This research was composed of two Cognitive Task Analysis studies. We focused on both an existing bright spot: chronic disease management and Diffusion of Innovations, specifically a phenomenon referred to as the "valley of death"; the point where innovations commonly fail to spread to the wider population. The early majority is needed to take innovation to scale and thus requires a greater investment in a workforce equipped to facilitate early majority efforts in their local contexts; a "mass customization approach". The following principles summarize our findings:

1. Address the early majority in terms that make sense to them
2. Help teams learn to distribute knowledge work activities and shift their mental models
3. Practice facilitation is essential
4. Focus incentive changes on removing barriers and obstructive incentives
5. Focus on team-based, systems-based Chronic Disease Management as the initial target

Read more about this work in our report.

BedMed is about medication timing. In particular this project is designed to determine if switching the time of day blood pressure medications is taken to bedtime (compared to conventional morning use) reduces death, stroke, heart attack or hospital admission for congestive heart failure. BedMed aims to test findings from the MAPEC trial, where Spanish researchers found a 61% reduction in adverse events similar for all individual components of the primary outcome (including death from all causes, stroke, myocardial infarction, new angina pectoris, heart failure and occlusion of the retinal artery). If true, a switch to bedtime prescribing would have more impact on the health of hypertensive Canadians than whether high BP is treated at all. BedMed is being conducted in Alberta, British Columbia and Manitoba.

More information can be found at bedmedstudy.ca or pragmatictrials.ca.

This research is being conducted in two phases. The first phase (completed) described the geographic and demographic characteristics of High volume (>50 visits/day) General Practitioner (GP) practice. This phase utilized a data set from Alberta Health that was linked with demographic provider data from the College of Physicians and Surgeons of Alberta. The second phase of this research is using these data to determine the odds of treatment failure, defined as Emergency Department or hospital utilization for primary-care-sensitive conditions (Diabetes, Heart Failure, COPD, Coronary heart Disease, Asthma) designated by the Health Quality Council of Alberta.

In addition, we have developed a normative method of calculating GP supply based on service day activities. This novel method is based upon the amount of service activity a provider supplies, and defines part time and full-time equivalents based upon specific service day cut points. We plan to describe GP supply across two provinces (AB & ON) based upon this novel method, and in the process refine our service day cut point definitions to most accurately depict GP activity for service planning purposes.

These results are important for policy-makers when considering the design of a payment system to optimize patient outcomes in Alberta. For more information on this work connect with Dr. Terrence McDonald.

This research endeavor began as an Alberta-specific project surveying Alberta NPs on their practice patterns. There are 436 registered NPs in Alberta and 214 of these responded to the survey. Results revealed that: only a small subset of NPs in Alberta work in a primary care setting, very few NPs have responsibility for large panels of patients, NPs can manage between 800-1000 patients in their panels, and there is potential for NPs to play an expanded role in primary care. In addition, only 11.5% reported satisfaction with the community's understanding of their role. The project is now expanding nationally to compare and contrast NP practice patterns across Canada.

For more information on this work connect with Dr. Tammy O'Rourke.

Our previous research on the valley of death and chronic disease management indicated that, to transform primary health care, practice teams need to shift how they think, not just what they do. This shift requires a workforce, Practice Facilitators (PFs), to provide support and determine how best to help teams move forward. Using a co-design approach, we tested whether we could teach PFs the skills needed. Working with 2 PCNs we discovered that training must be practical and flexible, and that a spectrum existed around how concepts were accepted- from the abstract to the more concrete. Our pilot was successful in demonstrating that we could teach these skills to PFs. It also revealed how this training could provide a shift in how PCNs view the PF role and Quality Improvement in general. We will continue to develop, test and scale this training in partnership with AMA-ACTT.

The aim of the AFPEE study (now complete) was to see whether family physician colonoscopists are reaching quality assurance benchmarks. Nine physicians at 11 sites were successfully recruited and more than 1700 procedures were entered. Findings confirm that family physicians are surpassing the benchmarks (e.g. proportion of successful cecal intubations targeted at 90% where family physicians participants were at 98%; patient comfort was targeted at less than 10% for moderate or significant discomfort where family physician participants held at 3.3%). The results of this project demonstrate that family physicians are performing high quality colonoscopies and that providing an electronic data collection tool improves data collection, reporting, and measuring quality benchmarks. Next steps include plans for future training programs for physicians, further studies involving other provinces, and developing the tool to expand nationally so all family physician colonoscopists and specialist colonoscopists are able to report their quality measures, receive feedback and self reflect on their practice - thus closing the practice loop.

The Cognitive Task Analysis (CTA) stream of the KOASK project was to gain an understanding of how family physicians think about managing early knee osteoarthritis (KOA) in real-world practice. We also wanted to know if family physicians would use or recommend a mobile-health risk management tool. Our findings revealed family physicians would not use or recommend a mobile-health risk tool but did suggest a mobile-tool be used by patients for self-management. Moving forward the aim was readjusted to focus on a tool that would increase patient and physician communication and engagement in terms of shared decision-making and evidence-based self-management planning. Co-design sessions involving physicians, patients, and members of the research team were completed and successful outcomes included recommendations on the needed features and functions of the self-management KOASK App, and meeting with App designers to create a proto-type based on the patient and physician suggestions.

Read more about this work here.