Research Excellence in Ambulatory Care and Health Care Systems

Research Excellence in Ambulatory Care and Health Care Systems Hotel Dieu Hospital Research Institute 2015/16 Activity Report

The Hotel Dieu Hospital Research Institute (RI) is pleased to report on a successful year in research in fiscal 2015-16, including an increase of over $300,000 in both externally-funded grants (e.g. government) as well as industry-sponsored awards. During the year, the RI has continued to provide support for new projects as well as ongoing assistance to HDH researchers at all stages of research, including literature searches, proposal development, ethics (Queen s HSREB) applications, statistical analysis, and dissemination of results. Support has also included timely review and approval decisions on TRAQ DSS applications, which evaluate impact on hospital resources of proposed projects. We are proud to report on the following six Enabling Directions of the RI s Strategic Plan for 2015-2019. Raising our profile Research symposiums. In 2015-16, the RI hosted two public research symposiums. In June 2015, The Secret World of Knees in the Human Mobility Research Lab showcased the work of Dr. Kevin Deluzio and Dr. Dan Borschneck, as well as Dr. Michael Rainbow s planned High Speed Skeletal Imaging Lab. In December 2015, Mapping the future of breast surgery: Using real-time electromagnetic navigation in breast-conserving surgery, with Dr. Jay Engel, Dr. Gabor Fichtinger, and Dr. Tamas Ungi, attracted the RI s largest symposium audience to date. Both symposiums provided an opportunity to portray the translation of research to clinical care improvements in our ambulatory care setting. Human Mobility Research Lab Photo credit: Human Mobility Research Lab, Queen s University Ophthalmology Research Day. The RI was pleased again this year to participate in the research training of Kingston Ophthalmic Training Centre students. Their work was presented at a poster session on Queen s Ophthalmology Research Day in June 2015 and showcased again in May 2016. One projects has been accepted for publication in the Journal of Ophthalmic Medical Technology. Council of Academic Hospitals of Ontario (CAHO) Healthier, Wealthier, Smarter (HWS) campaign. The HWS campaign overseen by CAHO aims to build the profile and impact of the province s academic research hospitals. To this end, the RI worked with HDH Public Relations, Dr. Heidi Cramm (Queen s Rehab) and Dr. Garth Smith to compile a research story on the challenges and barriers faced by military families who have a child with ASD when navigating the health care system from one deployment to another. In May 2016, the RI worked with Public Relations to plan a CAHO tour of Kingston s hospitals, with HDH research stops including a demonstration of breast cancer surgery piloted at HDH with the use of real time navigation technology, now in clinical trials here; a demonstration of the 3-D printer in the Ophthalmology Surgical Simulation lab and an overview of Ophthalmology research; demonstrations in the Human Mobility Research Lab and a view of the planned High Speed Skeletal Imaging lab; demonstrations of the KINARM and eye tracker in the Neurosciences Clinical lab; and a roundtable discussion of projects in youth mental health. Ophthalmology tour with UHKF. In April 2016, the RI and Dr. Rob Campbell hosted a tour of Ophthalmology clinics and labs at HDH for the Women s Giving Circle, a group of donors interested in advancing research, education and clinical practice at HDH. The RI worked with the University Hospitals Kingston Foundation (UHKF) and HDH Public Relations to promote and publicize the event.

Instruction in Queen s faculties. Vic Sahai, Director of the RI, provided support to Dr. Ana Johnson in teaching Health Economics EPID 807. Vic held three lectures and provided hospital-specific examples related to cost analysis. He also provided support to Dr. William Picket in teaching Epidemiology 399, presenting three lectures and scoring student presentations related to their critical appraisal projects. Institute for Clinical Evaluative Sciences (ICES) involvement. The ICES Data Workshop and ICES Queen s Science Day in December 2015 provided the opportunity for the RI to work with Dr. Ana Johnson (Site Director at Queen s for ICES) to develop project ideas for evaluation of health care at the systems level, and to highlight its own role in health care research with administrative databases. Best Practice Spotlight Organization (BPSO) support. The RI continued to assist BPSO champions at HDH to meet obligations required now that HDH has achieved BPSO designation. With guidance from the RI, Karen Bright, SLP (Professional Practice leader - Allied) will submit a manuscript on her BPSO work, and RN Nancy Benn presented a poster at the 2016 Kingston Nursing Research Conference, based on published BPSO work with RN Jennifer O Neil, also supported by the RI. Nurse-Led Clinic for Chronic Musculoskeletal Pain at HDH. The RI supported Mary-Anne Good in ensuring reliable and useful metrics to determine the success of this newly established clinic. The development of this clinic at HDH and positive outcome measures will demonstrate how the unique skills of the nursing profession can be maximized in an ambulatory care hospital setting. Ophthalmology Surgical Simulation Lab Photo credit: M. Manor, KGH Hotel Dieu Hospital Research Institute 2015/16 Activity Report

