Our Projects

Obesity is a complex, chronic condition that affects the health and quality of life of many Albertans, yet it is often under-recognized and inconsistently managed in primary care. The Provincial Pathways Unit approached PLP Co-Lead Dr. Denise Campbell-Scherer to be part of a working group aimed at developing a clinical and patient pathway to support earlier, evidence-based, and patient-centered care of patients living with obesity. The pathway aims to reduce stigma, guide clinicians in staging and managing obesity, while providing practical strategies spanning lifestyle interventions, psychological support, medications, and surgical options. It also clarifies when referrals to specialist care are indicated. By equipping providers with these tools and helping patients understand and actively manage their condition, this initiative strengthens primary care capacity and supports better long-term health outcomes for individuals living with obesity.

This initiative equips primary care providers and patients with practical, evidence-based tools to improve obesity management, reduce stigma, and support earlier, more effective interventions—ultimately enhancing long-term health outcomes for Albertans living with obesity.

Access to high-quality care transitions is not equally distributed across urban populations. Many health systems design transition processes that assume patients have stable housing, reliable social supports, and consistent access to primary care. However, underserved urban populations—often facing poverty, unstable housing, and high burdens of illness—frequently lack these supports. As a result, care plans may be difficult to follow and important needs may go unmet, leading to poorer patient outcomes, more fragmented care, and increased reliance on acute care services.

Building on the foundations of Phase I, this initiative contributes to a broader program dedicated to improving health outcomes for those facing social and economic insecurity. Initial findings from Phase 1 revealed that successful transitions are driven as much by social determinants—such as housing stability and community access—as they are by clinical factors.

Currently, the project is focused on validating these insights through deep engagement with healthcare providers and community partners. Led by PLP Medical Director Dr. Ginetta Salvalaggio, this collaborative process ensures that our findings reflect real-world practice. Early dissemination with teams at Radius Community Health and Healing and the Acute Care Addiction Recovery Program (RAH) has confirmed a strong alignment between our data and frontline experience. Moving forward, these partners are co-developing practical, equitable strategies to strengthen care coordination for underserved urban populations.

Current administrative health databases in Alberta do not reliably distinguish between Type 1 (T1D) and Type 2 diabetes (T2D), obscuring the unique clinical needs and resource requirements of the T1D population. With the prevalence and economic burden of T1D projected to rise sharply through 2040, developing a reliable, high-specificity case definition is a critical priority for health system planning.

Phase 1 of this project focused on validating the ability of Sharma’s¹ algorithm’s to accurately identify and distinguish T1D in adults using Alberta’s administrative and clinical datasets by evaluating performance metrics such as specificity, sensitivity, and predictive values. Phase 2 builds on this foundational work to significantly enhance diagnostic precision. 

In collaboration with Dr. Peter Senior, Dr. Padma Kaul, and PLP Medical Director Dr. Rose Yeung, the current work integrated complex laboratory and pharmaceutical variables to further refine Sharma’s¹ algorithm, as a result, T1D can successfully be differentiated within provincial administrative datasets.

This enhanced accuracy provides policymakers and clinicians with the granular insights essential for targeted healthcare delivery and strategic resource allocation. With data analysis now complete, findings were presented at the Family Medicine Summit in Calgary, Canada in March 2026, and the team is currently developing a manuscript to share these key findings with the broader medical and policy communities.

¹Sharma M. An algorithm for identification and classification of individuals with type 1 and type 2 diabetes mellitus in a large primary care database. Clin Epidemiol. 2016; 8: 373-80. https://doi.org/10.2147/CLEP.S113415

By enabling health systems to distinguish T1D from T2D in administrative health data, this work will help policy makers, clinicians, and the diabetes community better understand the needs and burdens of people with T1D, leading to improved healthcare planning and supporting more appropriate care for Albertans living with type 1 diabetes.

Over the past few years, PLP has supported several critical care focused initiatives, including Optimizing Safe and Effective Use of Human Albumin Solutions in Critical Care in Alberta, Don’t Misuse My Blood, Dialyzing Wisely and most recently HSAPA. Through this ongoing collaboration, PLP has built a strong and trusted partnership with critical care teams.

Building on this connection, PLP collaborated with ACA’s Critical Care Provincial Program Team to design and deliver five one-page educational resources focused on Albumin, ICU Delirium, Don’t Misuse My Blood, Dialyzing Wisely, and Venting Wisely. Developed using human‑centred design principles, these resources translate complex clinical guidance into accessible, practical tools that can be quickly used at the point of care. While designed primarily for medical residents, the tools are intentionally adaptable for use by interdisciplinary ICU teams, including nursing staff and laboratory professionals.

The design process emphasized:

• Rapid usability with content designed to be reviewed in under five minutes.

• Consistent structure and layout supporting ease of navigation across topics.

• Clear visual cues including use of colour, icons and bifold formatting.

• User relevance informed by feedback from medical residents and subject matter experts.

Collectively, these resources strengthen knowledge translation by providing ICU teams with standardized, visually intuitive reference materials that reinforce evidence‑based practices across multiple high‑impact areas of critical care. Visual examples of the one‑page tools, design elements, and layout conventions will be included in this report to illustrate how human‑centred design was applied to support uptake and usability in clinical environments.

Through a human‑centred design approach and collaboration with provincial critical care partners, standardized knowledge translation resources are improving access to evidence‑informed guidance and supporting system‑wide consistency in critical care practice across Alberta ICUs.

Recurrent and persistent low back pain (LBP) is a massive problem in Alberta, increasing in prevalence yearly. Unfortunately, PCPs and their patients lack access to patient education and exercise programs due to well-documented barriers, including limited physician training and confidence in LBP programs, insufficient time and system resources, and reluctance to recommend programs that require out-of-pocket patient costs. Impeded by these barriers, physicians often default to low-value, high-cost interventions (e.g., opioids, imaging, specialist referrals), creating significant inequity among the >50% of Canadians who do not have extended health care benefits.

To bridge this gap, a multidisciplinary team originally led by the late Dr. Greg Kawchuk co-designed a guideline-recommended LBP intervention alongside patients, clinicians, and administrators. Now led by Dr. Erin McCabe, Dr. James Young, and PLP Co-Lead Dr. Denise Campbell-Scherer, the project is evaluating the implementation of GLA:D® Back across Alberta’s PCNs, and follows previous work by the PLP to support implementation of this program, including use of human centred design to understand the patient journey and support for dissemination with PCNs participating in the initial phase. Leveraging PLP’s expertise in implementation science, this current project examines how modifications or adaptations of the program support broader implementation, how shifting contextual factors impact implementation and sustainment, and how insights from PCNs can inform and guide GLA:D® Back implementation at new PCNs.

Supported by a three-year Alberta Innovates grant, the knowledge transfer activities now include 18 engaged PCNs. The first year of implementation evaluation of the expansion into diverse primary care contexts has been completed. Preliminary findings have been presented as a poster at the 4th Swiss Implementation Science Conference in Zurich, Switzerland in February 2026, and a protocol manuscript is currently under review.

This project supports the implementation of an accessible, evidence-based program for low back pain, helping reduce reliance on low-value care, improve equity in access, and promote better patient outcomes across Alberta.

The primary goal of managing dyslipidemia is to mitigate the substantial risk of myocardial infarction and stroke—a task in which PCPs play a pivotal role. While statins remain the cornerstone of lowering LDL cholesterol, current clinical guidelines emphasize that high-intensity statin therapy is essential for high-risk populations, particularly those living with diabetes. To bridge the gap between these guidelines and daily practice, the PLP, led by Dr. Donna Manca in partnership with NAPCReN, provides clinicians with targeted, data-driven insights to ensure that patients with diabetes or cardiovascular disease, who are most likely to benefit from statin therapy, receive optimal evidence-based care.

Leveraging the CPCSSN dataset, these reports provide participating physicians with individualized practice data alongside benchmark comparisons. This dual-layered approach allows practitioners to monitor their prescribing patterns against provincial standards and evaluate the impact of practice changes over time. In its inaugural distribution year (2025–2026), the program successfully delivered 80 individualized physician practice reports.

The initial rollout was completed in October 2025, supported by a comprehensive development phase and targeted data extraction. Each report includes curated clinical resources designed to advance patient care and supports physicians in fulfilling quality improvement (QI) requirements, with referrals to past PLP learning resources including: Pressing Matters: How to Approach Hypertension; Platelets be Gone: Navigating the Latest in Antiplatelet Therapy; and Mercury Rising! Optimizing Blood Pressure. As part of a broader dissemination strategy, aggregate findings from these reports were featured in the October 7, 2025, learning event, Beyond Statins: Lipid Management that Works.

By transforming raw EMR data into actionable feedback reports, this initiative bridges the gap between clinical guidelines and daily practice—ensuring that Alberta’s high-risk cardiovascular patients receive the lifesaving, high-intensity therapy required to prevent avoidable heart attacks and strokes.

The Canadian Association of Gastroenterology (CAG) was awarded a $10,000 Choosing Wisely Canada grant to develop and implement toolkits that promote appropriate use of gastroscopy for patients under 60 years of age presenting with dyspepsia without alarm symptoms. Led by Dr. Sander Veldhuyzen van Zanten and Dr. Kelly Burak, this national initiative builds on prior provincial work demonstrating that many patients with dyspepsia can be safely managed without endoscopy, aligning care with current CWC and CAG recommendations.

PLP and Choosing Wisely Alberta (CWA) are supporting this work through the development of practical toolkits for health care teams, including patient‑facing resources, an updated primary care pathway, and an implementation toolkit that emphasizes the role of audit and feedback (A&F) in supporting uptake of evidence‑based practice. The primary care toolkit enhances and updates the existing Alberta Dyspepsia Primary Care Pathway, incorporating relevant resources from the Canadian Digestive Health Foundation to ensure applicability for a national audience. New patient resources are being developed to help individuals understand why gastroscopy is often not required for dyspepsia management and to support shared decision‑making.

A complementary toolkit for gastroenterologists and health system administrators focuses on implementation, describing how facilitated audit and group feedback can be applied to reduce low‑yield gastroscopies, building directly on lessons learned from the original PLP Dyspepsia project in Calgary.

Over the reporting period, work has focused on defining and refining toolkit content, aligning project team resources, engaging multidisciplinary stakeholders across Canada, and incorporating early feedback to ensure the tools reflect real‑world clinical practice. This foundational work positions the project for broader national dissemination, piloting, and evaluation in the coming phase.

Elevated blood glucose on the day of surgery is a well-established risk factor for surgical site infections, prolonged hospital stays, ICU admission, and readmission. PGMP has been successfully implemented across seven surgical sites in Alberta, yielding measurable improvements in postoperative glycemic control managed by surgical teams. Despite this progress, there is a persistent gap in day-of-surgery glycemic management, an area primarily overseen by anesthesiologists. Interviews with anesthesiologists and perioperative nurses indicate that this gap is often underestimated and that day-of-surgery hyperglycemia is not consistently linked to downstream patient harm, highlighting a critical opportunity for intervention.

Led by Dr. Shannon Ruzycki, with PLP Medical Director oversight from Dr. Sonia Butalia, this project brings together the Department of Medicine, Department of Anesthesiology and Pain Medicine, Community Health Sciences, CSM, and the University of Calgary to address this gap. This project leverages A&F strategies to provide anesthesiologists with individual-level feedback on their day-of-surgery glycemic management, alongside other data such as  length of stay and readmissions. This approach is intended to support reflection on practice and identification of opportunities to improve perioperative glucose measurement and treatment.

Initiated this reporting period, key milestones included completing a measurement and evaluation plan, and A&F report design. Ethics approval was obtained to support PLP data handling and develoment of a physician consent and opt-in process through Qualtrics. 

By February 2026, 65 anesthesiologists had consented to receive individual reports. Facilitated A&F sessions have been scheduled for April 10, 2026 (University of Alberta Hospital), April 24, 2026 (Peter Lougheed Centre), and May 8, 2026 (South Health Campus).

Individual audit and feedback for anesthesiologists supports improved perioperative glucose measurement and treatment for surgical patients with diabetes, contributing to closing a persistent gap in perioperative care.

Chronic Kidney Disease (CKD) affects one in ten Canadians, yet a significant gap remains between international treatment guidelines and real-world clinical practice. For Albertans, this gap in guideline-concordant care translates into a substantial health system burden, increasing the risk of ED visits, acute kidney injuries, and major cardiovascular events. Because untreated CKD often progresses to costly interventions such as dialysis and transplantation, understanding current management patterns is critical for provincial healthcare stability. In collaboration with Dr. Tyrone Harrison and nephrology specialists, this project utilizes a comprehensive analysis of Connect Care, Drug Optimization, Sustainability, and Evaluation (DOSE), and the pharmaceutical information network (PIN) administrative databases to establish a baseline for evidence-based care. The study specifically examines healthcare utilization and prescription patterns for key therapeutic classes—including sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon like peptide 1 (GLP-1) receptor agonists, and ns-MRAs—to evaluate their association with patient outcomes.

Over the past year, the project has transitioned from design to execution. With cohort identification and data extraction complete, the project has begun a high-level analysis of CKD care trajectories. These findings will provide the foundational evidence required to drive future QI initiatives and strategic resource allocation across Alberta’s healthcare landscape.

This work will establish baseline insights into CKD management across Alberta, identifying gaps in guideline-concordant care and informing future quality improvement and research initiatives.

Rising rates of endometrial cancer among younger women have necessitated a critical shift in clinical practice. In response, the Society of Obstetricians and Gynecologists of Canada (SOGC) recently updated provincial guidelines to recommend endometrial biopsies for younger patients presenting with abnormal uterine bleeding (AUB). Despite these recommendations, a persistent knowledge gap exists among frontline clinicians, potentially delaying the early detection and treatment of a condition that—while common—can signal underlying pathologies ranging from hormonal disruption to malignancy.

To bridge this gap and optimize diagnostic pathways, the PLP, in collaboration with Medical Director Dr. Darren Lau and Dr. Sanja Kostov, is conducting a longitudinal analysis of endometrial cancer prevalence among adult women in Alberta from 2013 to 2023. This project moves beyond simple prevalence assessments to examine the time-to-diagnosis across various age demographics. The analysis will compare time to diagnosis across age groups and explore factors that may influence diagnostic timing, such as prior iron therapy, to identify potential early indicators that may be overlooked in clinical practice.

This project will guide efforts to raise awareness of endometrial biopsy recommendations for younger patients with abnormal uterine bleeding, helping reduce delays in cancer detection and treatment.

An audit of gastroscopy use to investigate dyspepsia in young patients in the Calgary Zone was previously published in the Canadian Association of Gastroenterology Journal¹, and highlighted that many patients are receiving unnecessary endoscopies, contrary to published guidelines. In the follow up publication, we plan to report how facilitated audit and group feedback led to a nearly 50% reduction in low-value gastroscopies performed by Calgary gastroenterologists on otherwise healthy adults with dyspepsia.

Recognizing the growing demand among physicians and healthcare teams for practical strategies to drive meaningful clinical change, this work aims to provide a clear and actionable roadmap on how to affect change using the Calgary Audit and Feedback Framework (CAFF)  The resulting manuscript will also serve as the scholarly foundation for a new CWC toolkit being developed by CAG, CWA and PLP, focused on promoting appropriate use of gastroscopy for dyspepsia without alarm symptoms in patients under 60 years of age.

Work on a draft manuscript is currently underway, with submission for publication anticipated in Spring 2026.

¹Halasz, J. B., Burak, K. W., Dowling, S. K., Murray, B., Williams, J., Misra, T., Veldhuyzen van Zanten, S. J., Kaplan, G. G., Swain, M., & Novak, K. L. (2022). Do low-risk patients with dyspepsia need a gastroscopy? Use of gastroscopy for otherwise healthy patients with dyspepsia. Journal of the Canadian Association of Gastroenterology, 5(1), 32–38. https://doi.org/10.1093/jcag/gwab017

Substance use disorders remain significantly underdiagnosed and undertreated, despite their profound impact on patient outcomes and healthcare system sustainability. To improve identification and support, it is critical to understand exactly how and where individuals seek care for substance-related concerns. This foundational quantitative project, led by Dr. Kathryn Dong, examines the prevalence and distribution of healthcare encounters across Alberta between 2019 and 2024, assessing how substance use disorders are currently identified and managed within the provincial system. As part of a multi-phase program, these findings will drive the development of targeted interventions—including provider education and stigma-reduction initiatives—designed to enhance patient-centered care for people who use drugs (PWUD).

The project has transitioned from planning to execution. To further improve efficiency, the team developed and tested the statistical analysis workflow using a simulated dataset in advance of final data receipt. This approach is expected to reduce downstream timelines once the full dataset becomes available and keep the project on track to contribute high-level evidence that can inform optimization of substance use care pathways across Alberta.

This work will provide critical, system-level insight into how substance use disorders are identified and managed across Alberta's urgent care centres, emergency departments, and hospital settings. Findings will directly inform the development of targeted provider education and stigma-reduction initiatives, supporting more equitable, evidence-informed care for people who use drugs.

This project focuses on the development of physician- and patient-facing education and support materials to guide appropriate responses, follow-up, and interventions for radiology-reported incidental findings of Interstitial Lung Abnormalities (ILAs) identified on CT scans. ILAs may be indicative of early or subclinical Interstitial Lung Disease (ILD) and can present challenges related to variability in reporting, follow-up, and referral practices.

Initially launched as a Calgary initiative, the project is intended to establish a foundational pathway that can be scaled and spread provincially, with applicability across both specialist and general radiology settings. Led by Dr. Amanda Grant-Orser, this work is being advanced in collaboration with the Foothills Medical Centre Interstitial Lung Disease Clinic, ensuring alignment with specialist expertise and current clinical practice.

The proposed pathway will be designed to function as both a clinical decision support tool and a knowledge translation mechanism, supporting physicians in evidence-informed follow-up care, referral decisions, and patient communication. Emerging and forthcoming guidance, including anticipated updates from the American Thoracic Society, will be integrated into pathway content and associated materials as appropriate.

The project transitioned from early planning into active engagement, completing a needs assessment with radiologists, family physicians, and respirologists, as well as a patient engagement phase that included interviews and lived‑experience perspectives. A multidisciplinary design group convened a series of focus groups to review early findings, validate care gaps, and inform next steps. Two of the three planned focus groups have been completed and were attended by medical leadership, including PLP Medical Directors Drs. Katrina Nicholson and Oliver David. The second focus group incorporated patient participants, ensuring patient perspectives are embedded in ongoing pathway development.

Insights from this engagement are informing PLP’s next phase of work, including exploration of tools and resources to support clinicians receiving CT reports identifying ILAs, patient-facing information to clarify findings and next steps, and educational supports to build confidence in community-based ILD assessment, triage, and follow-up. Together, these efforts represent early but important progress toward a more coordinated, evidence-informed approach to the management of incidental ILAs.

