Adopting Research to Improve Care (ARTIC)

What is ARTIC?

The Adopting Research to Improve Care (ARTIC) Program is a proven model that accelerates the spread and implementation evidence-based health care interventions into broader clinical practice across Ontario’s health system.

Why ARTIC?

Too often research evidence that improves quality care is successfully implemented and adopted into practice in one organization, yet this knowledge is never spread to other organizations. The ARTIC Program’s unique model of supporting and accelerating the use of evidence-based care means we’re able to implement change a lot faster – within 2 years, instead of 17.

By helping to quickly and effectively spread evidence-based interventions, ARTIC ensures patients across Ontario receive the highest quality care.

How does ARTIC work?

Every year, the ARTIC Program issues a call for proposals for projects that will spread high-impact clinical interventions or practice changes that proven to work and are ready for spread. After completing a comprehensive review process, a project(s) is selected to spread across Ontario’s health system.

Effective evidence implementation and change management requires large investments of time, resources and knowledge.

ARTIC breaks down the barriers that commonly prevent uptake using a model that is based on five enablers:  strategic selection of interventions that have the potential for high impact; education and training; guidance and facilitating; executive championship and a clear governance structure; and evaluation.

ARTIC’s unique and proven infrastructure brings evidence-based care faster and more consistently to more people in Ontario and is now a resource for all health care organizations across Ontario.

Do you have proven research evidence that has already been implemented and is now ready for spread? Stay tuned for ARTIC’s annual call for proposals.

Background

The Council of Academic Hospitals of Ontario (CAHO) originally developed the ARTIC Program in 2010 to accelerate the adoption of research evidence within hospital settings. In 2014, CAHO and Health Quality Ontario (HQO) formed a partnership to transition ARTIC into a provincial resource to support the rapid implementation of evidence-based interventions across the range of health care delivery organizations in Ontario.

Current ARTIC Projects

  • Primary Care Memory Clinics, led by Dr. Linda Lee, enable family doctors in rural, remote and underserved Ontario communities to provide better care for those living with memory disorders. More than 85 memory clinics have been established across Ontario. With support from ARTIC, Dr. Lee will train clinicians and other health professionals in an additional 17 clinics in isolated and underserviced communities, accelerating the spread of a proven intervention that improves the quality of care for people living with dementia.
  • Choosing Wisely: An Idea Worth Spreading, led by Dr. Donna McRitchie and Deepak Sharma (North York General Hospital), aims to enable the adoption of hospital-relevant Choosing Wisely recommendations among the Joint Centres for Transformative Health Care Innovation, as well as targeted primary care recommendations across the associated Departments of Family and Community Medicine. The project will also develop implementation toolkits to be shared with health care providers across Canada.
  • Depression and Alcoholism – Validation of an Integrated Care Initiative (DAVINCI), led by Dr. Andriy Samokhvalov and Saima Awan (CAMH), aims to ensure patients with both a major depressive disorder (MDD) and alcohol dependence (AD) have access to a person-centered, evidence-based integrated care pathway;
  • Mentorship, Education, and Training in Addictions: Primary care-Hospital Integration (META:PHI), led by Dr. Meldon Kahan (Women’s College Hospital), integrates the alcohol or opioid addiction treatment provided by emergency department staff, addiction physicians, and primary care providers;

ARTIC Special Event

CAHO hosted a successful full-day event celebrating the ARTIC Program on March 3, 2014 at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital. This event, “Strong Foundations, New Collaborations,” profiled the CAHO community as innovators and leaders with a commitment to improve Ontario’s health care system. The common themes presented were: adopting research into practice requires partnership, collaboration and change management; and this is purposeful work that requires infrastructure, support and accountability.

This event underscored ARTIC’s tremendous potential to spread across the province with the help of valued partners including The Honourable Deb Matthews, Minister of Health and Long-Term Care (MOHLTC); Susan Fitzpatrick, Assistant Deputy Minister, Negotiations and Accountability Management Division, MOHLTC; and Dr. Joshua Tepper, President and CEO, Health Quality Ontario (HQO).

