CIHR-IPPH/IHSPR Community Based Primary Health Care Innovations: Second Annual Meeting: Summary of Discussion



Co-hosted by the CIHR-Institutes of Population and Public Health and Health Services and Policy Research, the second annual meeting of Community-Based Primary Health Care (CBPHC) Innovations was held in Montreal, Quebec n November 26th and 27th, 2014. The meeting provided an pportunity for participants to reflect upon key innovations in the multi-faceted field of CBPHC, promote diffusion and communication of successful innovations, as well as cross-jurisdictional learning. There were 60 participants in attendance including researchers from innovation teams, decision makers, new investigators and applied public health chairs in CBPHC, funding partners from Australia, BC and Quebec, Support for People and Patient-Oriented Research and Trials (SUPPORT) unit representatives, IHSPR and IPPH Scientific Directors and staff, and CIHR staff.

Meeting bjectives

  • Facilitate knowledge exchange and enhance cumulative learning among partners, innovation teams, and salary award winners in CBPHC
  • Discuss areas of common interest (citizen engagement, scaling up innovations and international cross-jurisdictional collaborations)
  • Discuss plans for reporting on a common set of CBPHC indicators

Cross-learning in Community based primary health care: embracing synergies and heterogeneity

Nancy Edwards, CIHR- IPPH Scientific Director

In the first discussion on "Cross-learning in community based primary health care: embracing synergies and heterogeneity", groups were asked to reflect on innovative features from their respective programs of research and knowledge translation. Several innovations were identified in the areas of methodologies, knowledge translation, and interdisciplinary programmatic research oriented towards interventions and models of CBPHC. Cross-cutting themes include: the study of technological innovations in CBPHC settings (e.g. EMR, use of IPADs in community centres), appropriate methodologies (e.g. community-based participatory research; mixed methods, realist syntheses); novel evaluation designs of CBPHC intervention studies (i.e. focus on processes, mechanisms and interactions of interventions with context; study of novel community-level interventions and models of care to address different chronic conditions (e.g. diabetes) and populations (e.g. First Nations) in different contexts (e.g. rural/urban); and, contributing knowledge to factors that contribute to high-system performance within high performing primary care practices.

It was noted that while knowledge translation efforts haves been largely unsuccessful in their current form, opportunities exist to involve a range of decision-maker and public stakeholders at multiple levels (individual, rganizational and system levels) and novel engagement tools and mechanisms (e.g. deliberate dialogues, social media).

Performance Measurement and Reporting

Erica Di Ruggiero, CIHR-IPPH Associate Director and Sabrina Wong, Director of the BC Centre for Health Services and Policy Research

The second discussion of the meeting on "Performance Measurement and Reporting" highlighted important trends in the assessment of research impact, a discussion of performance measurement and reporting for the CBPHC Team grants, and an update on the CBPHC Common Indicator Project. Denis Roy, Vice-President, Scientific Affairs at l'Institut national de santé publique du Québec provided a response to the presentations.

Key highlights from this session include to identify the target audiences for the mid-term reports (Governing Council, decision makers, CIHR Science Council, and funding partners), and to complement narrative reporting with effective communication products (e.g. video snapshots) that bring to life learnings from the teams' programs of research. The impact case-studies are an important strategy to characterize what is being produced at the project or program level within each of the teams. These case studies can provide a foundation for different communication products. In addition, there is a need to critically reflect upon what is working and what needs to be adjusted within programs of research at the mid-term and to show the value of dedicating investments to specific strategic initiatives such as CBPHC. We need to maximize the knowledge translation potential by rolling up the learnings about attributes of CBPHC models of care and high performance systems of care across these mid-term reports.

ACTION: Teams are invited to send written responses to the questions raised in Erica Di Ruggiero's presentation about mid-term reporting following consultation with other team members.

Scaling up Innovations in Primary Health Care

Nancy Edwards and Merrick Zwarenstein, Director, Centre for Studies in Family Medicine

The third session on Scaling up "Innovations in Primary Health Care" introduced and explored definitions of the concept of scaling-up in relation to innovation, as well as key factors which could limit the potential for scaling-up, which included underestimating the type and quantity of resources required for scaling up and the over-emphasis on either vertical or horizontal spread of innovations. Public health case-studies (on H1N1 vaccination, tobacco control, and policy change and the built environment) were presented to demonstrate key learnings and questions which arose throughout the research process. Finally, a set of highlights and recommendations on what we know and what we still need to investigate about scale-up processes was discussed.

