Alberta Health Services

Statistics Canada uses two self-report measures – Ancestry and Identity – in the Canadian Census to identify First Nations, Inuit and Métis (FNIM) peoples. How these measures are employed alone or in combination to assess definitional impact on the reporting of health conditions has not been investigated. To illustrate, we assessed how these measures, alone or in combination, estimate colorectal cancer rates. A working group comprised of Indigenous and non-Indigenous academics assessed the response patterns to the Identity and Ancestry questions in the 2006 Canadian Census Health and Environment Cohort and categorised the responses into groups: A) Identity only; B) Ancestry only; C) any Ancestry or Identity; D) both Ancestry and Identity. We then assessed concordance, and subsequently examined the way these groupings may impact the reporting of colorectal cancer rates (2010–2015). FNIM responses varied across the different combinations of the Ancestry and Identity questions. Concordance for FNIM was 76%, 81%, and 18% respectively for single responses, which impacted the estimation of colorectal cancer rates. To improve health reporting, it is essential that research teams choose the most appropriate definition in partnership with FNIM and urban Indigenous organisations to ensure the right data are analysed to align with community priorities.

Gallstones are rarely seen in preterm neonates with most cases reported in term singletons without any identifiable risk factors. Although most cases are self-resolving, neonatal gallstones can be associated with significant complications. We report a case of 34-week gestation monochorionic diamniotic twins with twin anemia-polycythemia sequence (TAPS) where the recipient twin presented with gallstones on the first day of life. To the best of our knowledge, this is the first case of gallstones in preterm twins following TAPS.

Overuse of hospital laboratory testing has been identified as a priority for quality improvement (QI). A multifaceted initiative to reduce blood urea nitrogen (BUN) ordering was implemented in hospitals across one Canadian province, preceded by either a system-focused (SF) [electronic medical record (EMR)], person-focused (PF) [performance audit and education], or no intervention. The purpose of this study was to demonstrate the impact of sequencing and combining interventions on Medicine physician BUN test ordering practice beyond a single hospital context. An interrupted time series with segmented regression analysis was completed. The total monthly BUN count for six hospital Medicine programs located in three different health zones in Alberta for a period of 6 and 7 years were grouped into EMR hospitals (n = 3) and non-EMR hospitals (n = 3) post-QI initiative participation. Monthly BUN test order count. Monthly BUN test ordering for each hospital medicine program resulted in a cumulative reduction of 51 to 95%, respectively. The highest reduction (95%, slope p < 0.001) occurred with the intervention sequence of PF followed by SF, with EMR implementation. A similar reduction (93%, slope p = 0.095) was observed when PF and SF were implemented concurrently, followed by an additional PF intervention. Hospitals with EMR implementation showed less data variability month-to-month compared to non-EMR hospitals. Lower reductions occurred with PF followed by another PF intervention (57%, slope p = 0.33) and a single PF intervention without follow-up (51%, slope p = 0.62). Reviewing total monthly BUN ordering over several years revealed that no intervention sequence or combination was similar; however, all (urban and rural) hospitals had continued reductions. An intervention applying the sequence of PF, SF, with EMR implementation while incorporating other influential factors is essential for sustained behavioral change. Effective implementation may require consideration of hospital workflows, practitioner norms, costs, and policy changes for broader adaptability.

Increasingly, health leaders recognize climate change as a crucial issue for healthcare operations, requiring a whole-of-system approach to mobilizing governance, leadership, and resources to respond appropriately. Granular-level guidance is needed to guide the operationalization of adaptation, resiliency, and mitigation strategies specific to acute-care clinical operations within Canadian health facilities. We present the Climate-Resilient Acute Care Clinical Operations Framework to guide the development, implementation, and evaluation of strategies within clinical operations to build more climate-resilient acute care systems. The experience of Alberta Health Services, which is currently the largest provider responsible for the delivery of acute care within Alberta, is highlighted as a case study to demonstrate the practical adoption of this framework. As more health systems adopt similar strategies, sharing data and insights generated will contribute to ongoing iterations and adaptations, ensuring the framework evolves to meet the dynamic needs of healthcare sustainability.