Building capacity by increasing external funding including industry Predictors of diabetic remission project (funded by Nestlé Health Science Canada). Based in the Bariatric Regional Assessment & Treatment Centre, this project was developed with assistance from the RI s Research Club as well as Dr. John Drover. It was presented by medical student Shannon Chun at the American College of Physicians Ontario Chapter Annual Scientific Meeting in Toronto in November 2015, and by Ryan Stallard, RD, at the International Conference on Obesity in Vancouver in May 2016. Ryan is also near submission of this paper to the Journal of Parenteral and Enteral Nutrition. High-Speed Skeletal Imaging (HSSI) Lab. The HSSI Lab led by Dr. Michael Rainbow (Queen s Engineering), to be built at HDH, has been funded in 2016 by the CFI ($200,000) as well as an NSERC Research Tools and Instruments grant ($150,000). The HSSI Lab will augment the adjacent Human Mobility Research Lab and the Neuroscience Clinical Lab. The goal of the lab is to develop treatments and preventative strategies for a range of orthopaedic ailments and injuries. We expect the lab to be completed and operational within the next year. Inspiration Plus clinical trial. Also in 2016, Dr. Onofre Moran-Mendoza set up his first clinical trial at the hospital. This Phase IV multicentre trial with Hoffmann-Laroche will investigate the effects of a medication used by patients with idiopathic pulmonary fibrosis, and awards $138,870 for a maximum of 20 patients, with funds held at HDH. The RI assisted Dr. Moran at all stages and continues to help with management of the trial. Chronic Pain Clinic at HDH. In early 2016 the Chronic Pain Clinic at HDH received $250,000 over 5 years to support research, as part of a CIHR SPOR Network in Chronic Disease award of $25 million. A funding proposal to the MOHLTC and implementation plan for integration of the HDH Chronic Pain Clinic into the Collaborative Health Outcomes Information Registry (CHOIR) was developed by Lobna Eslim, an RI volunteer. Sandbox Youth Mental Health Initiative. In 2015, a research project involving Dr. Sarosh Khalid-Khan and her team received funding of $488,749 from the Sandbox Project for research with TELUS Health Solutions. Phase II of the Sandbox Youth Mental Health Initiative will assess the utility of a novel mobile and web-based mental health self-care, education and therapeutic intervention for young people in need of mental health care for common mental disorders (primarily depression, anxiety disorders, and ADHD). The RI has provided ongoing support for this project, from agreement development to help in resolving funds management issues. Military families in Canadian context. For a project related to that mentioned under the CAHO HWS campaign, Dr. Heidi Cramm (Queen s Rehab), along with her co-principal investigator Dr. Sarosh Khalid-Khan and her team from Child and Adolescent Psychiatry, received a $150,000 grant from the Health Research Foundation to study the effects on Canadian military families of frequent mobility and deployment, and in particular access to specialized health care and school accommodations when navigating new civilian health care systems. This is an excellent example of Enabling Direction 3: Developing partnerships to enable collaborative research, discussed below. High-Speed Skeletal Imaging (HSSI) Lab Artist Redering

