Inappropriateness of health care in Canada: a systematic review protocol

Janet E Squires; Ian D Graham; Doris Grinspun; John Lavis; France Légaré; Robert Bell; Stephen Bornstein; Susan E Brien; Mark Dobrow; Megan Greenough; Carole A Estabrooks; Michael Hillmer; Tanya Horsley; Alan Katz; Christina Krause; Wendy Levinson; Adrian Levy; Michelina Mancuso; Alies Maybee; Steve Morgan; Letitia Nadalin Penno; Andrew Neuner; Tamara Rader; Janet Roberts; Gary Teare; Joshua Tepper; Amanda Vandyk; Denise Widmeyer; Michael Wilson; Jeremy M Grimshaw

doi:10.1186/s13643-019-0948-1

Inappropriateness of health care in Canada: a systematic review protocol

Syst Rev. 2019 Feb 11;8(1):50. doi: 10.1186/s13643-019-0948-1.

Authors

Janet E Squires^{1

2}, Ian D Graham^{3

4}, Doris Grinspun⁵, John Lavis⁶, France Légaré^{7

8

9}, Robert Bell¹⁰, Stephen Bornstein^{11

12}, Susan E Brien¹³, Mark Dobrow¹⁴, Megan Greenough¹⁵, Carole A Estabrooks¹⁶, Michael Hillmer¹⁷, Tanya Horsley¹⁸, Alan Katz¹⁹, Christina Krause²⁰, Wendy Levinson²¹, Adrian Levy²², Michelina Mancuso²³, Alies Maybee²⁴, Steve Morgan²⁵, Letitia Nadalin Penno^{15

26}, Andrew Neuner²⁷, Tamara Rader²⁸, Janet Roberts²⁹, Gary Teare³⁰, Joshua Tepper³¹, Amanda Vandyk¹⁵, Denise Widmeyer³², Michael Wilson⁶, Jeremy M Grimshaw³³

Affiliations

¹ Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, P.O. Box 201-B, Ottawa, Ontario, K1H 8L6, Canada. janet.squires@uottawa.ca.
² Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Canada. janet.squires@uottawa.ca.
³ Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, P.O. Box 201-B, Ottawa, Ontario, K1H 8L6, Canada.
⁴ Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
⁵ Registered Nurses' Association of Ontario, Toronto, Canada.
⁶ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
⁷ Population Health and Practice Changing Research, Research Centre of the CHU de Québec, Québec City, Canada.
⁸ Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, Canada.
⁹ Health and Social Services Systems, Knowledge Translation and Implementation Core, Quebec SPOR Support Unit, Montréal, Canada.
¹⁰ Department of Surgery, University of Toronto, Toronto, Canada.
¹¹ Newfoundland & Labrador Centre for Applied Health Research, Memorial University, St. John's, Canada.
¹² Department of Political Science and Faculty of Medicine, Memorial University, St. John's, Canada.
¹³ Public Reports, Health Quality Ontario, Toronto, Canada.
¹⁴ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
¹⁵ Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Canada.
¹⁶ Faculty of Nursing, University of Alberta, Edmonton, Canada.
¹⁷ Information Management, Data, and Analytics, Health System Information Management Division, Ontario Ministry of Health and Long-Term Care, Toronto, Canada.
¹⁸ Royal College of Physicians and Surgeons of Canada, Ottawa, Canada.
¹⁹ Manitoba Centre for Health Policy, Department of Community Health Sciences and Family Medicine, University of Manitoba, Winnipeg, Canada.
²⁰ British Columbia Patient Safety & Quality Council, Vancouver, Canada.
²¹ Institute of Health Policy, Management, and Evaluation, Department of Medicine, University of Toronto, Toronto, Canada.
²² Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada.
²³ New Brunswick Health Council, Moncton, Canada.
²⁴ Patients Advisors Network, Toronto, Canada.
²⁵ Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, Canada.
²⁶ Canadore College, North Bay, Canada.
²⁷ Health Quality Council of Alberta, Calgary, Canada.
²⁸ Canadian Agency for Drugs and Technologies in Health, Ottawa, Canada.
²⁹ Patient Collaborator, Toronto, Canada.
³⁰ Alberta Health Services - Alberta Cancer Prevention Legacy Fund, Population, Public and Indigenous Health, Calgary, Canada.
³¹ Department of Family and Community Medicine, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
³² Manitoba Institute for Patient Safety, Winnipeg, Canada.
³³ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Department of Medicine, University of Ottawa, Ottawa, Canada.

Abstract

Background: There is increasing recognition in Canada and globally that a substantial proportion of health care delivered is inappropriate as evidenced by (1) harmful and/or ineffective practices being overused, (2) effective clinical practices being underused, and (3) other clinical practices being misused. Inappropriate health care leads to negative patient experiences, poor health outcomes, and inefficient use of scarce health care resources. The purpose of this study is to conduct a systematic review of inappropriate health care in Canada. Our specific objectives are to (1) systematically search and critically review published and grey literature for studies on inappropriate health care in Canada; (2) estimate the nature and magnitude of inappropriate health care in Canada and its provincial and territorial jurisdictions.

Methods: We will include all quantitative study designs reporting objective or subjective measurements of inappropriate health care in Canada over the last 10 years. We will search the following online databases: MEDLINE, Cochrane Central Register of Controlled Trials, EconLit, and ISI-Web of Knowledge, which contains Web of Science Core Collection-Citation Indexes, Science Citation Index Expanded, Conference Proceedings Citation Index-Science, and Conference Proceedings Citation Index-Social Science & Humanities. We will also search grey literature sources to identify provincial and national audits of inappropriate health care. Two authors will independently screen, assess data quality, and extract data for synthesis. Study findings will be synthesized narratively. We will organize our data into three care categorizations: preventive care, acute care, and chronic care. We will provide a compendium of inappropriate health care for each care category for Canada and each Canadian province and territory, where sufficient data exists, by calculating (1) overall medians of underuse, overuse, and misuse of clinical practices and (2) the range of medians of underuse, overuse, and misuse for each clinical practice investigated.

Discussion: This review will result in the first-ever evidence-based compendium of inappropriate health care in Canada. We will also develop detailed reports of inappropriate health care for each Canadian province and territory.

Systematic review registration: PROSPERO CRD42018093495.

Keywords: Delivery of health care; Health services research; Quality of health care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Canada
Delivery of Health Care*
Humans
Meta-Analysis as Topic*
Quality of Health Care / standards
Research Design
Systematic Reviews as Topic*
Unnecessary Procedures*

Grants and funding

201709PJT-156240/CIHR/Canada