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Our Research » Management of Chronic Diseases » Interdisciplinary Capacity Enhancement Team (ICE)

Interdisciplinary Capacity Enhancement Team (ICE)

ICE Team
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The Interdisciplinary Capacity Enhancement (ICE) team is an interdisciplinary, international, health-services research alliance fosters a common interest in improving quality of care in long-term care (LTC) homes.

Our team includes researchers from various disciplines and expertise, including geriatrics, internal medicine, health services research, biostatistics, epidemiology, nursing, and nutrition. We will systematically develop valid measures of quality of care, identify groups of individuals who may be at risk of receiving poor care and will use the best available information to measure and understand disparities in quality of care. We will investigate ways to reduce disparities in LTC homes and improve quality through interventions designed to change practice and produce better information for the public.

The project will increase capacity through training, mentoring and team building. In short, we will work with the public, providers and government to translate new knowledge into better outcomes for residents living in LTC homes.

New and Notable

September 27, 2010:
Virtual Ward Mini-Symposium

A mini-symposium to discuss the Virtual Ward at Women's College Hospital, a program which focuses on the care of vulnerable patients after discharge from hospital, with the goal of preventing patients' readmission to hospital. The mini-symposium featured talks by Dr. Irfan Dhalla, Dr. Geraint Lewis, Karen Born (PhD Candidate), visiting professor Dr. Vince Mor, and ICE Team Scientist Dr. Geoffrey Anderson. This group led a discussion on the challenges facing the most vulnerable segment of our population, and strategies to mitigate the cycle of rehospitalization. Stakeholders from numerous local and provincial organizations were in attendance.

Patients with a high-risk of readmission to hospital within 30 days are referred to the Virtual Ward, where their post-discharge care can be closely monitored by a team of health care providers, easing their transition out of hospital and back to their homes.

The Virtual Ward team reconciles the patients' medications, provides active case management, and with collaborates with a variety of care providers, including the individuals' family doctor, with a focus on keeping the patient out of hospital, and developing a post-Virtual Ward care plan. Despite the fact that operations of the Virtual Ward have been underway for less than 6 months, they have already had numerous patient success stories, and recently admitted their 100th patient into the ongoing RCT.

September 21, 2010:
Dr. Susan Mitchell and the Burden of Dementia

Dr. Susan Mitchell, MD MPH (Harvard Medical School), joined the ICE Team to discuss issues related to transitions of care as they relate to older, vulnerable populations. Discussion focused on patients with advanced dementia, their care needs, and the high cost such individuals incur, both financially and socially. Other members of the ICE Team (Dr. Chaim Bell, Dr. Andrea Gruneir, Dr. Dallas Seitz, Munaza Chaudhry) and visiting professor Dr. Vince Mor extended the discussion by describing their work in their related areas, and how to better describe the use of services and disease severity in this population, along with the use of strategies, such as advanced directives, to help define desired care outcomes.

September 21, 2009:

Dr. Dallas Seitz Awarded The Future Leader Award

This week the Canadian Conference on Dementia (CCD) and Canadian Academy of Geriatric Psychiatry (CAGP) have chosen Dr. Dallas Seitz as this year’s recipient of The Future Leader Award sponsored by Pfizer.

This award is given to residents or fellows from geriatric medicine, geriatric psychiatry or neurology who demonstrates excellence in the field of dementia. Also as leaders in the field of dementia, Pfizer is pleased to partner with the CCD to support our future leaders who will provide the care of tomorrow to Canada’s seniors.

September 9, 2009:

Dr. Andrea Gruneir appointed as a scientist at the Women’s College Research Institute

Dr. Andrea Gruneir has been appointed as a scientist at the Women’s College Research Institute. Dr. Gruneir was recently awarded a five-year Career Scientist Award from the Ontario Ministry of Health and Long-Term Care. Through the career scientist awards program, the Ministry supports the best and brightest early researchers in the province to conduct independent research in health services research. Dr. Gruneir’s program of research was scored highly in the review process by both the scientific panel and the relevance panel.

Dr. Gruneir will use large population-based administrative databases to explore the health and support needs of the vulnerable older adults, primarily women, who reside in Ontario’s long-term care facilities. Andrea is currently leading a study examining the circumstances under which such at-risk individuals are sent to emergency rooms. She hopes to better understand how improvements in care might reduce such visits and the associated costs to both the patient and our health care system.

July 27, 2009:

Antipsychotic Drugs and Hyperglycemia in Older Patients With Diabetes

This week in The Archives of Internal Medicine, Lorraine Lipscombe and a team of Investigators published an article titled "Antipsychotic Drugs and Hyperglycemia in Older Patients With Diabetes".

The authors found that among older patients with diabetes, the initiation of treatment with antipsychotic drugs was associated with a significantly increased risk of hospitalization for hyperglycemia. The risk was particularly high during the initial course of treatment and was increased with the use of all antipsychotic agents.

