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Digestive Health Strategic Clinical Network™ Transformational Roadmap 2017-2021
Digestive Health
Strategic Clinical Network
Transformational Roadmap
2017-2021
AHS Vision:
Healthy Albertans. Healthy Communities.
Together.
Our Vision:
The best digestive health for all Albertans.
Our Mission:
Innovate and collaborate to create a person-focused,
high quality digestive health system through
prevention, research, and best practices.
February 20, 2018
1
Digestive Health Strategic Clinical Network™ Transformational Roadmap 2017-2021
Table of Contents
A Word from our Leadership Team 3
Executive Summary 4
Summary Infographic 6
Introduction 7
About the Digestive Health SCN 7
Development of our Transformational Roadmap 2017 – 2021 8
Our Strategic Goals 9
Strategic Goal: Integrate Primary/Specialty Care 10
Strategic Goal: Deliver high quality, standardized digestive healthcare 12
Strategic Goal: Provide clinically appropriate and efficient care 14
Strategic Goal: Prevent Digestive Diseases 15
Our Principles 17
Our Enablers 19
Research and Innovation 21
Conclusion 23
Appendix A: Strategic Clinical Network Leadership and Core Committee Members 24
Appendix B: Glossary 26
Appendix C: References 31
November 1, 2017
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Digestive Health Strategic Clinical Network™ Transformational Roadmap 2017-2021
A Word from our Leadership Team
The Digestive Health Strategic Clinical Network™ (SCN™) is dedicated to achieving the best
digestive health for all Albertans. This four year transformational roadmap is a dynamic and
integrated plan that sets an ambitious collective vision for the future of digestive healthcare in
Alberta. We have asked questions, analyzed data, and sought answers broadly on how to improve
care and outcomes for people with or at risk for digestive diseases. With input from patients and
families, physicians, front-line healthcare workers, researchers, administrators, community-based
organizations, and policy makers, we have created a roadmap that outlines the SCN’s strategic
goals and describes how these goals will be accomplished.
The Digestive Health SCN’s goals are to: improve access to gastroenterology services for all
Albertans and integrate the care delivered by primary care providers and specialty teams; support
the delivery of high quality digestive healthcare and reduce variation across the province; ensure
care is appropriate and efficient; and address the preventable causes of digestive diseases.
Foundational to all of our activities will be a focus on patients and families and fostering a culture of
inquiry, innovation, and quality improvement. This roadmap reflects the shared priorities of Alberta
Health Services and the SCNs, and is well aligned with the AHS 2017-20 Health Plan.
Thank you to our Core Committee for their exceptional passion, enthusiastic participation, and
dedication to improving the lives of individuals with digestive health concerns. This is their vision
and transformational roadmap for an improved future for digestive healthcare in Alberta. We look
forward to sharing our progress with you in achieving that vision.
The DHSCN is proud to be collaborating and aligning with our partners to lead a transformation in
digestive healthcare, one that is driving quality, innovation, and value to achieve better outcomes for
patients and families. We hope this roadmap will present you with the opportunity to engage with the
Digestive Health SCN and become a part of that transformation.
Many thanks to our past and future contributors,
Louise and Sander
Sander Veldhuyzen van Zanten Louise Morrin
Senior Medical Director Senior Provincial Director
Digestive Health Strategic Clinical Digestive Health Strategic Clinical
Network™ Network™
Alberta Health Services Alberta Health Services
3
Digestive Health Strategic Clinical Network™ Transformational Roadmap 2017-2021
Executive Summary
Digestive disorders, which include any conditions affecting the digestive organs (e.g. esophagus,
stomach, small and large intestines, liver, and pancreas), impact more than 2 million Albertans and
cost the Canadian healthcare system $18 billion dollars annually, with rates for many of these
disorders continuing to rise.
The Digestive Health Strategic Clinical Network™ (SCN™) was launched in November 2016 to
address key gaps in care and outcomes related to digestive healthcare across Alberta.
SCNs are province-wide teams bringing together the experiences and expertise of healthcare
professionals, researchers, administrators, government, communities, non-governmental
organizations, and patients and their families to improve our healthcare system. SCNs are the
mechanism through which Alberta Health Services empowers and supports physician and clinical
leaders both within Alberta Health Services and the community to work with patients and their
families to develop and implement evidence-informed, clinician-led, team-delivered health
improvement strategies across Alberta.
This transformational roadmap was developed through collaborative Core Committee meetings,
surveys, and by engaging a variety of interested stakeholders who provided valuable guidance and
input into the direction and activities for the SCN over the next four years.
The vision of the Digestive Health SCN is “The best digestive health for all Albertans.”
The mission statement, or how we will achieve this vision, is: “Innovate and collaborate to create a
person-focused, high quality digestive health system through prevention, research, and best
practices.”
To reach this vision and mission, the Digestive Health SCN has identified four strategic goals
to achieve over the next four years. These strategic goals are to:
1) Integrate Primary/Specialty Care approaches to digestive diseases and improve access
2) Deliver high quality, standardized digestive healthcare
3) Provide clinically appropriate and efficient care
4) Prevent digestive diseases
The Strategic Clinical Network has identified nine priorities under these strategic goals in order to
focus the work.