The Nose to Tail(NTT) tool was discussed by small groups. It offers innovation teams, innovators, and the essential stakeholders including end users and decision-makers a guide to:

  • identify what stage in the process their idea/innovation is at;
  • identify considerations that should be made at each stage by each stakeholder; and,
  • identify the contextual barriers that could hinder an innovation's success, which should be addressed prior to moving forward.

The NTT is a work in progress that is expected to be available online in the spring of 2015 for individuals to use and provide further feedback on refinement.

CBPHC Capacity Building Update

Moira Stewart, Distinguished University Professor at the Centre for Studies in Family Medicine at Western University

The fourth session provided a CBPHC Capacity Building Update. The goal is to create a national capacity building program for Primary health care (PHC) Research in Canada through CBPHC teams, SPOR Networks, and Support Units. Objectives for the 2015-2016 year are to build on the Transdisciplinary Understanding and Training on Research - Primary Health Care (TUTOR-PHC) program, add nline workshops and build partnerships with CBPHC innovation teams and the Quebec PIHCI Network.

ACTION: A capacity building designate for each team, a list of trainees and their contact information and a contact staff person/coordinator for each team was requested from each team.

Learning from international cross-jurisdictional research collaborations

Jeannie Haggerty, McGill Chair in Family and Community Medicine Research, and Walter Wodchis, Associate Professor at the Institute of Health Policy, Management and Evaluation at the University of Toronto

The fifth session explored the benefits and challenges of working in collaboration with international partners. Some challenges include accommodating for different time zones, and understanding each other's contexts and work cultures, learning from both researcher and knowledge user perspectives, and working towards vision coherence in implementing an international cross-jurisdictional program of research. Some benefits included being exposed to different perspectives and new ideas and approaches to research and knowledge translation, and opportunities for researchers to take risks by being pushed out of their comfort zones through these international collaborations.

SPOR: Linkages with Pan-Canadian Network on Primary and Integrated Health Care Innovations and SUPPORT Units – Update and Discussion

Robyn Tamblyn

The This sixth session offered an opportunity for participants to obtain the latest update on the SPOR Networks and in particular ACCESS Canada and the Pan-Canadian Network in Primary and Health Care Innovations and to discuss how meaningful linkages between SUPPORT Units and jurisdictional member networks can be enhanced.

ACCESS Canada (launched June 2014) is a SPOR Network in Youth and Adolescent Mental Health aiming to improve early identification of mental health issues in youth and early access to an evidence informed system. The Pan-Canadian Network in Primary and Integrated Health Care Innovations is a network of networks that aims to create cross jurisdictional opportunities for research on and scale up of innovative and integrated models of care. Network membership requirements were reviewed as were upcoming plans such as the launch f a quick strike research funding opportunity in line with member network priorities. Participants were reminded that one of the 10 membership requirements is for member networks to link up to CBPHC teams.

A dynamic cohort of complex needs/high system users is being developed with CIHI to establish what data can be used and support member networks who will be applying for quick strike research projects, when appropriate.  A network coordinating ffice for the pan-Canadian Network is also planned. This office is expected to facilitate priority setting, information exchange, communication and collaboration amongst member networks to deliver on KT, communication and capacity building activities at a pan-Canadian level.

SUPPORT Units could provide data access and technical expertise to those engaged in the pan-Canadian network to facilitate rapid data access and turnaround to support quick strike research projects, when appropriate.

Approaches to Citizen Engagement: Perspectives from research funders and decision-makers

Emma Whitehead, Australian Primary Health care Research Institute and Maureen Bilerman, Executive Director of Dots NB

The seventh session presented the benefits and challenges of working in collaboration with overseas partners from the perspective of funders. The panel reflected on strategies for meaningfully engaging patients and citizens, training and creating partnerships with consumer networks and lessons they learned throughout this process. They raised the need for safe, stigma free environments and capturing all consumer voices. Panelists spoke about the barriers to citizen engagement and their experience in vercoming these challenges to foster meaningful engagement and partnerships with different stakeholders. They highlighted how community members can be powerful advocates for the kind of health system transformation desired.

CIHR Open Reforms: Applying to the Foundation and Project Schemes; College of Reviewers – Update and Discussion

Nancy Edwards

The final session provided the opportunity for a discussion on CIHR pen Reforms. It highlighted the changes including two new funding schemes (foundation and project), a new peer review process, and the implementation of a College of Reviewers, which will support the peer-review process across the spectrum of health research.  These schemes will be supported by a new peer review process that addresses many of the challenges with the current system and is intended to reduce the burden felt by applicants and peer reviewers. To achieve this, CIHR will implement the following peer review elements: multi-stage competition process; structured review criteria; remote review; application matched to reviewers according to expertise; final stage of the review involving a face-to-face meeting to discuss "grey zone" applications.

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