WP 3 - Health Policy: Developing Health Equity and Access to Quality HF Care in Canada

Dr. Shelley Zieroth
  Dr. S. Zieroth
Dr. Sean Virani
  Dr. S. Virani


The Canada Health Act states that accessible universal health care is a fundamental human right for all Canadians. However, disparities—often more pronounced in certain groups (e.g., Indigenous peoples, women, immigrants, rural communities, lower socioeconomic status) - exist and are driven by varying contextual factors and policies. How can TRANSFORM HF provide a cohesive, consistent and longitudinal platform to develop a national assessment of HF service delivery, care gaps and quality?

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We will describe the burden of HF in Canada by mapping disease prevalence and risk factors (e.g., DM) for developing HF by community and province. This will create an inventory of existing HF services based on Tiers of Care Model for both in-patient and out-patient HF services, including Primary Care. We will overlay the map of disease prevalence with existing HF resources and track outcomes to identify service gaps based on population needs, with a focus on Indigenous and vulnerable populations, and will describe capacity within the system to accommodate the move of patients between tiers of HF care (more or less complex HF services). Where service gaps exist and there is insufficient ability in the system to accommodate patient flow across tiers of care, in partnership with WP2 (PRISM HF), WP4 (Digital Health Platform) and CC2 (C and T), we will assess the role of disruptive technologies and evaluation (CC3 HTA), as innovative solutions for health system transformation and drive policy accordingly (partners HSFC, HeartLife, Rogers).
Using mixed methods design (qualitative and quantitative studies), we will explore and identify key barriers to accessing HF services in Canada at each tier of care. We will prioritize barriers in terms of impact on outcomes relevant to the patient, provider, organization and system-level, and will describe whether barriers exist in series and/or in parallel, as a foundation for our understanding on how to optimize access. Where barriers to access exist, we will assess (CC3 HTA) tailored disruptive technologies (WP4) as innovative solutions for health system transformation and to drive policy. This data-driven approach (CC1) enables measurement of pre and post-intervention differences via WP2 (pragmatic clinical trials).
A policy model (CC3 HTA) will be used to map access and the quality of care in Canada, and to evaluate whether delivery of care is aligned with HF prevalence and wait-times to optimize efficiency in care (complementary to WP 3 Question 1; use of CC Data). We will explore regional variations in performance on existing Canadian Cardiovascular Society (CCS) HF Quality indicators (including assessing subpopulation variation in women and Indigenous peoples) and Institute of Medicine quality domains, including timeliness, efficiency, effectiveness, equity, safety and patient centred indicators. We will develop and validate new patient centred Quality Indicators, including assessment of QoL.