Objective We estimated the real‐world cost‐effectiveness of a standardized education and exercise therapy program (GLA:D®) compared to usual care (UC) for people managing hip and/or knee osteoarthritis (HKOA). Methods We used a prospective matched cohort design to recruit people (age>45 years) diagnosed with HKOA who used GLA:D® or UC (not on a surgical waitlist) throughout Alberta, Canada. Demographics, pain, function, quality of life, and an HKOA‐related cost questionnaire were administered over 12 months. The primary Ministry of Health (MOH) perspective used administrative data to estimate all public healthcare costs. The secondary healthcare perspective included MOH, private insurance, and out‐of‐pocket costs. We calculated our cost‐effectiveness measure, incremental net monetary benefit (INMB), over 12 months with a $30,000/QALY willingness to pay threshold and adjusted for the differences between cohorts. A Markov model was used to extend INMB over a lifetime time horizon (3 Results 254 participants (GLA:D® n=127, UC n=127; 72$6,065 (95%CI:3,648‐8,482) and $499 (95$2,913‐$3,912) from a MOH and healthcare perspective over 12 months and$6,574 and $1,775 over a lifetime with 54$30,000 per QALY. Conclusions GLA:D® had a positive INMB compared to UC from the MOH perspective over 12 months. The INMB remained positive but was less certain over a lifetime or when out‐of‐pocket and private insurance costs were considered.

Introduction PJ paralysis refers to the negative effects experienced by hospitalised patients who remain inactive and dressed in hospital clothing, and is a serious problem, affecting one-third of hospitalised older adults. This study evaluated the impact of a multicomponent hospital-based intervention to get patients out of bed, dressed in non-hospital attire, and moving around/mobilised. Methods A 3-month quality improvement initiative was conducted at one hospital unit in Western Canada, which aimed for 50% of all patients to be dressed in their own clothing by midday, sitting up in a chair for all meals and mobilising to activities. Healthcare providers, patients and family members received PJ paralysis education, and a new patient dress code care standard and physician patient care order were implemented. Measures included: daily percentage of patients dressed and up for meals, weekly mobilisation rates, patient and provider satisfaction, and complication rates. Descriptive statistics were completed. Results From July to October 2019, 70 patients participated. Approximately 14.3% of patients were dressed in their own clothing daily, 6.4% were sitting for all three meals, and the weekly mean number of patients mobilising to activities was 0.9 (SD 0.7) and mobilising for other reasons was 4.5 (SD 1.3). Five physician care orders were written. A trend was observed towards decreased falls, with minimal change in the number of staff, nursing assessment time and complication rates. Patient feedback revealed improvement in their self-identity. Conclusion Alleviating PJ paralysis in hospitalised older patients requires a complex multifactorial approach. Despite not achieving the project aim, the intervention demonstrated positive impacts without complications or additional workload, and ease of implementation suggests feasibility and (potential) long-term sustainability. Further research is needed to explore the experiences and perceptions of patients and healthcare providers to identify facilitators and barriers, which may aid in enhancing and implementing future interventions.

To develop a concise Consensus Statement on the management of venous leg ulcers (VLUs) that incorporates existing standards and guidance on new technology, including improvement of calf muscle pump function and the utilisation of advanced wound therapies. A multidisciplinary panel of 19 wound healthcare providers from across Canada, who treat patients with VLUs, was formed. A draft document was created and four rounds of consultation and feedback were sought from the panel. The Consensus Statement was completed in June 2024 with 100% consensus on 20 sections and > 85% consensus on the remaining three sections. The key elements are—Clinical assessment and investigations; Treatment‐compression to improve calf muscle pump function, and wound treatment with the principles of Wound Bed Preparation; When not healing or only suboptimal compression can be used ‐ add treatment with muscle pump activator by continuous Neuromuscular Electrical Stimulation of the common peroneal nerve to improve calf muscle pump function; When VLUs are not healing with optimal therapy ‐ an algorithm for the use of advanced wound therapies; and Prevention of VLU recurrence. The Consensus Statement is a concise guide for healthcare providers to use at the bedside and has been endorsed by leading nursing and homecare associations in Canada that also have physician representation.

