Creating a SustainableHealth Research

Enterprisein Canada

Presentation to the Health Research Board of

IrelandFebruary 27, 2015

Alain Beaudet, MD, PhDPresident, Canadian Institutes of Health Research

CIHR was created to support health research excellence

CIHR’s mandate is “to excel, according to internationally accepted standards of scientific excellence, in the creation of new knowledge and its translation into improved health for Canadians, more effective health services and products and a strengthened

Canadian health care system”

• CIHR was created in 2000 under the authority of the CIHR Act and reports to Parliament through the Minister of Health

• CIHR was created to transform health research in Canada by:

• funding more research on targeted priority areas

• building research capacity in under-developed areas, such as population health and health services research

• training the next generation of health researchers; and

• focusing on knowledge translation, so that the results of research are transformed into policies, practices, procedures, products and services for improved health outcomes and healthcare

2

CIHR’s Four Pillars

1. Biomedical 3. Health Services

2. Clinical4. Population

Health

EthicsKnowledge Translation

3

Addressing Health Research Priorities through 13 Institutes

CIHR is a unique model for health research

With its 13 Institutes, CIHR has become a meeting ground for Canada’s health research community

The model enables optimal use of existing knowledge to fill research gaps, maximize cooperation and minimize duplication

Population and Public

Health

Genderand

Health

Aboriginal Peoples’Health

Health Services

and PolicyResearch

Genetics

Infectionand

Immunity

Nutrition,Metabolism

and Diabetes

Cancer Research

Neurosciences,Mental Healthand Addiction

Aging

MusculoskeletalHealth and

Arthritis

Circulatoryand

RespiratoryHealth

HumanDevelopment,

Child and Youth Health

4

CIHR is a key player in the FederalGovernment’s S&T Structure

Prime Minister

Minister of Health Minister of Industry

Minister of State (Science and Technology)

Other Cabinet Ministers

Natural Resources

Canada

Fisheries and Oceans Canada

Environment Canada

Transport Canada

Defence Research and Development

Canada

Agriculture and Agri-Food

Canada

National Defence

Foreign Affairs, Trade

and Development

Industry Canada

Health Canada

Public Health Agency of Canada

Canadian Institutes of

Health Research

Canadian Food

Inspection Agency

Canadian Foundation

for Healthcare Improvement

Statistics Canada

National Research Council

Genome Canada

Canada Foundation

for Innovation

Social Sciences and Humanities Research Council

Natural Sciences and Engineering Research Council

Canadian Space Agency

Departments with national laboratories

Federal agencies conducting research

Research funding agencies

Foundations

5

The Financial Context

CIHR’s Total Budget

* Anticipated budget, including 2014-15 Supplementary Estimates C

6

CIHR investments and average relative citations

index in medical research

2005 2006 2007 2008 2009 20100.90

1.00

1.10

1.20

1.30

1.40

1.50

Avera

ge R

ela

tive C

itati

ons

Index

CIHR Investments 2000-2005 (Constant $)

2000-01 2001-02 2002-03 2003-04 2004-05 2005-06$0

$100,000,000

$200,000,000

$300,000,000

$400,000,000

$500,000,000

$600,000,000

$700,000,000

$800,000,000

$900,000,000

Average Relative Citations Index in Medical Research (2005-2010)

7

CIHR has maintained its competitiveness by leveraging investments from external

partners

8

CIHR’s leveraged funds from formal partnership agreements (constant 2008-2009 $)

2008-2009 2009-2010 2010-2011 2011-2012 2012-2013 2013-2014$0

$20,000,000

$40,000,000

$60,000,000

$80,000,000

$100,000,000

$120,000,000

$140,000,000

8

Bottom up Strategy: Investigator-Initiated (Open) Research

Full spectrum of CIHR mandate

Top Down Strategy: Priority-Drive (Strategic) Research

Targeted to specified areas of health research and knowledge translation. These programs and

initiatives are intended to:• Focus on gaps in specific research areas and

research communities or• Leverage existing strengths for impact

Open to all areas of health research and knowledge translation. This suite of programs is intended to:

• Capture excellence across all pillars• Capture innovative/breakthrough research

• Improve sustainability of long-term research enterprise• Integrate new talent

Funding Tools: Investigator-Driven vs. Priority Driven

9

10

Supporting health research through investigator-and priority-driven

investments

*Anticipated budget, including 2014-15 Supplementary Estimates C and adjustments to be provided by Treasury BoardFigures in Euros based on current rate of exchange

Investigator Initiated operating Support

CIHR Budget 2014/15 = 712.67 million EUR*

10

Investiga-tor-initi-

ated 353.22 €

50%

Overhead40.536%

Training122.517%

Priority-driven196.4228%

Type of investments by pillar

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CIHR has made progress in strengthening each of the four pillars

Biomedical Clinical

Health Systems / Services Social / Cultural / Environmental and Population Health

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• Quality of the idea• Feasibility and appropriateness of the

approach

• Multidisciplinary committees• Integration of results

Best minds: Foundation Scheme

Best ideas: Project Scheme

Successful candidates

selected

Successful candidates

selected

• Caliber of applicant • Vision for program

• Quality of program • Quality of environment

• Multidisciplinary committees• Integration of results

STAGE 1 STAGE 2 STAGE 3

STAGE 1 STAGE 2

Reform of CIHR’s granting system

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Increasing success of pillars 2, 3, 4 researchers

in CIHR investigator-initiated programs

Distribution of Applications by PillarDistribution of Applications by Pillar for Stage 1 of CIHR’s first Foundation Scheme competition

Pe

rce

nt

of

Ap

pli

ca

tio

ns

(%

)

Biomedical Clinical Health Systems/ Services

Social/Cultural/ Environmental/

Population Health

% of Successful Applications

% of Submitted ApplicationsHistorical OOGP Data (% of Successful Applications)

14

Promising results from new/early career researchers in investigator-

initiated programs

15

Canada excels in all health research sectors

Less Specialized World Average More Specialized

Specialization Index (SI)

Le

ss I

mp

act

Wo

rld A

vera

ge

Mo

re I

mp

act

A

vera

ge

Re

lativ

e C

itatio

ns

(AR

C)

Clinical Medicine

Biomedical Research

Biology Public Health and Health Services

Psychology and Cognitive Sciences

Source: The State of Science and Technology in Canada, 201216

The Canadian health system does not perform as well

United-Kingdom

2nd

United States

7th

Netherlands

1st

Canada

6th

New-Zealand

5th

Germany

4th

Australia

3rd

Quality Care 2 3 4 5 1 7 6

Access 1 2 6.5 3 4 5 6.5

Efficiency 3 1 2 5 4 6 7

Equity 1 2 4 3 6 5 7

Overall Ranking (2010)

1.00 - 2.33 2.34 - 4.66 4.67 to 7.00

Source: The Commonwealth Fund

Despite the excellence of the Canadian health research, Canada faces a challenge in turning this powerful information into high-quality and cost-effective care

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Canada is facing an increasing burden of diseases and increasing costs in the

healthcare system

Since 2000, health-care costs have more than doubled, surpassing the $200-billion mark in 2011 (including $50 billion of federal investments)

The growing burden associated with aging will only exacerbate the financial pressure already experienced by governments

Evidence shows that 50% of patients do not get treatments of proven effectiveness and up to 25% get care that is not needed or potentially harmful

Identify gaps and inefficiencies in the health care system

Develop, integrate and evaluate innovations that will improve the effectiveness of patient- and population-centered care

Monitor the use and costs, and evaluate the impact of health and policy interventions

The Issue

The Solution

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Giving ourselves the means

Change the paradigm for the conduct of clinical, health services and policy research

Leverage Canada’s unique data opportunities for research and a high performing learning health system

1

2

Collaborating on a national strategy that aims to ensure that the right patient receives the right intervention at the right time

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• Supporting and promoting comparative effectiveness research to evaluate the benefits and harms of current therapeutics and practices

• Developing implementation science to investigate and address major bottlenecks (e.g. social, behavioral, economic, management) that impede effective practice change

• Shifting from a researcher-driven to a health provider/patient-centered research agenda

Strategy for Patient-Oriented Research: Objectives

• Strengthening clinical research to increase our capacity to evaluate health innovations (preventative, diagnostic, therapeutic; drugs, practices, devices)

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Bridging the valleys of death

Bridging Valley 1 by fostering public-private partnerships and by providing clinical validation of research results

Bridging Valley 2 by ensuring that research results are integrated into the healthcare system

Valley 1Valley 2

Basic Biomedical Research

Clinical Science & Knowledge

Clinical Practice & Health-care Decision Making

Discovery Translation Evaluation Implementation

21

Strategy for Patient-Oriented Research: core elements

Support for People and Patient-Oriented Research and Trials (SUPPORT) Units

SPOR Networks

Training and capacity development

Improving the clinical trials environment

Patient engagement

22

SPOR SUPPORT Units are provincial and/or regional centres providing support and expertise on data access, methodological and research services, knowledge translation, clinical trials and capacity development

SPOR Networks represent national collaborations of decision-makers, health professionals, health researchers, patients and other stakeholders to generate research evidence and innovations designed to improve patient health and health care systems

Regional SUPPORT Units and pan-Canadian Networks are core components

of SPOR

23

Significant progress made to date on SPOR

Approved - Total Investment = $247.1M / 5 years

Under development – Estimated Investment = $131.2M / 5 years

Status of the SUPPORT Units Business Plans(investments include CIHR and partner funding)

Under discussion – Estimated Investment = $20M / 5 years

Three SPOR Network Opportunities

1. SPOR Network in Youth and Adolescent Mental Health – ACCESS Canada

2. Pan-Canadian SPOR Network in Primary and Integrated Health Care Innovations

3. SPOR Networks in Chronic Disease

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The Issue: Despite its widespread use, there was surprisingly little evidence to support the use of surgery for treating osteoarthritis of the knee

