Alberta Innovates- Health Solutions

There are differences however, between basic biomedical and clinical research and health services, community and population research. Among those are the nature of the training and the methodology, the location of the research, the type of infrastructure required, the types of alliances and partnerships, and the historical and/or current degree of support and development.

In Alberta, basic fundamental laboratory research and clinical research are relatively well established activities. Respected training programs, researchers, leaders, research teams, and well-identified funding sources at the national, provincial and local levels (both public and private) have been developed.

The commitment of the Alberta Heritage Foundation for Medical Research (AHFMR), other funding agencies, institutions, and the public to biomedical and clinical research remains strong. Current programs developed over time to address the needs of these sectors will continue to be supported.

However, it is recognized that the community, population and health services research are unevenly distributed and less well established provincially and nationally. The appreciation of these activities by practitioners, administrators and policy makers, and the size and development of the infrastructure and funding mechanisms, is also marginal. On the national level, important steps to address these perceived deficiencies include the establishment of the Canadian Health Services Research Foundation (CHSRF), and the Canadian Institutes of Health Research, particularly the Institutes of Health Policy and Services Research, and of Population and Public Health. At the provincial level in Alberta, important steps include the health research programs of AHFMR, and the Health Research Collaboration between AHFMR and Alberta Health and Wellness.

This document focuses on the health services, community and population health research side of the broad spectrum of health research. It builds on the lessons learned from the development of basic biomedical research, and also on the experience in building health services, community, and population research at the international, national, and local levels. It is meant to advise AHFMR's own programs in support of health services, community, and population research, the Health Collaborative Agreement with Alberta Health and Wellness (AH), the Regional Health Authorities and Provincial Boards, and the other partners with a stake in the conduct, and application of health research in Alberta. This document complements and extends other Alberta reports concerned with health research including the Stewart¹ and MacLeod² Reports on health research, the Life Sciences Strategy of the Alberta Science and Research Authority ³, and the Report of the Premier's Advisory Council on Health⁴ .

Definitions: Health research is a continuum, and so the definitions of the various fields overlap

1. Health is defined as a state of optimal physical, mental and social well-being and ability to function at the individual level, and not merely the absence of disease or infirmity.
2. Health research is a global term to describe research undertaken to identify, resolve and prevent health problems and improve well-being within a broad "determinants of health" framework. This encompasses all different types of research including basic, fundamental, laboratory, biomedical, medical, clinical, applied, epidemiology, psycho-social, health promotion, population health, technology assessment, utilization analysis, outcomes evaluation, health economics, health systems and health delivery systems. However, the principal focus of this agenda document is specifically on health services research, population health research, and health technology assessment.
3. Health services research is the use of the scientific method for acquiring information that can be used for rational decision-making in the management of health and the health system. It is ultimately concerned with improving the health of a community by enhancing the efficiency and effectiveness of the health system as an integral part of the overall process of socioeconomic development.
4. Population health refers to the health of a population as measured by health status indicators and as influenced by social, economic and physical environments, personal health practices, individual capacity and coping skills, human biology, early childhood development, and health services. As an approach, population health focuses on the interrelated conditions and factors that influence the health of populations over the life course, identifies systematic variations in their patterns of occurrence, and applies the resulting knowledge to develop and implement policies and actions to improve the health and well-being of those populations.
5. Health care technologies can be taken to include drugs, devices, medical and surgical procedures, and the organizational, administrative and support system in which health care is delivered.
6. Health Technology Assessment (HTA) is the systematic evaluation of the properties, effects and/or other impacts of health care technology. Its primary purpose is to provide objective information to support health care decisions and policy making at the local, regional, national and international levels.
7. Health determinants are broadly defined as what makes and keeps people healthy. For example, income and social status, social support networks, education, employment and working conditions, physical environments, biology and genetic endowment, personal health practices and coping skills, childhood development, and health services.

"Health Research Agenda" describes the overall directions and the important general principles, issues and priorities which should be addressed in the provincial plan for health research and leads to guidelines to help develop and maintain health research in Alberta.

Vision: what would an ideal Alberta health research environment of the future look like?

Alberta would have a critical mass of highly trained health researchers, working in an environment with attractive career opportunities. The focus of health research would be relevant in the immediate or longer term to improving and maintaining the health of individual Albertans and their descendants, as well as to those with the additional responsibilities of providing health services and making health policy. Quality and continuous improvement in research and its application would be assured through education and appropriate peer review. Research would contribute to positive change in population health and well-being, socioeconomic conditions and to the improvement of health service delivery.