OBJECTIVE To examine relationships between maternal glucose and breast milk composition and volume ingested by infants of mothers with type 1 diabetes (T1D), and to compare breast milk composition in women with and without T1D. RESEARCH DESIGN AND METHODS Midfeed breast milk samples were collected from 11 mothers with T1D. Maternal continuous glucose monitoring data were correlated with breast milk composition and volume ingested. Breast milk composition was compared between the women with T1D and five without T1D. RESULTS Forty-seven breast milk samples from mothers with T1D were analyzed. Maternal glucose 90–120 min before breastfeeding correlated with breast milk glucose and fructose but not with lactose, protein, fatty acids, leptin, or volume consumed. Breast milk leptin correlated with volume of breast milk consumed (r = 0.394; P = 0.008). Higher breast milk glucose (1.0 ± 0.3 vs. 0.7 ± 0.3 mg/mL) and leptin (463.6 ± 480.0 vs. 114.4 ± 68.6 pg/mL) were found in women with versus without T1D. CONCLUSIONS Maternal glucose is associated with breast milk glucose and fructose in women with T1D but not with volume of breast milk consumed.

Background Neonatal intensive care units (NICUs) often experience high acuity clinical events and can benefit from clinical event debriefing. Post-event team debriefs can reinforce success, identify areas for improvement, and support healthcare providers’ (HCP) psychological coping. However, barriers exist to debriefing regularly. Objective To implement and evaluate a structured clinical event debriefing program in four NICUs within a regional neonatal program. Methods We assembled a multi-disciplinary team of clinicians and debriefing specialists, adapted an existing tool, and identified site champions. A database, debrief triggers, and feedback processes were developed. We chose charge nurses as facilitators. Facilitators were trained in 2-h virtual sessions. Debriefs were started and tracked. A post-implementation survey was conducted after 6 months. Results Eighty-one HCPs responded to the pre survey. Respondents identified time constraints and skill /availability of facilitators as barriers to clinical event debriefs. Most were comfortable with debriefs prior to implementation. Ninety-five debriefs were conducted over 6 months. Median 7 (IQR 5–8) HCPs attended. Most were led by trained nurse facilitators. Debriefs took a median 12 min (IQR 8–17), and generated recommendations for equipment, teamwork, and process issues. Barriers to implementation included availability of trained facilitators, time constraints and competing quality improvement (QI) priorities. The post-implementation survey showed positive views of structured debriefs. Participants still listed time constraints as the main barrier to debriefs, although less than prior. Conclusion Nurse-led, structured clinical event debriefing can be implemented in NICUs. Clinical event debriefs allow HCPs to participate in identifying systems issues and solutions.

Background Children with cancer face an increased risk of complications and death beyond the 5‐year survival mark. National surveillance efforts facilitate the systematic tracking of long‐term health outcomes, including treatment‐related complications and late mortality, among childhood cancer survivors. We aimed to describe the population of 5‐year childhood cancer survivors in Canada, quantify the risk of death among survivors relative to the general population, and identify characteristics associated with late mortality. Methods This retrospective cohort study used the Canadian Cancer Registry linked to the Canadian Vital Statistics‐Death database (excludes Quebec). Survivors were diagnosed with cancer before 15 years old (1992–2012) and still alive five years after diagnosis. We approximated the risk of late mortality relative to the general population using standardized mortality ratios (SMRs) and absolute excess ratios (AERs). Cumulative all‐cause and cause‐specific mortality and time‐to‐event models identified characteristics associated with late mortality. Results Of the 10,800 5‐year survivors, 405 (4%) had a late death by 2017 (median follow‐up: 9.1 years). Cancer recurrence or progression caused most late deaths (64%), followed by subsequent primary neoplasms (11%) and other health‐related causes (15%). Survivors had a higher risk of all‐cause mortality than the general population (SMR = 9.4; 95% CI = 8.5–10.4; AER = 34.8, 95% CI = 30.8–38.8). Risk was highest in the first 5–9 years of follow‐up. Cumulative mortality differed significantly by age at diagnosis, sex and cancer type. Interpretation Our results underline the importance of long‐term surveillance of childhood cancer survivors, as mortality rates remain higher than the general population for at least two decades after diagnosis.

