Research

Michael Rachlis Publishes New Book on Innovation and Health Care Delivery

Dr. Michael Rachlis, Associate Professor in the Department of Health Policy, Management and Evaluation, recently had his book, "Prescription for Excellence: How Innovation is Saving Canada's Health Care System", published by HarperCollins. Dr. Rachlis has previously co-authored, with Carol Kushner, two national best-sellers on Canada's health care system. In his third book, Dr. Rachlis describes, in journalistic style, innovations in health care delivery he has encountered while travelling across the country. He argues that our health care system is not troubled by excessive costs, nor is it drastically underfunded. It does, however, require reorganization to effectively manage chronic illness and frailty. Innovation is the key to building a more effective system and improving the quality of care at minimal cost. Raisa Deber, in her April 10, 2004 Globe and Mail review, "Good News for Modern Medicine", observes that Rachlis's book focuses on what can be done "where the rubber meets the road: the millions of encounters between individual patients and providers". This is where the problems of overuse, underuse or misuse can be eliminated through improvements to the quality of care. Some of the successful innovations Rachlis describes include better interdisciplinary teamwork, use of non-drug therapies and improved prescribing. Dr. Rachlis currently practices as a private consultant in health policy analysis. Since 1990, he has consulted to the federal government, nine provincial governments, and two royal commissions. He has lectured widely on health care issues and has been invited to make presentations to committees of the Canadian House of Commons and Senate and the United States House of Representatives and Senate. For more information about the book, including a free download of chapter one, see: www.michaelrachlis.com.

Dr. Gillian Hawker Heads New Study of Pain and Fatigue In Osteoarthritis

Dr. Gillian Hawker, Associate Professor in HPME, is the principle investigator of a new study which will expand our understanding of women's experiences of pain and fatigue when living with osteoarthritis (OA). It is hoped that greater understanding of the interrelationships between pain, fatigue and mood, and how these relate to other factors, such as coping strategies, family support, and use of established treatments for OA, will enable the development of new treatments, targeted to individuals in the context of their families and the community as a whole. Co-investigators include Arthritis Community Research and Evaluation Unit (ACREU) investigators Elizabeth Badley and Monique Gignac, physical therapy researcher Aileen Davis (Professor in HPME), Shirley Brown, Chair in Women's Mental Health Research, Sarah Romans, and Allan Gordon from the University of Toronto Centre for the Study of Pain. This research initiative has been funded by the Canadian Institutes for Health Research and the Canadian Arthritis Network for a five-year period. Funding will support the development of a world-class team of clinical and population researchers in the area of pain and fatigue in OA, foster multidisciplinary collaboration and emphasize research training for young investigators. Dr. Hawker is a staff rheumatologist and the Director of the Osteoporosis Clinical Research Program at the Women's College Ambulatory Care Centre and is affiliated with Centre for Research in Women's Health. She is also a Senior Investigator with the Arthritis Community Research and Evaluation Unit at The Toronto Hospital Research Unit.

HCTP Strengthens Alliance with Change Foundation

In Fall 2003, the Change Foundation launched a $1M/5 year Strategic Alliance with the HPME program Health Care, Technology, and Place (HCTP), to support knowledge translation, research, and mentoring initiatives. These shared objectives promise to be enhanced with the addition of Gale Murray, Jiahui Wong, and Julie Gilbert as newly appointed Lecturers to HPME. Gale Murray is President and CEO of The Change Foundation, Dr. Julie Gilbert, a recent HPME PhD Graduate, is Research Manager, and Dr. Jiahui Wong is Research Associate at The Change Foundation. The Change Foundation was incorporated by the Ontario Hospital Association and endowed with part of the proceeds of the sale of Blue Cross in 1996 with a mandate to promote, support and improve health and the delivery of health care through four activity areas: Applied Research and Analysis; Development Program; Education; and Grants to Charities.

Primary Care Knowledge Transfer Activities

Two Primary Care Research teams will be exhibiting information about their studies at the Primary Care Today conference sponsored by the Dept. of Family & Community Medicine, University of Toronto (www.primarycaretoday.ca). The conference will take place on May 6 to 8, 2004 in Hall 5 at the International Centre, Toronto ON. The two studies are: 1) "Performance Indicators and Benchmarks in Primary Health Care" conducted by Dr's Jan Barnsley (PI), Whitney Berta, Rhonda Cockerill, Eugene Vayda and Judith MacPhail (Dept. of HPME) Jeff Bloom, Liisa Jaakkimainen,Yves Talbot (Dept. of Family & Community Medicine) and Raymond Pong (Laurentian University) and 2) "Coordination of Care: Factors that influence horizontal and vertical information transfer between primary care practices and medical specialists" conducted by Whitney Berta (PI), Jan Barnsley, Rhonda Cockerill, Dave Davis and Eugene Vayda (Dept. of HPME) Jeff Bloom, Liisa Jaakkimainen and Yves Talbot (Dept. of Family & Community Medicine). Please visit their booth to meet the Investigators and learn more about their research activities.

Performance Indicators and Benchmarks in Primary Health Care Study - Phase III

Dr's Jan Barnsley (PI), Whitney Berta, Rhonda Cockerill and Eugene Vayda (Dept. of HPME), Jeff Bloom, Liisa Jaakkimainen, Yves Talbot (Dept. of Family & Community Medicine) and Raymond Pong (Laurentian University) are involved in a number of study planning activities in preparation for the application of performance indicators in 48 Ontario practices over the next two years. Team members are meeting with key stakeholders such as Jan Kasperski (CEO, Ontario College of Family Physicians) and Mary Woodman (Manager, Nurse Practitioner Initiatives, The Nursing Secretariat, Ontario Ministry of Health & Long Term Care) to discuss study rationale, objectives and methods.