Priorities for Strategic Goal: Integrate Primary/Specialty Care approaches to digestive
diseases and improve access
1) Implement and monitor a complete, standardized provincial referral process and use
innovative models to improve access to care
2) Enhance support and resources for primary healthcare providers to manage digestive
diseases
3) Create a standardized wait time management system for consultations and endoscopic
procedures
4
Digestive Health Strategic Clinical Network™ Transformational Roadmap 2017-2021
Priorities for Strategic Goal: Deliver high quality, standardized digestive healthcare
1) Develop and implement provincial clinical pathways for patients to improve disease
prevention, management, and continuity of care
2) Address unwarranted clinical variation and improve quality of care for endoscopy
procedures
3) Standardized education and support for patients, families, and providers
Priorities for Strategic Goal: Provide clinically appropriate and efficient care
1) Improve appropriateness of testing and therapies
Priorities for Strategic Goal: Prevent digestive diseases
1) Prevent chronic liver disease through better identification and management of preventable
causes of this disease
2) Decrease incidence of C. difficile in acute care facilities
The Digestive Health SCN has developed seven Principles that provide the foundation for the
Network and will serve as the basis for establishing and achieving our strategic goals. These
principles are:
Patient and family focus
Engagement and collaboration
Culture of quality
Standardized, evidence-based approaches
Sustainability
Research and innovation
Healthcare equity
Five key Enablers have also been identified that are essential to the success of the Digestive
Health SCN. These Enablers are:
Information technology and quality data
Patient and provider education
Clinical pathways
Performance measurement
Communication
By focusing on the strategic goals, priorities, principles, and enablers described throughout this
document, digestive healthcare in Alberta will be more integrated, of higher quality, and more
clinically appropriate. This will result in improved patient outcomes, and bring us closer towards
achieving the SCN’s vision of the best digestive health for all Albertans.
5
Digestive Health Strategic Clinical Network™ Transformational Roadmap 2017-2021
6
Digestive Health Strategic Clinical Network™ Transformational Roadmap 2017-2021
Introduction
Strategic Clinical Networks™ (SCNs™) are province-
wide teams bringing together the experiences and
expertise of healthcare professionals, patients and
families, researchers, government, administrators,
communities, and non-governmental organizations to
improve our healthcare system. To achieve this, SCNs
are responsible for generating innovation, implementing
best evidence into practice, and utilizing change
management strategies to improve the quality of care
and outcomes and ensure long-term sustainability and
success of all initiatives. They also build capacity with
and within operations, using local improvements to drive
system innovation.
As a major stakeholder in health service delivery, the
work of the SCNs is aligned with Alberta Health
Services’ (AHS’) four foundational strategies, and the Figure 1: AHS' Four Foundational Strategies
quadruple aim approach (Figure 1). SCNs are the
mechanism through which AHS empowers and supports physician and clinical leaders both within AHS
and the community to work with patients and their families to develop and implement evidence-
informed health improvement strategies across Alberta.
About the Digestive Health SCN
As an SCN, we
The Digestive Health SCN™ was officially launched on November 18, are here to: ask
2016 as the fourteenth SCN. It is comprised of a Leadership Team and questions, find
a Core Committee, which has representation from a wide-range of answers, inspire
multi-disciplinary stakeholders across the province with a keen interest change, and
in digestive health. A complete list of our Leadership Team and Core transform the
Committee can be found in Appendix A. healthcare
system.
The scope of our work includes all digestive diseases, all liver diseases,
and cancers of the digestive system across the lifespan. A number of
project teams and working groups are being formed and will be responsible for the development and
implementation of priority projects aligned with the Digestive Health SCN’s strategic goals and
priorities.
7
Digestive Health Strategic Clinical Network™ Transformational Roadmap 2017-2021
Development of our Transformational Roadmap 2017 – 2021
Figure 2: Development of our Transformational Roadmap
8
Digestive Health Strategic Clinical Network™ Transformational Roadmap 2017-2021
Our Strategic Goals
Integrate Primary / Specialty Care Approaches
to Digestive Diseases and Improve Access
Deliver High Quality, Standardized
Digestive Healthcare
Provide Clinically Appropriate and
Efficient Care
Prevent Digestive Diseases
Digestive Health Strategic Clinical Network™ Transformational Roadmap 2017-2021
WHAT
Strategic Goal: Integrate Primary/Specialty Care approaches
to digestive diseases and improve access
Our Priorities:
Implement and monitor a complete, standardized provincial referral process and use innovative
models to improve access to care
Enhance support and resources for primary healthcare providers to manage digestive diseases
Create a standardized wait time management system for consultations and endoscopic
procedures
WHY
Currently available resources are inadequate to meet the demand for investigations and care
of patients referred for specialty gastroenterology care, leading to ever-increasing wait times
and unacceptable limitations to access1.
Triage processes and wait times vary across the province by reason for referral, with urgent
referrals prioritized to be seen first while non-urgent referrals may wait up to two years1.
Demand is expected to increase as the number of people living with chronic digestive diseases
continues to rise. The estimated number of referrals to Gastrointestinal (GI) services in the
Edmonton Zone alone exceeds 40,000 annually2.
The vast majority of referrals processed in Alberta remain outside of any electronic
management system, with little transparency into wait times, priority allocation (triage), and
endoscopy allocation, as these are determined individually/privately1. The different systems
have resulted in safety incidents as referrals are lost or misplaced and the patient is not seen
within the appropriate timeframe.
Strategies to improve access to GI services have been implemented in many sites/programs
across Alberta. For example, innovations
such as Central Access and Triage, Specialist
Link, and Primary Care Clinical Pathways in
Did you know? the Calgary Zone resulted in a 43% reduction
in routine referrals between 2014 and 20161.
The Canadian Association The GI Provincial Referral Guide has
of Gastroenterology
recently been completed and is ready for
recommended wait time for
implementation across the province.
consultation and endoscopy
for indications FIT positive,
rectal bleeding, and iron
deficiency anemia is 8
weeks3. Currently in Alberta,
less than half of patients are
meeting this criteria.
