PMCC: ‘The Dragon’s Den of health care’

Stop if you’ve heard this before.

 

The trio are part of the Peter Munk Cardiac Centre’s Innovation Committee – where leaders in business and health care use their acumen to decide which health care projects to fund (or not).

 

The Globe and Mail dubbed the Peter Munk Cardiac Centre’s Innovation Committee “The Dragon’s Den of health care”.

 

The committee funds the next wave of cardiac devices, novel clinical practice standards and patient-centred services.

 

Only in its second year, some of the successful projects have already been completed and promise t o deliver significant impact.

 

The Peter Munk Cardiac Centre (PMCC) is a fertile environment for a group like this. The size and scope of the 1,000-person program means it has the talent and patient base to make impactful, evidence-based recommendations to encourage provincial funding for effective projects.

 

 

Our focus on interprofessional care and our ability to collaborate with experts across UHN make innovation possible here in a way unlike anywhere else,” said Dr. Barry Rubin, Program Medical Director, PMCC. “Today’s innovation is tomorrows practice.”

 

So what kinds of projects have seen funding so far?

 

The problem: X-rays expose the body to radiation; exposure that has a cumulative effect over a lifetime. Many patients fear that this exposure could induce cancer, which affects the number of patients who undergo cancer screening for things like mammograms.

 

The solution: Radiologist, Dr. Kieran Murphy, and his team created an antioxidant pill that appears to cut DNA damage by 40 per cent when taken for five days before an X-ray.

 

The study: Their preliminary experience demonstrated a 40 per cent reduction in broken DNA with the antioxidant pill. The Innovation Committee approved a 30-volunteer study of heart patients who need cardiac CT scans; half will take the antioxidant solution, while the other half will not and Dr. Murphy’s team will analyze their blood for differences in DNA damage. The study began recruiting patients in September 2013.

 

The future: This is part of an evolving program Dr. Murphy is leading to protect patients from all forms of radiation injury and decrease potential side effects of radiation from screening. A reduction in exposure damage might encourage more patients to get screened – allowing more people to benefit from early detection.

 

The problem: When they turn 18, adolescents with congenital heart disease must transition from pediatric cardiac care at SickKids to the PMCC’s Adult Congenital Heart Disease program. Many patients struggle with the challenges of assuming greater responsibility for their health care management and decision-making -  lapses in care in this group of patients are not uncommon.

 

The solution: Adrienne Kovacs, clinical and health psychologist, developed a website targeting the needs of patients transitioning from pediatric to adult cardiac care. The iHeartChange website provides an introduction to the adult clinic, important medical and lifestyle information, and emphasizes the importance of increasing independence for adolescent and young adult patients.

 

The study: Results from the iHeartChange pilot study revealed that most patients found the website was easy to use, provided helpful information, and should be offered to all patients moving to adult care. By tracking page views, they also learned that transitioning patients’ informational needs go beyond their cardiac condition.

 

The future: PMCC funding will allow the team to update and improve the website and invite other Adult Congenital Heart Disease programs across North American to join iHeartChange.

 

The problem: Due to the complex nature of the patients that we manage, more than half of our cardiac surgery patients required red blood cell transfusions and more than a third required other blood products – giving Peter Munk Cardiac Centre one of the highest transfusion rates in the province. Blood is an expensive and precious resource. By reducing usage, we could improve outcomes in our patients and reduce costs to the healthcare system by conserving supplies.

 

The solution: Deputy Chief of Anesthesia, Dr. Keyvan Karkouti, and his team developed an in-house transfusion algorithm and a process for testing blood clotting at the point of care to determine a patient’s transfusion need.

 

The study: Dr. Karkouti’s team compared transfusion rates and clinical outcomes from the year before the algorithm was developed to the first six months of 2013, which was after the algorithm was used. Use of the algorithm substantially reduced the transfusion rate of red blood cell and other blood product during heart surgery, and significantly decreased the frequency of kidney injury and the need for repeat surgery. Overall, the program cost $150,000 to run for 6 months, and is projected to save the Hospital $1,500,000 in blood products this year.

 

The future: The program should be readily transferrable to other hospitals, reducing transfusions and improving outcomes for all cardiac surgical patients. Dr. Karkouti’s group has applied for multi-centre trial funding that would determine the scalability of the program.

 

 

In its inaugural year, the Innovation Committee funded eight projects -- 70 per cent of all projects submitted, which is a substantially higher rate than the 10 to 20 per cent most granting agencies fund.

 

The typical cost of most projects was between $50,000 and $100,000. Other devices evaluated by the PMCC Innovation Committee, like trans-apical aortic valve implantation (TAVI) are now funded by the Ministry of Health, so the philanthropic funds used to do the initial evaluation of TAVI have had a clear return on investment.

 

So what does the Innovation Committee have planned for an encore?

 

A few things, it turns out.

 

First, they’ve begun looking at more long-term investments.

 

“We’re seeing an influx of applications that involve stem cells,” said Rakowski. “By funding stem cell studies – some of which are in the pre-clinical phase – we’ve departed from our first year’s mandate that focused solely on projects that were quick investments and offered short turnaround.”

 

Second, the committee would like to commit to developing partnerships that would let the PMCC develop technology rather than using devices someone has already made and taken through initial trials.

 

“We already test, but we should be working with inventors and engineers, developing innovative devices that change the face of cardiac care,” said Rubin. “It’s not hard to imagine the Peter Munk Cardiac Centre becoming a living laboratory for that kind of progress.”

 

In order to be considered, projects cannot be eligible for funding from other granting agencies. This preserves the philanthropic funds for projects that are particularly unique and don’t decrease reliance on traditional grants.