A coordinated, evidence-informed pathway will support physician management of incidental ILAs, strengthening follow-up, referral, and patient communication while enabling early system alignment and potential for provincial scale and spread.

The Contrast RISK project, led by Drs. Matthew James and Michelle Graham, with Dr. Bryan Har serving as the Foothills Medical Centre site champion, and Dr. Kelly Burak, Assistant Dean, PLP

 relaunched in 2024 under a Health Innovation Implementation and Spread (HIIS) grant, is a provincial initiative aimed at reducing contrast-induced acute kidney injury (AKI) in patients undergoing cardiac catheterization. AKI remains a common and preventable complication associated with increased morbidity, mortality, and healthcare costs. Building on the success of the original PRIHS project (2018–2019), which demonstrated that facilitated audit and feedback can reduce AKI rates, this initiative focuses on re-engaging interventional cardiologists in evidence-based practices, including appropriate contrast use, hydration, and follow-up care. The project integrates clinical decision support, education, and facilitated audit and feedback to drive sustainable practice change across Alberta’s three catheterization laboratories. The original implementation demonstrated a reduction in AKI incidence from 8.6% to 7.2%, reinforcing the impact of A&F in improving patient outcomes.

During this reporting period, the project achieved key milestones to support implementation readiness and clinician engagement. PLP supported ethics approval and site engagement across all three catheterization laboratories (Foothills Medical Centre, Mazankowski Alberta Heart Institute, and CK Hui Heart Centre), alongside the onboarding of site champions and establishment of an advisory committee.

Significant progress was made in data validation and workflow alignment, with close collaboration between analysts and clinicians to ensure accuracy and completeness of AKI risk metrics and reporting. PLP also facilitated process improvement discussions with cath lab teams, focusing on integrating AKI risk scoring, contrast limits, and hydration practices into routine workflows and improving team communication across pre-, intra-, and post-procedural phases.

PLP delivered three A&F sessions with interventional cardiologists and incorporated a Commitment-to-Change (CTC) approach to support reflection and intended practice change. While early engagement varied across sites, this was addressed through ongoing follow-up, strengthened site champion involvement, and tailored engagement strategies to support sustained participation.

Key Performance Indicators and Early Indicators of Impact includes:

• 3 catheterization sites engaged provincially

• Site champions onboarded across all sites

• 3 A&F sessions delivered

• Commitment-to-Change approach implemented

Next steps include formal project evaluation in collaboration with the PLP data analytics team and delivery of additional A&F sessions in Spring 2026 to support continued engagement and practice change.

Supporting interventional cardiologists with personalized data and feedback to reduce contrast-induced kidney injury and improve patient safety across Alberta’s cardiac catheterization centres.

Black communities in Canada often face barriers to accessing healthcare and getting the information they need to stay healthy. These challenges can lead to poorer health outcomes and missed opportunities for prevention and early care. The Black Health Fair was created to help change that---by bringing health information directly to the community in a welcoming, accessible way. Led by PLP Medical Director, Dr. Eniola Salami, the Black Medical Students Association, the Black Health Portfolio, and community organizations, the Fair connects people with healthcare professionals, advocates, and educators. It's a space where health knowledge is shared, questions are welcomed, and trust is built.

This year, the PLP is proud to partner with the Fair to support this important work. Together with organizers, PLP has helped plan the April 26, 2025 event, and will provide practical, easy-to-understand tools for both patients and healthcare providers. These include supports for issues like income and housing insecurity, allergies, back pain, cancer diagnosis, and safe use of medications. Many of these supports have been redesigned to garner interest with community members. PLP's contributions will be presented in a way to encourage conversation and shared learning---not just for patients, but for doctors too.

Featured tools will include patient education tools around cancer diagnosis, adrenal insufficiency, antimicrobial prophylaxis use in pregnancy, and information around lower back pain, as well as tools for providers around prevention of surgical site infections and Group B Streptococcus.

This collaboration is about more than just information---it's about empowering communities, building trust, and making healthcare more inclusive and responsive to the needs of Black Canadians.

Cirrhosis is a chronic liver condition that affects many Albertans and often leads to repeat hospitalizations, complex care needs, and poorer outcomes when not managed consistently. Despite its severity, tools in the current Connect Care system are not optimized to support clinicians in delivering timely, coordinated care. Existing alerts are frequently ignored due to alert fatigue, and critical patient information is often scattered across different parts of the electronic record, making it difficult for healthcare teams to act efficiently.

To address this, the Alberta Cirrhosis Care Group partnered with the PLP's Human-Centred Design team to redesign how cirrhosis care is supported within Connect Care. Led by Dr. Puneeta Tandon, the team is working to improve Best Practice Alerts (BPAs), create flowsheet views tailored for cirrhosis, and design "smart" guidance that suggests next steps in care. We are engaging frontline clinicians---including internal medicine residents and allied health professionals---to identify pain points and co-develop practical solutions. This project draws from successful frameworks used for COPD and heart failure care and applies a rigorous, user-centred design approach from the outset. We are currently facilitating usability testing sessions with clinicians who manage cirrhosis patients in Connect Care. These sessions explore how proposed changes to flowsheets and alerts affect real-world decision-making and workflow.

This care path redesign aims to reduce alert fatigue and improve decision-making for patients with cirrhosis in hospital settings, ultimately leading to better outcomes and smoother discharge planning.

CWC has identified de-prescribing of antipsychotic and sedative medications in seniors over the age of 65 years as a priority area for improvement. Antipsychotics and sedatives (e.g. benzodiazepines and z-drugs, like zopiclone) are commonly prescribed to seniors with dementia and other cognitive impairments to manage aggressive behaviours or insomnia. However, these medications have side effects that can reduce quality of life and introduce additional unwanted behavior risks.  Many of these drugs are also identified in the Beers Criteria® as having potentially adverse effects in older people, with sufficient clinical evidence to avoid prescribing when there is no indication for use.

Associate Dean, PLP, Dr. Kelly Burak and PLP Medical Director Dr. Douglas Woodhouse are leading three related PLP projects aimed at improving prescribing of sedating medications (antipsychotics, antidepressants, sedatives) to seniors 65+ in Alberta, with a focus on patients residing in Long Term Care (LTC or Type A) and Designated Supported Living (DSL or Type B) sites. An Advisory Panel, with subject matter expertise in these areas, has been established to advise on these projects with Drs. Patrick Quail, Vivian Ewa, Zahra Goodarzi, Cassandra Hoggard, Jed Shimizu, and Marjan Abbasi.

These three projects are as follows

1. Reducing Overprescribing of Sedating Medications to Seniors in Alberta (CWA): Addressing Health Inequities

2. Appropriate Prescribing of Sedating Medications to Seniors in the Calgary Zone

3. Reducing Overprescribing of Sedating Medications to Seniors in Alberta (CWA): Provincial Spread and Scale

Data from previous PLP projects with Senior’s care health partners and the Provincial Appropriate Use of Antipsychotics Initiative have identified significant variability in prescribing of sedating medications to seniors at regional, site and individual physician practice levels.

This project will provide consenting physicians with baseline and repeat data reports on their individual prescribing practices of sedating medications to seniors aged 65+ residing in LTC (Type A) and/or DSL (Type B) sites in the Calgary Zone.

Physicians will be engaged through facilitated A&F sessions to reflect on their prescribing data, consider individual and contextual factors, and identify opportunities to improve the use of sedating medications. A set of administrative data metrics have been identified to provide contextual, clinical and behavioral insights related to seniors receiving sedating medications in LTC and DSL settings. These metrics include information on social determinants of health, outcome scales, goals of care and adverse events such as falls.

Data from Connect Care LTC sites are currently being analyzed by the PLP team and reviewed by the newly formed Advisory Panel to support the co-design of physician and site-level data reports. This process will inform how similar reports might can be created for non-Connect Care LTC sites using other data sources.

By providing individualized prescribing data and facilitating reflective workshops, this project will help Calgary Zone physicians identify opportunities to reduce sedating medication use and improve care for seniors in LTC settings.

Building on the Calgary Zone pilot, this initiative is focused on evaluating the implementation of an audit and feedback (A&F) intervention to inform strategies for potential provincial spread and scale. The overarching goal is to reduce inappropriate prescribing of sedating medications for seniors residing in LTC (Type A) and DSL (Type B) settings across Alberta.

The project aims to identify and engage clinical champions and health system collaborators and constituents  in facilitated discussions using data that highlight prescribing variation and potential health inequities. These discussions are intended to understand priorities, assess readiness and explore opportunities for alignment tosupport the development of a sustainable, province‑wide approach to improving prescribing practices.

. The Project Team continues to actively engage provincial collaborators, including Health Quality Alberta (HQA), Assisted Living Alberta (ALA), the College of Physicians and Surgeons of Alberta (CPSA), and the Alberta Continuing Care Association (ACCA) to build support for broader implementation.

The Advisory Panel of clinical, operational, research, and family/patient representatives has been established, with an inaugural meeting held on March 1, 2026, to inform and co‑design a data‑driven intervention to reduce inappropriate use of sedating medications in long‑term care.

The Choosing Wisely Alberta Provincial Symposium being held on June 8, 2026, will serve as a "soft launch" to raise awareness of the initiative, engage other constituents and collaborators and recruit physicians to request data reports and participate in facilitated group audit and feedback sessions. Ongoing engagement with the panel and provincial health system collaborators will support continued planning and assessment of opportunities for province-wide implementation.

Building on the Calgary pilot, this initiative is preparing for province-wide implementation by engaging stakeholders, refining evaluation strategies, and designing scalable interventions to reduce inappropriate prescribing across Alberta.

Effective blood pressure management is vital for preventing life-altering complications such as heart disease, stroke, and kidney damage. This project—led by PLP Medical Director Dr. Donna Manca as an extension of our ongoing collaboration with NAPCReN—complements existing monitoring efforts by focusing on the identification of patients with potentially undiagnosed hypertension. By leveraging a specialized CPCSSN algorithm, we can highlight patients who lack a formal diagnosis but exhibit clinical risk factors that warrant intervention. This proactive approach empowers physicians to close diagnostic gaps and ensure at-risk patients receive timely, guideline concordant care.

The 2024–2025 cycle marked the inaugural distribution of this specialized report, following a rigorous phase of algorithm testing and data retrieval. To translate these findings into clinical action, the reports include links to relevant practice guidelines and other resources. Distributed to 86 physician sentinels in March 2026, a total of 166 reports have been disseminated to date. These findings will help inform future PLP project planning, particularly in the area of cardiovascular health.

By identifying patients with high-risk clinical markers before a formal diagnosis is made, this project empowers physicians to intervene early and prevent the onset of irreversible cardiovascular damage. It draws on EMR data to proactively screen for undiagnosed hypertension, to advance guideline-based cardiovascular care for Albertans.

People living with poverty, unstable housing, and complex health issues often fall through the cracks in our healthcare system. For urban underserved populations in Canada, getting the right care---especially after a hospital stay---is harder than it should be. Discharge plans don't always reflect real-life challenges, services can be hard to access, and poor coordination between hospital and community care can lead to confusion, worsening health, or return visits to the emergency room.

To address this, PLP Medical Director Dr. Ginetta Salvalaggio, with support from Dr. Denise Campbell-Scherer and Dr. Lee Green, created a project to explore how to improve transitions in care for underserved patients. Working with partners from Radius Community Health and Healing, the Addiction Recovery and Community Health (ARCH) team at Royal Alexandra Hospital, and specialists in infectious disease and addiction recovery, the team looked at how healthcare providers make decisions during discharge planning. Using a method called Cognitive Task Analysis, the team spoke with 17 healthcare professionals to understand how they plan care for these patients. The findings were clear: helping people safely transition from hospital to community care requires trust, teamwork, and flexible, personalized plans that take into account social challenges like housing, transportation, and mental health. However, the system lacks the coordination, communication, and resources needed to make that happen.

Results will guide future knowledge translation activities to support the overarching goal of reducing care fragmentation and hospital readmissions for urban underserved patients by co-designing context-responsive transitions that prioritize equity.

To help reduce unnecessary avoidance of penicillin and improve patient safety, we are co-designing practical tools to support safe and accurate de-labelling of penicillin (beta-lactam) allergies. These easy-to-use patient-facing resources will empower individuals to better understand their allergy history and advocate for accurate updates to their medical records. Building on earlier work in surgical prophylaxis and antibiotic allergy management, this project contributes to the Navigating Antibiotic Allergy knowledge translation modules. The initiative is led by Dr. Lynora Saxinger and Dr. Ling Ling, in collaboration with the PLP, using a human-centred design approach to ensure the tools are both meaningful and user-friendly for patients and healthcare providers.

The planned tools include: a provider-facing algorithm and oral challenge protocol; a patient wallet card with QR code and medication history; a one-page educational handout with key allergy information; a fax template to update pharmacies and healthcare providers; and a potential self-assessment tool for patient pre-screening.

These tools aim to reduce unnecessary antibiotic avoidance and improve patient safety through more accurate allergy documentation in primary care and pharmacy settings.

Buckle fractures occur when the bone is compressed and buckles without breaking through the cortex. These fractures account for approximately half of all pediatric forearm fractures. Despite robust evidence accumulated over the past two decades suggesting that casts are unnecessary for managing these low-risk fractures, approximately 40% of emergency physicians in Canada continue to use casts, reflecting a persistent gap between evidence-based recommendations and clinical practice.

Recent research has shown that splints offer no additional benefit beyond pain management in the first two days post-injury, underscoring that immobilization with a splint or bandage often serves as a comfort measure rather than a medical necessity. When given the options, most families prefer splints over casts due to their flexibility and convenience. Splints eliminate the need for follow‑up visits for cast removal, reducing inconvenience, distress for children, additional imaging, and associated health care costs.

This project was initiated in August 2024 by pediatric emergency physician and PLP Medical Director Dr. Jennifer Thull‑Freedman. PLP analysts conducted an initial data review to define and better understand the actionable clinical problem of unnecessary casting for pediatric forearm buckle fractures. Preliminary analyses suggest that approximately 750 low‑value casts could be avoided annually in Alberta. In parallel, PLP’s design team updated existing decision support tools for dissemination to emergency physicians across the province.

Further review of preliminary data identified 1,888 pediatric emergency department visits for forearm buckle fractures in Alberta in 2025. While these cases occur across all emergency and urgent care sites, casting procedures are not consistently captured in administrative data, limiting the ability to accurately measure provincial casting rates. To address this gap, PLP has initiated a chart review approach to obtain reliable data. Two research assistants have been recruited, and an ethics application has been submitted. Once approved, data collection will proceed to establish a robust baseline and inform future improvement efforts.

Potentially eliminating up to 750 unnecessary casts each year, this work promotes evidence-based care and greater comfort for children with low-risk fractures.

The management of febrile infants, particularly those under two months old, remains a complex issue within pediatric medicine. Infants in this age group are at a heightened risk of serious infections due to their immature immune systems and exposure to bacteria at birth. Traditionally, this has led to a standardized approach involving extensive diagnostic testing - such as blood, urine, and spinal fluid analysis - hospital admission, and empirical antibiotic therapy.

More recent evidence and guidelines suggest that this approach may not be necessary for all infants, as the risk of serious infection varies considerably. The 2021 American Academy of Pediatrics (AAP) Clinical Practice Guideline represents a significant shift in care, providing a framework for more tailored, evidence‑based management of infant fever.

Despite these advancements, there remains a gap in practice consistency across various healthcare settings. Infants seen outside specialized centers like Alberta Children’s Hospital (ACH) and the Stollery Children’s Hospital are more likely to undergo extensive testing and hospital admissions, leading to variability in care and potential for unnecessary interventions.

This project was initiated in August 2024 by pediatric emergency physician and PLP Medical Director Dr. Jennifer Thull‑Freedman. Preliminary data were analyzed, identifying 312 low‑risk infants who could potentially have avoided hospital admission and 255 low‑risk infants who may have avoided a lumbar puncture. Further exploration of available data sources and ethics approval will continue once updated  American Association of Pediatrics Clinical Practice guidelines for febrile infants are released. The project is currently paused in anticipation of these updates, with plans to resume work in 2026 to ensure alignment with the most current evidence.

By supporting more consistent, evidence‑aligned decision‑making, this work has the potential to reduce unnecessary hospitalizations and invasive procedures for hundreds of low‑risk infants, improving patient experience while preserving health system resources.

In Alberta, the wait time for an autism diagnosis for young children can be as long as 18 months from the initial recognition of symptoms, and longer delays are common for girls and children over five. This is problematic, as timely diagnosis of autism is crucial for accessing appropriate supportive services and has been linked with improved social and health outcomes, with early interventions being particularly effective at younger ages. During the waiting period for diagnosis, families often encounter challenges due to the limited autism-specific training among healthcare providers.

This project, led by Edmonton PLP Scientific Director, Dr. Nonsi Mathe, was part of her Atlantic Fellowship for Health Equity. In collaboration with Dr. Daniel Morena De Luca and the Precision Medicine for Autism group (PRISMA), this project explores the relationship between healthcare utilization before and after autism diagnosis, to identify gaps in healthcare provision and inform the development of targeted interventions to improve access and health outcomes for autistic individuals. Using administrative health data, this project focuses particularly on understanding the needs of equity-seeking groups and is part of a broader initiative to enhance healthcare and social service planning for the autism community in Alberta. This study is using a community-engaged approach, and is collaborating with community partners like Autism Edmonton. These insights will be instrumental in enhancing healthcare planning and intervention strategies for individuals with autism.

Identifying existing gaps and challenges to timely autism diagnosis will illuminate opportunities for action to enhance care for people with autism.

The RVC is a weekly series of high-quality, online continuing professional development (CPD) sessions presented by clinical experts and hosted by CME&PD. Each evidence-based session delivers practical, relevant content tailored to rural and remote primary care and hospital settings.

In 2024–25, PLP contributed three sessions: two focused on enhancing cancer screening rates in primary care, and one on improving patient-centred care for children in emergency departments. PLP will continue its collaboration with CME&PD to support rural medicine through the 2025–26 RVC series.

Enhancing Breast, Colorectal, and Cervical Cancer Screening Rates

• March 5, 2024 - reviewed provincial screening guidelines and demonstrated how to access and interpret screening rates using HQA’s Panel Report. Over 145 rural physicians and healthcare providers attended.

• May 7, 2024 - engaged 97 participants in reflective group discussions to identify actionable steps for improving screening rates in their practices. Attendees were guided through documenting their PPIP activity using PLP’s MyPI tool, supporting their CPSA licensure requirements.

Improving Pediatric Emergency Care:

• March 4, 2025 “Doing Better by Doing Less: Five Opportunities to Improve Patient-Centred Care for Kids in the ED and in the Office” - addressed five key topics: bronchiolitis, pediatric UTIs, low-risk fractures, febrile infants, and reducing unnecessary X-rays for constipation. The session drew over 130 rural healthcare providers.
  