10Digestive Health Strategic Clinical Network™ Transformational Roadmap 2017-2021
HOW
Improve collaboration and integration between primary and
Did you
specialty care to ensure patients are better supported in their
medical home.
know?
Develop standardized referral processes based on best
After implementing
evidence and implement these broadly. eConsult in Ottawa,
Collaborate with primary care stakeholders to develop and 70% of cases did
implement innovative care models and clinical pathways to not require a face-
to-face specialist
support primary care and increase access to underserviced
visit, and in 40% of
areas, including outreach to rural and remote communities. cases, an
Work with the Access Improvement team to implement Alberta unnecessary
referral was
Netcare eReferral (advice request and consult request), creating
avoided4.
a common referral management platform for gastroenterology
services across the province.
Work with the Alberta Coding and Access Targets System (ACATS) team to expand utilization
of their wait time management solution to include endoscopy procedures.
MEASURING SUCCESS
Increased number of gastroenterology sites participating in eReferral.
Increased number of referring providers utilizing eReferral Advice Request.
• Increase in number of avoided gastroenterology consults (based on Advice Request
utilization and outcomes).
Reduction in wait time for gastroenterology consults at sites participating in eReferral.
Decreased wait times for endoscopy procedures.
Primary care providers are supported to manage their patients’ digestive diseases in a
variety of situations, including: prior to specialist consultation, in lieu of specialist
consultation, and after specialist consultation.
“As a family physician, I know that the digestive system is long and complex. Accessing
healthcare for the digestive system ideally should not be long and complex, yet challenges
exist in the current system that affect our patients' healthcare journey. I joined the Digestive
Health Strategic Clinical Network because I saw that there was a need for innovative
solutions to address access, continuity of care, and management of digestive health
concerns within a patient's medical home, and in the specialty care system. I am also
passionate about disease prevention, and saw an opportunity to be involved in preventative
health at the system level. Prior to joining, I was told that the gastroenterologists involved in
the Digestive Health SCN were highly motivated to hear what family physicians have to say,
and that has certainly been the case so far, but what has impressed me the most is that the
patient experience has been front and centre throughout. I am confident that, with such an
inclusive approach, the Digestive Health SCN will help Alberta lead the way in providing high
quality digestive healthcare."
- Dr. Julia Carter, Family Physician and DHSCN Core Committee Member
11Digestive Health Strategic Clinical Network™ Transformational Roadmap 2017-2021
WHAT
Strategic Goal: Deliver high quality, standardized digestive
healthcare
Our Priorities:
Develop and implement provincial clinical pathways for patients to improve disease prevention,
management, and continuity of care
Address unwarranted clinical variation and improve quality of care for endoscopy procedures
Standardized education and support for patients, families, and providers
WHY
In 2015, the prevalence of Inflammatory Bowel Disease (IBD) in Alberta was 0.67%, among
the highest worldwide5, and is expected to increase to ~1% by 20306.
There are marked disparities in access to care in rural and small urban sites where there is
limited access to a full range of gastroenterology services7.
The prevalence of Irritable Bowel Syndrome (IBS) is rising. The self-reported prevalence in
Canada was 2.4% in 2007-20088 and rose to 3.2% in 20149. This is an underestimation of the
actual prevalence given as few as 30% of patients consult a physician regarding IBS10 and there
is under diagnosis of IBS in the presence of established criteria11.
IBS puts considerable strain on healthcare resources, incurring a significant financial burden,
and accounts for up to 50% of gastroenterology consultations12.
There is a lack of standardized care for IBS due to the availability of a wide range of treatments
with varying effectiveness13.
While excellent educational resources for a variety of
GI disorders are available throughout the province,
these resources are not standardized or available to Did you know?
all Albertans or clinicians, nor have they been
developed for all digestive diseases. Inflammatory Bowel
Disease (IBD) is expected
Across the province, there are multiple versions of to impact ~1% of Albertans
patient materials with variation in content and advice. by 20306, a prevalence
In the Edmonton Zone alone, there were 37 different among the highest
worldwide, and costs ~$2.8
patient handouts being used across the zone on how
billion in direct and
to prepare for a colonoscopy. indirect costs in Canada
Endoscopy is performed at 65 sites across the each year14.
province. Over 315,000 endoscopy procedures were
performed in Alberta in 2016-1715. There is no
province-wide approach to endoscopy quality.
12Digestive Health Strategic Clinical Network™ Transformational Roadmap 2017-2021
The Alberta Colorectal Cancer Screening Program endorses the adoption of the Canada-
Global Rating Scale (C-GRS©) for all sites performing screening colonoscopy within Alberta
and is seeking organizational support to mandate this standard province-wide. This quality
improvement program improves quality of care and enhances the patient experience.
To date, 19 of 52 sites in Alberta are using the C-GRS© to assess the quality of their endoscopy
processes and procedures.
HOW
Collaborate with primary care providers to adapt existing or develop new clinical pathways for
digestive disorders. The initial focus will be on primary care oriented pathways.
Clinical pathways for more complex digestive diseases, such as IBD and liver disease, that
span the care continuum, will be developed and implemented for
conditions where there is significant variation in care and outcomes across the province.
In partnership with the Alberta Colorectal Cancer Screening Program, we will develop and
implement a strategy to improve the quality of endoscopy care, which includes broad
implementation of the C-GRS©.
Work with clinical experts across the province to develop and strengthen the information
provided to Albertans on digestive diseases, using MyHealth Alberta as a platform for
information that is accurate, peer-reviewed, and evidence-based.
MEASURING SUCCESS
Reduced variation in care and outcomes for Albertans with digestive disorders.
All sites that perform endoscopy in Alberta are using the C-GRS© and have quality
improvement initiatives underway.
