In this workshop we explored the ten requirements required of CIHR SPOR PIHCI grants and how to fulfill them.

1. Research
Ideas
Research
Topics or
Problems
*Work already in
development?

2. Idea Development and
SPOR-PIHCI Grant
Requirements
January 20, 2017
Delivering on Canada's Strategy for Patient-Oriented Research (SPOR)

3. Workshop Goals
 Cultivating ideas
 Bringing people and ideas together
 CIHR requirements

4. CIHR Strategy for
Patient-oriented Research
(SPOR)
 “Patient-oriented research refers to a continuum of
research that engages patients as partners, focuses on
patient-identified priorities and improves patient
outcomes.
 This research, conducted by multidisciplinary teams in
partnership with relevant stakeholders, aims to apply the
knowledge generated to improve healthcare systems and
practices.
 The objective of SPOR is to foster evidence-informed health
care by bringing innovative diagnostic and therapeutic
approaches to the point of care, so as to ensure greater
quality, accountability, and accessibility of care.”*
*CIHR Strategy for Patient-Oriented Research webpages: : http://www.cihr-irsc.gc.ca/e/41204.html

5.  Achieving the Network's overall goal of evidence-
informed transformation and delivery of more cost-
effective and integrated health care to improve clinical,
population health, health equity, and health system
outcomes means that researchers, clinicians,
governments and patients need to work together in a
different way than we have in the past.

6. Improving care and outcomes of patients with CKD managed in primary care.
Bello, Aminu (AB) Tangri, Navdeep, Singer, Alexander G (MB) et al
A Comparative Analysis of Centralized Waiting Lists for Unattached and Complex Patients
Implemented in Six Canadian Provinces
Breton, Mylaine (QUE), Kreindler, Sara, Turnbull, Michelle (MB) et al
Validation of Administrative and Primary Care Electronic Medical Record derived Frailty algorithms
Wong, Sabrina (BC); Katz, Alan; Edwards, Jeanette; Singer, Alexander G (MB) et al
Characterizing High System Use across the Primary-Tertiary Care Continuum: Parallel Analyses of
Select Canadian Health Datasets
Williamson Tyler (AB); Singer Alex, Katz Alan, Halas Gayle, (MB) et al
Evaluating the implementation and impact of an online tool used within primary care to address the
income security of high-cost users in Ontario and Manitoba
Pinto Andrew (ON); Katz A; Singer A; Halas Gayle, Anderson Kristin, McDermot Katlin (MB) et al
Connecting primary health care with social services, public health and community supports
Jeannie Haggerty (QUE) Tara Stewart-; Jeanette Edwards, Nancy Newall; Colleen Metge (MB) et al.
Interventions and Policies Influencing Primary Healthcare Professionals Managing Chronic Diseases:
An Evidence Synthesis
Bhupendra Chauhan, Jeanette Edwards, Ryan Zarychanski, Gayle Halas, Terry Klassen, Kathryn
Sibley, Alex Singer, Bev Temple, Kristin Anderson, Tamara Buchel, Colleen Metge, Carolyn Shimmin
(MB) et al

7. Funding Opportunities and
Requirements of CIHR
FOUR-YEAR LARGE GRANT DEVELOPMENT
To support larger cross-jurisdictional research projects based on
the medium and long term priorities identified by the member
networks.
• 4 grants
• $250k per year over 4 years (incl matching funds).
The launch date – Winter 2017
Application Deadline – Oct 2017
More details to follow as they arise.

8. Research Priorities
Innovation in integrated service delivery models that meet the needs of individuals with complex needs
High-users of the health care system, frequent users of the ER and hospitalizations, complex populations
Unique needs of the under-served
Service coordination consisting of multiple health care services
Patients requiring multiple services, gaps and challenges in service coordination, rural/remote access to care
Social determinants of health
Service across the continuum of care, including community-based team models
Child and Youth
Promoting health and healthy development
Prevention and Health Promotion
Prevention and health promotion across the lifespan and across health issues
Mental Health
Building Mental Health capacity - holistic approach, addressing homelessness, housing, poverty reduction
Senior Health
Unique needs of seniors, e.g., matching housing options with care needs
First Nations, Métis and Inuit
Co-morbidities related to chronic and infectious diseases
Mechanisms for cultural safety and diversity
Transitions in Care
Continuity from pediatric to adult care and services

9. Policy/Decision Makers:
Overview of priority areas
• MHHLS Vision – Healthy Manitobans through an appropriate
balance of prevention and care.
• MHHLS Mission – to meet the health needs of individuals,
families and their communities by leading a sustainable,
publicly administered health system that promotes well being
and provides the right care, in the right place at the right
time.
• Priorities and goals – Capacity building, health system
innovation, health system sustainability, improved access to
care, improved service delivery and improving health status
and reducing health disparities amongst Manitobans.