Across all sessions, participants were encouraged to review their own data and apply quality improvement tools like MyPI to support sustainable practice change.

Rheumatoid arthritis (RA) is the most prevalent inflammatory arthritis affecting an estimated 1.2% of Canadians aged 16 years and older. The economic burden of RA in Canada was estimated at $5.7 billion annually in 2011 and is rising due to an aging population.1 Sub-optimal care results in poor short- and long-term outcomes for people with RA including joint pain, stiffness, swelling and damage, and over time, also increases the risk for mood disorders, serious infections, joint replacement surgery, heart disease and stroke.  

RA is the most common condition managed by rheumatologists and understanding current individual and group practices will provide insights into ensuring best outpatient care for people with RA, decreasing the need for acute care services and reducing costs.

Drs. Steven Katz, Andrea Johnson and PLP Medical Director Dr. Oliver David are leading this project which aims to understand and improve how people with RA are receiving care in Alberta using administrative health data to engage rheumatologists and health system partners in facilitated sessions to reflect on the data and identify opportunities for improvement. Rheumatologists may consent to receive confidential, aggregate level reports on their practice.

Administrative data has been pulled and analyzed to create the cohort of patients with RA using a validated case definition.

Data analysis has been conducted that informs how people with RA are receiving care in Alberta including:

• Demographics of people with RA

• Health care utilization among people with RA including frequency of encounters

• Dispensation of medications used for pharmacological management of RA

• Timing and update of preventative vaccinations among people with RA

Report templates have been co-designed and report generation processes are being developed.

Twenty-one rheumatologists have consented to receive confidential, aggregate level reports on their practice and will be invited to participate in a facilitated audit and group feedback session in Fall 2026.

Engaging rheumatologists with their own clinical data will help improve care for patients with rheumatoid arthritis across Alberta.

¹ Hazlewood, G. S., Pardo Pardo, J., Barnabe, C., Schieir, O., Barber, C. E. H., Proulx, L., Richards, D. P., Tugwell, P., Bansback, N., Akhavan, P., Bombardier, C., Bykerk, V., Jamal, S., Khraishi, M., Taylor-Gjevre, R., Thorne, J. C., Agarwal, A., & Pope, J. E. (2022). Canadian Rheumatology Association living guidelines for the pharmacological management of rheumatoid arthritis with disease-modifying antirheumatic drugs. The Journal of Rheumatology, 49(10), 1092–1099. https://doi.org/10.3899/jrheum.220209.

Obstructive Sleep Apnea (OSA) care in Alberta has historically relied on a specialist-driven model that cannot meet the growing demand for services. Primary care physicians often encounter barriers to independently managing OSA due to limited knowledge and resources. To address this gap, the PLP team conducted a pilot study involving primary care providers and other partners and collaborators, identifying key challenges and opportunities. As a result, a primary care pathway was developed to enable the management of appropriate OSA cases within the community. The PLP team conducted usability testing of the pathway with participants and analyzed the findings to provide actionable recommendations to the physician lead for optimizing the tool’s effectiveness. The project is now complete.

This project empowers family physicians to manage obstructive sleep apnea in the community, improving patient access to timely and effective care.

RVC is a weekly series of high-quality, online CPD sessions presented by clinical experts and hosted by CME&PD through CSM at the UofC. The series delivers evidence‑based, practical clinical education presented by expert faculty, with content tailored to the needs of physicians practising in rural, remote, and smaller urban primary care and hospital settings. Sessions are designed to be interactive and practice‑relevant, supporting real‑world application and continuous improvement in care delivery. The series is free to participants, supported through educational grant funding and in‑kind resources from the Rural Health Professions Action Plan (RhPAP) and Alberta Health Services.

Plans are underway to present Choosing Wisely for Practice Improvement (CWPI): Antibiotics, in April 2026 as well as educational content focused on the Appropriate prescribing of sedating medications to seniors in the Calgary Zone in the 2025/26 curriculum. These upcoming sessions will further align CPD, quality improvement, and Choosing Wisely principles, supporting physician decision‑making and safer, more appropriate prescribing practices across care settings.

For more information on this series, visit: (link)

By expanding access to high‑quality virtual CPD, this initiative supports Alberta’s rural health care priorities and strengthens physician practice improvement across rural and remote communities.

In this project, the PLP, led by Medical Director Dr. Lynora Saxinger and supported by clinical immunology and allergy specialist Dr. Ling Ling, is developing online, self-paced learning modules to support healthcare professionals in accurately assessing beta-lactam (penicillin) allergy histories. These modules will provide up-to-date, evidence-informed content in a case-based format, helping clinicians differentiate between true allergies and outdated or incorrect labels. Participants will build practical skills to safely "delabel" inaccurate

allergy records and communicate changes effectively with patients---supporting better prescribing decisions, improved patient outcomes, and more accurate medical documentation.

These educational modules will equip physicians with the knowledge and tools to safely remove inaccurate penicillin allergy labels, allowing them to prescribe more effective antibiotics and improve patient outcomes.

CME&PD at the Cumming School of Medicine, in collaboration with PLP, continues to advance physician engagement in quality improvement through innovative digital tools.

In April 2023, the My Practice Improvement (MyPI) platform was launched to support physicians in meeting the CPSA’s Physician Practice Improvement Program (PPIP) requirements. These include:

1. Practice-driven quality improvement (QI),

2. CPSA Standards of Practice QI, and

3. A personal development activity.

   
   

MyPI is a user-friendly, accredited digital environment that enables physicians to complete QI cycles and earn CPD credits. PLP-led projects receive complimentary access to MyPI, enabling seamless documentation and enhancement of their practice improvement activities.

Over the past two years, seven PLP initiatives have been added to the MyPI platform, including Addressing Variation in Radiology Prioritization, Reducing Type and Screen as a Standard Order for Elective C‑Sections, Dialyzing Wisely, Don’t Misuse My Blood, Contrast RISK, and Choosing Wisely for Practice Improvement (CWPI): Antibiotics. This growth has brought the platform to 11 active projects and 216 users, with 64 new users joining in the most recent year. Physicians participating in PLP‑led audit and group feedback sessions continue to receive complimentary access to MyPI.

Planned enhancements include embedded access to MyPI from interactive dashboards, such as Don’t Misuse My Blood, as well as integration with new PLP initiatives launching in subsequent years.

Accreditation of MyPI remains in place beyond 2025, supporting continued physician engagement and sustainability.

CME&PD Associate Dean and PLP Co-Lead Dr. Thomas Raedler initiated the development a complementary tool to MyPI called SUPPORT for PPIP - Simplify, Understand & Perform Practice Optimization Requirements Together. This program is designed to help individual physicians confidently meet all three PPIP requirements through a structured and engaging learning experience. It offers step-by-step guidance using interactive online content, facilitated peer webinars, and built-in tools and reports that assist in generating and analyzing practice data from patient charts. Participants can complete the full suite of PPIP requirements within the program and earn up to 15 CME credit hours. To date, 90 physicians have participated in SUPPORT for PIPP, and the program has received positive feedback from both individual participants and physician groups. The University of Calgary Medical Group (UCMG) is now promoting the program to its members.

To learn more, visit the SUPPORT for PPIP program.

Empowering Alberta physicians with a user-friendly digital platform, MyPI is facilitating meaningful practice improvement and quality care through accessible, accredited learning.

Group B Streptococcus (GBS) is a common bacterium carried by 10–30% of pregnant women in Alberta. If passed to babies during childbirth, it can cause serious infections such as sepsis, pneumonia, or meningitis. In rare cases, these infections can be fatal. GBS can be prevented by screening pregnant patients and providing timely antibiotics, but decisions become more complicated when patients report a penicillin allergy. These patients are more likely to experience unnecessary cesarean deliveries, prolonged hospital stays, and suboptimal antibiotic choices.

To address these risks, the PLP launched a multi-phase project led by Dr. Eliana Castillo (OB/GYN Physician Lead). The project focused on improving antimicrobial decision-making during pregnancy. Using human-centred design methods, the team co-developed two tools to support GBS prevention and guide antibiotic use for surgical site infection (SSI) prevention during cesarean section. These tools help clinicians assess allergy risk and recommend safe, effective antibiotics.

To support patients directly, the team also redesigned the pregnancy care journey map from a patient’s perspective. This led to the development of a patient-facing educational one-pager that explains how antibiotic use fits into pregnancy care and encourages pregnant patients to discuss their allergy history early. The material is publicly available on the PLP website and will be shared at the Black Medical Student Association community event in April - the Black Health Fair, to ensure accessibility and cultural relevance.

Clostridioides difficile Infection (CDI) is a significant health concern in Alberta, causing symptoms from mild diarrhea to severe colon damage. Recurrent CDI (rCDI) is particularly challenging, leading to increased hospitalizations and healthcare costs. Fecal microbiota transplantation (FMT) has emerged as a highly effective treatment for rCDI, with success rates exceeding 80%. However, FMT delivery lacks standardization, is not widely accessible, and remains investigational in Canada.

To address these challenges, the PLP collaborated with the AHS Fecal Microbiota Transplant Team---Dr. Karen Wong, Dr. Dina Kao, Dr. Rose Franz---and PLP Medical Director Dr. Lynora Saxinger to develop a provincial clinical pathway for FMT. Initiated in fall 2023, the project employed a human-centred design approach to identify gaps in existing rCDI management pathways. Five process mapping sessions were conducted to adapt inpatient CDI pathways for outpatient settings.

The resulting simplified pathway underwent user testing and was revised based on feedback from primary care physicians, supported by consultants from AHS Knowledge & Evaluation, Research, and Innovation teams.

In November 2024, the revised algorithm was submitted to the Connect Care Pathway team for review, ensuring alignment with provincial electronic health record standards. The pathway is now finalized and being integrated into the Connect Care Pathway Hub.

This initiative aims to standardize rCDI management across Alberta, improving patient outcomes and reducing healthcare costs through timely and effective interventions.

Overprescribing medications to seniors (inappropriate prescribing and polypharmacy) can predispose patients to increased risk of falls, fractures, delirium, and other adverse events. Recently, CWC and the Canadian Institute for Health Information (CIHI) reported significant chronic use of benzodiazepines and other sedative-hypnotics across eight provinces in Canada. There was significant regional variation in overuse of benzodiazepines and other sedative-hypnotics in older adults, with some provinces being as high as 20% (Saskatchewan 5%, Alberta 10%).

Engagement of pan-provincial partners in discussions about administrative data collection, access, and challenges in Saskatchewan and Alberta may inform how other jurisdictions could improve assessment of variation and reporting of sedating medications dispensed to seniors 65+.

This project aimed to assess variation in dispensing of antidepressants, antipsychotics and sedatives to seniors 65+ in Alberta between July 1, 2021, and June 30, 2023, using administrative data.

This project found that over 25% of Alberta seniors 65+ were dispensed at least one sedating medication and there were significant variations in dispensations of antidepressants, antipsychotics and sedative based on sex, age, location within Alberta, and residence in the community or LTC facility. Females, patients living in rural communities, and those in LTC facilities were dispensed potentially inappropriate sedating medications at higher frequencies.

These findings will be used to target improvement activities to populations with the greatest need.

Preliminary discussions with health system partners in Saskatchewan identified significant differences in data collection and access compared to Alberta which create challenges for pan-provincial collaboration.

This foundational study revealed that over one in four Alberta seniors are prescribed sedating medications, with notable disparities by sex, geography, and care setting---insights that are now guiding targeted improvement efforts.

PLP Medical Director Dr. Selena Au, in collaboration with the DCCM and AHS eCritical, is leading the development of a physician practice metrics dashboard for Calgary's critical care physicians. This initiative aims to enhance QI rounds by enabling clinicians to review individual and group-level data, identify practice gaps, and collaboratively develop action plans.

The physician practices selected for dashboard creation were voted on as being meaningful and actionable and selected directly by the frontline Calgary ICU physicians. The first dashboard, focused on Post-Cardiac Arrest Temperature Management, launched in October 2023 and demonstrated early impact. An evaluation survey revealed that 89% of participants identified practice gaps relative to guideline goals, and 78% indicated they were likely to modify their practice based on dashboard insights and QI discussions. This integrated approach---combining dashboards with facilitated QI rounds---supports data-informed practice change and continuous QI.

In spring 2024, facilitated QI sessions were completed following the launch of the extubation failure metric. These sessions gathered local physician input on metric selection, interpretation, and improvement strategies. The dashboard now includes three key metrics: post-cardiac arrest temperature management, extubation failure, and readmission. Physicians can view their individual performance in comparison to peers, fostering reflection and accountability.

From project start, six dashboard-driven QI Rounds sessions were held and engaged 30 to 40 physicians and allied health professionals per session. PLP attended these sessions so that feedback on first draft metrics and data visualization was brought back to eCritical for dashboard reworking, adhering to philosophies of a Learning Health System and user co-design. Feedback has been overwhelmingly positive, with 80% of participants reporting that the dashboards are useful for comparing practices against evidence and standards, visualizing practice gaps, and benchmarking against peers. On average, 83% of participants indicated a high likelihood of changing their practice because of the sessions. To support sustainability and encourage reflective practice, the dashboard will soon include a direct link to the MyPI tool, enabling physicians to document their practice improvement activities.

By integrating real-time performance data with facilitated quality improvement rounds, this dashboard initiative is transforming critical care practice in the Calgary Zone---empowering physicians to identify gaps, benchmark performance, and drive measurable improvements in patient care.

The Reshape T1D project aimed to understand how people who live with type 1 diabetes (T1D) interact with healthcare systems in Alberta for diabetes quality improvement. This study's design, from beginning to end, included people living with T1D and clinicians working in T1D care settings as partners, which made it possible to address questions that are directly relevant to clinicians for improving clinical practice.

Key findings highlighted the need for a centralized hub offering consistent, reliable, and up-to-date T1D education and resources. Participants emphasized the importance of integrating mental health support within T1D care settings and expressed a desire for flexible appointment options, including in-person and virtual consultations, with after-hours availability. The findings also underscored the significance of patient choice in assembling their care teams and addressing individual-specific needs. Notably, experiences of medical trauma were found to have long-term impacts on healthcare perceptions, leading to reluctance in seeking future care. Women participants reported challenges in discussing reproductive health with clinicians. Additionally, diabetes online communities were recognized as valuable adjuncts to clinical care, providing peer support. However, barriers such as cost and limited access to advanced technologies like insulin pumps and continuous glucose monitors persisted, especially concerning publicly funded programs. The findings also identified patient concerns that are not typically captured in clinical metrics, like emotional burdens and system navigation barriers.

Carried out by Dr. Jamie Boisvenue and supervised by PLP Senior Medical Director Dr. Roseanne Yeung, this completed doctoral dissertation project was supported by PLP and other partners and grant funding. The Reshape T1D study is now in its knowledge translation phase, sharing findings with communities and clinics.

By highlighting patients' lived experience with type 1 diabetes and system gaps in diabetes care, the findings from this project can inform impactful changes in practice and policy, and improve patient-centered care for people living with type 1 diabetes.

Diabetes Continuity of Care

Managing chronic conditions such as type 2 diabetes (T2D) often involves transitions across various healthcare settings - from community-based care to hospital admissions and back. Primary care physicians' (PCP) involvement in routine management of chronic conditions helps to ensure continuity of care and improve health outcomes for patients. In collaboration with PLP Physician Liaison Dr. Terrence McDonald, and PLP team including Dr. Darren Lau, Dr. Donna Manca, Dr. Denise Campbell-Scherer, Dr. Rose Yeung, and Nandini Desai, this project examined the health outcomes and healthcare utilization of over 200,000 patients living with diabetes (PLWD) who are under the care of community primary care physicians.

We analyzed health data for 202,222 patients with diabetes, examining primary care visits and the impact of continuity on acute care use. Comparisons between rural and urban PLWD showed that rural patients had fewer PCP visits, and had worse outcomes, including more emergency visits and hospitalizations. Patients, including the most medically complex, who always saw the same doctor or received care from the same clinic team had significantly fewer emergency department visits and hospital stays. This project highlights the critical role of continuity in care for managing diabetes effectively. These findings underscore the importance of policies and practices that promote continuous care relationships, particularly for PLWD, in both rural and metropolitan settings. This study was presented at the Canadian Association for Health Services and Policy Research conference in Ottawa, in May 2024, and at the PLP 2024 Summit in June.

This project demonstrates the positive impact of continuity in care for effective diabetes management, resulting in better health outcomes and significantly lower health care utilization.

Development of Resources to Support Continuous Glucose Monitoring in Adults with T2D

People living with type 2 diabetes are often prescribed continuous glucose monitoring (CGM) devices. While these tools provide a wealth of data to support self-management, many patients struggle to understand their glucose reports, mainly the Ambulatory Glucose Profile (AGP), which summarizes trends over time. This gap in comprehension can limit patients' ability to make informed decisions about their health.

To address this challenge, we created a simplified educational resource to help patients interpret the AGP and use it to guide conversations with their healthcare team. The project involved

collaboration between PLP Medical Directors Dr. Darren Lau and Dr. Roseanne Young, and human centred designer Jordan Tate. We worked closely with patients, endocrinologists, and certified diabetes educators to identify learning needs and design an accessible tool. The result is a visual, easy-to-understand explainer video that walks viewers through the 7-day AGP report. It introduces the meaning of

key visuals such as the median line, the "river" showing typical glucose variation, and the broader shaded range. This complements a previously developed trifold brochure, offering a more engaging format with written materials for people

with lower literacy or limited comfort. The CGM video is being finalized, and is representative of all CGMs available in Canada. All tools and resources for this project will be found on the PLP website.

How to Read My AGP - Continuous Glucose Management Guide

How to Read My AGP - Guide

This resource aims to improve health outcomes by empowering people with type 2 diabetes to understand and act on their glucose data.

Iron deficiency anemia (IDA) is a significant, yet frequently overlooked, health concern that disproportionately affects vulnerable populations. Despite clearly defined diagnostic and treatment pathways, IDA impacts approximately 10% of Canadian women of childbearing age and is directly linked to adverse maternal and infant outcomes, increased ED utilization, and a higher reliance on blood transfusions. In Alberta, recent data reveals alarmingly high rates of IDA among pregnant individuals, particularly within rural, low-income, and immigrant communities. However, significant knowledge gaps remain regarding Indigenous populations and the systemic barriers preventing timely diagnosis and effective treatment.

This PLP initiative, led by Dr. Cynthia Wu and Dr. Linda Sun, in collaboration with PLP Medical Director, Dr. Rose Yeung, seeks to close these gaps by conducting a comprehensive prevalence analysis of anemia and IDA among Albertans of reproductive age. By examining clinical practice patterns and healthcare utilization across the province, the project aims to identify specific opportunities for systemic improvements in IDA screening and management, ensuring that high-risk groups receive equitable, evidence-based care.

With the core data analysis largely complete, the team is currently integrating final healthcare utilization variables to provide a comprehensive view of patient care. These findings will help optimize care trajectories and support systemic improvements for IDA management across Alberta.