Improved endoscopy quality indicators.
Standardized digestive health related educational materials are universally accessible and
meet the information needs of Albertans
"It was an honour to be asked to join the Digestive Health SCN Core
Committee. After decades of working towards improvement of quality of GI
care within our zone, it is very refreshing to participate in thoughtful discourse
in a room with individuals who have such a great mix of vision, passion,
pragmatism, and varying life and occupational experiences related to
gastrointestinal disease. Also, the ability to tap resources that produce
evidence-based data to guide our deliberations will result in the crystallization
of vision into more effective outcomes for our patients. What a very nice
group of people! I am confident that patients in this province will ultimately
receive improved care, going forward, through this process of collaboration."
- Dr. Dave Koegler, Gastroenterologist and DHSCN Core
Committee Member
13Digestive Health Strategic Clinical Network™ Transformational Roadmap 2017-2021
“As a Patient Advisor on the Core Committee for the Digestive Health SCN, I have
been able to share my experiences and knowledge, not just with Digestive Health, but
with the Alberta Health System. It has been an insightful experience to see the process
that goes into designing policy and strategic goals and truly invaluable to be able to
provide feedback and participate as the patient voice within those conversations. It’s a
challenging position, but the chance to help improve those suffering from Digestive
Health diseases and illnesses makes it incredibly rewarding."
- Amy van Engelen, Patient Advisor, DHSCN Core Committee Member and
PaCER (Patient and Community Engagement Research) Graduate
WHAT
Strategic Goal: Provide clinically appropriate and efficient care
Our Priority:
Improve appropriateness of testing and therapies
WHY
Up to 30% of selected medical tests and therapies are not clinically indicated, resulting in
increased costs to the healthcare system and exposure of patients to risk16.
There is a high prevalence of use and overuse of Proton Pump Inhibitors (PPIs). Pantoprazole
was the fifth most common drug prescribed in 2012, with more than 11 million prescriptions
dispensed in Canada17. Spending on PPIs by public drug programs (excluding Quebec and
the territories) totalled $249.6 million of the $7.8 billion spent on prescription drugs by these
programs in 201318.
Chronic use of PPI’s is problematic, with studies showing a lack of documented ongoing
indication for between 40% and 65% of hospitalized patients19.
The Canadian Association of Gastroenterology’s Choosing Wisely recommendation is: don’t
maintain long-term PPI therapy for gastrointestinal symptoms without an attempt to
stop/reduce PPI at least once per year in most patients20.
Inappropriate and inconsistent use of the Fecal Immunochemical Test (FIT) stool test for colon
cancer screening outside the target population continues to be a problem across Alberta21.
Colorectal Cancer Screening Clinical Practice Guidelines recommend asymptomatic
individuals aged 50-74 who are at average risk complete a FIT test every 1-2 yrs22.
Colon cancer screening using the FIT will lead to colon cancer diagnosis in 3.7% of
patients2
14Digestive Health Strategic Clinical Network™ Transformational Roadmap 2017-2021
HOW
We will partner with Pharmacy Services, the Physician Learning Program, and other SCNs to
develop and implement an appropriate prescribing strategy for PPIs.
In collaboration with the Alberta Colorectal Cancer Screening program, we will develop and
implement approaches to improve appropriateness of FIT testing.
MEASURING SUCCESS
Reduced prescriptions for PPIs.
Increased appropriateness of FIT testing.
"In my current role as the manager of ambulatory care at the QE II, I am responsible for the
Endoscopy program and the IBD and Hepatology Clinics. As a core team member of the
Digestive Health Strategic Clinical Network, I am excited to build great networking
opportunities and to learn from other’s successes as we strive to improve our patients’
healthcare experience. Through the work of this SCN, I look forward to working to
standardize and advance our approach to optimal care for every one of our North Zone
digestive health patients."
- Tracey Parsons, Manager, Ambulatory Care, QEII Hospital and DHSCN Core
Committee Member
WHAT
Strategic Goal: Prevent Digestive Diseases
Our Priorities:
Prevent chronic liver disease through better identification and management of preventable
causes of this disease
Decrease incidence of C. difficile in acute care facilities
WHY Did you
Digestive diseases account for an annual cost of $18 billion dollars know?
per year in Canada due to healthcare costs and lost productivity23. Digestive
disorders impact
By preventing the onset and progression of diseases related to the
more than 2
digestive system, we can decrease the impact these diseases have million Albertans,
on patients, families, clinicians, and our healthcare system. and rates for
many of these
It is estimated that one in 10 Canadians, or more than three million disorders are on
people, has some form of liver disease24. the rise23.
The most common forms of liver disease – viral hepatitis, fatty liver
disease, and liver cancer – are all on the rise.
15Digestive Health Strategic Clinical Network™ Transformational Roadmap 2017-2021
Death from liver disease in Canada increased by 30% from 2000-2008 and is expected to
rise further in the future25.
Hepatitis C Virus infection hospitalization costs increased by an average of 41% per year
in the Calgary Zone from 2000-200426. These costs are continuing to rise and aren’t
expected to peak until 2020-203027.
Non-Alcoholic Fatty Liver Disease (NAFLD) is the most common cause of liver disease25,
is directly related to obesity, and impacts approximately 1/3 of Albertans28.
Hospital-acquired Clostridium difficile infection (CDI) increases healthcare costs four-fold
which translates into additional costs of $100 million dollars annually in Canada29.
It is estimated that approximately 3000 Albertans are impacted by CDI each year, leading to
about 30-50 deaths yearly30.
