What We Do
Ongoing and Recent Projects
SPIDER (Structured Process Informed by Data, Evidence and Research)
Team members: Dr. Mathew Grandy (PI), Dr. Fred Burge (Co-I), Sarah Sabri, Anders Lenskjold, Keri Harvey, Jennifer Isenor, Natalie Kennie-Kaulbach, Lisa Woodill, Matt Holland, Erin Leith, Juanna Ricketts
National team members: Dr. Michelle Greiver, Dr. Simone Dahrouge, Dr. Donna Manca, Dr. Marie-Thérèse Lussier, Dr. Mathew Grandy, Dr. Alex Singer, Dr. Fred Burge, Dr. Stephanie Garies, Jianmin Wang, Patricia O’Brien, Dr. Noah Ivers, Sumeet Kalia, Babak Aliarzadeh, Margo Twohig, Barb Farrell
SPIDER: A Research and QI Collaboration Supporting Practices in Improving Care for Complex Elderly Patients is a national study led by Dr. Michelle Griever at the University of Toronto. MaRNet-FP is leading the Nova Scotian arm of the study. SPIDER is a pragmatic randomized control trial aimed at deprescribing in elderly patients who are on 10 or more medications by employing quality improvement practices in primary care settings. The study is ongoing and is expected to be completed in the spring of 2022.
Team members: Dr. Mathew Grandy (PI), Beverley Lawson, Sarah Sabri, Ingrid Sketris, Heather Neville, Virginia McIntyre, Isaac Bai
This is a local project led by Dr. Mathew Grandy to validate a case definition for chronic opioid use within primary care EMR data. Following this we will do descriptive work, applying the definition to the provincial MaRNet-FP data set with the hope that we can eventually aid in informing practitioners about high-risk patients in their practices and long-term risk reduction for these patients.
Pandemic Primary Care: How do we get care to those who need it?
Team members: Dr. Fred Burge (PI), Dr. Anders Lenskjold (Co-PI), Dr. Emily Marshall, Sarah Sabri, Dr. Mathew Grandy, Dr. Joanna Zed, Erin Christian, Matt Holland, Juanna Ricketts
We are analyzing EMR data collected before and during the pandemic from MaRNet-FP participants to understand patient visit patterns and how they’ve changed over the last year. Not only will we use standard statistical descriptions, but we are excited, that for the first time, we will be using machine learning to identify characteristics of patients at risk who were not previously meeting this categorization. The results will shed light on the type of patients seen in-person or virtually and those who were not seen by their primary care provider. The overarching goal of this study is to deliver the best possible care to at-risk patients in Nova Scotia. The results of the study are expected to be published in the spring of 2021.
Testing, and Overtesting: Using MaRNet-FP data to help
Team members: Dr. Fred Burge, Dr. Anders Lenskjold, Dr. Samina Abidi, Dr. Raza Abidi, Dr. Mathew Grandy.
Diagnostic overtesting is not always beneficial for patients or providers. For patients, there is the potential to do more harm by labelling and overtreating them with further unnecessary health services. For the provider, possible overuse of health services may reduce availability for other patients. Thyroid Stimulating Hormone (TSH) testing is among “Choosing Wisely Canada’s” list of “Thirteen Things Physicians and Patients Should Question”. For his master’s thesis study, Dr. Anders Lenskjold will use MaRNet-FP data to explore the extent of TSH testing, its possible overuse, and the consequences in Nova Scotia for patients and primary care providers.