With one in five Albertans living with hypertension, untreated high blood pressure remains a leading cause of severe complications such as heart attack, stroke, and kidney damage. Now entering its third cycle in collaboration with NAPCReN, this project, led by PLP Medical Director Dr. Donna Manca, provides PCPs with individualized, benchmarked feedback reports that track hypertension prevalence and the frequency of in-clinic blood pressure monitoring, as consistent monitoring is important for hypertensive patients. These reports utilize the CPCSSN to access real-time EMR and lab data, which allows clinicians to identify at-risk patients through validated algorithms even in the absence of a formal diagnostic label.

The 2025–2026 cycle bridged the gap between data and practice by integrating educational resources directly into the reporting process, including the Mercury Rising! learning event and a Pearls for Practice clinical summary. In March 2026, reports were distributed to 86 physician sentinels, bringing the four-year cumulative total to 316 individualized reports. By presenting aggregate data at Pan-PCN learning events and QI workshops, this initiative continues to provide primary care teams with the actionable insights necessary to drive meaningful practice change and improve patient outcomes.

These annual reports transform raw EMR data into a helpful tool for preventative care, moving beyond simple statistics to identify hidden at-risk patients who lack formal diagnoses and ensuring that more Albertans receive the timely monitoring necessary to prevent life-altering complications like strokes and heart disease.

Accurate documentation of smoking status is essential for managing lung disease, yet this critical information is frequently underreported in patient records. Now in its third year, this initiative—led by PLP Medical Director, Dr. Donna Manca in collaboration with NAPCReN—addresses this gap by providing individualized, benchmarked feedback reports to PCPs. While HQA reports rely on annual administrative data and lack specific lifestyle metrics, this project leverages real-time CPCSSN EMR data to offer timely, actionable insights into patient smoking status. Providing individualized and benchmark data on the percentage of patients with COPD, as well as the percentage of patients with COPD who currently smoke or do not have smoking status documented, these reports empower clinicians to improve documentation practices and monitor patient health more effectively than traditional high-level databases allow.

The third reporting cycle completed in 2025–2026 distributed updated reports to 86 physician sentinels in March 2026, with a cumulative total of 235 reports distributed to date. To bridge the gap between data and clinical practice, the reports included integrated resources and links to expert-led learning events, such as Targeted Screening & Management of Copd and How to Help Your Patients Quit Smoking. By presenting aggregate data at pan-PCN learning events and within the A Breath of Fresh Air webinar series, the project continues to foster a culture of continuous QI and evidence-based care for Albertans with chronic lung conditions. 

Empowering physicians with these precise EMR insights allows for more targeted tobacco cessation and COPD management, directly reducing the long-term burden of chronic lung disease on both patients and the healthcare system.

Primary care providers often encounter challenges in managing obstetrics and gynecology (OBGYN) concerns in adolescents, compounded by long wait times for pediatric specialist referrals. Many of these issues, however, can be effectively addressed within primary care settings when clinicians are equipped with the right tools and guidance.

To bridge this gap, PLP played a key role in the development of the Adolescent Abnormal Uterine Bleeding Pathway in 2023–24 and supported the design of the Adolescent Ovarian Cyst Pathway in 2024–25. These initiatives exemplify how specialized OBGYN care can be integrated into primary care, improving access and reducing the need for specialist referrals.

In 2024–25, PLP collaborated with Specialist Link, primary care physicians, and OBGYN specialists to design a clinical pathway for managing ovarian cysts in adolescents. This work is now in its final stages and approaching completion.

PLP continues to engage with Specialist Link and the Provincial Pathways Unit to explore future opportunities for collaborative pathway development.

Earlier pathways supported by PLP for Adult Abnormal Uterine Bleeding and Urinary Incontinence remain widely used. Between April and June 2024, these pathways were among the Top 20 most downloaded on the Provincial Pathways Hub, with 120 downloads for the Abnormal Uterine Bleeding pathway and 134 for the Urinary Incontinence pathway. From July to September 2024, the Urinary Incontinence pathway remained in the Top 20 with 143 downloads.

PLP supported the refinement of an adolescent ovarian cyst pathway, contributing to improved usability and integration, while continuing to advance primary care capacity through widely used adult OBGYN pathways.

Physicians receive little QI training in their formal education and benefit from professional development opportunities for QI training and skills. As the new Physician Practice Improvement Program (PPIP) requirements for physicians progresses, more work is needed to understand the impact and effectiveness of QI training programs, how QI training impacts physicians' QI projects, and what it takes to implement a practice-driven QI project using objective data.

In 2022, driven by their personal and professional experiences, Drs. Lauren Eastman, Sanja Kostov, and Rose Yeung came together to develop a quality improvement project to improve breastfeeding rates in the community. Led by PLP Medical Director Dr. Rose Yeung, this project explores the work required to develop and implement a QI project in primary care. Interviews and focus groups were conducted with physicians who led the project, residents who worked on the project, and context experts in QI in healthcare. Analysis is currently underway, with an academic manuscript and a summary of key findings being prepared to support effective implementation of QI projects. Additional resources will be crafted to disseminate recommendations from the key findings to relevant groups, organizations, agencies, etc.

Findings from this project offer insights on how the provincial health ecosystem can better support and improve QI work.

Depression is a common mental health condition, with highest prevalence among working age adults (15--64 years), and contributing to work-related disability and lost productivity. Working with PLP Medical Director Dr. David Ross (Chair of the Department of Psychiatry at the UofA), we are developing a program of work in psychiatry to support depression care, informed by this project's aim of understanding baseline conditions of depression care in Alberta. Clinical practice guidelines for depression management provide recommendations for pharmacotherapy, including antidepressant administration. However, there's a paucity of information about the long-term trends of antidepressant prescription patterns in the Canadian context.

This project examined a decade of Alberta healthcare data (2012-2022) on adults newly diagnosed with depression to identify these patterns and inform quality improvement. We also incorporated socio-economic variables like location, education, income, and visible minority status in consideration of health equity. We examined types of antidepressants by year stratified by several variables, including: age, sex, prescribing physicians specialty, urban-rural locality, neighbourhood education, neighbourhood income, and neighbourhood visible minority status to identify whether there were differences in the trends. Our findings indicate that antidepressant prescribing patterns are generally aligned with guidelines. Additionally, we found that benzodiazepine use alongside antidepressants decreased after 2016, highlighting the positive impacts of provincial regulatory efforts to reduce inappropriate benzodiazepine prescribing.

Understanding antidepressant prescription patterns will inform knowledge translation activities and will inform subsequent work on advancing practice for depression care.

People with cirrhosis often end up back in the hospital soon after being discharged ---usually because care isn't consistent or well-coordinated. These repeated hospital stays are hard on patients and families and put added pressure on Alberta's healthcare system. To bridge this gap, PLP Medical Director Dr. Puneeta Tandon, and her research team, supported by the PLP and the Digestive Care Strategic Clinical Network, created a province-wide best practice care guide (order set) for doctors treating cirrhosis. This guide helps standardize treatment, so patients receive high-quality, consistent care---no matter where they are in Alberta.

The project also looked at how this new care guide is being used in hospitals and what helps or hinders its adoption. This evaluation, led by Dr. Denise Campbell-Scherer and Dr. Lee Green, found that when the order set was easy to fit into hospital routines and supported by strong teamwork, doctors were more likely to use it. However, challenges like COVID-19 disruptions and new technology made implementation more difficult in some places. Despite these hurdles, the team adapted through flexible, collaborative approaches---making the work stronger and more sustainable.

Their findings are being shared through academic journals, conferences, and are supporting real world applications through grand rounds and meetings with patients and healthcare teams.

This work is helping Alberta move closer to more reliable, effective care for people with cirrhosis, reducing hospital readmissions and improving lives.

Antibiotic prophylaxis during pregnancy is critical for preventing serious complications, including early-onset neonatal Group B Streptococcus (GBS) disease and post-cesarean surgical site infections. Although penicillin remains the preferred first-line agent—and cefazolin is a safe alternative—many patients with a documented penicillin allergy are prescribed less effective second-line antibiotics. This is often driven by outdated assumptions or inaccurate allergy labels, despite strong evidence that the vast majority of reported penicillin allergies are not clinically significant.

This multi-phase project aims to better understand current prescribing patterns and the factors contributing to suboptimal antibiotic use in pregnancy. Insights from this work will inform targeted knowledge translation and intervention strategies to support more appropriate, evidence-based antimicrobial use and improve outcomes for both mothers and infants. The project is led by PLP Medical Director Dr. Eliana Castillo, in collaboration with Dr. Lynora Saxinger and the AHS Antimicrobial Stewardship group.

Building off of the first phase of this project, we examined Alberta’s obstetrical antimicrobial prophylaxis practices to identify gaps and opportunities for clinical improvement. This used healthcare administrative data to establish a baseline of current antimicrobial prophylaxis practices for early-onset neonatal Group B streptococcus (GBS) disease and surgical site infection (SSI) prevention during labor and delivery. The analysis of obstetrical information on patients who delivered in Alberta hospital sites between November 1, 2022 and May 31, 2023 showed that the majority of patients received appropriate antimicrobial prophylaxis for GBS and SSI prevention. However, suboptimal second-line antibiotics persisted in some penicillin allergy cases, despite cefazolin being the most common alternative. 

Considering the persistence of inappropriate penicillin allergy labelling and administration of suboptimal antimicrobial prophylaxis, there are opportunities for quality improvement (QI) initiatives to promote validation of allergy status and address the use of sub-optimal antibiotics for penicillin allergy. This QI work will be incorporated into the broader KT work that is on-going for our program of work in optimizing antimicrobial use in Alberta. A report summarizing this work has been prepared and an academic manuscript will support broader dissemination of the findings.

Across Alberta, PCNs and their improvement facilitators are tasked with the vital work of supporting physicians through QI initiatives. However, these teams are often under-resourced, and the high degree of variation in QI approaches across the province has historically impeded the success of large-scale, coordinated projects.

To address these barriers, the PLP, in collaboration with the L3, launched a pilot initiative to build a unified, sustainable QI infrastructure. By providing a shared framework and robust training tools, this partnership empowers PCNs to lead their own improvement projects with greater efficiency and autonomy.

The pilot began with Chinook PCN in April 2023 and expanded in December 2023 to include Edmonton O-day’min and Edmonton North PCNs. The impact was immediate: 21 workshops have since trained 260 participants, certifying 11 PCN facilitators to lead future QI work independently.

The success of this framework is best demonstrated through the diverse, patient-centered projects currently taking shape across the province. In the Chinook PCN, the Taber Clinic developed a targeted initiative to optimize clinic workflows, directly improving patient access to care. Meanwhile, the Edmonton O-day’min PCN focused on chronic disease management, with United Health Centers establishing a new annual protocol for diabetes care and a proactive identification process for pre-diabetic patients. As we evaluate these partnerships with Chinook and Edmonton O-day’min, we are using the findings to refine the Advanced Quality Improvement PCN model.

By supporting this vital QI infrastructure, we are helping PCNs transition to active QI leadership—equipping them to address local priorities and drive measurable improvements in patient care.

Early cancer detection is the cornerstone of improved survival rates and successful treatment outcomes. Alberta’s Screening for Life Program provides essential early detection for breast, cervical, and colorectal cancers across key age demographics. However, the onset of the COVID-19 pandemic necessitated a total suspension of these provincial programs from March to May 2020, followed by over two years of intermittent public health restrictions. This unprecedented disruption led to a significant decline in screening rates and new diagnoses, creating a critical screening gap that persisted well into the recovery period.

This project, led by Dr. Finlay McAlister, aims to quantify the long-term impact of these disruptions by conducting a comprehensive assessment of Alberta’s cancer screening trajectories. A primary focus of the study is the integration of 2021 Canada Census socioeconomic indicators, allowing the team to explore how factors such as income, geography, and primary care access influenced screening utilization during and after the pandemic. By evaluating adherence to provincial screening recommendations across diverse populations, the project provides the clinical intelligence necessary to help drive targeted recovery efforts. The insights generated from this work are essential for identifying vulnerable populations that may have been disproportionately affected by the pandemic. 

These findings will provide critical baseline data to identify where screening gaps are most pronounced across Alberta — informing targeted knowledge translation activities and quality improvement efforts to support equitable access to cancer screening and reduce the long-term burden of late-stage cancer diagnoses.

In Alberta, newcomer and rural patients face significant barriers to timely cancer diagnosis. Language differences, long travel distances, limited access to healthcare services, and unfamiliarity with the Canadian system often lead to delays in diagnosis and later-stage cancers, impacting patient outcomes and quality of life.

To address these gaps, the Cancer Strategic Clinical Network™ (Cancer SCN) partnered with our human-centered design (HCD) team. Through interviews and process mapping with 15 Alberta primary care providers, the team explored barriers faced by newcomers and rural residents. Special attention was given to collaborating with Low German-speaking health navigators, the Multicultural Health Brokers Co-operative, and initiating work with the Alberta International Medical Graduate Association (AIMGA) to ensure diverse voices and culturally relevant solutions were included.

Key findings showed that newcomers often struggle with fragmented care and cultural misunderstandings, while rural patients face logistical, financial, and emotional challenges in accessing diagnostic services. Using these insights, the team co-developed culturally sensitive, patient-centered solutions, including step-by-step visual guides, educational resources tailored to different communities, and navigation supports. These tools are now being prepared for broader implementation and translation into prioritized languages.

• Cancer Diagnosis Resources - Patient Package - Importance of a Family Doctor

• Cancer Diagnosis Resources - Patient Package - Diagnosis Process

• Cancer Diagnosis Resources - Signs and Symptoms

This project aims to reduce diagnostic delays and support a more equitable, patient-centered cancer diagnosis process for newcomer and rural patients across Alberta.

CWC recommends that routinely performing a type and screen (T&S) test at the time of delivery is unnecessary unless no prior test had been completed during the current pregnancy and/or the risk of maternal hemorrhage is high. PLP Medical Director Dr. Eliana Castillo and Physicians Leads Drs. Phillipa Brain and Rahim Janmohamed are collaborating with AHS Calgary Zone, Grey Nuns OBGYNs and Transfusion Medicine in Calgary on this project, which aims to maintain safe practices for patients while reducing wasted resources.  This project previously consulted with the MNCY SCN, Grey Nuns Hospital and Foothills Medical Center to identify strategies that reduce practice variation and increase adherence to CWC guidelines at these sites.

PLP conducted six interviews with OBGYN physicians at urban and regional centers in Alberta to understand potential causes of the unnecessary ordering of T&S tests. These interviews, current testing rate data, and consultations with anesthesiology, lab services, and transfusion medicine informed the development of a pre-delivery order set as an intervention strategy to reduce practice variation. An approved Connect Care order set will be launched in Alberta. Practice variation and adherence to CWC guidelines will be monitored to identify whether further interventions, such as facilitated audit and group feedback, may be needed.

In October 2024, January 2025, and March 2025 site-level progress reports were distributed reiterating evidence for the project, test costs, and project benefits and timelines as well as the most up to date T&S testing data. These reports were created for the nine hospital sites in our project as well as two sites who were interested in seeing data only.

The project was submitted to the Women’s Health PIN for consideration as a priority initiative, and an abstract was submitted to the 2025 Canadian Society for Transfusion Medicine Annual Conference. Since April 2025, the work has been presented at that conference, and a poster was presented at the 2025 Centre for Quality Improvement and Patient Safety Conference. A fourth round of follow‑up data was distributed to all nine sites, with final project data shared in August. As the project concludes, a sustainment plan has been developed in collaboration with the Women’s Health PIN and Transfusion Medicine, including site‑specific T&S testing thresholds that trigger alerts to site leaders if testing rates increase. With all deliverables completed, the project has been approved for closure, with lessons learned documented, materials archived, and a final project report completed. Support for future publication of this work is planned.

By aligning obstetric practice with Choosing Wisely Canada recommendations, this work promotes safe, more efficient care through reduced unnecessary pre‑delivery testing and improved stewardship of health system resources across Alberta hospitals.

Prophylactic antibiotic use in pregnancy is essential to prevent serious complications such as early-onset neonatal Group B Streptococcus (GBS) disease and surgical site infections following cesarean delivery. While penicillin is the first-line treatment—and cefazolin a recommended alternative—many patients with a documented penicillin allergy receive less effective second-line antibiotics. This is often due to outdated information or inaccurate allergy labels, despite evidence that up to 98% of individuals reporting a penicillin allergy are not truly allergic.

Optimizing antimicrobial use in pregnancy is critical to improving outcomes for both mothers and infants. This multi-phase project aims to better understand current practices and gaps in care to inform targeted knowledge translation and intervention strategies that support appropriate, evidence-based antibiotic use. The project is led by PLP Medical Director Dr. Eliana Castillo, in collaboration with Dr. Lynora Saxinger and the AHS Antimicrobial Stewardship group.

For the first phase of this project, we undertook a stakeholder mapping activity by engaging with relevant stakeholders in this space to inform the study design and extend the network for dissemination of this work. We engaged with individual and organizational stakeholders across the care continuum, in rural and urban settings, and across a range of obstetrical team roles. We met with obstetrical networks, associations, and organizations, including the AHS Maternal, Newborn, Child, and Youth Strategic Clinical Network (i.e., MNCY SCN). 

Using human centred design approaches, we developed a patient journey map that illuminates the perinatal process of a patient that qualifies for antibiotic prophylaxis and their care. The goal was to understand the process(es) related to prenatal allergy identification, reaction risk assessment, documentation, and communication across the care continuum. In addition to interviewing family physicians, obstetricians, obstetrical nurses, midwives and residents, we reviewed a broad range of documents, including processes, policies, and documentation, including prenatal records, standing order sets, and electronic documentation across and within the care continuum. Through this clinical process mapping activity, we found that nurses and pharmacists play crucial roles in documenting and reviewing reported allergy assessments, although without detailed investigation to assess the nature of the immune reaction which is appropriate given the over-reporting of penicillin allergy. There are challenges with allergy data in ConnectCare, and standardized processes for updating inaccurate allergies are insufficient. The findings from the patient journey map are being incorporated with the data component from phase 2 of the project, to inform intervention planning and execution of KT activities. The findings also identified the need for decision algorithms for group B streptococcus and cesarean surgeries.

To address the growing complexity of managing T2D alongside serious cardiac and renal comorbidities, PLP Medical Director Dr. Donna Manca continues to collaborate with NAPCReN on this initiative to help optimize high-impact prescribing. Because these comorbidities significantly elevate the risk of mortality and organ failure, PCPs are advised to use the newest therapeutic agents recommended by Diabetes Canada, specifically sodium–glucose cotransporter 2 inhibitors (SGLT2i). This project leverages CPCSSN data to move beyond basic monitoring, providing physicians with a sophisticated look at how often these SGLT2i medications are being prescribed to their highest-risk patients.

