CARDIOVASCULAR SURVEILLANCE IN CANADA A Clinicians Perspective

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CARDIOVASCULARSURVEILLANCEIN CANADA A
Clinicians Perspective

• Jack V. Tu, MD PhD FRCPC
• Team Leader, Canadian Cardiovascular Outcomes
• Research Team (CCORT)
• Canada Research Chair In Health Services Research
• Senior Scientist, Institute for Clinical
  Evaluative Sciences
• Professor of Medicine, Public Health Sciences
• and Health Policy, Management, Evaluation,
• Sunnybrook Health Sciences Centre, University of
  Toronto

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CARDIOVASCULARSURVEILLANCE

• There is a lot of interest among many clinicians
  in cardiovascular disease surveillance.
• Wielgosz A, Arango M, Johansen H, et al. eds.
  The Growing Burden of Heart Disease and Stroke in
  Canada 2003, Heart and Stroke Foundation of
  Canada, May 2003
• TU JV, Ghali WA, Pilote L, Brien S. eds. CCORT
  Canadian Cardiovascular Atlas. Pulsus Group Inc.
  and Institute for Clinical Evaluative Sciences,
  Toronto, 2006 (www.ccort.ca/atlas.asp)

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CLINICIANS (DATA)
RESEARCHERS (STATISTICS)
ADMINISTRATORS ()
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RATIONALE FOR INTEREST (NEEDS)

• Clinical Practice
• Outcome Assessment PCI, CABG
• Quality Improvement AMI, CHF
• Patient Safety and Adverse Events
• Research
• Academic Publications
• Health Policy Management
• Hospital Utilization - Resource allocation

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CLINICAL vs ADMINISTRATIVE DATABASES

• Many clinicians do not have much faith in the
  CIHI Discharge Abstract Database
• Most clinicians prefer clinical databases
• But clinical databases are expensive and
  time-consuming to collect
• Administrative databases still have very
  important role to play.

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CHALLENGES TO CARDIOVASCULAR SURVEILLANCE

• Lack of standardized cardiac databases in Canada
• Limited grant and operating funding for database
  development / data entry
• Most clinicians dont have a statistical
  background
• Competition among academic investigators
• Data ownership concerns Fear of misuse
• Lack of statistical personnel to do surveillance
• Privacy legislation
• Multiple groups involved (Federal, Provincial,
  Regional)

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POTENTIAL SOLUTIONS

• ADMINISTRATIVE DATABASES
• Reduce barriers and costs to accessing CIHI and
  Statistics Canada, provincial administrative
  databases
• Provide more timely, user-friendly access to
  administrative data reports
• External data quality audits Enhance confidence
  of clinicians in administrative data
• Involve clinicians in enhancing administrative
  data

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POTENTIAL SOLUTIONS

• CLINICAL DATABASES
• Try to develop national standards (e.g., data
  definitions) for clinical databases
• Try to develop secure funding for establishment
  and maintenance of clinical registries
• Try to widen investigator access to these
  clinical databases
• Involve administrators in their development and
  dissemination
• Develop more clinical databases across broader
  spectrum of CV disease

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Clinical databases (contd)

• Support training of students in cardiovascular
  surveillance
• Support projects exploring potential of
  electronic medical records
• Advocate for privacy legislation/policies that is
  supportive of databases/registries/data sharing
• Support data linkage projects (e.g. clinical,
  hospitals, drug, vital stats, physician billing,
  etc.)
• Support teams and individual academic
  investigators interested in surveillance-type
  research and work through operating grants /
  career awards, etc.
• Support establishment of Framingham type cohort
  studies.
• Support establishment of one or more secure
  clinical data centres.

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CONCLUSION

• There is a growing need for cardiovascular
  surveillance in Canada
• Need to make better use of existing data and
  promote data linkages
• Need to selectively develop new clinical data
  sources
• Need to promote importance of surveillance
• to Universities, policy makers, students.
• 5. Greater dialogue between clinicians,
  researchers and administrators