ACHORD Retreat: Building Collaborations

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ACHORD RetreatBuilding Collaborations

• The Banff Centre
• Banff, Alberta
• March 18-19, 2004

2
Acknowledgements

• Alberta Health Wellness
• ACHORD NET Grant
• Institute of Health Economics
• Population Health Investigator with AHFMR
• Canada Research Chair in Diabetes Health Outcomes

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Building ACHORD Collaborations

• Find out more about ACHORD
• Find out more about you
• Share ideas
• Share databases
• Interact
• Socialize
• 15 minutes of fame
• simple game rules

4
ACHORDs story

• Institute of Health Economics
• Health Outcomes Research
• Quality of Care

5
Evaluating Care - SPO
Structure - the physical layout of site and
qualifications of care providers
Process - the actual delivery of patient care,
including technical and interpersonal aspects
Outcomes - changes in patient health as a
direct result of antecedent care
Source Donabedian, 1960s-1980s
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Outcomes - The ECHO Model
Economic
Clinical
Humanistic
Source Kozma et al., 1993
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ACHORDs story

• Institute of Health Economics
• JJ, ET
• Alberta Health Wellness
• National Diabetes Surveillance System
• Prairie Pilot Project (MB, SK, AB) 1998-1999
• Initial funding
• SmithKline Beecham (?GSK) seed funding
• CIHR Opportunity Fund
• IHRT (2000)

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Prevalence of Diabetes in Canada 1999/2000
Source www.NDSS.ca, 2003
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Prevalence of Diabetes in Canada 1999/2000
20
Source www.NDSS.ca, 2003
15
10
5
0
20-29
30-39
40-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85
Men
Women
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ACHORD Investigators (circa 1999/2000)
1. British Columbia Dr. Robert Reid,
UBC 2. Alberta Dr. Jeffrey Johnson, UA/IHE
Dr. Ellen Toth, UA Dr. Philip Jacobs,
UA/IHE Mr. Larry Svenson, AHW 3. Saskatchewan
Dr. William Osei, SH 4. Manitoba Dr. Jamie
Blanchard, MH/UM 5. Nova Scotia Dr. Murray
Brown, Dalhousie
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ACHORDs story

• Institute of Health Economics
• JJ, ET
• Alberta Health Wellness
• National Diabetes Surveillance System
• Prairie Pilot Project (MB, SK, AB) 1998-1999
• Initial funding
• SmithKline Beecham (?GSK) seed funding
• CIHR Opportunity Fund
• IHRT (2000) not successful
• CIHR New Emerging Team competition (2001)
• INMD/ICR/CDA/HS/KF Partnership

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ACHORD Investigators

• Jeff Johnson, PhD (Chair)
• Bill Ghali, MD, MPH
• Phil Jacobs, PhD
• Me2 Majumdar, MD, MPH
• Ellen Toth, MD
• CIHR New Emerging Team (NET)

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ACHORD - Multiple Objectives

• Establish a collaborative, multidisciplinary
  research consortium focusing on diabetes health
  outcomes research
• Establish and conduct a policy-relevant research
  agenda for diabetes health outcomes
• Develop more comprehensive diabetes health
  outcomes research proposals and competitive
  funding applications
• Development of research personnel in the form of
  graduate studentships and fellowships in diabetes
  health outcomes research
• Enhance the level and scope of health services
  research for diabetes in Canada

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ACHORD NET - Research Themes
Research themes build on the experience and
strengths of the individual investigators, as
well as the research assets of the centers across
the 5 provinces 1. Epidemiology/Pharmacoepidem
iology 2. Cost Economic Evaluations 3. HRQL
Studies 4. Interventions/Alternative Care
Delivery Strategies
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ACHORD Collaborators

• Jamie Blanchard
• Winanne Downey
• David Feeny
• TK Lee
• Richard Lewanczuk
• Braden Manns
• Finlay McAlister
• Ying Chu Ng
• Colleen Norris
• Murray Brown

• Steve Newman
• Arto Ohinmaa
• William Osei
• Ron Plotnikoff
• Rob Reid
• Eddie Ryan
• James Shapiro
• Larry Svenson
• Ross Tsuyuki
• Ron Wilder

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ACHORD Research Staff
Administrative Assistant Jackie Lewyk Research
Coordinator Betsy Thomas Research
Associates Scot Simpson Maria
Kotovych Samantha Bowker Graduate
Students/RAs Lauren Brown (MSc) Dean Eurich
(MSc/PhD) Sheri Maddigan (PhD) Alison Supina
(MSc) Post-Doctoral Fellows Nan Luo (PDF)
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• ACHORD
• Research Projects
• Funding