The purpose of the project is to work collaboratively with family physicians and nurse practitioners to implement and evaluate a performance measurement system. An Advisory Committee will be established to offer independent consultation to the research team and assist with practice site recruitment, data analysis and interpretation and knowledge transfer.

Two workshops, which were temporarily postponed related to the SARS Alert, of the Phase II Field Test of Primary Care Performance Indicators Project have now been conducted. These 10 consultative workshops were held at participating practices and included 25 family physicians and 2 nurse practitioners/Registered Nurses (Extended Class). During the workshop, the research team obtained extensive feedback about data quality and indicator feasibility. This feedback was reviewed and used to revise the performance indicators for the Phase III study. The revised data collection instruments are being converted to an electronic version which will be pre-tested at pilot sites within the next several months.

For additional details about study activities, contact Judith MacPhail, Project Coordinator at email address primary.care@utoronto.ca

Research and Teaching Profile

Faculty associated with the Department of Health Policy, Management and Evaluation (HPME) are involved in a broad range of research activities with a variety of organizations. Success of the HPME Knowledge Transfer initiative is dependent on presenting our stakeholders with a unified, clear image of the depth and breadth of Departmental expertise. To promote greater internal awareness of the knowledge developed through HPME, faculty research profiles will be included as a regular feature of this newsletter.

This issue of the HPME newsletter features a research profile for Dr. David A. Davis.

+ + PROFILE OF THE MONTH + +

David A. Davis, MD, CCFP, FCFP, BA

Dr. Dave Davis is a Professor in the Departments of Health Policy, Management & Evaluation and Family and Community Medicine, and Associate Dean of Continuing Education, Faculty of Medicine, the University of Toronto. He is an active staff physician in the Department of Family & Community Medicine at the Toronto Western Hospital, University Health Network.

Education and Work Background

Completing his medical training at the University of Western Ontario and the University of Toronto in 1969, Dr. Davis entered private family practice in Burlington, Ontario and began a life-long interest in continuing medical education (CME). This interest culminated in the development of a community hospital-based continuing education program under the rubric of the Interprofessional Education Council at Burlington's Joseph Brant Hospital, and his appointment, in 1977, as Director of Continuing Medical Education at the new Faculty of Health Sciences, McMaster University in Hamilton. Between 1977 and 1991, Dr. Davis was the primary developer of a comprehensive, faculty-wide program in continuing health sciences education, incorporating innovative programming (distance education, individualized and problem-based learning and other methods), competency assessment and objective evaluation strategies. During this time he also practiced as a staff physician at the North Hamilton Community Health Center, an inner-city primary care teaching practice. In 1994, Dr. Davis took up his current position as the Associate Dean for Continuing Education in the Faculty of Medicine, University of Toronto.

In addition to his leadership at the local level, Dr. Davis has been actively involved in provincial, national, bi-national and international organizations, projects and committees related to CME. He has served as chair of the CME Committee of the Council of Ontario Faculties of Medicine; president of the Standing Committee on CME for the Association of Canadian Medical Colleges; the president of the Alliance for Continuing Medical Education (1990-1992), the largest organization of CME providers in the US and Canada; and the president of the Society for Academic Continuing Medical Education (1997-1998).

Dr. Davis is currently serving as:

• Interim Leader of the Knowledge Translation Program based out of the Faculty of Medicine, Office of Continuing Education;
• Chair of the Guidelines Advisory Committee of the Ontario Medical Association and the Ontario Ministry of Health and Long Term Care;
• Chair of the Advisory Council of the Centre for Research in Education of the Faculty of Medicine and University Health Network; and
• Chair of the CME Congress 2004 Planning Committee (for details about the Congress, see the Other Notables section of this newsletter)

Research Activities

Dr. Davis is the principal or co-principal investigator of CME research grants totalling over $2 million and is a member of study teams in further grants totalling a further $5 million. He is currently involved in research studies examining the development and implementation of clinical practice guidelines and training opinion leaders.

While at McMaster, he was involved in several academic CME developments, including: the concept of a CME membership (allowing physicians to register at all CME programs by paying an annual fee); the application of problem-based learning principles to CME; a comprehensive competency assessment program supported by the provincial licensing body; a Ministry of Health funded national audio-conferencing network; the use of innovative needs assessment and evaluative techniques, including standardized patients; a unique data base of CME research, called the Research and Development Resource Base in CME; and the evolution of an evidence-based CME working group.

Dr. Davis has authored approximately 100 peer-reviewed papers, monographs and chapters, and co-edited a text on CME, "The Physician as Learner: Linking Research to Practice". Recent publications (2002-2003) include:

• The Case for Knowledge Translation: Shortening the Journey from Evidence to Effect (full-text)
• Continuing Medical Education and the Physician as Learner: Guide to the Evidence (full-text)
• Can We Alter Physician Behavior by Educational Methods?(abstract)
• Assessing Guidelines for Use In Family Practice (full-text)

Teaching and Supervisory Responsibilities

Dr. Davis teaches "Continuing Education in the Health Professions" for the Family and Community Medicine MHSc Program in the Department of Public Health Sciences. He is active in the supervision of several graduate students in education and health services research. At the clinical level, he teaches medical students in the Faculty of Medicine Determinants of Community Health program, and acts as a preceptor for clinical clerks in his practice setting.

Future Research

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