By translating complex prescribing data into individualized, benchmarked feedback, the initiative empowers clinicians to bridge the gap between evolving clinical guidelines and daily practice. The 2025–2026 cycle delivered updated reports to 86 physician sentinels, bringing the total to 312 reports distributed since 2022–23. To ensure these insights are immediately actionable, the reports include a comprehensive educational suite, with recordings from diabetes-focused learning events, including Team up for health: Integrating diabetes and kidney care, Your Diabetes Dilemmas: Comment on real life cases; and From sugar highs to fat fries: The latest in diabetes and lipid management; and Beyond blood sugar: Pearls for practice. This data-driven approach ensures that Albertans with complex diabetes receive the most advanced care available to improve their long-term survival and quality of life.

By providing a clear view of prescribing patterns for high-risk patients, these reports help physicians translate data into action, supporting organ-preserving care and improving access to evidence-based therapies for those who need them most.

To address the growing complexity of managing T2D alongside serious cardiac and renal comorbidities, PLP Medical Director Dr. Donna Manca continues to collaborate with NAPCReN on this initiative to help optimize high-impact prescribing. Because these comorbidities significantly elevate the risk of mortality and organ failure, PCPs are advised to use the newest therapeutic agents recommended by Diabetes Canada, specifically sodium–glucose cotransporter 2 inhibitors (SGLT2i). This project leverages CPCSSN data to move beyond basic monitoring, providing physicians with a sophisticated look at how often these SGLT2i medications are being prescribed to their highest-risk patients.

By translating complex prescribing data into individualized, benchmarked feedback, the initiative empowers clinicians to bridge the gap between evolving clinical guidelines and daily practice. The 2025–2026 cycle delivered updated reports to 86 physician sentinels, bringing the total to 312 reports distributed since 2022–23. To ensure these insights are immediately actionable, the reports include a comprehensive educational suite, with recordings from diabetes-focused learning events, including Team up for health: Integrating diabetes and kidney care, Your Diabetes Dilemmas: Comment on real life cases; and From sugar highs to fat fries: The latest in diabetes and lipid management; and Beyond blood sugar: Pearls for practice. This data-driven approach ensures that Albertans with complex diabetes receive the most advanced care available to improve their long-term survival and quality of life.

By providing a clear view of prescribing patterns for high-risk patients, these reports help physicians translate data into action, supporting organ-preserving care and improving access to evidence-based therapies for those who need them most.

Accurately identifying individuals with Type 1 Diabetes (T1D) in healthcare datasets is challenging but critical for resource planning, targeted care, and research. Without reliable methods to distinguish T1D from Type 2 Diabetes (T2D) in administrative data, health systems risk misallocating resources and missing opportunities to improve care for this distinct patient population.

To address this gap, a team led by Dr. Roseanne Yeung, with Dr. Peter Senior and Dr. Padma Kaul, applied and validated Sharma et al.'s 20161 algorithm---a tool to classify diabetes types---across Alberta's health datasets. Using inpatient records, physician claims, pharmacy data, and clinical registries, the project analyzed over 5,000 records to assess the algorithm's accuracy. Key collaborators included the REDISCOVER research group and AHS.

The results were promising: In the eClinician dataset, the algorithm correctly identified T1D with 94.6% specificity and 75.5% sensitivity, while in the Insulin Pump Registry, sensitivity improved from 76.9% (2008 diagnoses) to 98.2% (2023 diagnoses)---showing especially strong performance in younger age groups. These findings provide a validated method to track T1D in Alberta's health system, measuring disease prevalence, enabling tailored interventions, and supporting research.

This project lays the foundation for precise diabetes surveillance and care improvements, ensuring resources reach those who need them most.

Preventing recurrent myocardial infarction (MI) depends on strong secondary prevention, including appropriate cardiac interventions, medication adherence, and ongoing follow-up care. This project, led by Dr. Robert Welsh and Dr. Pishoy Gouda, examined post-discharge care from the perspective of cardiologists at the Mazankowski Heart Institute. Focusing on 2,464 patients who experienced a MI and received a bare-metal or drug-eluting stent, the study evaluated adherence to guideline-recommended medications and follow-up laboratory testing as care transitioned from hospital to community.

Findings showed strong adherence to recommended cardiac interventions and medications. Among patients treated at the Mazankowski Heart Institute, 91% underwent coronary angiography, 79% received percutaneous coronary intervention (PCI), and 87% received either PCI or coronary artery bypass grafting (CABG). Medication adherence was similarly high, with 93% of patients maintaining antiplatelet therapy in the first three months and 88% between months four and twelve. Long-term use of statins, angiotensin converting enzyme (ACE) inhibitors, or angiotensin II receptor blockers (ARBs) also remained strong through and beyond the first year.

Supplemental analysis this year by PLP Medical Director Dr. Darren Lau identified an important opportunity for improvement: adults living with diabetes and those with dementia had consistently lower long-term use of these medications, beginning at 4–13 months with further decreases 14-36 months after discharge. While declining kidney function may explain some discontinuation of ACE inhibitor or ARB therapy, reduced long-term statin use in people living with diabetes remains an important care gap, due to their increased risk of cardiovascular events.

Overall, the findings suggest that while broad adherence to secondary prevention is strong, there are opportunities to optimize care for specific patient groups. We are exploring opportunities for dissemination, and considering a possible follow-on study focused on dyslipidemia management to inform QI activities

Patients living with chronic conditions like type 2 diabetes frequently navigate transitions between healthcare settings—from community clinics to hospital wards and back to primary care. These transitions often result in care fragmentation, which can compromise patient safety. Consistent continuity of care with a family physician or clinic team can mitigate this fragmentation, supporting improved health outcomes and reducing emergency department visits and avoidable hospitalizations.

This initiative, led by Dr. Terry McDonald in collaboration with PLP, examined how continuity of care is associated with health outcomes for Albertans living with diabetes. Using provincial data from 202,222 people living with diabetes, the analysis explored patterns in primary care use and continuity, as well as associated impacts on acute care utilization. Findings showed that rural patients had fewer visits with their family physician compared with those in urban settings, yet experienced higher rates of emergency department visits and hospitalizations. In contrast, individuals who consistently saw the same physician or clinic team, particularly those with greater medical complexity, had fewer emergency visits and hospital stays. These findings reinforce the importance of continuity and team-based care models in supporting effective diabetes management.

With the primary scope of work now complete, activities this year have focused on maintaining visibility of these findings and promoting their uptake through knowledge translation activities.

By reinforcing the importance of continuity and team-based care, this work helps inform care models that reduce fragmentation, support more consistent relationships between patients and providers, and ultimately contribute to fewer emergency visits and hospitalizations for Albertans living with diabetes

Alberta spends $457 million on 2.9 million diagnostic imaging (DI) procedures annually; however, wait times for DI procedures, like CT and MRI, are significantly higher than in other provinces leading to delays in necessary care. CWC and the Canadian Association of Radiology (CAR) estimates that up to 30% of DI procedures may be low value.

The completeness and appropriateness of DI referrals by referring physicians have been shown to impact patient wait times. However, few QI initiatives have engaged directly with radiologists to identify opportunities for practice improvement on prioritization of DI referrals. This project partnered with AHS Diagnostic Imaging (Calgary Zone) to investigate variation in how radiologists prioritize musculoskeletal (MSK) MRI referrals against established AHS guidelines. By utilizing practice-level data and building radiologist consensus, the project aims to reduce unwarranted variation, strengthen referral guidelines and ultimately improve timely access to imaging for patients.

This project was led by physician leads Drs. Richard Walker and Dorian Nobbee, with oversight from PLP Medical Director Dr. Oliver David. The project team is grateful to the nine Calgary Zone radiologists who participated in the audit-and-feedback sessions and completed follow-up prioritization reviews as their engagement was essential to the project's success. Support from AHS Diagnostic Imaging, Calgary Zone was instrumental in enabling data access and platform development.

In June 2025, nine individual follow‑up reports reviewing the prioritization of 30 MRI requisitions were distributed. Project closing documentation was completed in July 2025, including a Qualtrics survey to capture project team perspectives on successes and limitations. A Lessons Learned session was subsequently held at PLP Monthly Rounds in December 2025, consolidating insights to inform future work. In early 2026, physician lead Dr. Richard Walker confirmed plans to pursue publication in the Canadian Association of Radiology Journal.

Reduced unwarranted variation in musculoskeletal MRI prioritization through radiologist-led A&F, supporting more timely access to MRI and contributing to efforts to update diagnostic imaging guidelines.

Health system innovations aimed at improving healthcare access are complex interventions that can have unintended consequences; hence the need for near real-time evaluation approaches that capture evolving contexts and impacts. This need became apparent with the initiation of the Alberta Surgical Initiative’s Facilitated Access to Specialized Treatment (FAST), a province-wide centralized access and triage system to address surgical case backlogs. The goal of FAST is to improve surgical access for patients and reduce wait times for initial surgical consultation. 

This project explored how to design a system to provide near real-time feedback on context and impacts to inform health system innovations like FAST; and how to operationalize data collection across diverse patient populations and providers. We reached out to primary care providers, surgeons and their teams, patients, families, and advocates across the province. We generated a diagrammatic representation of the Illuminate 360^o approach for monitoring and adapting complex health system innovations. Examples of the types of information that can be collected by this approach included micro-narratives about patient and provider experiences which are linked with quantitative descriptions. These data can help identify emergent patterns in responses from patients and health care providers, which can inform communication strategies and adjustments to the implementation roll-out. This study is the first of its kind in applying this approach  to the pressing challenges of generating near real-time information to support the roll-out and ongoing optimization of a complex intervention in healthcare. This PLP-partnered project was a collaboration with the AHS Surgery SCN, and the Illuminate Lab at the University of Alberta. It is being led by Dr. Mary Brindle, Dr. Sanjay Beesoon, Dr. Sandy Berzins, and PLP co-lead Dr. Denise Campbell-Scherer. 

Building capacity to generate near real-time information about evolving context and multifaceted impacts of innovations can provide critical insights for action in healthcare systems.

Lower back pain significantly impacts patients’ quality of life and increases healthcare utilization and costs. There are several challenges to addressing lower back pain. Notably, the reliance on opioids for pain management presents an undesirable risk of addiction. Limited access to affordable physiotherapy, inadequate physician training in alternative therapies, and time constraints on providing interventions hinder the delivery of effective, guideline-based interventions that meet patients' needs. The Good Living osteoArthritis in Denmark (GLA:D) back program addresses many of these issues, and has introduced a sustainable evidence-based education and exercise regimen to address chronic and recurrent lower back pain. 

Inspired by this European project, Professor of Rehabilitation Medicine, Dr. Greg Kawchuk, aims to implement the GLA:D back program in Primary Care Networks across Alberta, through the Alberta Back Care pathway (ABCp) initiative, and assess its impact on physician management of lower back pain patients. To support the implementation of this program, Dr. Kawchuk collaborated with PLP to leverage our expertise in human-centred design approaches, to develop a patient journey map for patients living with chronic back pain. The patient journey map illustrates patients’ experiences with back pain, past treatments, and common issues or fear, and is intended to provide patients and physicians with information and context about the back pain treatment journey. Information collected through interviews and co-creation sessions with patients and physicians who specialize in back pain management indicated the benefits of the ABCp program for patients with chronic back pain. It also showed that because of the long duration of chronic pain, patients tend to experiment with different types of treatment. These findings informed the next stage of the project, where the ABCp project team, patients, and providers, co-developed journey maps that would visualize the ideal paths for managing chronic pain, focusing on identifying barriers and opportunities for action. These maps have been refined and validated with input and feedback from the rehabilitation team. Next steps will involve exploring the useability of the journey maps in the primary care context, to support program uptake among family physicians. 

This project is developing visual care pathways to support the incorporation of the GLA:D back program into back pain management in primary care settings in Alberta.

Continuous Glucose Monitoring (CGM) has been a transformative advancement in diabetes care, enabling real-time glucose tracking without the need for frequent finger pokes. By capturing glucose levels every few minutes—including during sleep—CGM provides a comprehensive picture of patterns and trends, supporting earlier intervention and helping reduce the risk of hypoglycemia and other complications. However, despite the availability of this rich data, many people living with diabetes and their care teams face challenges in interpreting CGM outputs and translating them into day-to-day management decisions. 

To address this gap, the PLP used a human-centred design (HCD) approach to develop tailored, plain-language resources that make CGM data more understandable and actionable. This work builds on PLP’s broader commitment to creating practical tools that support both clinical decision-making and self-management. This work has been presented as posters at the Diabetes Canada/CSEM Conference in Toronto, Ontario in November 2025, and at the Family Medicine Summit, in Calgary, Alberta in March 2026.

Under the leadership of PLP Medical Directors Dr. Rose Yeung, Dr. Darren Lau, and Dr. Donna Manca, the CGM project team adapted the original How to Read My AGM printed guide into a dynamic, interactive web-based platform. Developed using human-centred principles, the tool emphasizes intuitive navigation, clear visualizations, and plain-language explanations to support people across a range of literacy levels, digital comfort, and device types.

Currently, the interactive tool is publicly accessible, with early-stage usage data collection already underway. These insights will inform ongoing, iterative refinements to ensure the resource remains relevant, usable, and responsive to the needs of Albertans and their care teams.

By translating complex glycemic data into a practical, easy-to-use digital format, this resource helps bridge the gap between advanced monitoring technology and everyday diabetes management. In doing so, it supports more informed decision-making, strengthens self-management, and has the potential to reduce avoidable complications and reliance on acute care services.

Acute kidney injury is seen in approximately 60% of ICU patients. Dialysis is administered to approximately 10% of critically ill patients, with usage increasing annually. Findings from the Alberta led STARRT-AKI trial¹ indicate that early initiation of dialysis may increase the likelihood of patients requiring life-long dialysis and that a delayed strategy can result in a 50% avoidance of dialysis. Provincial data suggests that up to 59% of acute dialysis starts may be early or inappropriate, highlighting a significant opportunity to improve care quality and reduce long-term health system burden.

Building on this evidence, Dialyzing Wisely optimized dialysis use across 20 adult and pediatric ICUs in Alberta. The initiative was physician‑led by Dr. Oleksa Rewa, with PLP Medical Director Dr. Selena Au, and was delivered in collaboration with ACA’s Critical Care Provincial Program. The work focused on aligning clinical practice with evidence‑based guidelines using data‑driven audit and feedback as a core improvement strategy.

Last spring, PLP facilitated two additional audit and group feedback sessions with a total of 21 physician participants. These sessions aim to support sites and individual practitioners to reflect on their data, while facilitating the development of actionable plans to sustain and build upon their practice improvements.

In the prior year, PLP supported the rollout of quarterly site‑level audit and feedback reports across all 20 ICUs, completing the step‑wedge implementation by June 2024. These reports, alongside individualized physician‑level feedback launched in fall 2024 and made available through a Tableau dashboard, provided the foundation for ongoing monitoring, improvement planning, and sustained practice change. This work set the stage for an upcoming survey to the program and presentation of results in the next 3-6 months

By providing data‑driven audit and feedback to clinicians, PLP is supporting more appropriate use of dialysis in critical care, improving patient outcomes, reducing unnecessary treatment, and strengthening system stewardship across Alberta.

¹ STARRT-AKI Investigators, Canadian Critical Care Trials Group, Australian and New Zealand Intensive Care Society Clinical Trials Group, United Kingdom Critical Care Research Group, Canadian Nephrology Trials Network, Irish Critical Care Trials Group, Bagshaw, S. M., Wald, R., Adhikari, N. K. J., Bellomo, R., da Costa, B. R., Dreyfuss, D., Du, B., Gallagher, M. P., Gaudry, S., Hoste, E. A., Lamontagne, F., Joannidis, M., ... Zarbock, A. (2020). Timing of initiation of renal-replacement therapy in acute kidney injury. The New England Journal of Medicine, 383(3), 240–251. https://doi.org/10.1056/NEJMoa2000741

Reducing avoidable blood transfusions in patients admitted to critical care and high-risk surgical units in Alberta and reducing blood volume loss through implementation of small-volume tubes in patients admitted to critical care and high-risk surgical units in Alberta

Led by Dr. Daniel Niven and funded by an Alberta Innovates PRIHS grant, the Don’t Misuse My Blood (DMMB) initiative aims to:

• Reduce potentially low-value transfusions of red blood cells, platelets, fibrinogen, plasma, and prothrombin complex concentrates across 39 adult and pediatric critical care and high-risk surgical units in Alberta.

• Minimize avoidable blood loss by transitioning 17 hospitals to small-volume blood collection tubes, reducing iatrogenic blood loss and associated healthcare costs.

*Please note: The original project title references “blood tests,” but Phase 2 has since shifted to focus on reducing blood volume loss through small-volume tube implementation.

The transition to small-volume blood collection tubes was completed in February 2026, following full implementation of the transfusion reduction strategy across all 39 sites in June 2024.This project was supported by PLP Calgary’s expertise in data analysis and reporting, including the development of a custom-built data pipeline that enabled timely, site-specific A&F. Quarterly A&F reports were distributed to clinical teams, providing actionable insights that supported behavior change and clinician engagement.

An interactive dashboard with key project metrics has been completed and launched provincially. This system allows local sites and individual physicians to receive continuous feedback on their performance and allows for monitoring to ensure improvements are sustained. PLP has worked with ACA to develop strategies to provide additional support for sites and individual physicians if the use of unnecessary blood products increases.

Phase 3, expanding the implementation of small-volume blood collection tubes throughout participating hospitals was completed in February 2026.

Cumulative project impact (June 2023 to March 2026):

• 39% reduction in potentially unnecessary blood product transfusions

• 1,357 patients avoided unnecessary blood product exposure

• $1,716,190 in costs savings realized

• 2,884 transfusions avoided

• 21,802 kgs of CO₂ equivalent saved

Coordinated, evidence‑informed blood utilization practices are reducing low‑value transfusions and avoidable blood loss, strengthening physician decision‑making and delivering sustained clinical, financial, and environmental benefits across Alberta’s critical care and high‑risk surgical settings.

Inappropriate use of antimicrobials in the treatment of asymptomatic bacteriuria (ASB) is a commonly recognized issue across health care. PLP continues to collaborate with the AHS Antimicrobial Stewardship group to support decision making for appropriate urine testing, with PLP having previously co-developed adult and pediatric algorithms that have reduced unnecessary testing. This new project, led by PLP Medical Director Dr. Lynora Saxinger, extended the program work with an adaptation for the long term care setting, and involved updating the Long-Term Care urinary tract infection (UTI) care and management checklist initially developed by Towards Optimized Practice (TOP). Our human centered designer worked with the multidisciplinary project team to co-design the new tool, in alignment with the design and utility of the previously designed suite of tools for pediatric and adult diagnosis and management of UTI. Use of this tool in long term care will support appropriate testing and prescribing, and will improve patient care and outcomes.

