Advancing PROMs for health system use in Canada and beyond.

PROMs are essential to delivering patient-centred health care, and when applied routinely they can enhance communication between patients and providers, inform decisions for value-based health system improvements and improve overall patient care experiences and outcomes. The use of patient-reported outcome measures (PROMs) across Canada varies across provinces and territories, partly because of differences in health care delivery models across these jurisdictions. A national program that coordinates uses of PROMs is needed to ensure that this information is comparable across jurisdictions. This commentary provides a summary look at the development of national PROMs data standards and reporting for hip and knee replacement surgery, including the selection of survey tools, building consensus, developing and promoting standards, and reporting on the results nationally and internationally as well as outlining recent learnings from regional implementation of data standards. In 2017, the Canadian Institute for Health Information published national PROMs data collection standards for hip and knee arthroplasty that included guidelines for survey time points, the minimum data set and PROMs instruments. This broad-scale PROMs collection initiative had stakeholder engagement and support from multiple levels within the health system, including administrators, clinic managers, patients, and health system decision-makers. Learnings from regional implementation of the standards demonstrated the importance of assessing existing infrastructure and information technology requirements, mapping clinical workflows, planning for human and information technology resources, navigating local legislation and hospital policies and ensuring data linkage capabilities. This initiative showed the need for a common regional approach for PROMs collection to be efficient and effective. The learnings from implementation of the national Canadian PROMs program for hip and knee arthroplasty can be used as an example for other jurisdictions and clinical areas such as renal care and mental health. Common data standards allow for secondary use of this data that is valuable for reporting and informing policy and guidelines as well as meeting care delivery goals to further the shift in health care systems becoming more patient-centred to improve the quality-of-life of patients.

Opioids in Canada.

The opioid crisis in Canada is a complex issue with devastating consequences for individuals, families and communities. Pan-Canadian data that provide a better understanding of the crisis are a high priority to help guide efforts for reducing opioid-related harms. The objective of this study is to summarize recent trends of opioid-related harms and opioid prescribing across Canada. Opioid-related harms examined in this study include opioid poisonings, opioid use disorders, adverse reactions to opioids and infants born with neonatal withdrawal symptoms. Data are reported at the pan-Canadian, provincial and community levels.

At-a-glance - Hospitalizations and emergency department visits due to opioid poisoning in Canada. / Aperçu - Hospitalisations et visites à l'urgence en raison d'un empoisonnement aux opioïdes au Canada.

The rise in opioid-related harms is an issue of increasing public health importance in Canada. This analysis used data from the Hospital Morbidity Database and the National Ambulatory Care Reporting System to determine the number of opioid poisoning hospitalizations and emergency department visits in Canada. Opioid poisoning hospitalizations have increased over the past 10 years, reaching 15.6 per 100 000 population in 2016/17. Emergency department visits due to opioid poisoning have also increased in Alberta and Ontario, the two provinces that collect emergency department data at the level of detail required for this analysis. These findings highlight the importance of pan- Canadian surveillance of opioid-related harms, as well as the need for evidence-based policies to help reduce these harms.

RÉSUMÉ: L'augmentation des méfaits attribuables aux opioïdes constitue un problème de plus en plus préoccupant en santé publique au Canada. Cette analyse a utilisé les données de la Base de données sur la morbidité des hôpitaux et du Système national de rapports sur les soins ambulatoires pour déterminer le nombre d'hospitalisations et de visites aux services d'urgence en raison d'un empoisonnement aux opioïdes au Canada. Le nombre d'hospitalisations pour empoisonnement aux opioïdes a augmenté au cours des 10 dernières années, atteignant 15,6 par tranche de 100 000 habitants en 2016-2017, et celui des visites aux services d'urgence en raison d'un empoisonnement aux opioïdes a également augmenté en Alberta et en Ontario, les deux provinces qui ont recueilli des données des services d'urgence assez détaillées pour être analysées. Ces résultats soulignent l'importance de la surveillance pancanadienne des méfaits attribuables aux opioïdes, ainsi que la nécessité de politiques fondées sur des données probantes pour aider à les réduire.

Opioid-Related Harms in Canada.

The rise in harms associated with opioids is an issue of increasing public health importance in Canada. The Government of Canada recently reported 2,816 apparent opioid-related deaths across the country in 2016. Recent 2017 data show that deaths involving fentanyl-related opioids have doubled from January to March as compared to the same time period in 2016 (Government of Canada 2017). Additional measures that provide a better understanding of opioid-related harms, such as hospitalizations and emergency department (ED) visits, are a high priority. The objective of this study is to present pan-Canadian data on hospitalizations and ED visits because of opioid poisoning.

The Canadian National System for Incident Reporting in Radiation Treatment (NSIR-RT) Taxonomy.

PURPOSE: Incident investigation, reporting, and learning are core elements of quality improvement in radiation treatment. This report describes the development of a Canadian National System for Incident Reporting in Radiation Treatment (NSIR-RT), focusing especially on the taxonomy. METHODS AND MATERIALS: The NSIR-RT was developed to provide a framework in Canada for reporting and analyzing radiation treatment incidents. A key objective was to assure compatibility with other international reporting systems to facilitate future information exchange. The Canadian community was engaged at every step of the development process through Delphi consensus building and inter-user agreement testing to promote awareness of the system and motivate broad-based utilization across the country. RESULTS: The final taxonomy was comprised of 6 data groups (impact, discovery, patient, details, treatment delivery, and investigation) and 33 data categories with predefined menu options. There was a high level agreement within the Canadian community about the final suite of data categories, and broad alignment of these categories with the World Health Organization and other American and European radiation treatment incident classifications. CONCLUSIONS: The Canadian NSIR-RT taxonomy will be implemented as an online, web-based reporting and analysis system. It is expected that the taxonomy will evolve and mature over time to meet the changing needs of the Canadian radiation treatment community and support radiation treatment incident learning on a global scale.