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Bridging the gap

December 19, 2011

By Alisa Kim

The latest figures from Statistics Canada show that heart disease is the number two killer of Canadians, surpassed for the first time by cancer. That it is no longer the leading cause of death in Canada can be attributed in part to advances in treatment such as cholesterol-lowering drugs. With risk factors such as obesity and diabetes on the rise, however, the dangers of cardiovascular disease loom large for Canadians.

The enormous burden of heart disease on the health care system is a reality with which clinician-scientist Dr. Jack Tu is all too familiar. A cardiologist and senior scientist in evaluative clinical sciences at Sunnybrook Research Institute, Tu is one of the country's leading health services researchers. His research focuses on improving the quality of cardiac care. The Canadian Institutes of Health Research recently awarded Tu a $2-million team grant to measure and improve the quality of outpatient care of people in Ontario with cardiovascular risk factors or chronic conditions such as heart failure and stroke. Risk factors include smoking, high blood pressure, high cholesterol and diabetes.

"We've been trying to improve the quality of in-patient care for patients with heart disease, and there's been a lot of progress, but we've realized that a lot of what goes on in health care is outside the hospital setting, and relatively little is known about that in Canada," says Tu, who also holds the Canada Research Chair in Health Services Research and is a professor of medicine at the University of Toronto.

Tu will work with 21 researchers from five Ontario universities to carry out the study's threefold objectives. The first aim is to identify a set of quality indicators and performance benchmarks to measure the quality of outpatient cardiovascular care. Such indicators include the proportion of smokers in the community who are offered smoking cessation counselling, the proportion of patients who were tested for diabetes and high cholesterol, and the proportion of patients with high blood pressure whose blood pressure is controlled.

The second objective is to identify the reasons for regional variations in the incidence rates of cardiovascular events such as heart attacks across "physician networks" in Ontario. A physician network consists of specialist physicians who work at a local hospital and primary care doctors who refer their patients to that same hospital. "The concept of physician networks is very new. It's the first time people have studied this concept within a Canadian context," says Tu. His team will use statistical models and interviews with care providers to determine factors that contribute to variations in outcome across these networks within Ontario.

Finally, Tu and his colleagues will work with knowledge users from the province's Ministry of Health and Long-Term Care, and the Heart and Stroke Foundation to publish report cards and papers on the quality of outpatient cardiac and stroke care in Ontario. "We'll work closely with the people who will be using the information we're gathering to make sure that what we're doing will be relevant and helpful to the people who manage and work in the health care system," he says.

Tu says his hope is that through this research, family doctors and specialists will start working together closely to provide the best care possible for patients with chronic diseases. "For the most part, primary care doctors work in isolation from specialists in hospitals. I think this initiative will help promote greater integration and continuity of care, so that when patients leave the hospital, there will be better outpatient care and greater information-sharing."