Developing partnerships to enable collaborative research Student research collaborations. In the 2015-16 academic year, a collaboration with St. Lawrence College has resulted in a research project for a nursing student related to falls rates for short-stay patients who have had joint replacement surgery at HDH. In the 2014-15 academic year, another collaboration involved a survey in the Urgent Care Centre regarding the perspectives of patients on wait times, with a presentation by the student at a Research Club meeting. Urban Poling project. The RI provided support to dietitians Anne MacDonald and Marjan Shalchi in the Diabetes Education & Management Centre in developing a research project on the effectiveness of Urban Poling in sustainment of exercise in diabetic patients. This is a collaboration with Dr. Agnes Coutinho, a kinesiologist at the University of Guelph- Humber. Hand hygiene and vaccine compliance research. The RI has engaged a Queen s Master s of Psychology student Daniel Hargadon in a project on hand hygiene compliance among health care workers. Daniel will be working with Ian Kudryk (Infection Control). His project stems from a Public Health Ontario (PHO) workshop, Applying Behaviour Change Strategies in IPAC, that was co-hosted by the RI and Queen s in October 2014. Further, a PHO grant of $61,145 was awarded for a project on changing hygiene behaviour to key PHO and Queen s researchers who were integral to the workshop. Two major papers involving these Queen s researchers (Dr. Tara MacDonald and Dr. Lea Fabrigar) have been accepted for publication in Vaccine and Journal of Hospital Infection. HDH values research. A research project on the religious values of HDH and their historical correlation with performance, staff satisfaction and patient-centered care is being developed by the RI with Rev. Dr. Neil Elford and Sherri McCullough. Transparency and openness through the engagement of researchers CAHO metrics/financials. Again this fiscal year, the RI worked with the KGH Research Institute, Providence Care, Queen s and HDH Finance to submit research financial and metric data to CAHO. In 2014-15, total revenue was calculated at $2,358,692.80, an increase of 15.88 % from $2,035,467.30 in 2013-2014. Hospital RI update meetings. Meetings with KGH RI and Providence Care every two to three months have provided the opportunity to discuss issues of common concern and collaborative plans. Model of care indicators. The RI continues to HDH Program Managers in developing model of care indicators for their portfolios, and in gathering and analyzing data for these indicators. This includes assistance to the program managers in evaluating the program changes to ensure that there are no unintended consequences to patient care and outcomes. Hotel Dieu Hospital Research Institute 2015/16 Activity Report

Moving research into practice Breast Assessment Program (BAP) telemedicine project. The RI has been involved in development of a research project on the use of telemedicine in nursing consults for patients with new breast cancer diagnoses. The project aims to compare the effects of telemedicine and face-to-face consultations on anxiety reduction and knowledge retention in these patients, and to use the results to potentially expand the offer of telemedicine to patients in distant locations. Otolaryngology (ENT) telemedicine project. The RI had the opportunity to assist in the launch of a pilot study involving patients from Ininew Patient Services who present with a primary ear complaint. A telemedicine visit will include images of their ear captured by an otoscope with a camera attached. The outcome measures will include diagnostic accuracy and wait time to see a specialist. NaviENT study. The RI assisted otolaryngologist Dr. Russell Hollins in acquiring the approvals (e.g. from Health Canada, HSREB and TRAQ DSS) for testing of an investigational device in sinus surgery, an image-guided navigation system that could in functional endoscopic sinus surgery. UCC research projects. After a recent Urgent Care Centre patient survey, the RI assisted with entry and analysis of data, including entry and analysis of time logs that will be used to demonstrate improvements in wait times for care at the UCC to the SE LHIN. Hand Hygiene Research. In Q1 and Q2, the RI had two Letters to the Editor accepted for publication, in Education for Health and the Canadian Journal of Infection Control. These addressed different aspects of the research project, led by RI Director Vic Sahai, on hand hygiene knowledge, attitudes and self-reported behaviour among medical students and residents. An invited paper on the entire project has been accepted by the Canadian Journal of Infection Control. Spirometry research. In April, Angie Zapotichny, RT presented her research project on the effect of animation on spirometry measures to the Management Communications Committee. Angie s project was first developed at the RI Research Club and is now in preparation for journal submission to The Canadian Journal of Respiratory Therapy.