10. 1 •Tri-partite leadership (research, policy, practice): Annette Schultz, Marcia Thomson, Tamara Buchel
2 •Strategic scope: individuals with complex care needs, across the life course
3
•Bridge silos - engagement of key experts and stakeholders across the care continuum + cross-
sectoral approach (sectors beyond health services, e.g. social services, housing and education)
4 •Patient, citizen and family engagement in network activities and governance
5 •Implement and evaluate eHealth solutions
6 •Capacity for rapid monitoring, evaluation, feedback
7 •Partnerships – building research capacity via multi-disciplinary research centres, other institutions,
mentorship of students
8 •Geographic scope: Coverage + cross-jurisdictional
9 •Linkage with CBPHC Innovation Teams
10 •Partnership funding – Research Manitoba
Ten Requirements of
SPOR-PIHCI

11. 1. Tripartite Leadership
 Each member network within the pan-Canadian SPOR Network in Primary and
Integrated Health Care Innovations (referred to hereafter as the pan-
Canadian Network) will be co-led by clinical, research and policy leads that
collectively cover the continuum of care (prevention, primary, secondary,
tertiary, and home care),1 one of which must represent primary health care.
 In addition to the science, clinical and policy network leads, the member
network team involves relevant stakeholders (e.g., policy makers,
healthcare providers, researchers, patients/citizens/informal careproviders)
with the required experience and expertise to bridge existing silos in care to
achieve primary and integrated health care transformation in the member
network’s jurisdiction.

12. 2. Strategic Scope
Focus on new approaches to the delivery of primary and
integrated care and Iindividuals with complex care needs,
including:
 older adults with multiple chronic conditions, the frail elderly, those with
multiple co-morbidities, those with mental illness, Aboriginal peoples,
children with complex care needs, and individuals of low socio-economic
status and living in conditions of vulnerability.
 Age groups from children to older adults
Multi-sector integration of upstream prevention strategies and
care delivery models:
 Assessing the upstream predictors of high and complex health care needs
 Developing prevention strategies that are integrated with community-
based primary health care delivery models w/ the potential to decrease
the burden and cost of treatment and improve overall health and well-
being across the life course.

13. 3. Engagement of Key Stakeholders
 Meaningful and sustainable engagement in the re-design,
implementation and evaluation of primary and integrated health
care
 Bridge silos in social services, community-based primary health
care, public health, acute care and long-term care (e.g.home
care, ambulatory specialty care, pre-hospital emergency care,
rehabilitation, counseling, community pharmacies, long term and
palliative care, community support and advocacy groups)
 Involve other key sectors that influence the determinants of
health (e.g., housing, education, transportation, employment).

14. How to Intersect with
Policy/Decision Makers
Enough lead time needed to:
 Connect the right department staff to a proposed
research proposal.
 Department staff need to be actively engaged in
research project – extent will vary depending on
project. This could include contributing to research
questions, proposal development and knowledge
translation plan.
 Secure Department approval if researcher is looking for
matched funding from Research Manitoba.

15. 4. Patient, public, caregiver
or family engagement
 Meaningful mechanisms for patient engagement
 In core activities
 designing and conducting studies,
 interpretation of results,
 disseminating results,
 monitoring change
 Active participants
 part of the decision-making process for planning small and
large scale implementation
 will contribute to the identification and development of
indicators that measure patient experiences and outcomes.

16. Patient Engagement
The Belief that Patient Involvement in Health Research will:
• Lead to improved outcomes and an enhance healthcare
system;
• Will improve the quality, appropriateness, acceptability,
transparency, and relevance of research; and
• Ensuring it addresses issues of importance to patients and the
public.

17. Patient Engagement
Centre for Healthcare Innovation
The Patient Public
Engagement Network
in Manitoba

18. Patient Engagement
Levels of Involvement:
• Consultation
• Involvement
• Collaboration
• User-controlled research

19. Patient Engagement
Q: How can the patient and partner needs be taken
into account during the design phase?
 Patients bring the perspective as ‘experts’ from
their unique experience and knowledge gained
through living with a condition or illness, as well
as their experiences with treatments and the
health care system. Citizens, patients and their
caregivers can collaborate meaningfully through a
range of roles in governance structures, priority
setting and in generating research questions.
Patients can also support researchers to recruit
others and to reach out to under-represented
groups.

