Measuring performance in vascular disease management in primary care settings based on the Canadian Cardiovascular Harmonization of National Guidelines Endeavour

Principal Investigator:
Dr. Karen Tu, Institute for Clinical Evaluative Sciences 

Dr. Sheldon Tobe
, Sunnybrook Health Sciences Centre
Dr. Noah Ivers, Women’s College Hospital
Dr. Liisa Jaakimainen, Institute for Clinical Evaluative Sciences
Dr. Debra Butt, Scarborough Hospital

Dr. Peter Liu, University of Ottawa Heart Institute

This project aims to measure current performance by family physicians in the screening for and management of vascular diseases when measured against national harmonized vascular disease guidelines. This aligns with Priority 1 of the Canadian Vascular Network, which is ‘prevalence and management of vascular disease risk factors in primary care settings in Canada’ and relates to Priority 3, ‘development of quality indicators to evaluate process, structure and outcomes of programs in vascular prevention and management.’

The harmonized guidelines were set by the Canadian Cardiovascular Harmonization of National Guidelines Endeavour (C-CHANGE), using a consensus model to integrate hundreds of recommendations from separate guidelines to a set of 89 key recommendations for the management of vascular risk factors. These guidelines have recently been updated and reduced to 74 recommendations. This project will assess how well the management of vascular disease in primary care currently aligns with the new C-CHANGE guidelines and will examine patient and provider factors that may impact the quality of care. We will utilize the Electronic Medical Record Administrative data Linked Database (EMRALD) housed at the Institute for Clinical Evaluative Sciences (ICES), which contains data from almost 350 family physicians and over 400,000 patients distributed throughout Ontario. This is a unique data source that combines the clinical detail contained in primary care electronic medical records (EMRs) with province wide administrative data.

This project will further our understanding of the prevalence and primary care management of vascular disease and its risk factors. By examining current practice patterns and obtaining a baseline assessment of family physician performance, this seed funding will form the foundation for future evaluation of the impact of different interventions to improve quality of vascular disease care and the impact of guideline compliance on patient outcomes.


Vascular disease in Canada – Risk factors and quality indicators

Principal Investigator:
Dr. Jack Tu
, Institute for Clinical Evaluative Sciences

Dr. William Hogg, University of Ottawa
Dr. Sharon Johnston, University of Ottawa
Dr. Dennis Ko, Institute for Clinical Evaluative Sciences
Dr. Sacha Bhatia, University of Toronto
Therese Stukel, Institute for Clinical Evaluative Sciences

This application will address Priorities 1 and 3 of Research Theme 1 of the Canadian Vascular Network – Improving Prevention and Management of Vascular Conditions. Measuring the burden of vascular diseases in Canada is challenging as there is no one complete source of this information. Rather, multiple data sets are used to assemble the required information, each with its own associated strengths and limitations. Furthermore, although quality indicators for vascular prevention have been proposed by different organizations, it remains uncertain which indicators can be accurately measured on an ongoing and timely basis in Canada.

In this initiative, Dr. Jack Tu, Network Investigator, and colleagues from the Cardiovascular Health in Ambulatory Care Research Team (CANHEART) and the Institute for Clinical Evaluative Sciences (ICES) will work with the Canadian Vascular Network to measure the baseline prevalence of major vascular risk factors in millions of Canadians using the CANHEART cohort. This unique cohort was created by linking together several population-based databases available to the CANHEART team, at ICES. As part of this grant, the group will also identify, define, and validate a set of measurable population-based quality indicators that can be used for ongoing surveillance of vascular health, disease management and outcomes. Building upon recent, related initiatives led by Dr. Tu including the Canadian Cardiovascular Society’s (CCS) International Environmental Scan of Cardiovascular Quality Indicators and Best Practices for Quality Indicator development; the CANHEART Health Index – a tool designed to measure vascular health in Canada in support of the Heart and Stroke Foundation of Canada’s 2020 Mission Impact Goals; and the CCORT Canadian CV Atlas, the proposed research will lay the foundation for future studies by the Canadian Vascular Network aimed at improving vascular health, disease prevention and management in Canada.