Supportive infrastructure that enhances research and knowledge translation Orientation requirements for Research hospital appointments. The RI worked to finalize Orientation requirements for individuals who are credentialed to do research at HDH. With the assistance of the medical administration and Department of Education & Organizational Development, a booklet was developed covering essential aspects of General Orientation. At the September 2015 Medical Administration Committee Executive meeting, the updated relevant policies were approved and have since been consistently applied. Research policies. The RI has been working to review and revise research policies on hospital research requirements, overhead, intellectual property, research accounts, and Standard Operating Procedures so as to reflect current practice. Child & Adolescent Mental Health centralized triage project. This project was successful in acquiring further funding. The RI was requested by psychiatrist Dr. Khalid-Khan to work with Human Resources and Finance to resolve compensation issues, and was able to do so successfully. Tools for Research at Queen s Data Summary & Signature (TRAQ DSS) applications. The RI continues to work internal stakeholders, the Queen s TRAQ team and its partner hospitals to streamline the TRAQ DSS application procedure for researchers. This has included adding a template form to provide more information regarding use of hospital resources. Other hospital research-related approvals. The RI has also worked with Queen s and hospital lab managers to become proficient in guiding researchers in biohazard permit requirements and applications needed for use of HDH labs. Research office for Urology. Additional inroads into research at the hospital include the establishment of a research office for Urology, enabling easier access to patients for the clinic s well-established research program. Ethics best practice development. The RI collaborates with the HSREB to define best practice in ethics approval for research. For example, the RI has provided information to the Queen s ethics compliance advisor for the development of an SOP on research data security. Board and Members meetings. The RI held its 7th Board meeting and 4th Members meeting in June 2015, and its 8th Board meeting in October 2015. In June 2015, the RI welcomed Dr. Michael Fitzpatrick, Chief of Staff, to its Board of Directors. Accreditation. The RI was involved in preparing for hospital-wide accreditation by Accreditation Canada in September 2015, and was pleased that the hospital was accredited with exemplary standing, and that the accreditors noted the dynamic research environment in our ambulatory care setting. Volunteers with the RI. In 2015-16, three volunteers worked on projects that would otherwise compete with the many priorities of the RI. Karen Eden volunteered for three years with the RI and assisted with many projects, including research into hand hygiene attitudes and behavior, and also supported the BAP telemedicine project. Karen has moved on to employment in research projects with the HDH Child Development Centre. Lobna Eslim drafted a business plan for the Health Care Tomorrow team on a centralized plan for the HDH/KGH Diagnostic Imaging intake clinic, and also developed a project plan for the Collaborative Health Outcomes Information Registry (CHOIR). She is now employed at Providence Care in IT project management. Shikha Gupta worked on submission of a paper on the epidemiology of rheumatoid arthritis to the Canadian Journal of Public Health, and continues to work on other projects. The RI is indebted to its past and present volunteers for their contribution to excellence in ambulatory care and health care system research. Hotel Dieu Hospital Research Institute 2015/16 Activity Report

Publications: Sahai V, Eden K, Glustein S. Hand hygiene and health care hierarchy: a resident s perspective. Educ Health. 2014;27(3):297-298. Sahai V, Eden K, Glustein S. Hand hygiene and health care hierarchy by year of medical education. Educ Health. 2015;28(2):148-149. Sahai V, Eden K, Glustein S. Medical hierarchy and comfort level with HH requests. Can J Infect Control. 2015 (fall). Sahai V, Eden K, Glustein S, Nesdole R. Hand hygiene knowledge, attitudes and self-reported behaviour in family medicine residents. Can J Infect Control. 2015 (winter). Manuscript in press: Simpson, HL, Sahai V, Simms C, Glustein S, Campbell RJ. Comparison of a biometry ultrasound probe and a standardized A-scan ultrasound probe for axial length measurements. Journal of Ophthalmic Medical Technology. Manuscripts in development: Stallard R, Sahai V, Drover J, Chun S, Keresztes C. Defining And Using Pre-Operative Predictors Of Diabetic Remission Following Bariatric Surgery. To be submitted to the Journal of Parenteral and Enteral Nutrition. Towheed T, Glustein S, Gupta S, Sahai V. Quantifying the Arthritis Pyramid for Ontario by Using Comprehensive Community Health Data. Zapotichny A, Sahai V, Gupta S, Moran-Mendoza O. Use of Computer Animation Programs as an Incentive to Adults Performing Maximal Expiratory Flow During Spirometry. To be submitted to the Canadian Journal of Respiratory Therapy. BPSO-related publications: Bright K. Implementing Best Practice for Fall Risk Assessment in Ambulatory Care. To be submitted to the Journal of Patient Safety. O Neil J, Benn N. Moving from vision to reality: A success story in enhancing foot complication risk assessments, education and documentation. Diabetic Foot Can. 2015; 3: 34 39. Poster presented by Nancy Benn at the Kingston 2016 Nursing Research conference. Publications originating out of the Public Health Ontario workshop, Applying Behaviour Change Strategies in IPAC that was co-hosted by the RI and Queen s in October 2014: Corace, K., Srigley, J. A., Hargadon, D. P., Yu, D., MacDonald, T. K., Fabrigar, L. R., & Garber, G. (in press). Using behavior change frameworks to improve healthcare worker vaccination rates: A systematic review. Vaccine. Srigley, J. A., Corace, K., Hargadon, D. P., Yu, D., MacDonald, T. K., Fabrigar, L. R., & Garber, G. (in press). Applying psychological frameworks of behavior change to improve healthcare worker hand hygiene: A systematic review. Journal of Hospital Infection.