International media coverage of these findings included the The Globe and Mail, CBC and Canadian Press.

May 20, 2009:

Association Between Tamsulosin and Serious Ophthalmic Adverse Events in Older Men Following Cataract Surgery

This week in JAMA, Chaim Bell and a team of Investigators published an article titled "Association Between Tamsulosin and Serious Ophthalmic Adverse Events in Older Men Following Cataract Surgery".

The authors found that exposure to tamsulosin within 14 days of cataract surgery was significantly associated with serious postoperative ophthalmic adverse events. There were no significant associations with exposure to other a-blocker medications used to treat BPH.

International media coverage of these findings included the New York Times, Reuters and U.S. News & World Report.

August 28, 2008:

Effect of regulatory warnings on antipsychotic prescription rates among elderly patients with dementia

This week in the Canadian Medical Association Journal, Team members Elmira Valiyeva, Paula Rochon, Sudeep Gill and Geoffrey Anderson published an article titled "Effect of regulatory warnings on antipsychotic prescription rates among elderly patients with dementia: a population-based time-series analysis".

The authors found that despite Health Canada warnings regarding serious adverse events related to the use of atypical antipsychotic drugs, overall prescription rates of these drugs did not change. More effective interventions are necessary to improve post-market drug safety in vulnerable populations.

International media coverage of these findings included the Globe and Mail and Dagens Nyheter (Swedish language).

May 26, 2008:

Antipsychotic Drug Use and Mortality Among Older Adults With Dementia

This week in The Archives of Internal Medicine, Paula Rochon and a team of Investigators published an article titled "Antipsychotic Therapy and Short-term Serious Events in Older Adults With Dementia".

The authors found that serious adverse events, as indicated by a hospital admission or death, are frequent following the short-term use of antipsychotic drugs in older adults with dementia. This reinforces the need for health professionals to prescribe antipsychotic drugs with caution even when short-term therapy is being prescribed.

International media coverage of these findings included the Washington Post, Reuters and the National Post.

New ICE Team - Book Chapters

Drs. Andrea Gruneir and Vincent Mor have co-authored a chapter titled “Nursing Home Safety: Current Issues and Barriers to Improvement”, published in the textbook Annual Reviews of Public Health 2008.

Abstract: The past few decades have seen increasing concern about the quality of nursing home (NH) care. As with other health care sectors, NHs have attempted to embrace a culture of safety, but the additional barriers that they face place the NH industry at a distinct disadvantage. In this review, we provide a summary of current models of NH quality and an overview of two important clinical areas for quality improvement: pressure ulcers and falls. Despite heavy regulation of the NH industry, hoped-for improvements in quality have been limited. We argue that systemic barriers, such as staffing shortages, NH organization, and an adversarial regulatory environment, preclude advances in NH quality.

October 24, 2007:

Oral Drug Therapy for Multiple Neglected Tropical Diseases

This week in JAMA, Madhuri Reddy and her ICE Team colleagues published an article titled "Oral Drug Therapy for Multiple Neglected Tropical Diseases: A Systematic Review".

This article systematically examined drug trials which sought to treat highly prevalent diseases, which mainly effect populations in developing countries. The authors found that at least 2 of the most prevalent neglected tropical diseases can be treated simultaneously with existing oral drug treatments, facilitating effective and efficient treatment. Increasing awareness about neglected tropical diseases, their global impact, and the availability of oral drug treatments is an essential step in controlling these diseases.

Media coverage of these findings included Harvard's Focus.

April 9, 2007:

Variation in Nursing Home Antipsychotic Prescribing Rates

This week in Archives of Internal Medicine, Paula Rochon and a team of investigators published an article titled "Variation in Nursing Home Antipsychotic Prescribing Rates" .

The authors found that residents in facilities with high antipsychotic prescribing rates were about 3 times more likely than those in facilities with low prescribing rates to be dispensed an antipsychotic agent, irrespective of their clinical indication.

Media coverage of these findings included CBC.

August 23, 2006:

Preventing Pressure Ulcers: A Systematic Review

This week in JAMA, Madhuri Reddy, Paula Rochon and Sudeep Gill published an article titled "Preventing Pressure Ulcers: A Systematic Review".

The authors examined and evaluated appropriate strategies to prevent pressure ulcers, including using support surfaces, repositioning the patient, optimizing nutritional status, and moisturizing sacral skin. Despite a large number of trials which have evaluated preventive strategies for pressure ulcers, many of them had important methodological limitations. The authors conclude that there is a need for future research which addresses these limitations, including reporting nonpharmacological interventions providing data on cost-effectiveness for these interventions.

Media coverage of these findings included CTV.

For general information about the ICE Team contact:
Peter Anderson, Research Facilitator
phone: 416-351-3732 x2129
fax: 416-351-3746

CIHR This research is sponsored by: