Anna Gagliardi

Research Synopsis

Improving the development, implementation and use of guidelines (CIHR funded)

Guidelines synthesize scientific evidence on a given condition, disease, procedure or therapy. Guideline recommendations are therefore fundamental to health care planning, delivery, evaluation and quality improvement. However, guidelines are widely under-utilized, leading to suboptimal health care, poor patient outcomes, and increased costs for health systems. It is also a waste of considerable resources when government, academic, professional and not-for-profit organizations in Canada and worldwide develop guidelines that are not used. My research advanced the concept of implementability, developed and validated the Clinician Guideline Determinants Questionnaire, and generated criteria and methods for developing guideline implementation tools. This research resulted in an increase in guideline implementability content from 30% in 2011 to 67.5% in 2017, international recognition as a guideline implementation expert, and use of the Questionnaire by international groups.

Preventing and managing adverse medical device events (CIHR funded)

Medical devices (i.e. cardiovascular, orthopedic) extend life and improve quality of life; however, adverse medical device events (AMDEs) constitute approximately 10% of hospital incidents. My research, in partnership with the Health Canada Medical Devices Bureau, described medical device recalls in Canada over a ten-year period, assessed how physicians choose devices and engage patients in those decisions, and identified factors that influence whether physicians report adverse medical device events. More recently, I partnered with Health Canada to assess how they can strengthen consideration of sex and gender based analysis across the medical device lifecycle. This research contributed to new Health Canada policy requiring that hospitals across Canada capture and submit information about adverse medical device events, and the implementation of new procedures at Health Canada to collect and analyze data on sex and gender when reviewing and monitoring medical devices.

Patient and family engagement in hospital health service planning and improvement (CIHR funded)

Hospitals increasingly involve patients (or family/care partners/consumers) in planning or improving hospital services, which is required for accreditation. My research explored the conditions needed to optimize patient/family engagement, knowledge needed to ensure that the patient voice is actually used to improve what hospitals do. In this research, I surveyed hospitals about engagement activities; identified hospitals with high engagement capacity, interviewed stakeholders (patient/family advisors, engagement managers, clinicians) about strategies that support engagement, organizational capacity for engagement, and impacts of engagement. This research resulted in patient/family advisor and health professional consensus on 32 recommendations to optimize engagement, and a casebook, which highlights key findings and offers 40 one-page project-specific cases derived from aforementioned interviews featuring processes, enablers and impacts of patient/family engagement.

Implementing person-centred care for women across the lifespan

Compared with men, women are less likely to access the care they need for health issues across their lifespan, report sub-optimal communication with clinicians, and have poorer health outcomes. Person-centred care (PCC) – active engagement of patients in their own health and health care based on needs, life circumstances and preferences -- improves many patient-important and clinical outcomes. Through syntheses, analysis of government policies, clinical guidelines and medical curriculum, and interviews with diverse women and clinicians, this research generated insight on what constitutes person-centred care for diverse women, and identified approaches, interventions and tools needed to support person-centred care for women (PCCW). This research resulted in consensus among women and healthcare professionals on 49 recommendations to achieve PCCW, and informed current research on the design and impact of question prompt tools, and the role of community agencies in health promotion to immigrant women. Ultimately, this research may reduce gendered inequities in quality of care, and improve care and outcomes for women in areas of focus: ductal carcinoma in situ, hypertensive disorders of pregnancy, dementia and osteoarthritis.