Co-creations with 10 members of the Appropriateness & Stewardship in Asymptomatic Bacteriuria (ASAB) team informed revisions to the algorithm, while user testing with nurses/nurse practitioners informed improvements in the Connect Care CIS integration, and supported further tool refinement. Extensive user testing sessions included participants from AHS operated LTC facilities, AHS wholly owned subsidiaries, contracted partners (primarily DSL), and some provincial programs (e.g., Seniors Health, QI and Pharmacy Services). The final revision of the tool was approved with the ASAB group, and the finished algorithm is available on the PLP website and the “Do Bugs Need Drugs?” resource library. Other knowledge transfer and

implementation opportunities are being explored, with the goal of spreading access to the algorithm to other long term care providers and facilities.

We had broad consultation on this project and wish to acknowledge our participating stakeholders, which included: Provincial Seniors Health & Continuing Care, North Zone Seniors Health Clinical Nurse Educators and Clinical Support, Central Zone Seniors Health Clinical Nurse Educators and Clinical Support, Capital Care Norwood, Capital Care Grandeview, Capital Care Strathcona, Shepherds Care, Tuoi Hac Golden Age Manor, Kensington Cottages (DSL), Edmonton People in Need Shelter Society, Citadel Care Centre, Chinook Care Centre, and Balwin Villa.

Patients who have inaccurate beta-lactam (i.e., penicillin) allergy labels receive suboptimal antibiotic therapy, which is associated with poorer patient outcomes and higher system costs.

Although there is new evidence regarding penicillin allergy and cross-reactivity to certain classes of antibiotics, this information has not been widely disseminated. Led by PLP Medical Director Dr. Lynora Saxinger and primary care physician Dr. Helene Cuddihy, this project focused on developing and testing a decision algorithm that supports primary care physicians in identifying patients with true beta-lactam allergies. Developed to improve the shared understanding and management of true allergic reactions, it is available on the PLP website, ready for implementation. This complements the ongoing knowledge transfer work for the larger surgical site infection project.

Public health responses and reduced economic activity associated with the COVID-19 pandemic are affecting the housing and income security of ethnocultural communities in Edmonton. Local, provincial, and national programs and services can provide support, but information about them is fragmented and challenging to navigate. A coalition of organizations serving immigrants and refugees, including AHS, City of Edmonton, and the PLP team, represented by PLP Co-Lead Dr. Denise Campbell-Scherer, has been gathering information on eligibility and scope of services for various programs. Building on previous work carried out in partnership with the Multicultural Health Brokers Cooperative to validate and expand this information and to create a knowledge tool for community brokers, the PLP human centred design team led several co-creation sessions with multiple stakeholders, including social workers from the Rundle Health Centre, primary care physicians, nursing faculty at the U of A, and MCHB brokers to test and refine the tool’s useability for physicians and health care teams. The finished tools for resources for income and economic insecurity and housing insecurity were presented at the U of A Faculty of Medicine & Dentistry Grand Rounds in December, and spread and scale activities are ongoing.

Approximately 70,000 people in Alberta were waiting for surgery at the time of the AHS Review in 2019, and 50% were considered waiting longer than clinically appropriate. The PLP team, led by PLP Medical Director Dr. Katrina Nicholson, in collaboration with AHS ASI (led by Dr. Stewart Hamilton) and AHS IHOT (led by Dr. Donald Dick), are focusing on reduction of clinical variation of 17 procedures identified by AHS ASI executive team in this multi-year

initiative. The aim is to improve the provision of surgery within our province, by reducing clinical variation to promote equity and timely access to appropriate procedures using the latest evidence and guidelines.

This project facilitates leadership from the specific specialties to generate effective change strategies within each of the identified surgeries. PLP will use its expertise in peer-to-peer driven change, HCD, and implementation science to support the ASI. The focus in 2024-25 was on three surgical procedures: tonsillectomy, prostate resection, and ureteral calculi.

PLP completed work with three working groups in 2024-25. See the summaries listed below for more information about each procedure area. PLP is not anticipating new work with the Reduction in Clinical Variation (RCV) program, although additional procedures may be considered depending on the priorities of the ASI.

PLP's engagement with the RCV team and procedure working groups produced data-informed recommendations for the ASI. For each working group, PLP contributed to the review and clinical context of procedure data, facilitated the identification of clinical variation, and supported the development of recommendations with clinicians. The PLP team brought skills in data visualization and interpretation, as well as facilitation of co-creation session(s) to the collaboration with the RCV program. The high quality of the data presented sparked valuable discussions with clinicians.

Tonsillectomy

A working group of pediatric otolaryngology specialists and PLP reviewed initial data and measures to comprehend the observed variation. To aid in this effort, PLP provided its expertise in data visualization.

In conjunction with the ASI, PLP designed and facilitated three working group meetings in 2023. These collaborative efforts are aimed at understanding and reducing clinical variation in tonsillectomy procedures, ensuring that patients receive consistent and equitable care.

In 2024-25, a final summary of recommendations was sent to ASI executive leadership for next steps. PLP's engagement with this working group is completed.

Prostate Resection

We established a working group of urologists from both the Calgary and Edmonton Zones to initiate data review and explore additional data points and measures to understand the observed variation. PLP played an instrumental role in designing and facilitating the working group meetings in collaboration with the RCV program team and Dr. Stewart Hamilton.

In 2024-25, PLP, and the RCV team led by Dr. Hamilton delivered two co-creation sessions that looked at the economic analysis of prostate resection, the opportunities for optimization of utilization of day surgery unit for this procedure, as well as access to virtual care to reduce recurrent ED visits. The working group data refinement process resulted in a recommendation to explore development of a standardized provincial treatment pathway. This work has been taken on by the clinical subject matter experts in the group. PLP's engagement with this working group is completed.

Management of Retained Ureteral Calculi

A working group was established with urologists from both the Calgary and Edmonton Zones to initiate data review and explore additional data points and measures to understand observed variation in this procedure. PLP was involved in designing and facilitating three working group meetings in collaboration with the RCV program team and Dr. Stewart Hamilton.

In 2024-25, PLP focused on exploring the reasons for variation through extensive data review and additional discovery work. The working group indicated an interest in involvement of other zones, to understand the approach to management of retained ureteral calculi in rural zones. In addition, PLP completed work to optimise the care pathway documents for Calgary Zone. A final set of recommendations was presented to ASI executive leadership. PLP's engagement with this Working group is completed.

PLP's multi-year collaboration with ASI and RCV program brought together surgical teams from across the province to explore practice variation in six key procedures. Using a HCD approach, PLP facilitated 14 interactive workshops that transformed high-level administrative data into meaningful insights through tailored visualizations, relevant comparators, and collaborative tools. These sessions enabled clinicians to identify drivers of variation---including system-level factors such as access, equipment, and perioperative supports---and to share ideas for aligning care across sites. The process not only surfaced opportunities for standardization and advocacy but also highlighted the value of ongoing data collection to support equity and evidence-based surgical care. While the project has now concluded, the clinician-informed recommendations and strengthened provincial connections continue to inform ASI's efforts to improve surgical quality and access.

Polypharmacy—defined as the concurrent use of ten or more medications—is a significant driver of adverse drug events and poorer health outcomes in older adults. To help mitigate these risks, PLP Medical Director Dr. Donna Manca, in partnership with NAPCReN, utilizes CPCSSN data to provide primary care physicians with high-resolution feedback on their prescribing patterns. These reports specifically target polypharmacy and sedative use, offering clinicians the point-of-care intelligence needed to support appropriate prescribing and safer medication management.

A key differentiator of this initiative is its reliance on EMR and laboratory data rather than traditional administrative health data (such as HQA reports). While administrative data tracks filled prescriptions annually, the CPCSSN dataset is updated multiple times per year and captures prescriptions written at the point of care, regardless of whether they are filled. This provides a more immediate and accurate reflection of clinical intent, allowing physicians to identify and address suboptimal prescribing patterns with greater precision.

December 2025 marked the sixth annual reporting cycle of this successful collaboration, providing physicians with individualized prescribing data, benchmark comparisons, and evidence-based resources for deprescribing and insomnia management. During this most recent cycle, 77 individualized reports were distributed, bringing the project’s cumulative reach to 479 reports delivered to physician sentinels since its launch in 2020–21. By transforming EMR data into actionable feedback, this initiative continues to empower Alberta’s family physicians to advance their clinical practice and enhance the safety of senior care across the province.

This report equips participating family physicians with individualized practice data and 

evidence-based tools to empower safer, more effective prescribing, leading to better patient outcomes and more sustainable care.

To effectively manage obesity and its related conditions—includingT2D, metabolic associated steatotic liver disease (MASLD), and coronary artery disease—PCPs require reliable, real-time data that traditional administrative datasets often overlook. Led by PLP Medical Director Dr. Donna Manca, this initiative uses the CPCSSN platform to capture essential point-of-care metrics such as weight, blood pressure, and smoking history. Central to this work is the EOSS-DPT dashboard tool, co-developed by NAPCReN and PLP. Based on the Edmonton Obesity Staging System (EOSS) and the research of PLP Co-Lead Dr. Denise Campbell-Scherer, this unique tool provides actionable insights not available through HQA or standard EMR systems, offering a more personalized approach to obesity management.

In March 2026, updated reports were distributed to 86 participating physicians, bringing the cumulative total to 488 reports since the report’s launch in 2020–21. These reports connect clinicians with the Managing Obesity in Primary Care learning series and Pearls for Practice resources, all rooted in the 2020 Canadian Adult Obesity Clinical Practice Guidelines. 

This report provides participating family physicians with information on using the CPCSSN dashboard tool to identify patients living with obesity and other comorbidities, and provides additional resources to support patient care.

To optimize diabetes management, PCPs require meaningful, data-driven insights that reflect the full complexity of patient care. By leveraging the CPCSSN dataset, the PLP, led by Dr. Donna Manca, in partnership with NAPCReN, provides clinicians with reports drawn directly from point-of-care EMRs. 

This project distributed feedback reports to 77 participating physicians in November 2025. Featuring individualized practice data alongside aggregate benchmarks, the reports help clinicians identify opportunities for care optimization. Data are stratified by age (<65, ≥65), and include information on A1c control, hypertension management, blood pressure monitoring, and weight/BMI documentation. Since its inception in 2020–21, this initiative has distributed a cumulative total of 482 diabetes reports, offering a robust foundation for longitudinal practice improvement across Alberta.

To ensure data leads to direct clinical action, the reports are integrated with high-impact educational resources. The basic diabetes report provided links to relevant diabetes resources, including recordings of four past PLP learning events: Remission is Possible: A New Way to Think About Type 2 Diabetes; Ketogenic Diet for Diabetes and Weight Management; Toe-Morrow Never Dies: Approach to the Diabetic Foot, and Beyond Blood Sugar: Improving Kidney and Lipid Care in Diabetes Management.

These reports provide physicians with targeted EMR insights to help bridge gaps in diabetes management. This allows clinicians to align their practice with current standards, ensuring more proactive and effective care for Albertans living with the disease.

Asthma affects approximately 12% of Albertans, and suboptimal management frequently leads to preventable Emergency Department (ED) visits, rising healthcare costs, and increased patient morbidity. Now in its sixth year, this collaborative initiative with the Northern Alberta Primary Care Research Network (NAPCReN) is led by Dr. Donna Manca, who serves as a PLP Medical Director, Director of Quality Improvement, and the Director of NAPCReN. 

This project distributes individualized, benchmarked feedback reports annually to help Primary Care Physicians (PCPs) optimize asthma prescribing. The report provides individual and benchmark comparison data on prescribing practices for short-acting broncholidators, inhaled steroids, and systemic steroids like prednisone and decadron, alone or in combination, over the past year.While HQA reports that rely on annual administrative data from filled prescriptions, this project leverages the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) to extract real-time electronic medical record (EMR) and lab data. By capturing all prescribed medications—including those left unfilled—this data provides a more comprehensive view of clinical intent and a superior baseline for identifying and correcting suboptimal care patterns.

The 2025–2026 cycle reinforced the connection between data and clinical application, distributing reports to 84 physicians in March 2026. These reports were paired with curated educational resources, including recordings from our A Breath of Fresh Air and How to Help Your Patients Quit Smoking learning events. Since its inception in 2020–21, the project has distributed a cumulative total of 487 individualized reports. By integrating these insights into quality improvement (QI) workshops and pan-Primary Care Network (PCN) events, we empower practitioners to align their prescribing habits with the latest clinical guidelines, ultimately reducing exacerbations and improving long-term respiratory health for Albertans.

By revealing the discrepancy between what is prescribed and dispensed medications, this project equips physicians with their panel EMR data needed to bridge gaps in asthma management. This targeted insight allows clinicians to align their practice with modern guidelines, shifting the focus from reactive emergency care to proactive, long-term respiratory health for Albertans.

Educational materials and decision support tools have been created as part of this multi-faceted intervention to improve bronchiolitis management in children in Alberta. The development of these resources was driven by the needs and questions of participating sites and their families. The library of work includes a total of 15 new resources, 5 updated resources, and 2 videos. Family resources have been evaluated in collaboration with ACH and Stollery Children's Hospital Patient and Family Advisory Committees. In addition, we are continuing our efforts to develop additional resources aimed at assisting healthcare practitioners in effectively utilizing the tools within Connect Care, ensuring that these valuable resources can be seamlessly integrated into clinical practice.

In the past year, new development of resources on heated humidified HFNC for staff were co-designed based on input from physician leads and subject matter experts on this aspect of bronchiolitis management. A new guideline and an updated order set was developed and rolled out to all participating sites in the project to promote standardization of care for patients requiring supplemental oxygen.

Empowering clinicians and families with co-designed, evidence-based tools to support consistent, high-quality care for children with bronchiolitis across Alberta.

Cardiovascular disease is widespread across Canada. It is the leading cause of death for women, and the second leading cause of death of all Canadians. Dyslipidemia can be modified with effective, safe, and inexpensive treatment using cholesterol-lowering medications, such as statins. Unfortunately, only about 25% to 66% of individuals who would benefit from statins, or other management strategies, are currently benefiting from them.^1,2  

PLP Medical Directors, Drs. Sonia Butalia, Katrina Nicholson and Oliver David collaborated extensively with patient partners, family physicians, specialists, and pharmacists to co-create a dyslipidemia clinical decision support tool for individuals and physicians. By visiting the site and reading through the material, individuals can learn about dyslipidemia, statin indicated conditions, use a health heart calculator (Framingham Risk Score), and explore treatment options. Physicians can leverage the physician guide to facilitate evidence-based cholesterol management. This work was funded by Diabetes Canada, and PLP provided in-kind HCD and technical development expertise. 

The tool was implemented in November 2023 (https://cholesterol-tool.ucalgary.ca/). In collaboration with AHS and Alberta Precision Laboratories, the online clinical decision support tool is included with every lipid profile result, appearing in NetCare, electronic medical records, and other clinical systems. It is also publicly available and has been integrated into Health Quality Alberta panel reports.

Over this past year, the project focused on enhancing the impact of the dyslipidemia clinical decision support tool across the province. Periodic reviews of analytics were conducted to monitor the tool’s effectiveness and patterns of user engagement. These analyses, together with user feedback, identified emerging needs related to knowledge mobilization and informed future improvement opportunities. Throughout the year, dedicated technical maintenance ensured the tool remained reliable, current, and clinically relevant.

Since it’s launch, the tool has continued to demonstrate strong uptake and sustained engagement, amassing over 11,000 active users from Canada, the United States, the United Kingdom, France, Mexico, India, and China, with more than 12,000 direct traffic sessions and over 22,000 user engagement sessions.

Ongoing provincial and national presentations supported continued awareness and use of the tool by promoting shared decision‑making in cholesterol management. These efforts reinforced knowledge mobilization and the tool’s role as an evidence‑based resource for patients and providers, with positive feedback reported across provincial, national, and international audiences.

Co‑designed with patients, clinicians, and health system partners, this digital tool supports shared decision‑making in cholesterol management through accessible, evidence‑based guidance embedded at the point of care, achieving extensive reach and sustained engagement across Canada and internationally.

¹ Chen G, Farris MS, Cowling T, et al. Atherosclerotic cardiovascular diseases and low-density lipoprotein cholesterol management in Alberta, Canada [abstract]. Population Science- 91: Epidemiology and Population Studies. presented at: American Heart Association’s Scientific Sessions; November 10-12 2018; Chicago.

² Butalia, S., Lewin, A., Simpson, S., & others. (2014). Sex-based disparities in cardioprotective medication use in adults with diabetes. Diabetology & Metabolic Syndrome, 6(1), 117. https://doi.org/10.1186/1758-5996-6-117.

Antimicrobial stewardship aims to reduce antibiotic resistance by promoting appropriate antibiotic selection and duration of therapy. Drs. Joan Robinson, Cora Constantinescu, Alena Tse-Chang, and PLP Medical Director Jennifer Thull-Freedman are leading this work in collaboration with Calgary and Edmonton Zone EDs, focusing on antibiotic prescribing practices for pediatric emergency visits related to urinary tract infections (UTIs).

PLP supported the co‑creation of aggregate‑level data reports for 14 emergency and urgent care sites across Calgary and Edmonton. These reports include a clinical algorithm outlining evidence‑based diagnosis and management of pediatric UTIs, alongside data on testing and treatment patterns to support practice reflection and improvement.

PLP conducted an evaluation of antibiotic prescribing practices for pediatric UTIs by analyzing repeat data on antibiotic choice and duration of therapy across Calgary and Edmonton emergency and urgent care settings. This analysis was undertaken to assess changes in practice over time and evaluate alignment with evidence‑based recommendations. For children aged 0–4 years, appropriate narrow‑spectrum antibiotic use increased from 2% to 10%, while average treatment duration decreased from 7.6 to 7.3 days. For children aged over 4 years, narrow‑spectrum antibiotic use increased from 10% to 16%, with treatment duration decreasing from 6.9 to 6.7 days.

Aggregate reports were prepared for Alberta Children’s Hospital, Stollery Children’s Hospital, and emergency and urgent care sites in both zones, with dissemination pending final approval from project leads.

In May 2025, this work was presented as a virtual poster at the 2025 ICEM/CAEP Conference. In total, 19 site‑level reports were distributed to physician leads, and six individual physician reports were prepared and shared. These reports reinforced the clinical pathway and provided updated data on antibiotic choice and prescription duration.

The project has since been approved for closure, with lessons learned documented, materials archived, and a final project report completed.

Improved antibiotic prescribing for pediatric UTIs in Calgary and Edmonton EDs is advancing antimicrobial stewardship, with early data showing increased use of narrow-spectrum antibiotics and shorter treatment durations.

Amyotrophic Lateral Sclerosis (ALS) is a rapidly progressive neurological disease where early intervention is the primary driver of improved quality of life. Currently, the diagnostic journey is often fragmented, with patients navigating multiple specialty referrals before reaching a multidisciplinary ALS clinic. These delays create significant barriers to accessing life-extending therapies. To address this, the PLP is developing a specialized Tableau dashboard designed to monitor and analyze prescribing patterns for ALS-specific medications at the University of Alberta ALS Clinic.

