The APPROACH cardiac registry broadens its scope

Dr. Merril Knudtson. Photo by Riley Brandt, courtesy of the University of Calgary

What started out in 1995 as Dr. Merril Knudtson’s vision for a provincial database, to collect and process health information to improve cardiac care, has now grown into one of the world’s largest and most-encompassing cardiac registries.

APPROACH (Alberta Provincial Project for Outcomes Assessments in Coronary Heart Disease) currently tracks more than 200,000 patients with chronic heart disease in Alberta. The tool pioneered a way to monitor and electronically record important data such as hospital readmission stats, death rates and quality of life questionnaires.

In 2011, it was one of only six initiatives across Canada to receive a Top Achievement in Health Research Award from the Canadian Institutes of Health Research and the Canadian Medical Association Journal. There have been 150 peer-reviewed publications by APPROACH investigators and more than 40 people who’ve done their Masters and PhD theses using data from the registry.

“APPROACH is a fantastic resource that is providing our Institute with a major advantage in delivering cardiac care to our community,” says Dr. Ed O’Brien, director of Research at the Libin Cardiovascular Institute of Albertaand section chief of Cardiology. “As we increasingly focus on measuring and improving the outcomes of patients, APPROACH is also serving as an important research tool from which we can learn how to optimize health care delivery, prevention and resource allocation.”

CARAT workspace

British Columbia Today, China Tomorrow

In February 2012, the APPROACH registry debuted in British Columbia in partnership with the Provincial Health Service Authority (PHSA). Information on tests, patient status, indicators and procedural data were entered into the registry which is called “Heart IS” (Heart Information System). It went online in Victoria at the Royal Jubilee Hospital, then St. Paul’s Hospital and Vancouver General Hospital after that. Sites yet to be phased in are Royal Columbian Hospital and Kelowna General Hospital.

“B.C. has been a really good partner and their clinicians have been very involved in APPROACH to enhance the data, particularly in surgery,” says APPROACH manager Diane Galbraith. Clinicians in that province will now be able to print real-time operating room reports and utilize the data accordingly.
Currently, more than 18 major cardiovascular centres across Canada have adopted the model in British Columbia, Saskatchewan, Ontario and Newfoundland. Next year, new partnerships start in Manitoba and New Brunswick as well as new sites in Quebec and extra sites in Ontario. Internationally, APPROACH is attracting the attention of the First Affiliated Hospital of Harbin Medical University in China, longstanding partners of the University of Calgary.
At the APPROACH national meeting in June 2012, Knudtson said their Chinese partners were currently in discussion to adopt the system for a pilot project in Harbin.

“They will be trying the English version of APPROACH in one hospital in Harbin with the view that in a fairly short turnaround time, they will decide to either can the idea or more likely, support a full translation of the software that can be used not only in the one hospital, but the whole province,” he says.

Knudtson points out that while they’re still in the early stages, taking a global view on the future of APPROACH provides another area for potential growth.

Easier Data Access through Dashboards
Another area discussed at the national meeting for further development was dashboards.

“Dashboards allow us the ability to take data and convert it into knowledge so you don’t just get raw data but you can do something with it,” says Galbraith. Essentially, it’s about making the data more “visible” and getting the information to the right people at the right time.
“In the new system and with leadership from British Columbia, we built a waitlist dashboard so surgery and cath lab booking individuals can pull up information by site and there’s detailed info for each coordinator.”
Depending on the type of user (administrator, researcher, clinician, nurse, etc.), different dashboards will be relevant and customizable. For example, certain dashboards could be used to help inform physicians in understanding how clinical practice guidelines apply to patients but also to share with patients so they understand what they’re personal treatments and cardiac care encompasses.

The Future of APPROACH
To keep pace with this national and global expansion and to maintain the APPROACH project’s position as a cutting edge academic research initiative, the team plans to redesign and transform the application, query and reporting systems to operate on a web-based platform. While different sites across the country have different requirements, the hope is that all sites will eventually upgrade to the web version of the registry.
Talks are already in place to build new research capacity through the addition of bio-banking infrastructure and collaborating with partners at the University of Alberta in genotyping and metabolomics.

“APPROACH has held two prior Canadian Foundation for Innovation awards, one in 2001 and 2006,” says Dr. William Ghali, Director of Research, APPROACH. “Each time, the awards were titled Broadening the Scope of Approach in Phase 1 and Phase 2. We decided to push Phase 3.”

“There’s a vision to go into new modules,” says Ghali. This includes developing an electrophysiology module down the road and working with colleagues in British Columbia to establish a heart failure and cardiac rehab module.

“In APPROACH, we know that we need to have balanced attention to producing information for clinical documentation, information for clinical decision-making and for research,” says Ghali. “It’s a tool that’s most powerful when those three areas of emphasis are not in silos but instead, integrated.”

This next chapter will mean further opportunities to further explore the factors that cause, influence or modify cardiovascular disease. Amplifying a foundation of knowledge that will inform therapeutic innovation and health system transformation, in turn, can produce global health benefits.


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