The Study: CIHR-funded researcher Dr. Alexandra Kirkley (University of Western Ontario) compared the outcome for patients who receive surgical versus non-surgical therapy for osteoarthritis of the knee

The Results:

• Results suggested that the surgical treatment that was part of the normal process of care for osteoarthritis of the knee failed to show any benefit for patients

• These results are changing clinical practice around the world

• The total reduction in this surgery translates into national savings (in the US) of between $82 million and $138 million annually

Evidence to improve the efficiency of the healthcare system

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Evidence for better care and cost savings

The Issue: In 2012, Canada ranked 27th among OECD countries (out of 34 countries) in terms of lowest infant mortality rate (source: OECD)

The Study: Dr. Shoo Lee, from Mount Sinai Hospital in Toronto developed a Canadian Neonatal Network and initiated a project aimed at reducing mortality, major morbidity, and hospital length of stay

The Results:

• This project, which started as a pilot project in 12 sites, is now implemented in 30 hospitals and 17 universities across Canada

• Outcomes of the pilot project include:• 30% decrease in hospital acquired infection• 2 days average reduction in length of hospital stay• $7-10 million annual cost savings

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CIHR’s strategic directions for the next five years

Roadmap II’s strategic directions will guide efforts and investments to advance knowledge and capture innovation for better health and health care

Promoting Excellence,

Creativity and Breadth in Health Research and Knowledge Translation

Mobilizing Health Research for Transformation and Impact

Roadmap II

Capturing Innovation to Produce Better Health and Health Care for Canadians

Achieving Organizational Excellence

•Feeding the innovation pipeline

•Re-defining excellence in training

•Identifying research gaps and prioritizing needs•Developing strategic initiatives•Increasing capacity and impact

27

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CIHR is committed to supporting investigator-initiated research

• Supporting investigator-initiated ideas and research, from discovery to application

• Decreasing researcher burden with the implementation of the Foundation and Project Open funding schemes

• Improving the effectiveness, consistency, reliability, fairness and sustainability of peer review decisions through changes to peer review processes

• Ensuring the sustainability of the health research enterprise through the development of a national vision to position trainees for success in both academic and non-academic careers

Staying the course on Investigator-Initiated Research

EX

CE

LL

EN

CE

Strategic Direction #1 Promoting excellence, creativity and breadth in health research and knowledge translation

28

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• Maximizing the health, social and economic impact of research through targeted and partnered investments

• Enabling multidisciplinary research and increasing capacity to address complex research questions

• Focusing on critical health issues championed by Canadians

• Forging strategic alliances with new health and non-health partners

Partnering to ramp up Priority-Driven Research

Mobilizing health research for transformation and impactStrategic Direction #2

MO

BIL

IZE

Success in health innovation will be achieved through strategic alliances

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Identified research priorities conform with those of major international

research organizations

New Therapeutics/Diagn.

Clin & Translational Research

Patient-Oriented Research & Care

Personalized Medicine

Environment & Health

Health Care Efficiency

Aging

Electronic Health Records

Child & Maternal Health

Access to Care

Mental Health

Chronic Diseases

0 2 4 6 8 10 12

Importance (%)

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Roadmap Signature InitiativesResearch Priority Areas

Roadmap Signature Initiatives

Pathways to Health Equity for Aboriginal Peoples

Strategy for Patient-Oriented Research (SPOR)

Personalized Medicine

Community-Based Primary Health Care

International Collaborative Research Strategy for Alzheimer’s Disease

Inflammation in Chronic Disease

Canadian Epigenetics, Environment and Health Research Consortium

Evidence-Informed Health Care

Priority-driven agenda is delivered through major research initiatives referred to as: Roadmap Signature Initiatives

31

Enhanced patient experiences and outcomes through health innovation

Health and wellness for Aboriginal peoples

A healthier future through preventive action

Improved quality of life for persons living with chronic conditions

31

Valley 1 Valley 2

Basic Biomedical Research

Clinical Science & Knowledge

Clinical Practice & Health Decision Making

Translational Continuum

Community-based primary heath-care

Personalized medicine

Alzheimer’s disease and associated dementias

Evidence-informed health-care

Epigenetics

Roadmap Signature Initiatives – Alignment with the Strategy for Patient

Oriented Research

32

CIHR has initiated an in-depth review of the role and slate of Institutes to ensure that the current Institute Model is optimal for delivering on CIHR’s mandate and for enhancing the organization’s capacity for impact and transformation.

From…. To….

• Addressing the needs of a specific community (a home for every researcher…)

• Mobilizing communities to focus on achieving greater impact

• Knowledge translation activities that focus on sharing the results of research with decision makers

• Involving patients and decision makers in the research process to accelerate change in policy and practice

• Inviting partners to co-fund research in gap areas that are of interest to them

• Working with partners to co-design and co-fund transformational initiatives

CIHR’s changing role in the evolving Canadian

research landscape

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