Successful research linkages and partnerships in the commissioning, conduct and funding of research would include consumers, communities, service providers, Regional Health Authorities (RHAs), provincial boards, government, industry, researchers, and funders. Users of research information would have the training, capacity and time to acquire and aggregate research results to inform policy and practice. Evidence-based decision-making would be valued. Health research would be recognized as a viable industry in the province and the quality of life and fertile environment would attract expertise and interest from around the world.

Health research in Alberta would be built on past experience and current strengths, and would be future oriented, promoting excellence leading to more excellence!

Principles:

Excellent health research is fundamental to improved health and delivery of health services;

A broad Alberta base of quality researchers, assured through adequate research training and protected time, enables responsive actions to meet the research needs of the health system of today and tomorrow;

A strong and stable infrastructure is an essential resource for effective health research in Alberta;

Effective multidisciplinary research alliances and complementary of research programs among research funding organizations are critical to a successful research endeavor;

Effective mechanisms/structures for linkages between providers and users of health research enhance the relevance and value of research and enable knowledge transfer for effective research-based service delivery.

Goals of a Health Research Agenda:

Improve the health of Albertans through excellent health research and knowledge transfer;

Build and support the capacity for health research in Alberta - people, funding, infrastructure;

Encourage and support effective partnerships for health research;

Contribute to a culture of the evidence-based decision-making in the health system;

Support the development and application of measures of the impact of health research.

Implementation:

The following implementation plan supports the goals, principles and vision for the Alberta Health Research agenda. The implementation plan highlights four main components: capacity building, infrastructure, partnerships, and priority setting.

1. Capacity Building

By capacity, we are referring to the ability of communities of researchers, practitioners and decision-makers in Alberta to conduct health research, and to form the alliances and partnerships required to use the information from health research for evidence-based decision-making at all levels of our society. Capacity consists of people to carry out transfer and apply and/or use the research, and a stable infrastructure to support them.
1. Peer Review

   An appropriate, efficient and effective peer review system ensures high quality, internationally respected, and ethically appropriate research and the best research information on which to make decisions. All major funding decisions should be supported by the peer review according to the accepted principles of the discipline/field.

2. Training and Personnel Support

   Insofar as developing the people "potential", the two fundamental elements are quality training programs and incentives. Incentives include protected time for the research activities (generally protected through salary support, as in personnel support programs leading to career development in research), acknowledgment of the value of the research accomplishments for individuals, and opportunities to share research results.

Infrastructure is not only research operating funds but also the information systems, data access, communication linkages, libraries, internet-based information resources, etc., which provide the essential underpinnings to research. The entire post-secondary education system is fundamental to the provision of skilled practitioners, managers, and the other knowledge workers that form the educated workforce of the health system.

An essential part of the health research infrastructure is an appropriate information system. It enables consumers, researchers, communities, policy makers, managers, and service providers to make informed decisions. It is critical to the success of such important provincial initiatives as the Utilization and Outcomes Commission. It should include information on a variety of determinants of health such as health status, socioeconomic status, and health care use. It should have the capability to assess medical and non-medical interventions on a comparable basis. It should be capable of not only demonstrating variation in practice between areas, but, more importantly, the relationship between the expenditure of resources and health in these areas. It includes a culture that values seeking and obtaining reliable data and turning it into accessible, timely, relevant information. WellNet and related initiatives are critical to the development of health research in Alberta.

The users of research information, particularly practitioners, the RHAs, and government ministries, also require the capacity to acquire, receive, aggregate and interpret research findings, to identify needs, and to set individual and collective priorities. They need to demonstrate a commitment to the value of evidence, determine whether they have the capacity to receive and use the evidence, and move to develop the receptor and knowledge transfer capacity attuned to their information needs.

1. Alliances and Partnerships

   While the principal focus of this document is the provincial health research activity, national and international alliances and partnerships are critical to success. The national and international research activity, experience, literature, databases, training opportunities, research funding, and research standards must be part of the provincial activity. Alberta should be a user of, and a contributor to, the health research activities throughout the world and acknowledged for its contribution to the global health research activities.