Screening for Gestational Diabetes Mellitus and Postpartum Type 2 Diabetes: A Retrospective Cohort Study using Primary Care Electronic Data
Team members: Dr. Helena Piccinini-Vallis (PI), Dr. Pantelis Andreou (Co-I), Dr. Lynn Bussey (Co-I), Dr. Jillian Coolen (Co-I), Dr. Matt Grandy (Co-I), Leanne MacKeen (Co-I)
This study, led by Dr. Helena Piccinini-Vallis, is novel in Nova Scotia and Canada. It will pioneer the systematic extraction of prenatal data from primary care EMRs containing prenatal and postpartum data that represent the continuity of care during women’s reproductive years as is typical in primary care. Such a platform could contribute to a robust knowledge base in the area of maternity care, with the potential for regional (Maritime provinces) and national expansion and collaborations leading to improvements in the delivery of primary maternity health care. As a secondary objective, this study also expands the relatively unchartered territory of linking the Nova Scotia Atlee Perinatal Database with the primary care platform developed through this study. The study aligns with the chronic disease priority of Nova Scotia Health on many levels, as it pertains to the diagnosis and management of a precursor of chronic disease (GDM), the diagnosis of a chronic disease (type 2 diabetes), and the prevention of another chronic disease (downstream childhood obesity). Further, the results of this study are potentially of particular relevance to African Nova Scotians and Indigenous Peoples of Nova Scotia, who experience very disproportionate rates of GDM, type 2 diabetes, and obesity (including childhood obesity).
Heart Failure Case Definition
Team members: Dr. Mathew Grandy, Dr. Fred Burge, Neala Gill, Sarah Sabri, Dr. Michael Fleming
Team collaborators: Joanne Lamb, Kathy Harrigan, Dr. Brian Clarke, Lena MacDonald, Dylana Arsenault, Natalie Nichols, Dr. Kim Anderson
This study was carried out by MaRNet-FP in partnership with Cardiovascular Health Nova Scotia. The objective of this study was to develop a validated case definition to identify patients with heart failure using primary care EMR data that can subsequently be used for monitoring key indicators of heart failure (HF) care. An interdisciplinary team of domain experts including family physicians, nurse practitioners, pharmacists, and a cardiologist came together to develop an HF case definition. We were able to validate the developed HF case definition among 600 random patients over 40 years old in Nova Scotia. The results revealed sensitivity of 68.18% and specificity of 96.30% for our HF case definition.
Team members: Dr. Olga Theou (Co-PI), Dr. Barry Clarke (Co-PI), Susan Savage (Co-I), Dr. Melissa Andrew (Co-I), Dr. Fred Burge (Co-I), Melissa Buckler (Co-I), Dr. Valerie Lewis (Co-I), Dr. Emily Marshall (Co-I), Dr. Kenneth Rockwood (Co-I), Dr. Grace Warner (Co-I), Dr. Mary Gorman (Co-I), Dr. Elaine Moody (Co-I), Dr. Grace Park (Co-I), Dr. Xiaowei Song (Co-I), Dr. Jaymi Cormier, Beverley Lawson, Lynn Edwards, Lisa Bedford, Ron Swan, Dr. Olive Bryanton
Dr. Sabrina Wong from the University of British Columbia led this project. The aim of this research was to create and validate a case definition of frailty using primary care EMR data. Locally we recruited practices to help validate this case definition by applying the Rockwood clinical frailty scale to a number of their patients. Once the initial validation work was completed, we utilized machine learning to help hone the definition in the hopes that we would be able to translate this finding into a tool that allows for better identification of frail patients for early intervention and health service planning. The project has been submitted for publication and should be published later this year.
Primary Care Data Platform
MaRNet-FP has a database of high-level Nova Scotian primary care data. We ensure that any research conducted using MaRNet-FP data is scientifically and ethically sound and complies with applicable REB requirements, privacy and data protection legislation, and legal agreements. All requests for access to MaRNet-FP data will be received by the MaRNet-FP network manager.
MaRNet-FP values the views of the sentinels who comprise the network. MaRNet-FP will not participate in research that sentinels believe presents a conflict of interest. Sentinels do not want to participate in research for, or be funded by, the pharmaceutical industry. Research proposals from other commercial industries will be reviewed by the advisory committee during regularly scheduled meetings. The advisory committee must come to a unanimous decision for proposals from commercial industries to be approved. Additional input may be sought from sentinels who are not part of the advisory committee to ensure decisions made regarding funding are representative of MaRNet-FP sentinels.
Contact us if you have questions or would like to apply for access to the MaRNet-FP database.