In order to integrate and coordinate appropriateness work conducted throughout the province, an Appropriateness of Care Network was established. This provincial network allows members from all health regions to learn from each other’s work, to provide input on projects, and to serve as a platform for clinical quality improvement methodology.
The Appropriateness of Care Network is supported by the provincial appropriateness program team, and includes representatives from each health region, the Saskatchewan Cancer Agency, eHealth Saskatchewan, HQC, the Ministry of Health, the Saskatchewan Center for Patient Oriented Research (SCPOR), and the Saskatchewan Medical Association (SMA), as well as patient and family advisors.
Click here for information about regional appropriateness-related projects led by individual health regions/organizations.
The Appropriateness of Care Program supports a number of provincial projects to address clinical quality improvement for system-wide issues. This work involves bringing together a group of clinicians who work in a focused area. The clinicians can identify root causes of variation and inappropriate care – and then consider opportunities for improvement.
In 2016-17 the provincial appropriateness initiative is focused on these projects:
- Peripheral Artery Disease
- Breast Cancer
- Imaging of Low Back
- Pre-Operative Testing
Other appropriateness-related projects
There are a number of other appropriateness-related projects currently underway in the Saskatchewan health system. Although not directly part of the Appropriateness of Care initiative, these projects aim to improve patient care.
Acute Stroke Pathway
HQC also collaborates on the clinical quality improvement work of the Saskatchewan Acute Stroke Pathway. HQC researchers provide measurement support to the pathway development team and to health regions that are testing and implementing the pathway. This work is led by the Ministry of Health. Click here for more information.
In February 2016, the Saskatchewan Disease Control Laboratory implemented a project to reduce unnecessary vitamin D testing. A clinical guideline for ordering vitamin D testing was developed and shared with physicians across the province, along with information for patients about testing and dietary and other sources of the vitamin. Click here for the clinical guideline and here for patient information. The Saskatchewan Disease Control Laboratory has also begun improving the appropriateness of fecal immunochemical testing (FIT) and drugs of abuse testing, along with Vitamin D testing. For an update on these projects, click here and see Page 25.
Antimicrobial Stewardship Program
In 2013, Accreditation Canada added an antimicrobial stewardship program to optimize antimicrobial use in acute care facilities as a required organizational practice. The Ministry of Health is supporting implementation of antimicrobial stewardship programs across the health system. Recently, the Saskatchewan Disease Control Laboratory developed and shared an antibiotic susceptibility guideline which will assist clinicians system-wide in selecting the best antibiotic for each patient’s care.
Adult Surgical Antibiotic Prophylaxis
The Ministry of Health has collaborated with the Saskatchewan Order Set Collaborative to produce a provincial document on Adult Surgical Antibiotic Prophylaxis. This guideline specifies appropriate procedure-specific antibiotic selection, dose, and timing while taking into account antibiotic resistance patterns in Saskatchewan. It was reviewed by surgeons, anesthetists, infectious disease physicians, a medical microbiologist, and pharmacists from nine of the 10 regions offering surgical services. The Ministry of Health collated all feedback from reviewers for decisions and finalization by pharmacy experts going forward.
The Appropriateness of Care Program has identified education and training in clinical quality improvement as a key foundational piece to support appropriateness work. Increasing the capacity and capability in the Saskatchewan health care system is an important component for driving and sustaining these efforts.
Clinical Quality Improvement Program
The Clinical Quality Improvement Program (CQIP) is an 11-month course that is designed to build capability for clinicians to lead improvement work, with a particular focus on clinical quality improvement projects. The program includes a mix of theory and experiential learning, along with individual coaching and a community of practice.
This is a sister program to the internationally recognized Advanced Training Program (miniATP) developed by Intermountain Health in Salt Lake City, Utah. It has been adapted as a standard clinical quality improvement methodology for improving Appropriateness of Care.
The program will be delivered through the Health Quality Council (HQC) with support from the provincial Appropriateness of Care Program and the Saskatchewan Medical Association (SMA). The first cohort of this program will start in January 2017 and continue until November 2017.For more information about the program and the application process, please click here. NOTE: The application deadline has been extended to November 13th, 2016. Physicians who have already applied have the option of revising and re-submitting their applications.