For patients with Recurrent CDI (RCDI),
Fecal Microbiota Transplantation (FMT) has
been shown to be the most effective therapy
(success rate > 80%) and the most cost
effective treatment31,32,33,34,35.
A timely FMT, offered after the 3rd episode
of RCDI, has been shown to reduce
healthcare spending by approximately
$30,000 per patient36.
Figure 3: The Fecal Microbiota Transplantation Team
receiving the 2017 President’s Excellence Award for
Outstanding Achievement in Innovation and Research
Excellence from AHS President and CEO Dr. Verna Yui,
(front row, fourth from left).
HOW
We will work with stakeholders to implement effective policies and screening, diagnostic,
and treatment options to address the preventable causes of liver disease.
In partnership with researchers, Infection Prevention & Control and gastroenterology
clinicians, and clinical operations, we will develop strategies to improve antimicrobial
stewardship, reduce in-hospital transmission of CDI, and operationalize effective and
timely treatment strategies for recurrent CDI.
MEASURING SUCCESS
Decrease in CDI and its associated costs in Alberta’s acute care facilities.
Decrease in incidence of chronic liver disease.
Increase in appropriate screening for liver diseases.
“The Digestive Health Strategic Clinical Network was created as a vehicle to deliver the best
digestive healthcare possible to Albertans; including better quality, better outcomes, and better
value. The mandate for the DHSCN is to help focus resources on what patients need, to help
develop and support local models of patients care, and then effectively transfer them across
Alberta. In essence, the DHSCN is designed to enhance innovative healthcare delivery by
using the input of patients alongside scientific evidence and expertise of frontline providers. I
look forward to seeing many improvements supported by this network.”
- Dr. Mark Swain, Hepatologist, Head of the Calgary Division of
Gastroenterology, and DHSCN Core Committee Member
16Digestive Health Strategic Clinical Network™ Transformational Roadmap 2017-2021
Our Principles
Our guiding principles provide the foundation for our work and
are the basis for establishing and achieving our strategic goals
Patient and family focus
Engagement and collaboration
Culture of quality
Standardized, evidence-based approaches
Sustainability
Research and innovation
Healthcare equityDigestive Health Strategic Clinical Network™ Transformational Roadmap 2017-2021
Patient and family focus
From conception through to implementation and evaluation, our initiatives will be centered on the
needs, priorities, and experiences of patients and their families. We recognize that we can only focus
on these needs by involving patient advisors throughout the process.
Engagement and collaboration
We will engage the broader digestive health community across the continuum of care, including
primary healthcare and end of life care, and spectrum of age (including children and the elderly) and
seek input in all stages of an initiative’s cycle – from planning to implementation to evaluation and
sustainability. We know that to be successful, we must collaborate with a wide variety of
stakeholders, including front-line providers, researchers, government, other SCNs, and patients and
families. Our approach to stakeholder engagement will be articulated in a Communications and
Engagement Plan, to be developed in fall 2017.
Culture of quality
We will foster a culture of quality improvement, based on the six dimensions of quality (as defined by
the Health Quality Council of Alberta), to achieve safe, effective, patient-centred, timely, efficient,
and equitable digestive healthcare.
Standardized, evidence-based approaches
We will endeavor to minimize provincial variations in practice; ensuring practice is based on current
scientific knowledge and best available evidence, while taking into account local context and the
needs and preferences of patients and families.
Sustainability
We are committed to optimal use of limited healthcare resources to drive a sustainable system of
digestive healthcare based on quality.
Research and innovation
We will foster and support research throughout the digestive health community by building and
embedding evidence into our practice, and actively supporting knowledge creation and translation.
We will lead a culture of innovation to improve outcomes, where innovation is any evidence-
informed, value-added service, device, technology, or model of care.
Healthcare equity
We will promote equitable access and fairness in the distribution, quality, production, and control of
healthcare resources for all communities and Albertans.
18Digestive Health Strategic Clinical Network™ Transformational Roadmap 2017-2021
Our Enablers
Our enablers are the elements we need to focus on as an SCN in
order to achieve success in our strategic goals
Information technology and quality data
Patient and provider education
Clinical pathways
Performance pathways
CommunicationDigestive Health Strategic Clinical Network™ Transformational Roadmap 2017-2021
Did you know?
Specialist Link in
Calgary receives ~40
calls per month, many
of which avoid
unnecessary
consultation.
Photo Credit: Edmonton University Hospital Foundation
Information technology and quality data
Quality outcomes and improvement will be achieved by using information technology to measure
and record reliable, provincially consistent data that we will use to drive change and monitor impact.
Patient and provider education
Evidence-based provincially consistent patient education, knowledge translation, and multi-
disciplinary provider education strategies will be employed to support uptake of all SCN initiatives.
Clinical pathways
The Digestive Health SCN will help design, evaluate, and utilize clinical pathways consisting of
evidence-informed, patient-centred interdisciplinary care to help patients affected by digestive
diseases achieve optimal health outcomes.
Performance Measurement
Performance measurement, based on reliable provincially consistent data, is required to improve the
quality of decisions made regarding priorities for digestive healthcare improvement, the evaluation of
improvement initiatives, and the sustainability of positive outcomes.
Communication
Digestive Health SCN initiatives will incorporate strategies to optimize communication between
providers, and between patients and providers, to ensure that information is accessible throughout
the patient’s journey, and thereby improve the delivery and integration of digestive healthcare and
health outcomes.
