substantial consistency on several key metrics, most notably on whether new information was learnt and impact on decision to refer.

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Using an Integrated Knowledge Translation (IKT) Approach to Enable Policy Change for Electronic Consultations in Canada

Cited by 8 publications

References 13 publications

Key factors for national spread and scale-up of an eConsult innovation

Key factors for national spread and scale-up of an eConsult innovation

Assessment of the Generalizability of an eConsult Service through Implementation in a New Health Region

Supporting the spread and scale-up of electronic consultation across Canada: cross-sectional analysis

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