Delphi studies in disaster medicine lack consensus on expert agreement metrics. This study examined various metrics using a Delphi study on chemical, biological, radiological, and nuclear (CBRN) preparedness in the Middle East and North Africa region. Forty international disaster medicine experts evaluated 133 items across ten CBRN Preparedness Assessment Tool themes using a 5‐point Likert scale. Agreement was measured using Kendall's W, Intraclass Correlation Coefficient, and Cohen's Kappa. Statistical and machine learning techniques compared metric performance. The overall agreement mean score was 4.91 ± 0.71, with 89.21% average agreement. Kappa emerged as the most sensitive metric in statistical and machine learning analyses, with a feature importance score of 168.32. The Kappa coefficient showed variations across CBRN PAT themes, including medical protocols, logistics, and infrastructure. The integrated statistical and machine learning approach provides a promising method for understanding expert consensus in disaster preparedness, with potential for future refinement by incorporating additional contextual factors.

Background Cerebral Palsy (CP) is the most common childhood-onset motor disability. Play-based early intensive manual therapies (EIMT) is an evidence-based practice to improve long-term hand function particularly for children with asymmetric hand use due to CP. For children under two years old, this therapy is often delivered by caregivers who are coached by occupational therapists (OTs). However, why only a few Canadian sites implement this therapy is unclear. There is a need to identify strategies to support implementation of EIMT. The primary objective of this study was to identify the facilitators and barriers to EIMT implementation from the perspectives of (1) caregivers of children with CP (2), OTs and (3) healthcare administrators for paediatric therapy programs. Methods The Consolidated Framework for Implementation Research (CFIR) was used to guide development of an online 5-point Likert scale survey to identify facilitators (scores of 4 and 5) and barriers (scores of 1 and 2) to implementation of EIMT. Three survey versions were co-designed with knowledge user partners for distribution to caregivers, OTs, and healthcare administrators across Canada. The five most frequently endorsed facilitators and barriers were identified for each respondent group. Results Fifteen caregivers, 54 OTs, and 11 healthcare administrators from ten Canadian provinces and one territory participated in the survey. The majority of the identified facilitators and barriers were within the ‘Inner Setting’ CFIR domain, with ‘Structural Characteristics’ emerging as the most reported CFIR construct. Based on the categorization of the most frequently endorsed facilitators and barriers within the CFIR domains, the key facilitators to EIMT implementation included the characteristics of the intervention and establishing positive workplace relationships and culture. The key barriers included having workplace restrictions on EIMT delivery models and external influences (e.g., funding) on EIMT uptake. Conclusions We identified key facilitators and barriers to implementing EIMT from a multi-level Canadian context. These findings will inform the next steps of designing evidence-informed and theory-driven implementation strategies to support increased delivery of EIMT for children under two years old with asymmetric hand use due to CP across Canada.

Background The increasing rates of early-onset colorectal cancer in Canada suggest that earlier screening may be warranted. Canadian guidelines recommend biennial screening at 50 years of age with a fecal immunochemical test (FIT). Methods OncoSim was used to project the outcomes of revised colorectal cancer screening guidelines in Canada for four cohorts born between 1973 and 1992. Cohort risk ratios were calibrated to Canadian incidence data to reflect early-onset trends. We evaluated the incremental colonoscopy burden of earlier FIT screening and primary colonoscopy screening compared with a reference scenario screening with FIT biennially at 50 years of age (FIT 50). Sensitivity analyses were performed by adjusting screening participation and discount rates. Results FIT at 45 and 40 years of age (FIT 45 and FIT 40, respectively) increased the colonoscopy demand by 3.9% and 6.6%, respectively, over the lifetime of screening. Colonoscopy screening resulted in 89.0% to 116.7% more colonoscopies than FIT 50. Screening and total costs increased in all scenarios, but treatment costs decreased. FIT 45 and FIT 40 reduced the incidence by 103 and 161 and colorectal cancer deaths by 43 and 71 per 100,000, respectively. Colonoscopy screening led to 858 to 954 fewer cases and 260 to 303 fewer deaths per 100,000, resp. FIT 45and FIT 40 had incremental cost-effectiveness ratios of $5,850 per quality-adjusted life year (QALY) and$7,038 per QALY, respectively, compared with FIT 50. Colonoscopy scenarios had incremental cost-effectiveness ratios of $2,743 to$7,509 per QALY. Conclusions Updated screening can reduce the colorectal cancer burden in younger populations. Increasing FIT screening with earlier initiation is more feasible logistically than increasing colonoscopy first approaches. Impact These findings may inform future guideline revisions in Canada addressing early-onset colorectal cancer.