A Canadian multi-site hospital amalgamation, Niagara Health System runs multiple sites serving over 450,000 residents across the 12 cities making up the Regional Municipality of Niagara, Canada. One of the province of Ontario’s largest hospital systems, Niagara Health System employs nearly 5,000 with 600 physicians and a budget of about $550 million. With the onset of pandemic and a novel pathogen, the health system moved to ramp up clinical research as a care option. With no known treatments for SARS-CoV-2, a robust portfolio of COVID-19 clinical trials becomes a matter of life and death. A challenge, however, in Canada and its big neighbor to the south is that much research didn’t happen in community hospitals but rather in academic medical centers. That is, although a majority of community hospitals in Canada cared for COVID-19 patients (75%), actual clinical trials occurred in the academic hospitals in major cities such as Toronto, Montreal, or Vancouver.
TrialSite has identified a similar chasm between governemnt researh agencies and elite academic research partners on the one hand and even the biggest, sprawling health systems in America that aren’t part of decision making in relation to the COVID-19 research agenda. That the research as a care option movement will influence the more equitable and efficient allocation of research throughout the clinic, from giant health systems to regional health networks to federally qualified health centers or critical access hospitals.
But during this pandemic, the nature of the health crisis and the lack of treatments accelerated the embrace of research in the community health setting. And this is just the beginning as TrialSite chronicles the incremental, progressive move to the health system embrace of clinical trials not just for novel outliers but core research as a care option focused program. For example, as reported by CBC, Dr. Jennifer Tsang, a Niagara Health research lead, “The discrepancy between where COVID-19 patients receive care and where COVID-19 research is conducted resulted in slow patient recruitment to urgent COVID-19 clinical trials in Canada.” The pandemic educates all executives in healthcare that a robust and permanent research infrastructure benefits the local population.
Now with more research making its way into the health clinics, such as Niagara Health System, trials evaluating everything from the safety of some drugs to strategies to reduce a patient’s need for ventilation or admission to the hospital, CBC reports on some important trials conducted at this health system.
· The CATCO study evaluates the safety of ritonavir/lopinavir (kilter), used to treat HIV, and remdesivir, developed to treat Ebola, in hospitalized patients. It’s being conducted in conjunction with the World Health Organization’s Solidarity trial, says the release, which is one of the largest international trials for COVID-19 treatments.
· The REMAP-CAP Study looks at the clinical effectiveness and safety of various COVID-19 treatments in patients who are in the Intensive Care Unit, including the use of corticosteroid.
· The COVI-Prone study is examining the benefits of COVID-19 patients with respiratory failure lying on their stomachs, and whether this reduces the need for mechanical ventilation.
· The Anti-Coronavirus Therapies to prevent progression of COVID-19 trial is studying whether treatment with certain medicines can prevent the need to be admitted to the hospital or ICU.
The Health System
A regional healthcare provider with multiple sites and a growing network of community-based and virtual services, Niagara Health System has over 600 physicians and 750 volunteers. Serving over 450,000 residents across Niagara, advanced services from Acute Care, Cancer Care and Cardiac Care to Complex Care Emergency and Urgent Care, Kidney Care, Mental Health and Addictions, Stroke Care and Surgical Care associate with ongoing Accreditation with Exemplary Standing.
The system serves nearly 195,000 emergency and outpatient encounters per annum. With 967 beds, 34, 527 new admissions occur per year.
Niagara Health Research positions its commitment to community hospital research. Most recently, two of their researchers published in the prestigious Canadian Medical Association Journal (see here), examining the impact of research activity in community health settings.
A team here at Niagara Health Research found that a boost in research participation affords more opportunity for national research, not to mention expedited knowledge translation, boosts in staff engagement and continuous education and enhanced clinician career satisfaction. Led by Dr. Jennifer Tsang, Research Lead, Intensivist and Co-Director, Critical Care Research for the health system she is supported by Paige Gehrke, a Registered Nurse in their ICU at St. Catharines. See the research group’s website.