By tracking these clinical indicators over time, the dashboard serves as a proxy for referral timeliness, identifying whether patients are reaching specialized care earlier in their disease progression. This data-driven approach provides the clinical intelligence necessary to identify knowledge-to-action gaps among referring providers. Ultimately, these insights will inform targeted interventions to streamline the referral pathway, ensuring Albertans with ALS receive a diagnosis and initiate treatment during the most critical therapeutic windows.

The initial dashboard architecture is complete, and preliminary testing is currently underway. To ensure the tool’s utility across the province, feedback is being integrated from collaborators at the University of Calgary ALS Clinic. Following this validation phase, the project team will explore expanded collaboration for the implementation and change management stages, aiming to foster a unified, data-informed approach to ALS care across Alberta

This dashboard will highlight how many patients are receiving specialized medications as a result of earlier diagnosis — potentially improving outcomes for people in Alberta living with ALS.

Cirrhosis, a chronic illness involving the liver, is a major cause of health complications and premature death. The Partnership for Research and Innovation in the Health System (PRHIS) sponsored a research team led by PLP Medical Director Dr. Puneeta Tandon to develop a website for physicians and patients about cirrhosis care. Last year, the PLP created the hierarchies and algorithm layouts for four decision algorithm tools and tables on the symptom management pages of the website (including varices, ascites, hepatic encephalopathy, spontaneous bacterial peritonitis). Now that the site has launched, we are undertaking scenario-based user testing, using human centred-design approaches to collect, understand, and address physician feedback on these decision algorithms, and to validate the content and its accuracy, and identify opportunities to improve the usefulness of the online resource.

The Division of Endocrinology & Metabolism at the University of Alberta has been dedicated to enhancing the quality of care for patients diagnosed with adrenal insufficiency (AI). AI is a relatively uncommon hormonal disorder characterized by malfunctioning adrenal glands that do not produce enough of the hormone cortisol, which requires hormone replacement therapy in the form of steroid medications. These medications alleviate symptoms such as fatigue, aches, and nausea while maintaining safe blood pressure levels. Moreover, during stressful events like infections or surgeries, patients have to make special medication adjustments, known as "stress dosing". As patients often have to make these changes on their own, in real time, it is imperative that they receive specific education and guidance.

Led by our Senior Medical Director, Dr. Rose Yeung, the PLP worked with patients living with AI and physicians in the Division of Endocrinology and Metabolism to co-create a patient education toolkit, aimed at enhancing patients’ knowledge about their illness and supporting active engagement in their treatment. The three-piece toolkit includes an AI patient resource featuring educational information on adrenal hormones, common symptoms, treatment, adrenal crisis, and when to contact their healthcare provider. An AI wallet card which can be filled in with key health information to let emergency personnel know that they are in adrenal crisis and expedite treatment. Lastly, there is a personal treatment plan document with information about adrenal crisis and common scenarios that might require stress dosing adjustments. The physician can fill in their regular treatment doses of certain medication for easy reference.

Between April 2023 to March 2024, the education toolkit was successfully launched and is now available on the PLP website, marking the completion of this project phase. In January 2024, Dr. Adam Sinclair presented the toolkits to the UofA Division of Endocrinology & Metabolism at Grand Rounds, further highlighting their significance within the medical community. Furthermore, to disseminate these findings and tools to a broader audience, a manuscript detailing the toolkit's development and testing process has been submitted for publication and is currently under review. The team is actively formatting the AI toolkit for inclusion in ConnectCare to facilitate integration into clinical practice.

A follow-on knowledge translation project "Adrenal Insufficiency Toolkit Dissemination and Implementation" has been launched to promote widespread adoption and utilization of these tools. Webinars and other learning events to increase awareness among healthcare providers, as well as outreach initiatives with patient organizations like the Addison's Society, are underway to support the tools’ accessibility and uptake, in order to improve patient outcomes.

This toolkit will help empower patients with adrenal insufficiency to better manage their condition, reducing the risk of adrenal crises and enhancing overall quality of life.

Patients that receive suboptimal surgical antimicrobial prophylaxis (SAP) have a considerably higher risk of postoperative infection compared to those receiving optimal SAP. In 2018, guidelines changed to recommend cefazolin as the drug of choice for patients with a beta-lactam allergy (often referred to as penicillin allergy). Appropriate prescribing of SAP is one of the key factors in reducing surgical site infection; however, this involves a combination of factors, including the right indication, antibiotic, dosage, route, timing of administration, and duration. A recent pilot study at the Sturgeon Hospital revealed an ongoing under-prescribing of cefazolin for patients with a beta-lactam allergy, suggesting that a deeper understanding of surgical teams and their SAP process was needed. Recognizing this as an area of clinical importance to patients and the health system, PLP partnered with the Edmonton Zone members of AHS’s Antimicrobial Stewardship Committee and the Zone Clinical Directors Executive Committee for Surgery and Anesthesiology to assess the appropriateness of antimicrobial surgical prophylaxis.

With PLP Physician Liaison Dr. Lynora Saxinger, and the clinical project team which included Drs. Holly Hoang, Justin Chen, Alena Tse-Chang, Uma Chandran, and Susan Fryters, the PLP team conducted a chart audit at five hospital sites in Edmonton to determine whether cefazolin was underprescribed for SAP in patients with a beta-lactam allergy, and to explore the extent of inappropriate or suboptimal prophylaxis for all patients undergoing surgery. Our study found that, despite changes to guidelines in 2018, cefazolin is still being under-prescribed in SAP for surgical patients with beta-lactam allergy, and there are large variances in SAP practices across sites and specialties in the Edmonton Zone.

Championed by Obesity Canada and the Canadian Association of Bariatric Physicians and Surgeons, the 2020 Canadian Adult Obesity Guidelines were substantially revised and published in the Canadian Medical Association Journal in August 2020, followed by publication of the French version in December 2020. PLP co-lead Dr Denise Campbell-Scherer, served on the Executive Committee of the Canadian 2020 Adult Obesity Guidelines and was lead author of the Primary Care and Primary Healthcare chapter. In partnership with Obesity Canada, the PLP used human-centred design approaches to create a one-page visual algorithm summarizing the essence of the revised guidelines, which are complex and more than 400 pages long. The design process was gearedtowards making an algorithm more accessible and usable for family physicians, primary care

interdisciplinary team members, individuals living with obesity and those who support their care,

and policymakers. This publication was the most read article in CMAJ in 2020, and it received over

81 million earned media impressions in the first month with international coverage including

CNN and the Guardian, and national coverage with front page stories in the Globe and Mail,

Toronto Star, and National Post, and all major TV news outlet services in Alberta.

Bronchiolitis is a seasonal viral lower respiratory infection, typically occurring between November and April. It is the leading cause of infant hospitalization and a major driver of inpatient medical expenditures for young children in Canada. Although clinical practice guidelines recommend against the routine use of certain diagnostic tests and medications in bronchiolitis management, prior studies have shown that these low‑value interventions continue to be commonly used in emergency departments and inpatient settings.

Led by Drs. Michelle Bailey, Daina Thomas, Brittany Sunderani, Lindsay Long, and Piush Mandhane, and in collaboration with the ACA’s Children’s Health Provincial Program and Improving Health Outcomes Together (IHOT), PLP co-created individual physician-level and aggregate site-level data reports to support improved bronchiolitis care across Alberta. PLP led the statistical analysis, data visualization, resource development, and report generation and facilitated A&F sessions as part of a multi-faceted intervention to reduce low-value care.

This work served as a foundational component of Alberta Children’s Hospital’s successful application to the Choosing Wisely Canada Hospital Designation Program, which recognizes hospitals that take deliberate action to reduce overuse and minimize patient harm.

The project has transitioned into a sustainment phase across 25 sites (17 EDs, 8 inpatient units). Aggregate end-of-season reports were distributed to all participating sites, and two “Year in Review” sessions were hosted in September 2025, drawing a combined 60 attendees, PLP led the completion of data validation and finalizing balancing measure analysis, and implemented a sustainment plan to support site champions going forward. Ongoing sustainment will be monitored and evaluated over a four‑year period (2025/26; 2026/27; 2027/28; 2028/29).

A qualitative manuscript on barriers and facilitators to de-implementation across Alberta’s healthcare settings is currently under editorial review at the Journal of Hospital Medicine. In the coming year, work will focus on continued sustainment, dashboard enhancements, and collaborative knowledge translation activities to share project outcomes and impact more broadly.

Key Performance Indicators and Early Indicators of Impact includes:

·        25 sites engaged provincially, (17 EDs, 8 inpatient units) representing tertiary, regional, urban, and rural facilities

·        Approximately 300 ED physicians and 95 Inpatient physicians attended A&F sessions and received aggregate reports

·        Clinician feedback highlighting strong engagement and meaningful use of data to support patient‑centred care

Driving province-wide improvements in bronchiolitis care by reducing unnecessary interventions and aligning practice with evidence through data, education, and feedback.

For bacteriuria patients who are asymptomatic, routine urinalysis and use of antimicrobial medications may be inappropriate. The context of patient symptoms must be assessed. Building on past success with a decision algorithm to support antimicrobial stewardship in adults with asymptomatic bacteriuria, our human-centred design team worked with PLP Medical Director Dr. Lynora Saxinger and AHS pharmacist Darren Passay to develop a tool for use with pediatric patients. This decision algorithm for pediatric patients is available on the PLP website as well as the AHS webpage (appropriateness of care for asymptomatic bacteriuria).

Inappropriate use of antimicrobials in treatment of asymptomatic bacteriuria is a commonly recognized issue across health care. Overuse of urine tests including both urinalysis and urine cultures as routine tests or tests of nonspecific symptoms, combined with treatment of positive urine test results is an inappropriate use of resources. This overuse can result in unnecessary antibiotic therapy with potential patient harm, including the development of bacterial resistance, adverse and allergic reactions to antibiotics, and promotion of serious infection.

We identified a gap in knowledge with physicians and their teams regarding best practices in urinary infection testing. Together, we created an algorithm to support a consistent testing process in order to reduce unnecessary urine testing and antibiotic use.

Access to high-quality care transitions is not equally distributed across urban populations. Many health systems design transition processes that assume patients have stable housing, reliable social supports, and consistent access to primary care. However, underserved urban populations—often facing poverty, unstable housing, and high burdens of illness—frequently lack these supports. As a result, care plans may be difficult to follow and important needs may go unmet, leading to poorer patient outcomes, more fragmented care, and increased reliance on acute care services.

Co-Designing Equitable Care Transitions for the Urban Underserved - Phase 1

This project aims to identify systemic gaps and promote more equitable care transition  models. Using a Cognitive Task Analysis (CTA) method known as Concept Mapping, the project examines how multidisciplinary teams make decisions, form shared mental models and adapt their strategies when coordinating transitions for patients with complex social and medical needs.

Led by PLP Medical Director Dr. Ginetta Salvalaggio, this project is being conducted in collaboration with Radius Community Health and Healing, which serves Edmonton’s most disadvantaged communities, the Addiction Recovery and Community Health (ARCH) team and acute infectious disease teams at the Royal Alexandra Hospital (RAH)  and the University of Alberta Hospital (UAH), and addiction and recovery specialists.

Results highlight that both system-level barriers and individual patient circumstances affect how information is shared and how relationships between providers are maintained, with both factors being critical for effective care transitions. The findings suggest that improving transitions for underserved urban populations requires more than new policies or programs; it depends on providers’ ability to integrate clinical and social knowledge, manage uncertainty, and coordinate across fragmented systems. Strengthening connections between clinical and community resources, along with timely information sharing between acute and primary care teams, emerged as particularly important for supporting effective transitions. These insights are also informing broader knowledge translation efforts, including an oral presentation on centering community voices in systems of care delivered at the 28th Harm Reduction International Conference in Bogotá, Colombia, in April 2025.

These findings underscore the urgency of integrating acute and primary care through enhanced information sharing. By bridging these systems, we can directly improve health outcomes for underserved urban populations. 

CWC and CIHI estimate that Canadians receive over one million unnecessary laboratory tests each year. In the inpatient setting, low-value laboratory testing often occurs in the form of daily repetitive use of routine tests and is associated with hospital-acquired anemia, increased blood transfusions, prolonged hospitalization, and higher morbidity for patients. Physician lead Dr. Anshula Ambasta and PLP Medical Director Dr. Douglas Woodhouse developed a multifaceted intervention bundle to reduce routine daily laboratory testing, which included virtual facilitated audit and group feedback sessions. 

The following presentations at healthcare and research conferences have helped increases awareness of how a multi-faceted intervention that was implemented using evidence informed approach reduced unnecessary daily lab testing in hospitalized patients, supporting safer, more efficient care and contributing to national efforts to reduce low-value testing:

Woodhouse D, Pokharel S, Omodon O, Ferrie L, Duncan D, Mehta A, Ambasta A.   A novel approach co-designing intervention bundles: applying theory with pragmatism. Oral presentation at the ACFP Family Medicine Summit – Research Showcase on March 6, 2026.

Woodhouse D, Duncan D, Law S, Peterson A, Burak K, Ambasta A. Best Practices for virtual Audit and Group Feedback workshops that effectively engage clinicians. Workshop delivered at the 10th International Audit & Feedback in Healthcare Conference: Celebrating a Decade of Progress & Shaping the Future, Toronto, Canada on November 7, 2025.

Woodhouse D, Duncan D, Ferrie L, Omodon O, Mehta A, Pokharel S, Ambasta A. Virtually Delivered Audit and Group Feedback is Effective in Reducing Laboratory Utilization. Oral presentation delivered at the 10th International Audit & Feedback in Healthcare Conference: Celebrating a Decade of Progress & Shaping the Future, Toronto, Canada on November 6, 2025.

Woodhouse D, Ambasta A, Burak K, Duncan D, Sampson L. Best practices for virtual QI workshops that effectively engage clinicians. Workshop delivered at the Choosing Wisely National Meeting -Winnipeg, Canada on May 27, 2025.

Ambasta A, Woodhouse D. Re-Purposing the Ordering of Routine laboratory Tests (RePORT). Oral presentation delivered at Choosing Wisely National Meeting -Winnipeg, Canada on May 27, 2025.

Increasing awareness of how the implementation of a multi-faceted intervention reduced unnecessary daily lab testing in hospitalized patients, supporting safer, more efficient care and contributing to national efforts to reduce low-value testing.

In collaboration with PLP Calgary, CME&PD developed a Peer Coaching course designed to build foundational coaching skills among physicians. The course includes online self-learning modules, interactive virtual workshops, and peer coaching conversations. Modules 1 and 2 provide a strong introduction to peer coaching, while Module 3 is designed for more advanced application and is ready for pilot testing. The program supports the development of a community of practice and aims to foster a culture of coaching for change within the healthcare system.

In 2024 - 25, interest in peer coaching has grown significantly across the Cumming School of Medicine (CSM), with multiple offices -including the Office of Faculty Development and Performance (OFDP), DEIP, and CME&PD - expressing interest in adopting or adapting the program. Peer coaching is increasingly recognized as a flexible tool that can support a wide range of needs, from general peer support to more specialized areas such as quality improvement, behavioral coaching, and clinical content.

CME&PD is exploring opportunities to offer the program to a second cohort. Discussions are also underway to define the value of the program and ways to support sustainability. This initiative presents a strong opportunity for inter-office collaboration, aligning coaching efforts across CSM while supporting CME&PD’s operational model and long-term goals.

Across Alberta ICUs, variation in sedation and analgesia practices continues to impact patient outcomes, including prolonged mechanical ventilation, delirium, and increased healthcare utilization. Despite guidance from Choosing Wisely Canada and PADIS recommendations, continuous sedation use remains common, highlighting a gap in standardized, evidence-based care. Building on the success of the ROSA pilot, the HSAPA initiative aims to harmonize sedation and analgesia practices across the province through standardized clinical tools, audit and feedback, and multidisciplinary collaboration.

The project officially launched with PLP in August 2025, with a focus on building implementation-ready tools, education, and data infrastructure to support provincial scale-up. PLP collaborated with ACA’s Critical Care Provincial Program and clinical partners to develop five standardized clinical decision support tools, including Spontaneous Awakening Trial (SAT) and Spontaneous Breathing Trial (SBT) tools for ICU and CVICU settings, and a Pain, Agitation, and Delirium (PAD) tool. These tools are designed to support consistent, evidence-based bedside decision-making across 17 ICU sites in Alberta.

To support adoption, PLP co-designed an education and process improvement workbook grounded in the Alberta Improvement Way and PROSCI change management principles. This workbook has been used to deliver 7 pre-education sessions, reaching 150+ critical care team members across the province and supporting early engagement and readiness for change.

In parallel, PLP is supporting dashboard and metric refinement, including enhancements to the delirium dashboard, to enable meaningful audit and feedback and data-driven practice reflection. This work lays the foundation for future site-level and physician-level reporting. Early progress has been supported by strong provincial collaboration and alignment across stakeholders. Key learnings emphasize the importance of reinforcing evidence-based practices supported by standardized tools, meaningful dashboard metrics, and structured education to drive sustainable behavior change in complex ICU environments.

Key Performance Indicators and Early Indicators of Impact includes:

• 5 standardized clinical decision support tools developed (SAT, SBT, PAD for ICU and CVICU)

• 17 ICU sites engaged provincially

• 7+ education sessions delivered

• 150+ interdisciplinary participants reached (RNs, RRTs, physicians, and critical care team members)

• Education and process improvement workbook developed and implemented

• Provincial dashboard and metric refinement underway (including delirium dashboard updates)

Provincial implementation is planned for April 2026, supported by phased rollout, audit and feedback reporting in July, and continued clinician engagement.

This work is led by Dr. Wendy Sligl in collaboration with PLP, which is supporting project management, human-centred design and data analytics under the guidance of PLP Medical Director, Dr. Kelly Burak.

Through PLP supported co-design, data analysis, and audit‑and‑feedback support, standardized sedation and analgesia practices are being advanced across Alberta ICUs, strengthening system alignment and enabling safer, higher‑quality critical care.

Action Planning for Equitable Care Transitions - Phase 2

Building on the foundations of Phase I, this initiative contributes to a broader program dedicated to improving health outcomes for those facing social and economic insecurity. Initial findings from Phase 1 revealed that successful transitions are driven as much by social determinants—such as housing stability and community access—as they are by clinical factors.

Currently, the project is focused on validating these insights through deep engagement with healthcare providers and community partners. Led by PLP Medical Director Dr. Ginetta Salvalaggio, this collaborative process ensures that our findings reflect real-world practice. Early dissemination with teams at Radius Community Health and Healing and the Acute Care Addiction Recovery Program (RAH) has confirmed a strong alignment between our data and frontline experience. Moving forward, these partners are co-developing practical, equitable strategies to strengthen care coordination for underserved urban populations.