20Digestive Health Strategic Clinical Network™ Transformational Roadmap 2017-2021
Research and Innovation
The Digestive Health SCN recognizes Alberta’s well-developed research landscape. As outlined by
our Scientific Office’s six pillars of activity in Figure 4 below, our Scientific Director (Dr. Gil Kaplan)
and Assistant Scientific Director (Dr. Susan Jelinski) partner directly with researchers to increase
communication and collaboration, support and
champion research projects, increase capacity for
research in the health system, and translate
Did you know?
knowledge generated from research into the clinical
setting. Through 2017-2021, we will continue to
The Scientific Office created the
work collaboratively with research teams across the Alberta IBD Surveillance cohort,
province to identify knowledge gaps aligned to the the first of its kind in the
priorities of the SCN and bring more research into province. This allows us to track
practice. incidence, prevalence, healthcare
utilization, variation in care, and
outcomes for Albertans with IBD.
Figure 4: Six Pillars of Activity of the SCN Scientific Offices
21Digestive Health Strategic Clinical Network™ Transformational Roadmap 2017-2021
The Digestive Health SCN has developed a research plan outlining our research goals and the role
the SCN will have in research and innovation for digestive health, and our accountabilities in relation
to research and innovation underway in Alberta. Our Scientific Office has initiated an annual Seed
Grant competition, awarding grant funds to researchers to complete research projects and
systematic reviews related to the SCN’s priorities. Another major priority is to focus on data
liberation to support the development of provincial cohorts of digestive diseases that can be used
by the Digestive Health SCN to inform evidence-based decision making and to track outcomes
overtime. For example, the Scientific Office created the Alberta IBD surveillance cohort that allows
us to track incidence, prevalence, healthcare utilization, variation in care, and outcomes for
Albertans with IBD.
Did you know?
The SCN Scientific Office partners directly with
researchers to increase communication and
collaboration, support and champion research
projects, increase capacity for research in the health
system, and translate knowledge generated from
research into the clinical setting.
"I am excited to be part of the Digestive Health SCN and to work with such passionate and
enthusiastic people in the area of digestive health. The challenges faced by healthcare today are
complex and require innovation and new ways of doing things. I believe that the Digestive Health
SCN can be instrumental in the translation of research into the clinical environment which in turn will
improve health outcomes for patients. Collaborations between many different individuals are
necessary to identify common obstacles and to induce positive changes. I am proud to be part of
the Digestive Health SCN and to contribute to the transformation of digestive healthcare in
Alberta."
- Dr. Karen Madsen, Clinical Researcher and DHSCN Core Committee Member
22Digestive Health Strategic Clinical Network™ Transformational Roadmap 2017-2021
Conclusion
The strategies identified in this four year Transformational Roadmap will push Alberta to a
leadership position within Canada in the prevention and management of digestive diseases. By
focusing on the strategic goals and priorities described throughout this document, we are
confident we will be delivering care that is integrated, high-quality, and clinically appropriate,
and ultimately improving patient outcomes. We look forward to working together with our
network members to meet the challenges and opportunities ahead.
“Digestive health involves complex systems that are difficult for patients, such as myself, to
understand and navigate. I feel privileged to provide a patient voice in association with a
group of medical professionals dedicated to improving care within the Digestive Health SCN.
I believe that the group will ultimately provide improved patient care through more uniform
practices and attention to the patient perspective.”
- Brendan Murphy, Patient Advisor and DHSCN Core Committee Member
23Digestive Health Strategic Clinical Network™ Transformational Roadmap 2017-2021
Appendix A: Strategic Clinical Network Leadership and Core
Committee Members
SCN Leadership and Core Committee Members as of: October 2017
Name Title
Leadership Team
Dr. Sander Veldhuyzen van
Senior Medical Director
Zanten
Louise Morrin Senior Provincial Director
Leanne Reeb Executive Director
Jessica McLarty Manager
Dr. Gilaad Kaplan Scientific Director
Dr. Susan Jelinski Assistant Scientific Director
Core Committee
Amy van Engelen Patient Advisor
Barb Kathol Senior Program Officer, CIS
Brendan Murphy Patient Advisor
Dr. Brennan Walters Head of Gastroenterology, Misericordia Hospital
Dr. Chris Sikora Medical Officer of Health
Dr. Christian Turbide Gastroenterologist
Clare McCabe Woodrow IBD Nurse
Dr. Clarence Wong Provincial Physician Lean, Colon Cancer Screening
Dr. Dan Sadowski Director, Division of Gastroenterology, UofA
Deon Druteika Clinical Practice Lead – Pharmacy
Derek Drager Patient Advisor
Dr. Diana Mager Associate Professor UofA, Clinical Nutrition
Dr. Doug Simmonds Gastroenterologist, Red Deer
Dr. Hien Huynh Director, Pediatric Gastroenterology
Holly Knight Director, Health Professions Strategy & Practice
Executive Director, Outpt Medicine, Allied Health, Transition Units & Neuro
Jennifer Coulthard
Rehab , Foothills Medical Centre
Jennifer Courtney Unit Manager, Medicine
Dr. Jessica Abraham General Surgeon, Medicine Hat
Jodi Glassford Director, Access Improvement
Jon Ashmead Patient Advisor
24Digestive Health Strategic Clinical Network™ Transformational Roadmap 2017-2021
Dr. Julia Carter Family Physician
Karen Hamilton Patient Advisor
Dr. Karen Madsen Director - CEGIR
Dr. Kerri Novak Gastroenterologist; QA/QI Medical Lead, Calgary Zone
Executive Director, Ambulatory Care, Emergency, Endoscopy &
Kim Kostiuk
Ophthalmology (Edmonton Zone)
Dr. Leah Gramlich Gastroenterologist, AHS Provincial Medical Advisor Nutrition Services