20. Patient Engagement
Assessing Internal Expectations:
• To what extent does the research team believe people with
lived experience will improve the outcome of the research?
• What is the potential for people with lived experience to
influence the decision-making process?
• What is the likelihood the research team will fully consider
input from people with lived experience?
• What resources are likely to be available to support
involvement?

21.  Question: Are there requirements for documenting the costs
for including the patients… [for] Finance [dept] is there is a
need to justify every expense, and meeting audit
requirements for use of the grant money?
 Answer: Expenses around engaging patients may include cost of
parking, childcare, etc. are expected as part of the budget and
there’s quite a range of allowable expenses in the budget.
 Everyone else at the table is getting paid… It’s important to
ask people on your team how they would like to be paid
because it could affect their disability payments etc. Other
ways to compensate [other than cash] could be to pay tuition
for a class, etc.
Patient Engagement

22. 5. Capacity for Rapid Evaluation,
Monitoring and Feedback
 MPN draws from evaluation expertise and processes
through:
 Centre for Healthcare Innovation (Evaluation platform)
 MaPCReN/CPCSSN database
 MCHP databases (breadth of Manitoba patients, health care
and social services)
 plan to collect information on patient-recorded outcomes
 develop and integrate new approaches to data collection

23. 6. Implementing and Evaluating
eHealth Solutions
 Each member network will need to demonstrate that it has capacity to
embed and evaluate eHealth innovations or Smart Health Applications
within primary and integrated care that include:
 (a) integrated solutions to support the continuum of personal and
population-based care;
 (b) empower patients to manage their health conditions and
improve health;
 (c) patient-centered care through personalized decision support;
and/or
 (d) access to population and health system monitoring for
prevention, early detection and intervention.

24. 7. Partnership(s) to Develop
Research Capacity
 GOAL: to increase the number of graduate students trained, and
the number of scientific faculty to provide training and
mentorship.
 GOAL: developing the unique capacity to work across sectors and
jurisdictions.
 graduate student research mentorship within MPN-supported
studies.
 training opportunities that are integrated into graduate level
training in clinical, health services, policy, and population
health,
 partnerships with other universities and their health
professional and graduate level training programs

25. 8. Geographic Scope
 The proposed 5-year goal for the pan-Canadian SPOR PIHCI
Networks is to have 25% of Canada’s population with complex
care needs linked to primary and integrated models of care.
 Evidence suggests that individuals with complex needs account
for approximately 5% of the total Canadian population.
 To achieve this proposed goal, networks need to demonstrate that
the models of care that are linked to their network cover a
minimum of 5% of the subpopulations of focus (e.g., individuals
with complex needs) in their jurisdiction at the time of
application, and have a viable plan to increase the network’s
population coverage to specific targets in the first 5 years
 For example, if a province has a population of 500,000,
approximately 25,000 individuals (5%) are expected to be individuals
with complex needs. Of this 25,000, it is expected that 1,250 (5%) are
linked to the network at entry.

26. Geographic Scope
 Several mechanisms facilitate MPN’s reach across the
province and to the required minimum of 5% of the
subpopulations over the next five years:
 1) the broad geographical dispersion of clinicians, researchers
and decision makers within teams
 2) the availability of comprehensive patient data and
province wide holdings of MCHP
 4) linkage to the evolving patient medical home networks
(“My Health Teams”) in all health regions in Manitoba.

27. 9. Linkage With Community-Based
Primary Health Care Innovation Teams
 The 12 recently funded CBPHC Innovation Teams
 To build on synergies and scale up from successful CBPHC Team
innovations
 Member networks can expand upon a common set of jointly
defined indicators

28. 10. Partnership Funding
 The pan-Canadian Network involves a partnership funding
model (1:1 matching)
 A network’s partnership funding can come from a variety of
public, private for-profit and/or private not-for-profit
sources (e.g., ministries of health, social services, and/or
education; provincial health research funding organizations;
health charities; private foundations, etc.).
 Matching CANNOT be from tri-council funds (CIHR, SSHRC,
NSERC)

29. Project Development in
other jurisdictions
 NS: Improving patient--centered, family focused end-of-life
care
 NS: Mental Health – hot spotting to target and design change
 BC: Spine care pathways
 BC: Heart Failure and COPD comorbidity
 AB: Diabetes Foot Ulcer Care Pathway: Scale-Up and Spread
 AB: The BedMed Initiative (Timing of blood pressure meds)
 AB: CHANGE: Lifestyle Intervention in Primary Care
(programming targeting metabolic syndrome)
 AB: ERAS in Primary Care with Vulnerable Patients (best
practices for enhanced recovery after surgery)

30. More information or MPN support:
Gayle.Halas@umanitoba.ca
MPN Webpage:
http://chimb.ca/manitoba_spor_pihci_network