This work translates evidence into action by engaging frontline providers to co-develop practical, equity-focused solutions, helping improve care transitions and outcomes for underserved urban populations.

Current administrative health databases in Alberta do not reliably distinguish between Type 1 (T1D) and Type 2 diabetes (T2D), obscuring the unique clinical needs and resource requirements of the T1D population. With the prevalence and economic burden of T1D projected to rise sharply through 2040, developing a reliable, high-specificity case definition is a critical priority for health system planning.

Phase 1 of this project focused on validating the ability of Sharma’s¹ algorithm’s to accurately identify and distinguish T1D in adults using Alberta’s administrative and clinical datasets by evaluating performance metrics such as specificity, sensitivity, and predictive values. Phase 2 builds on this foundational work to significantly enhance diagnostic precision. 

In collaboration with Dr. Peter Senior, Dr. Padma Kaul, and PLP Medical Director Dr. Rose Yeung, the current work integrated complex laboratory and pharmaceutical variables to further refine Sharma’s¹ algorithm, as a result, T1D can successfully be differentiated within provincial administrative datasets.

This enhanced accuracy provides policymakers and clinicians with the granular insights essential for targeted healthcare delivery and strategic resource allocation. With data analysis now complete, findings were presented at the Family Medicine Summit in Calgary, Canada in March 2026, and the team is currently developing a manuscript to share these key findings with the broader medical and policy communities.

¹Sharma M. An algorithm for identification and classification of individuals with type 1 and type 2 diabetes mellitus in a large primary care database. Clin Epidemiol. 2016; 8: 373-80. https://doi.org/10.2147/CLEP.S113415

By enabling health systems to distinguish T1D from T2D in administrative health data, this work will help policy makers, clinicians, and the diabetes community better understand the needs and burdens of people with T1D, leading to improved healthcare planning and supporting more appropriate care for Albertans living with type 1 diabetes.

Supporting physician-led QI is essential for maintaining high standards of care and fostering professional growth. To help clinicians navigate evolving regulatory requirements, the PLP Edmonton, in collaboration with the L3, developed MyLifelongLearning Plan (MyL3Plan). This free, virtual platform guides users through a structured five-step improvement cycle, specifically designed to align with CPSA PPIP requirements while offering valuable CPD credits.

MyL3Plan simplifies the complexities of the QI process by leveraging objective practice data and facilitated feedback. Available province-wide, the platform serves as a practical engine for continuous cycles of improvement for both individual physicians and their clinical teams.

 Accreditation for MyL3Plan has been renewed for up to 12 Mainpro+® Certified Assessment Activity credits. Members of the Royal College (RCPSC) can also claim credits under MOC Section 2: Self-Learning (Personal Learning Projects) for 2 credits per hour.

As of March 31, 2026, a total of 273 physicians are actively using MyL3Plan to manage their cycles and activities, reflecting strong provincial engagement and a growing culture of data-driven practice improvement. Over the coming year, the PLP will continue focusing on targeted outreach and engagement to further scale adoption. By integrating MyL3Plan into PLP-hosted learning events and QI workshops, the program ensures that physicians have a seamless, end-to-end pathway to fulfill their standards of care and personal development goals.

To learn more visit the My Lifelong Learning Plan

MyL3Plan provides physicians with a practical, accessible way to engage in meaningful quality improvement while meeting regulatory requirements. By simplifying the process and integrating practice data, feedback, and CPD opportunities, the platform supports continuous practice improvement and helps physicians translate learning into measurable improvements in patient care.

The Emergency Medicine Practice Improvement Dashboard is a provincial data platform developed within Connect Care by the Clinical Departments of Emergency Medicine in the Calgary and Edmonton Zones, in collaboration with the formerly named AHS Data Analytics and the Emergency Medicine Strategic Clinical Network (SCN) groups. Building on prior PLP work, the dashboard integrates metrics for both adult and pediatric emergency care across Alberta, with the intent of supporting data‑driven QI at both the individual physician and system levels.

Early development and usability testing, conducted in 2023 by PLP through a working group of emergency physicians, confirmed that the dashboard was technically sound and clinically relevant. Physicians identified the platform’s potential to support individual QI projects by enabling real‑time reflection on practice patterns.

Lessons from this work reinforced that these platforms are most effective when paired with strong clinical leadership and active practice champions. While PLP successfully supported the technical foundation and usability of the dashboard, sustained practice change requires physician‑led ownership of improvement priorities which continues to guide future PLP collaborations.

PLP is involved in several ED QI projects which could potentially be monitored using the dashboard, including:

• Reducing low-value care in bronchiolitis management (provincial initiative)

• Reducing unnecessary casting for pediatric forearm buckle fractures

• Improving the care of febrile infants

• Management of pediatric UTIs in Calgary and Edmonton EDs

These projects will generate the data and use cases necessary to demonstrate the dashboard’s utility and inform future enhancements. The dashboard remains a key tool for enabling data-driven practice improvement in emergency medicine across Alberta.

The Emergency Medicine Practice Improvement Dashboard is laying the foundation for data-driven quality improvement in emergency departments across Alberta, with pediatric-specific measures now integrated and future projects poised to demonstrate its full potential.

A rapid review was completed to inform future evaluation, implementation, and potential scale‑up of prescribing improvement strategies. The review examined literature related to the use of antipsychotics and sedating medications among seniors residing in long‑term care (LTC) and designated supportive living (DSL) settings, the use of administrative and clinical data to identify health inequities, and whether variation in prescribing practices may be associated with inequities experienced by these populations.

Findings from the rapid review indicate substantial regional variation, both provincially and nationally, in the use of potentially inappropriate antipsychotics among seniors in LTC and DSL. While limited Canadian research directly examines inequitable prescribing of antipsychotics in these settings, the review identified several factors associated with variability in prescribing practices, including:

·        LTC facility size and type (e.g., level of care provided)

·        Rural versus urban location

·        Staffing composition

·        Nursing home culture

·        Language discordance between residents and care providers

Insights from the rapid review, alongside analysis of Connect Care LTC data and consultation with the newly formed Advisory Panel, will inform how health equity considerations are incorporated into audit and feedback reporting and future improvement strategies.

This project is investigating health equity in prescribing improvement strategies by identifying systemic disparities and tailoring A&F reports to support more equitable care for seniors across Alberta.

This Continuing Professional Development (CPD) initiative focuses on addressing the over‑prescribing of antibiotics by supporting physicians to apply evidence‑based guidelines, reflect on prescribing behaviours, and use data to inform continuous quality improvement. The course is grounded in Choosing Wisely Canada (CWC) recommendations and integrates education with facilitated audit and feedback to support meaningful practice change in primary care.

Initially developed as a CPD series offered in collaboration with CME&PD, PLP, and Choosing Wisely Alberta (CWA), this first-in-the-series course is designed for broader adoption across Alberta by aligning education, quality improvement, and regulatory requirements. Physician leadership for the initiative includes Drs. Kevin Schwartz, Lynora Saxinger, Janet Reynolds, and Monica Wickland‑Weller, with PLP Medical Director oversight from Drs. Kelly Burak, Katrina Nicholson, and Oliver David, who also comprise the steering committee. The work is further strengthened through collaboration with a patient partner, D’Arcy Duquette, and system collaborators including the College of Physicians & Surgeons of Alberta (CPSA) and Choosing Wisely Canada.

Delivered as an integrated CPD and practice improvement offering, the program combines asynchronous learning with facilitated audit and feedback using the CAFF model and existing MD Snapshot reports available through CPSA. This approach also enables physicians to meet CPSA PPIP requirements while earning CPD credits through the MyPI tool, supporting reflection, peer discussion, and individual quality improvement. Delivery includes asynchronous vodcasts, followed by in‑person or virtual group audit and feedback sessions, with opportunities for self‑reflection and application of learning in practice.

Over the last year, the project progressed from planning and design into late‑stage development and early implementation readiness. Key activities included the launch of a Scientific Steering Committee to guide content and methodology, completion of a needs assessment, definition of learning objectives, establishment of an evaluation framework, and alignment with accreditation requirements. Content development is now largely complete, with the majority of asynchronous vodcasts recorded and prepared for integration into the learning platform, where they will be hosted on the eCME website.

The official course will launch in conjunction with the Choosing Wisely Alberta Symposium on June 8, 2026, at the Foothills Campus of the University of Calgary, where a full facilitated audit and feedback session will be delivered as part of the symposium program. A soft launch of course materials will occur through CME&PD’s Rural Virtual Conference Series in April 2026.

A coordinated, evidence‑informed CPD and practice improvement approach is being advanced to support physician decision‑making and system alignment in antibiotic prescribing, strengthening the use of audit and feedback, reflection, and data‑driven improvement while enabling scalable implementation across primary care.

Adrenal Insufficiency (AI) is a rare but life-threatening hormonal disorder requiring lifelong steroid replacement therapy. Effective management is critical, particularly during periods of physiological stress—such as acute illness or surgery—where patients must precisely adjust their medication dosing to prevent an adrenal crisis. Despite this, many patients lack the specific education and tools required for safe self-management and emergency preparedness.

Led by PLP Medical Director, Dr. Rose Yeung, this knowledge transfer initiative will disseminate PLP’s AI toolkit which provides both clinicians and patients with a practical framework for AI management, including clear guidance on stress dosing and standardized emergency protocols.

The toolkit continues to gain traction, with emerging academic and practice-based engagement. A recent publication in the International Journal of Endocrinology outlines the initiative’s development and impact. The project was recently presented at the Family Medicine Summit on March 6, 2026, and it may also be presented at the upcoming Endocrine Summit in April. These efforts are complemented by growing use among frontline providers, supporting care delivery across the province.

Toolkit downloads to date:

• Adrenal Insufficiency Personal Treatment Plan: 153 downloads

• Adrenal Insufficiency Patient Resource: 152 downloads

• Adrenal Insufficiency Emergency Wallet Card: 49 downloads

By equipping clinicians and patients with practical tools to manage adrenal insufficiency—including guidance for stress dosing—this work supports safer care, helps prevent life-threatening adrenal crises, and improves patient self-management. 

PLP Calgary is a key partner in four critical care initiatives in collaboration with Acute Care Alberta’s (ACA) Critical Care Alberta Provincial Program (formerly the CC PIN) and physician researchers leveraging eCritical and Connect Care systems. The first two projects are funded through PRIHS grants, co-sponsored by Alberta Innovates and AHS. Together, they represent significant opportunities to enhance the quality and value of care in Alberta’s critical care settings.

PLP contributes expertise in A&F, including facilitated audit and group feedback, implementation science, data analytics, data visualization, and HCD to support these initiatives. The four projects include:

1. Don’t Misuse My Blood (DMMB) – focused on reducing avoidable blood transfusions and unnecessary blood tests in critical care and high-risk surgical units.

2. Dialyzing Wisely – optimizing the use of dialysis in critically ill patients.

3. Harmonization of sedation and analgesia practices in Alberta Critical Care (HSAPA) – aims to harmonize best practices for sedation and analgesia management across Alberta’s ICUs through evidence-based, multidisciplinary collaboration.

4. Critical Care KT and Physician Resource Bundle – a set of five visually consistent, digestible one-pager handouts, originally designed for resident education, that have evolved into multi-purpose onboarding tools for ICU teams, including nurses and lab technicians, through a human-centered design process.

Patients with cirrhosis require highly specialized, evidence-based management to prevent or treat life-threatening complications. Traditionally, clinical decision-support tools—such as best practice alerts—have seen inconsistent uptake when they fail to align with the realities of a busy clinical environment. Building on findings from the Cirrhosis: Evaluation of New Order Sets and Web Resources project, this initiative focused on developing an intuitive, integrated Cirrhosis Carepath within the provincial Connect Care system. Led by PLP Medical Director Dr. Puneeta Tandon, and leveraging success from existing carepath models for COPD and heart failure, PLP Edmonton’s Senior Human Centred Designer guided the human centred design approach to translate frontline clinician input into practical, workflow-aligned digital tools. The multidisciplinary team also included specialist physicians, clinical informaticists, Connect Care software developers. By prioritizing early and ongoing clinician input, the team ensured the digital tools were not only clinically rigorous but also practical for daily use.

Initially, PLP developed modular infographic elements, now used in two cirrhosis Our Practice Advisories (OPA, previously called best practice alerts), which flag important information and direct care providers to the cirrhosis summary dashboard. Since their launch in fall 2025, there have been approximately 330 interactions with the cirrhosis OPAs. Based on the success of that work, the project expanded to include the Connect Care Cirrhosis Summary dashboard and progressed through two strategic phases: a Collaborative Design Phase to gather frontline feedback and a Qualitative Evaluation Phase to refine the tools based on real-world effectiveness. While the underlying clinical data (e.g., laboratory results, medications, imaging) already existed within the EMR, this project introduced a fundamentally new workflow layer that aggregates fragmented information into a centralized clinical summary dashboard organized around clinically meaningful domains. Designed to support decision-making rather than simple data viewing, this functionally new interface represents a net-new clinical product experience within Connect Care. In parallel, integrated documentation templates were enhanced to auto-populate key laboratory values, model for end-stage liver disease (MELD) scores, medications, and complications, which reduced documentation burden while improving consistency and quality of data capture.

Following a successful soft launch with on-site observations and iterative workflow refinements, including longitudinal medication tracking and automated risk calculations, the Cirrhosis Carepath officially launched province-wide on January 15, 2026, making it available to all clinicians caring for inpatients with cirrhosis across Alberta. To support the new cirrhosis OPA and summary dashboard implementation, PLP developed a “New Inpatient Cirrhosis Care Support Tools tip sheet”, a provider education tool, to summarize the features and help support workflow integration. This comprehensive suite of tools enhances clinical efficiency and reduces information fragmentation within Connect Care by consolidating relevant clinical information and laboratory results, providing standardized order panels to streamline admission and discharge workflows, and offering a centralized clinical summary dashboard for real-time decision support.

With the Cirrhosis Summary dashboard and carepath now live, the project has transitioned into its analytics and scale phase. Current work includes development of an outpatient version and activation of the Chronic Liver Disease Registry, creating the high-quality data infrastructure needed for provincial quality evaluation and long-term improvements in patient outcomes.

By introducing a functionally new clinical workflow layer within Connect Care, the Cirrhosis Carepath centralizes fragmented data, reduces documentation burden, and embeds evidence-based decision support directly into clinician workflows. This enables safer, more timely clinical decisions while creating a scalable foundation for province-wide quality improvement in cirrhosis care.

Formerly: Healthy Active Recovery in Mental Health and Obesity: Network for Youth (HARMONY)

People with severe mental illness face up to a 20-year reduction in life expectancy, largely due to cardiovascular disease—of which obesity is a modifiable risk factor. Several medications used to manage psychiatric symptoms can cause significant weight gain and metabolic changes, increasing the risk of diabetes and cardiovascular disease. In psychiatric care, cardiometabolic monitoring (CMM) refers to the routine assessment of metabolic health to detect and manage these risks early. While psychiatrists are responsible for CMM and for initiating interventions to address obesity, many do not consistently meet recommended monitoring standards. As a result, children and young adults may miss critical opportunities for early intervention, increasing the likelihood of developing long-term comorbidities.

Psychiatrists are aware that metabolic health is a priority; however, they may require further knowledge and skills on CMM and implementation of early interventions. With a targeted intervention to upskill psychiatrists, this proactive approach to metabolic health can become a routine part of their practice.

Project milestones completed to date include collaborating with Dr. Araba Chintoh and PLP Co-Lead Dr. Thomas Raedler to submit an approved ethics from the Conjoint Health Research Ethics Board, approved data disclosure agreement with AHS, a scan of literature and current clinical guidelines, and a completed data management plan. Due to a longer than expected wait to access administrative health databases, we anticipate preparing individual data practice reports and engaging clinicians in a facilitated A&F session in early 2026.

Following the initial project with psychiatrists, PLP may explore opportunities to engage with primary care physicians, who also manage the care for some youth with mental illness and prescribe psychiatric medications.

IMPROVE empowers psychiatrists to proactively address cardiometabolic risks in youth by combining prescribing data, monitoring insights, and guideline-based education to support earlier, evidence-informed interventions.

Dr. Lara Cooke, former Associate Dean, CME&PD and PLP Co-Lead, and colleagues with the University of Calgary Department of Clinical Neurosciences (DCN) used a modified Delphi approach to develop and rank a set of over 50 quality indicators for inpatient Neurology care and identified one quality measure that could be accurately captured and reported at an individual physician level.

An interactive dashboard was created to capture the quality measure of how often prn (as needed) benzodiazepines are ordered for patients with a history of epilepsy or seizure disorder when they are admitted to inpatient neurology at four acute care sites in Calgary. In the Fall of 2024, facilitated sessions engaged neurologists to reflect on the data and identify opportunities for improvement of this quality measure.

Eight neurologists participated in two follow-up interactive sessions in the Fall of 2025. A review of the data demonstrated improvement of this quality measure with increased ordering of benzodiazepines for these patients on admission to inpatient neurology.

Dr. Lara Cooke is the lead author of the CAFF (Clinical Audit and Feedback Framework).

Laying the groundwork for data-informed quality improvement in inpatient neurology through the development of meaningful, clinician-driven performance metrics.

To enhance care for patients with cirrhosis, PLP Medical Director Dr. Puneeta Tandon and her PRHIS-sponsored team developed standardized Connect Care order sets and clinical algorithms as part of the AHS Acute Care Bundle Initiative. In this partnership, the PLP conducted a qualitative implementation evaluation across four clinical sites to identify the real-world factors that facilitate or hinder the use of these tools in daily practice.

The evaluation revealed that while clinicians initially faced a steep learning curve, they successfully integrated the order sets through collective adaptation and sensemaking. Key findings highlighted that social capital—specifically peer influence and local clinical champions—was more critical for driving engagement than top-down mandates. However, adoption varied by site due to differing organizational cultures, resource constraints, and the lingering impacts of COVID-19.

These insights underscore that successful provincial scaling requires a complexity-informed strategy that remains flexible and uses real-time feedback. Beyond refining cirrhosis care, this work provides a foundational framework for evaluating other complex health interventions. To date, the team has shared these findings through Grand Rounds, patient advisory sessions, with one peer-reviewed manuscript submitted and two others in development. Additionally, a poster on the contextual factors and mechanisms influencing the adoption of a cirrhosis order set in complex tertiary healthcare systems was presented at the 4th Swiss Implementation Science Conference, in Zurich, Switzerland in February 2026, and an oral presentation on investigators’ cognitive work in implementing a complex intervention in a dynamic health system was delivered virtually at the Pharmaceutical Care Network Europe, in Innsbruck, Austria in February 18, 2026.

This project aims to contribute to optimizing the implementation of evidence-based cirrhosis care order set and reduce hospital stays and readmission across Alberta acute care sites.