Dr. Linda Slocombe Lead, Calgary pan-PCN Group
Lindsay Steward Manager, Edmonton North PCN
Lisa Westin Case Manager, Gastroenterology, Med. Specialty Clinics, RDRH
Lorna Driedger Director, Nutrition Services, Calgary Zone
Lynn Goughnour Director, Patient Care Surgery, Chinook Regional
Dr. Mark Swain Head, Division of Gastroenterology and Hepatology, Calgary
Michelle Carbonneau Nurse Practitioner, Cirrhosis Care Clinic
Dr. Naseem Hoque Gastroenterologist
Peter Campbell Alberta Health Policy Advisor
Dr. Puneeta Tandon Director, Cirrhosis Care Clinic; Associate Professor of Medicine, UofA
Ralph Ennis-Davis Patient Care Manager, Endoscopy, Edmonton Zone
Dr. Rick Ward Family Physician; Medical Director, Primary Care
Sandra Owen Senior Planner, AHS Primary Care
Dr. Smitha Yaltho Family Physician
Steve Lucas Program Manager, Operative, Endoscopic & Recovery Services, GNCH
Dr. Steven Heitman Head, Colon Cancer Screening Clinic
Tracey Parsons Unit Manager, QEII Hospital
Dr. Yolande Westra Physician, Internal Medicine, Grand Prairie
Business Support Team
Darryl Lacombe Senior Consultant, Engagement & Patient Experience
Jessica Lamb Senior Consultant, Engagement & Patient Experience
Dr. Stafford Dean Senior Program Officer, Analytics
Stewart Lee HTA Analyst
Susan Miskiman Business Relationship Partner, Clinical Services IT
Susan Sobey-Fawcett Senior Planner
Terry Baker Senior Consultant, SCNs
25Digestive Health Strategic Clinical Network™ Transformational Roadmap 2017-2021
Appendix B: Glossary
Alberta Innovates (formerly A provincially-funded Corporation tasked with delivering on
Alberta Innovates Health the research and innovation priorities of the Government of
Solutions) Alberta. In the health sector, Alberta Innovates provides
leadership for Alberta’s health research and innovation
enterprise by directing, coordinating, reviewing, funding,
and supporting health research and innovation. Working
with its many partners in the health system, Alberta
Innovates ensures that health research achieves innovation
in care, policy, and practice, and that the needs of patients
and clinicians influence research.
Antimicrobial Stewardship Antimicrobial stewardship is an interdisciplinary activity that
promotes optimal antimicrobial therapy including
assessment of the need for antimicrobials, and if
antimicrobials are needed, the appropriate selection,
dosing, route and duration of antimicrobial therapy.
Appropriateness Health services are relevant to user needs and are based
on accepted or evidence based practice. Appropriateness
refers to the collaboration between the patient and the
healthcare provider to determine the care respects the
needs and preferences of the patient and is supported by
evidence-informed practice.
Best Evidence Best evidence, also known as primary evidence, usually
denotes an original writing, which is considered the most
reliable proof for the existence and/or content for a
particular topic (e.g., Gastroenterology and Hepatology).
Best evidence is usually found in clinically relevant research
that has been conducted using sound methodology. It is
one of the components in Evidence Based Practice, the
other two being clinical expertise and patient preferences
and values.
Best Practice Systematically developed statements of recommended
practice in a specific clinical or healthy work environment
area, that are based on best evidence, and are designed to
provide direction to practitioners and managers in their
clinical and management decision-making.
Canada-Global Rating Scale The Global Rating Scale (GRS) is a web-based survey tool
(C-GRS) that offers a comprehensive, systematic approach to the
measurement of endoscopy quality to assess the quality of
the colonoscopy service and patient experience. The self-
assessment tool can be used to help teams in endoscopy
units to prioritize and create action plans targeting specific
quality improvement initiatives. The C-GRS© examines 12
26Digestive Health Strategic Clinical Network™ Transformational Roadmap 2017-2021
items related to clinical quality and the quality of the patient
experience:
Consent process including patient information
Safety
Comfort
Quality of the procedure
Appropriateness
Communicating results
Equality of access
Timeliness
Booking and choice
Privacy and dignity
Aftercare
Ability to provide feedback
Change Management Change management is the process, tools, and techniques
to manage the people side of change to achieve the
required business outcome. Change management
incorporates the organizational tools that can be utilized to
help individuals make successful personal transitions
resulting in the adoption and realization of change.
Cirrhosis Cirrhosis represents a diffuse liver disease characterized by
structurally abnormal nodules of liver cells surrounded by
fibrosis.
Clinically Indicated A complex term encompassing appropriate patient
treatment/intervention based on, but not limited to:
i. the clinician’s unique body of knowledge and
expertise;
ii. a patient’s clinical presentation;
iii. the cost of treatment;
iv. the scientific merit to the treatment/intervention (e.g.,
scientifically supported clinical pathways); and,
v. ethics.
Clinical Pathway A description of evidence-informed, clinician recommended
interdisciplinary care to help a patient with a specific health
condition or concern move progressively toward optimal
health outcomes.
Clinician A physician or other healthcare provider who is involved in
the treatment and observation of patients, as distinguished
from one engaged in research.
Digestive Diseases Ailments affecting the digestive organs (e.g. esophagus,
stomach, small and large intestines, liver, and pancreas).
Digestive Health Any action or activity that would affect the improvement,
maintenance, and/or prevention of the overall functioning of
the digestive health system.
27Digestive Health Strategic Clinical Network™ Transformational Roadmap 2017-2021
Digestive System Consists of the digestive tract and other abdominal organs
that play a role in digestion such as the liver and pancreas.
The system, or group of organs, that break down food in
order to absorb its nutrients into the body.