Along these lines, CAHO and HQO are working together to continue the ARTIC Program’s evolution as a platform for moving evidence into action. Tepper said at the special event, “The opportunity of HQO to work together with CAHO is huge; specifically the opportunity to move this more broadly into the system is incredibly exciting.”

To read the related Catalyst article covering the special event, go here: http://bit.ly/1f3j6t3.

Phase I Evaluation of the ARTIC Program 

CAHO recently conducted an Evaluation of the ARTIC Program, to assess if the program is meeting its objectives. This is meant to shape the future of the ARTIC Program and ensure that it is providing the right mix of supports to effectively facilitate the rapid movement of evidence into practice.

The key findings of the Report, released on November 15, 2013, are:

  • ARTIC’s design and structure support, enhance and accelerate the implementation of research evidence into Ontario’s health care system, the Program’s primary objective.
  • The ARTIC Program is well positioned to make a significant impact on quality improvements in Ontario’s health care system going forward.
  • The guidance and management from the centralized program office have been invaluable to the successful implementation of ARTIC Projects and have increased standardization and quality across projects.

The evaluation also identified areas for improvement. According to the evaluation, the ARTIC program is capable of spread and scale beyond CAHO hospitals. This includes the documentation and sharing of guidelines with a broader community of stakeholders and organizations. Other recommendations include the adoption of regular feedback mechanisms for all projects, as well as the definition and adoption of standardized metrics for measuring value, impact and sustainability across all current and future.

CAHO engaged Cathexis Consulting to conduct the evaluation and produce a report. The full report, by Cathexis Consulting Inc., is attached for your reference: CAHO ARTIC Phase 1 Evaluation Final Report.

Phase II Evaluation of the ARTIC Program 

CAHO recently conducted the Phase II evaluation to assess the impact, value and sustainability of the ARTIC Program. The Phase II Evaluation of the ARTIC Program had six key findings:

1. The ARTIC program made implementation of evidence-based interventions more likely, faster and more consistent with the research evidence.

2. The ARTIC program supported high levels of sustainment.

  • The first four ARTIC projects were fully sustained in 76% of the sites. This is an impressive sustainment rate, when compared with other relevant Ontario-based multi-site studies that cite sustainment rates of 50-60%.

3. Directly through ARTIC, the 6 projects were spread to 79 sites and beyond.

  • An unexpected, but very positive, outcome of ARTIC was extensive spread of its projects’ interventions to more than 200 additional hospital sites. The ARTIC program acted as a spread agent by connecting the project leads with potential adopters.

4. The ARTIC program built substantial implementation capacity and leadership across the system.

  • The ARTIC program built a broad range of capacity and leadership in the implementation of research evidence by providing active hands-on implementation experience to >25 researchers, >220 site champions/ coordinators, and >1500 site staff/volunteers.

5. Each of the ARTIC projects reported broader healthcare impacts.

  • The ARTIC projects collectively impacted the care of over 18,000 patients. The lead project teams reported a variety of outcomes related to improved patient care, interprofessional collaboration, patient experience, health outcomes, and system efficiency.

6. The unique value of the ARTIC program lies in its proven model for implementing established evidence-based interventions.

  • ARTIC has proven effective at implementing selected evidence-based interventions in multiple sites consistently, rapidly, and with high levels of fidelity and sustainment. The ARTIC program is unique: there are no other programs in Canada that focus exclusively on intensive multi-site implementation of established interventions.

CAHO engaged Cathexis Consulting to conduct the evaluation and produce a report. The full report, by Cathexis Consulting Inc., is attached for your reference: CAHO ARTIC Phase II Evaluation Final Report

CAHO is pleased that the Program is successfully meeting its goals in supporting the wide-spread adoption of evidence and positively impacting health care in Ontario. In partnership with Health Quality Ontario, CAHO is expanding ARTIC to build a cross-sectoral systematic pathway for evidence implementation. Five years after the creation of the ARTIC Program, it has been validated as a proven model for accelerating and supporting the sustainable and wide-spread implementation of research evidence.