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Epi/Pharmacoepi studies

• Pharmacoepidemiologic Study of Metformin and
  Clinical Outcomes in Diabetes Mellitus
• AHFMR/IHE funded
• Epidemiologic and Economic Burden of Illness
  Studies of Diabetes Administrative Data from
  Saskatchewan Health, 1991 to 2001
• Pfizer/Aventis/IHE funded
• Pharmacoepidemiologic assessment of medication
  adherence rates and clinical outcomes in type 2
  diabetes mellitus
• IHE funded
• Population-based Estimates of the Incidence and
  Prevalence of Depression in People with Diabetes
• CIHR funded

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Study Cohorts Crude Mortality
Source Johnson et al., Diabetes Care 2002
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CVD Fatal and Non-fatal Events
Source Johnson et al., submitted
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ACEI Study CVD Fatal and Nonfatal Events
Control ACE Inhibitors
Source Eurich et al., Diabetes Care, in press
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Intervention studies in diabetes

• Diabetes Outreach Van Enhancement (DOVE) Study
• CDA/IHE funded
• Diabetes Outreach Van Enhancement (DOVE)
  Follow-Up Study.
• IHE funded
• Study of Testing Response in Patients with Type 2
  DM (STRIP-Type 2)
• Aventis/IHE/CDA funded

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Results - of Subjects Achieving Primary Outcome
Difference 7 absolute 19 relative p 0.19
Majumdar et al., Diabetes Care, 2003
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Results - Secondary Outcomes
Difference 17 absolute 68 relative p0.004
p0.33 p0.44
Majumdar et al., Diabetes Care, 2003
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HRQL studies in diabetes

• Health Utilities Index Mark 3 in Diabetes
  Evaluating the construct validity from population
  health survey data.
• AHFMR funded
• Diabetes Outreach Van Enhancement (DOVE) Study
• CDA/IHE funded
• Health-Related Quality of Life and Cost-Utility
  Analysis of Clinical Islet Transplantation in
  Type 1 Diabetes Mellitus
• JDRF funded
• Health-Related Quality of Life in People with and
  without Diabetes Undergoing Cardiac
  Revascularization (APPROACH)
• CIHR-NET funded

27
National Population Health Survey Data Overall
HUI3 Scores
plt0.001 for all comparisons relative to the
control group
(Maddigan et al., IHE WP 2004)
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DOVE - HUI3 Overall Score
Diff0.065 p0.018
Mean change scores adjusted for baseline score,
age, sex, BMI, income, education, FN status
(Maddigan et al., Diabetes Care 2004)
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Economic studies in diabetes

• Expenditures on Diabetes and Related Conditions
  in Saskatchewan 1991 - 1996.
• Sask. Health/IHE funded
• Coverage of Diabetes Testing Supplies An Budget
  Impact for Alberta
• IHE (Merck Foundation) funded
• Health-Related Quality of Life and Cost-Utility
  Analysis of Clinical Islet Transplantation in
  Type 1 Diabetes Mellitus
• JDRF funded
• Epidemiologic and Economic Burden of Illness
  Studies of Diabetes Administrative Data from
  Saskatchewan Health, 1991 to 2001
• Pfizer/Aventis/IHE funded
• Economic Evaluation of Population-Based Diabetes
  Prevention Programs
• CIHR funded

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Total Cost of Care for People with DMby
Comorbidity, Saskatchewan 1996
Source Simpson et al., CMAJ 2003
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Thesis/Dissertation Research

• Epidemiology of Depression in People with
  Diabetes
• Lauren Brown (MSc)
• ACE Inhibitor Therapy for Primary Prevention of
  CV Morbidity Mortality in Patients with Type 2
  Diabetes
• Dean Eurich (MSc) completed December 2003
• Studies of HRQL Assessment in Type 2 Diabetes
• Sheri Maddigan (PhD)
• Beta-blockers and CV morbidity and mortality in
  patients with type 2 diabetes after first MI
• Charlotte McDonald (MSc UWO)
• Social and Behavioral Correlates of Glycemic
  Control
• Chad Mitchell (MSc) completed May 2003
• Construct Validity of HRQL measures in Type 1
  Diabetes
• Alison Supina (MSc)
• Use of Metformin in Type 2 Diabetes Mellitus and
  CHF
• Dean Eurich (PhD)

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Quality Indicators in Diabetes

• Literature review quality improvement studies
  in diabetes
• CIHR - NET funded
• Quality Indicators Set for Diabetes (QISD)
• Minimum dataset for researchers/health systems
• To complement CDA-CPG
• Modified Delphi process
• Round 1 Establishing Indicator Set
  (completed May 03)
• Round 2 Establishing Targets/Benchmarks (sche
  duled for March 04)

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• ACHORD
• Communication Activities

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Communication Activities

• ACHORD Newsletter
• currently every 4 months
• ACHORD Website
• www.ACHORD.ca (launched September 2003)
• Policy Advisory Forum
• Held on Novermber 2000
• ACHORD Retreat
• March 18-19, 2004
• Invitational Research Meeting
• September 24-26, 2004
• Location TBA

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Building ACHORD Collaborations

• Find out more about ACHORD
• Share ideas
• Share databases
• Interact
• Socialize
• 15 minutes of fame
• simple game rules