Strategy on Patient-Oriented Research

1. Strategy on Patient-Oriented Research

2. Background Prior successes and competitive advantages: • Large number of pivotal trials that changed practice • High-quality workforce trained in evidence-based medicine • High-quality research environment and health system • Strengths in systematic reviews Despite successes and strengths: • Lack of financial support, coordination and prioritization for clinical studies • Clinician-researcher training and support lacking • Private-sector investment declining and moving elsewhere As a result: • Adoption and use of health interventions vary widely • Health decisions at all levels often lack evidence base • Health system costs rising

3. Definition of Patient-Oriented Research Scope of definition Westfall, J. M. et al. JAMA 2007;297:403-406

4. Strategy on Patient-Oriented Research Goal: • Improving health outcomesthrough research Aims: • to enhance clinical applications and economic impact of health innovations • to provide health professionals and decision-makers with information on how to deliver high-quality care and services in a cost-effective manner Implies a continuum from: • “first in patients” studies to • how new and old drugs, devices and procedures are integrated into health systems

5. Bridging the “valleys of death” between research and outcomes Valley 1 Valley 2 Clinical Practice & Health Decision Making Basic Biomedical Research Clinical Science & Knowledge Translational Continuum

6. Four major components of the Strategy on Patient-Oriented Research • Improve the research environment and infrastructure 2) Set up mechanisms to better train and mentor health professionals and non-clinicians 3) Strengthen organizational, regulatory and financial support for multi-site studies 4) Support best practices in health care

7. Component 1: Improve the research environment and infrastructure Improve the research environment and infrastructure: Develop SUPPORT Units across Canada • Integrate research activities into the health system • Conduct research over the continuum of care, from prevention through diagnosis and treatment Create networks for patient-oriented research • Focused on specific disease topics • Capitalize on clusters of excellence in the clinical and scientific communities • Establish programs to build capacity in areas of greatest need, such as primary care and chronic disease management

8. Component 1: SUPPORT Units - A Matrix Model CORE FUNCTIONS Data management Biostatistics and methods support Project management Consultation and education Mental Health Primary Care Research Network 3 Research Network 4 Research Network 5 SPECIALIZED MODULES Large international trials Systematic reviews Biobanks and translational medicine Knowledge translation

9. Component 1: Networks for Patient-Oriented Research Themes of research and Networks for Patient-Oriented Research • Broad thematic networks • Examples: mental health, primary care, chronic disease • Develop a coordinated nation-wide research agenda • Link to other researchers in their area • Link multiple SUPPORT Units • Assist in conducting research and disseminating results from academic settings to the patient-care community • Mentor emerging researchers • Oversee enrolment, ensure highest ethical and operating standards in all large-scale studies

10. Component 2:Capacity building –Mechanisms for training and mentorship Develop human capacity for patient-oriented research: • Train more health professionals in health-oriented research • Mentor, develop and support careers of researchers • Train more non-clinicians with advanced degrees in core research methodology • Re-engineer career training and salary awards to build capacity in patient-oriented research for individuals aligned with patient-oriented research units

11. Component 3: More efficient health systems Strengthen organizational, regulatory and financial support for multi-site studies: • Streamline ethics review for multi-centre trials • Adopt a national template for contracts and inter-institutional agreements • Ensure that Good Clinical Practice (GCP) standards meant for industry do not stifle investigator-initiated research efforts • Develop national standards of operation for all clinical research activities

12. Component 4: Putting evidence into practice Support best practices in health care: • Develop more capacity for knowledge synthesis • Develop training for guidelines developers • Enhance guidelines with new implementation tool (eg standardized order forms and algorithms of care) • Develop a KT strategy that outlines how to disseminate research information to the right target audiences

13. Proposed long-term outcomes of strategy 1) Improve existing environment, establish infrastructure Years 1- 2: • Nationwide coordinating office Year 3: • Research networks and research programs • Support 7-10 existing SUPPORT Units • 2 new international trials coordinating centres Years 3-5: • 7-10 new SUPPORT Units • Coordinated patient-oriented research activities in Canada 2) Training Years 3-5: • Recruiting researchers in priority areas, such as mental health and primary care • Training programs supporting key personnel

14. Proposed long-term outcomes of strategy (continued) 3) More efficient health systems Years 1-2: • Governance and financial structure with all partners/stakeholders • Streamlined ethics review and contracts • Standards of operation for all clinical study sites Years 3-5: • Four-fold increase in grants and projects • Aligned stakeholder investments and priorities 4) Supporting best practices in health care Years 3-5: • Several large international studies and programs • Clinical decisions relying on research-based evidence Years 5-10: • Publish 3-5 practice-changing studies per year • Uptake of major research studies and programs • Improved local, regional and national health outcomes

15. Patient-Oriented Research: The value proposition Patients: • The right care, right place, at the right time. Institutions: • Ability to attract the best and brightest • Enhanced capabilities to evaluate patient-oriented programs • Resources to identify or generate evidence for decision-making Governments: • Resources to evaluate new and existing programs • Evidence-based decision-making • Evidence of cost-effectiveness to ensure sustainability Private Sector: • Enhanced capabilities to test new therapies in cost-effective, timely and quality system Scientists: • Significant resources to enhance research output

16. Key Questions • Have we identified the most important major components within the Strategy on Patient-Oriented Research? • SUPPORT Units and Networks; • training and career support; • strengthen organizations; • support best practices • Will it be possible to implement these strategies locally? If not, why?

17. President’s Advisory Board Mandate: Provide the President of the CIHR with high-level strategic advice on patient-oriented research

18. Thank you