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Appropriateness of Care

Helping patientThe provincial Appropriateness of Care Program was established in 2015 to lead provincial initiatives and provide support to regional improvement efforts. The Ministry of Health and the Health Quality Council (HQC) work with physicians across the province on specific projects. 

Appropriate care is defined by the Canadian Medical Association as: "the right care, provided by the right providers, to the right patient, in the right place, at the right time, resulting in optimal care." The Ministry of Health’s 2009 Patient First Review, For Patients' Sake, indicated that at times patients in Saskatchewan may not receive the best treatment options – or appropriate care – for a variety of reasons. 

Some of these reasons include availability of services, access to care, variation in physician practices, and lack of solid evidence available for physicians to support the best treatment options. This can lead to uncertainty and variation in decision-making. All of these factors impact the appropriateness of care that patients, clients and residents receive and contribute to underuse, overuse, misuse and variation in services and, consequently, inappropriate care. 

The Saskatchewan health system is committed to addressing these issues through the development and implementation of a provincial Appropriateness of Care Framework. This framework is designed to support physicians, health care providers, patients, and families in an effort to improve appropriateness of care throughout the health system. 

Click here for more information on the Appropriateness of Care Framework.

Click here for the Appropriateness of Care schematic.

Appropriateness of Care


 About Choosing Wisely Saskatchewan

Choosing Wisely Saskatchewan is a joint venture among provincial organizations, including the Saskatchewan Health Quality Council, the Saskatchewan Medical Association, and the provincial Appropriateness of Care Program. Together we implement the following strategy through the engagement of clinicians, patients, and medical students:



In Saskatchewan, work is underway in partnership with the provincial Appropriateness of Care Program to undertake the following Choosing Wisely Canada topics:

Pre-Operative Testing

Imaging of Low Back

In addition to provincial projects, individual clinicians are engaged in Choosing Wisely topics. For example:

• Regina Qu'Appelle Health Region

     º Pre-operative testing guidelines project

• Clinical Quality Improvement Program

     º Appropriate Pre-Operative Testing

     º Radiotherapy for Bone Metastases


Choosing Wisely Saskatchewan Partners

- Saskatchewan Health Quality Council (host organization)

- Saskatchewan Medical Association

- Regional health authorities

- Ministry of Health

- College of Medicine, University of Saskatchewan

- eHealth Saskatchewan

- Saskatchewan Cancer Agency

- Provincial patient and family advisors


Who can I contact to learn more about Choosing Wisely Saskatchewan?

Jennifer Wright

Choosing Wisely Saskatchewan Coordinator

306-668-8810 ext. 136


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: 

  1. Peripheral Artery Disease
  2. Breast Cancer
  3. Imaging of Low Back
  4. 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.

Lab Testing

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.

Below are resources available to learn more about appropriateness of care in Canada and beyond. 

Choosing Wisely Canada is a campaign to help physicians and patients engage in conversation about unnecessary tests, treatments and procedures. 

Choosing Wisely Patient Information -- Image Testing for Lower Back Pain 

Lumbar Spine CT Checklist

Overview of Lumbar Spine CT Checklist Project -- communique

MRI of Lumbar Spine Checklist

Intermountain Healthcare miniAdvanced Training Program is a practical, in-depth course for clinicians and health care professionals who teach, implement and investigate quality improvement, outcome measurement and management. 

Regina Qu’Appelle Health Region established an Appropriateness of Care Program and agenda in 2015, and has multiple projects underway. 

The Saskatchewan Disease Control Laboratory (SDCL) is currently working on a number of guidelines and policies for appropriate test ordering. 

Appropriateness of Care Network Launch presentations (Sept. 30, 2016):

Clinical Quality Improvement – Dr. Gary Groot and Dr. David Kopriva

Deploying Appropriate Use Criteria into Clinical Workflows to Optimize Care Delivery – Dr. Brent James

Video: Deploying Appropriate Use Criteria into Clinical Workflows to Optimize Care Delivery

Implementing Clinical Quality Improvement – Dr. Gary Groot and Dr. David Kopriva

Pre-Operative Testing in Saskatchewan – Dr. Gary Groot and Dr. David Kopriva

Clinical Quality Improvement Program – Shari Furniss, Health Quality Council

Regina Qu’Appelle Health Region Project – Dr. Theo Le Roux and Dr. David McCutcheon

Prairie North Health Region Project – Dr. Bruce Murray and Dr. Rachelle O’Keefe

Saskatchewan Cancer Agency Project – Dr. Bernard Lawlor


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