   Alliances and partnerships will be a fundamental requirement in the commissioning and/or funding of research. We envisage that all health research in the province would be a partnership among communities, those in the delivery system at the regional level, and those providing the methodological rigor and research expertise. The nature and extent of involvement, consultation, and funding by the partners would vary across the spectrum of research supported. For building and maintaining the capacity of the multidisciplinary foundation of health research, the lead role in support would be government, the universities and colleges, philanthropy, the private sector, community groups and AHFMR. If the research were of immediate interest to the policy makers, RHAs, provincial boards, and other community organizations and groups, they might take the lead in commissioning and/or funding the research.

   Involvement of the research partners, the public and the providers in both formulating the question, and implementing the results helps to ensure the effective dissemination of the research information throughout the Alberta community. On the other hand, the partnership with strong methodological expertise ensures a high quality of research which can be used with confidence in the health system.

   To encourage and maintain alliances and partnerships will require infrastructure support for communication and networking (e.g., travel, workshops, refresher courses, regional meetings, and electronic communication between regions).

2. Funding

   The funders will include Alberta Health & Wellness (both directly and through the Health Collaboration Agreement with AHFMR), AHFMR (both directly, and through the Health Collaboration Agreement with Alberta Health), the RHAs and Boards, the Health Services Utilization and Outcomes Commission, Alberta Innovation and Science through the Life Sciences Strategy, voluntary agencies, federal granting councils, Health Canada, international health organizations, and the private sector. Funding from AHFMR will contribute to training, protected time for research, and for travel and communications. The funding from AHFMR as part of the Health Research Collaboration will be a province-wide resource for health research. Direct funding from Alberta Health and Wellness will be for infrastructure, particularly health information systems.

   A basic principle for the use of provincial health research funds is kick starting and leveraging. We will encourage the use of provincial funding to provide a platform that ensures the successful acquisition of additional research funds from public and private sources, both nationally and internationally.

   Accordingly, provincial funds (e.g., AHFMR, AH&W) should be used to attract complementary investment from federal, international, private and industry sources.

3. Engagement

   We are engaging to close the gap between the generation of health research findings and living healthcare policy, organization, and practice at all levels. Policy makers, administrators, healthcare providers, communities, and individual consumers should make choices based on evidence obtained from research. This "culture of evidence" creates excellence, effectiveness and efficiency in the system, and promotes individual healthy lifestyles as well as bringing about appropriate socioenvironmental changes. To get the information out to create the culture of evidence requires attention to all stages of the knowledge transfer process - dissemination, adoption, implementation and maintenance. Those proposing research should address these issues, and the means of evaluating the impact of their research findings.

There are numerous challenges in formulating recommendations to develop and maintain an ideal research environment now and in the future. These include balancing the requirement to be open to innovative ideas and new approaches, while at the same time to be in a position to address the immediate pressing needs of the health system, the various research communities and the public.

To do this requires a very broad multidisciplinary base of activity that can carry out the theoretical and original research on which the advances of tomorrow are based. At the same time, such a research environment, which has the necessary skills and expertise, can respond to the immediate needs of the "users" of research. This balance between a high level capacity to carry out health research and responsiveness to the needs of the user, maintains the goals and principles articulated earlier in this document.

Accordingly, we are committed to two main complementary activities:

1. To build, and to maintain a broadly-based and responsive research capacity through training programs, direct investigator support, and linkages and exchange programs that will help develop alliances and partnerships. This will include a grants program that supports capacity, and is also responsive to provincial needs and priorities.
2. The consideration of provincial needs and priorities. This has led already to the development of four broad research themes developed through processes advised by the following sources of information and groups:
   • AHFMR Regional Health Authority Consultations 1999-2000
   • Alberta Health and Wellness
   • Listening for Direction -- A National Consultation on Health Service and Policy Issues
   • AHFMR Health Research Advisory Committee
   • AHFMR Health Advisory Committee
   These research themes are:
   1. Continuum of care and delivery models
   2. Information management and information technology for health improvement
   3. Financing and public expectations
   4. Governance and accountability

The knowledge base that currently informs some specific topics under these four research themes has been evaluated through "State of the Science" reviews, copies of which are available on the AHFMR web site. Research to inform these themes will be supported through programs of research and through the project funding allocated through the Health Research Fund. Further details are available on the AHFMR web site, or by contacting the Foundation offices.