Endoscopy Endoscopy is a procedure in which a physician uses
specialized instruments to view and operate on the internal
organs and vessels of the body. It allows the doctor to view
inside the body without making large incisions. An
endoscope is a flexible tube with an attached camera that
allows the doctor to see.
Evidence-Based Practice It is the conscientious, explicit and judicious use of current
(EBP) best evidence in making decisions about the care of the
individual patient. It is the integration of: (a) clinical
expertise/expert opinion, (b) external scientific evidence,
and (c) client/patient/caregiver perspectives to provide high-
quality services reflecting the interests, values, needs, and
choices of the individuals we serve.
Evidence-informed Using evidence to identify the potential benefits, harms, and
costs of any intervention and also acknowledging that what
works in one context may not be appropriate or feasible in
another.
Fecal Immunochemical Test The Fecal Immunochemical Test (FIT) is a screening test
(FIT) for colon cancer. FIT detects blood in your stool.
Fibrosis The thickening and scarring of connective tissue, usually as
a result of injury.
Gastroenterology The medical subspecialty that deals specifically with the
investigation, diagnosis, and management of disorders of
the digestive system including the pancreas and liver.
Gastrointestinal (GI) Adjective referring collectively to the stomach and small and
large intestines. The commonly used abbreviation for
gastrointestinal is GI.
Healthcare Equity Healthcare equity refers to the distribution and quality of
healthcare resources, including the accessibility,
acceptability, and appropriateness of health services. It also
implies justice or fairness in the production and control of
healthcare resources.
Hepatologist A specialist who diagnosis and treats disorders of the liver,
pancreas, gall bladder, and biliary tree. It is a sub-specialty
of gastroenterology, which studies the digestive systems as
a whole.
Hepatology Hepatology is the branch of medicine that incorporates the
study of liver, gallbladder, biliary tree, and pancreas as well
as management of their disorders.
Innovation A device, drug, technique, method, system, or a service
procured from outside an organization or developed within,
with ideally clear evidence of its added value over existing
approaches.
28Digestive Health Strategic Clinical Network™ Transformational Roadmap 2017-2021
Knowledge Translation A dynamic and iterative process that includes the synthesis,
dissemination, exchange and ethically sound application of
knowledge to improve health, provide more effective health
services and products, and strengthen the healthcare
system.
Pan-SCN Concepts or initiatives that are applicable or of interest to
multiple Strategic Clinical Networks.
Partnership for Research and A partnership between Alberta Innovates (AI) and Alberta
Innovation in the Health Health Services (AHS) that provides a partnered funding
System (PRIHS) opportunity targeting high impact research activities within
the SCNs that align with the priorities identified in the
Alberta Health Research and Innovation Strategy and the
AHS Health Plan. PRIHS supports networks of health
researchers and clinical practitioners to reassess potentially
inefficient activities within the health system and identify
sustainable solutions to improve overall quality of care and
value for money in the health system.
Patient-and Family-Centered Patient - and family-centered care sees patients and
Care families as integral members of the healthcare team, and
encourages their active participation in all aspects of care,
including as partners in planning, implementation and
evaluation of existing and future care and services.
Person-focused A popular term for healthcare and social services which
reflect the individual’s unique preferences, values and
needs, identified and agreed upon in partnership with the
physician.
Proton Pump Inhibitors (PPIs) A group of drugs whose main purpose is the prolonged
reduction of the production of gastric acid.
Quadruple Aim AHS' approach to achieve four key objectives:
1. Improve patient and family experiences.
2. Improve patient and population health outcomes.
3. Improve the experience and safety of our people.
4. Improve financial health and value for money.
Quality The Health Quality Council of Alberta (HQCA) defines
quality within the Alberta Quality Matrix for Health
framework, which includes six quality dimensions:
1. Acceptability
2. Accessibility
3. Appropriateness
4. Effectiveness
5. Efficiency
6. Safety.
Quality Improvement A continuous process which includes identifying issues and
opportunities, applying well thought out and often innovative
solutions, and then learning from the process and resulting
outcomes.
29Digestive Health Strategic Clinical Network™ Transformational Roadmap 2017-2021
Referral The act of referring someone or something for consultation,
review, or further action:
The directing of a patient to a medical specialist by a
primary care physician.
A person whose case has been referred to a
specialist doctor or a professional body.
Strategic Clinical Networks Networks developed by Alberta Health Services comprised
(SCNs) of people who are passionate and knowledgeable about
specific areas of health, challenging them to find new and
innovative ways of delivering care that will provide better
quality, better outcomes, and better value for every
Albertan.
Strategic Goals Strategic goals determine the long range direction of the
DHSCN based on their mission and vision. Each strategic
goal’s name reflects what the DHSCN wants to change in
order to better meet their mission and help resolve strategic
targets identified through stakeholder consultation and
engagement.
Sustainability Incorporation of measures intended to ensure the ongoing
maintenance of initiatives once project funding has ended.
The Scientific Office of the Includes the Scientific Director and the Assistant Scientific
Digestive Health Strategic Director of the SCN. It leads the promotion, adoption, and
Clinical Network diffusion of innovation as well as the creation and use of
evidence to drive decision making in digestive health. The
six pillars of activity are:
1. Knowledge Translation
2. Advancing Research Knowledge
3. Building Partnerships for Research
4. Research Facilitation
5. Research Capacity Building and Training
6. Research Prioritization
Transformational Roadmap The strategic plan of a Strategic Clinical Network that
(TRM) outlines how they will transform healthcare over a three -
four year time period. Includes vision and mission
statements, foundational principles, enablers of success,
and strategic goals with corresponding priorities.
30Digestive Health Strategic Clinical Network™ Transformational Roadmap 2017-2021
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