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ICES (formerly known as the Institute for Clinical Evaluative Sciences) is an independent, non-profit corporation that applies the study of
health informatics Health informatics is the field of science and engineering that aims at developing methods and technologies for the acquisition, processing, and study of patient data, which can come from different sources and modalities, such as electronic hea ...
for health services research and population-wide health outcomes research in
Ontario Ontario ( ; ) is one of the thirteen provinces and territories of Canada.Ontario is located in the geographic eastern half of Canada, but it has historically and politically been considered to be part of Central Canada. Located in Central Ca ...
, Canada, using data collected through the routine administration of Ontario's system of
publicly funded health care Publicly funded healthcare is a form of health care financing designed to meet the cost of all or most healthcare needs from a publicly managed fund. Usually this is under some form of democratic accountability, the right of access to which are se ...
.   ICES scientists have secure access to Ontario's health administrative data. ICES research teams produce
peer-reviewed scientific journal In academic publishing, a scientific journal is a periodical publication intended to further the progress of science, usually by reporting new research. Content Articles in scientific journals are mostly written by active scientists such as s ...
articles, as well as reports and atlases to assist health care providers, government planners and policy makers in improving population health through the advancement of
evidence-based practice Evidence-based practice (EBP) is the idea that occupational practices ought to be based on scientific evidence. While seemingly obviously desirable, the proposal has been controversial, with some arguing that results may not specialize to indiv ...
and
health policy Health policy can be defined as the "decisions, plans, and actions that are undertaken to achieve specific healthcare goals within a society".World Health Organization''Health Policy'' accessed 22 March 2011(Web archive)/ref> According to the ...
. ICES was established in 1992 and is governed by a Board of Directors. ICES receives core funding from the Ontario Ministry of Health and Long-Term Care (MOHLTC). In addition, ICES faculty and staff receive peer-reviewed grants from federal funding agencies such as the Canadian Institutes of Health Research, and project-specific funds from provincial and national organizations. ICES' central location is on the campus of
Sunnybrook Health Sciences Centre Sunnybrook Health Sciences Centre (SHSC), commonly known as Sunnybrook Hospital or simply Sunnybrook, is an academic health science centre An academic medical centre (AMC), variously also known as academic health science centre, academic healt ...
in Toronto, with satellite locations in
Kingston, Ontario Kingston is a city in Ontario, Canada. It is located on the north-eastern end of Lake Ontario, at the beginning of the St. Lawrence River and at the mouth of the Cataraqui River (south end of the Rideau Canal). The city is midway between Toro ...
,
London, Ontario London (pronounced ) is a city in southwestern Ontario, Canada, along the Quebec City–Windsor Corridor. The city had a population of 422,324 according to the 2021 Canadian census. London is at the confluence of the Thames River, approximate ...
, Hamilton, Ontario and Sudbury, Ontario.


Research programs

ICES research is distributed across eight health areas: # Cancer # Cardiovascular # Chronic Disease and Pharmacotherapy # Kidney, Dialysis and Transplantation # Life Stage # Mental Health and Addictions # Populations and Public Health # Primary Care and Health Systems


History

In the early 1990s, the
Government of Ontario The government of Ontario (french: Gouvernement de l'Ontario) is the body responsible for the administration of the Canadian province of Ontario. A constitutional monarchy, the Crown—represented in the province by the lieutenant governor†...
identified a growing need for evidence on
health system Health, according to the World Health Organization, is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World Health Organiza ...
performance in Ontario, in order to ensure the quality and efficiency of health services being provided. Dr. David Naylor and Dr. Jack Williams proposed to provincial health officials the creation of a new research institute that would securely analyse the administrative data routinely collected by the government through the
Ontario Health Insurance Plan The Ontario Health Insurance Plan ( French: ''Assurance-Santé de l'Ontario''), commonly known in both official languages by the acronym OHIP (pronounced ), is the government- run health insurance plan for the Canadian province of Ontario. OHI ...
(OHIP), in order to produce population-based evidence. ICES was launched in April 1992, with Naylor as the founding Chief Executive Officer.


Privacy and security

ICES is designated as a "prescribed entity" in Ontario under the
Personal Health Information Protection Act The ''Personal Health Information Protection Act'', (the Act) also known as PHIPA ('pee-hip-ah'), is Ontario legislation established in November 2004. PHIPA is one of two components of the Health Information Protection Act 2004. The ''Health Info ...
(PHIPA). Under Section 45 of PHIPA, this designation allows ICES to collect and use administrative data for the purposes of monitoring and evaluating the provincial health system. To be eligible to collect and use information under this authority, an organization must receive the approval of the Information and Privacy Commissioner of Ontario (the IPC), which must find that the organization is equipped to protect it. All ICES policies, practices and procedures for using data are reviewed and approved by the IPC every three years.


Methodology and data holdings

The ICES data repository consists of patient-level, coded and linkable health records. It includes publicly funded administrative health services records for the Ontario population eligible for universal health coverage since 1986, within Ontario's population of 14.7 million (as of 2019). Through partnerships, the data repository also securely links data from a variety of health surveys and registries. By linking the different data sets together using anonymous numeric
unique identifier A unique identifier (UID) is an identifier that is guaranteed to be unique among all identifiers used for those objects and for a specific purpose. The concept was formalized early in the development of computer science and information systems. ...
s, ICES scientists track different aspects of health service use and patient outcomes over time and across the province.


Examples of research impact

# A 1997 ICES study led by Dr. Donald Redelmeier and published in the New England Journal of Medicine on the links between mobile phone use and motor vehicle collisions helped lay the groundwork for legislation banning driver cell phone use in Ontario and many other jurisdictions. # A 2004 ICES study led by Dr. Muhammad Mamdani published in
The Lancet ''The Lancet'' is a weekly peer-reviewed general medical journal and one of the oldest of its kind. It is also the world's highest-impact academic journal. It was founded in England in 1823. The journal publishes original research articles, ...
found that of 45,000 Ontario seniors prescribed
rofecoxib Rofecoxib is a COX-2 inhibitor, COX-2 selective nonsteroidal anti-inflammatory drug (NSAID). It was marketed by Merck & Co. to treat osteoarthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, acute pain conditions, migraine, and dysmenor ...
, 80% had an increase in hospital admissions for heart failure, while patients using other NSAIDs had a 40% increase. Although the absolute risk for heart failure was less than 1%, this finding was significant, given that more than 1 in 5 Ontario seniors were taking these medications. Vioxx was withdrawn from the market later that year. # A 2006 ICES study led by Dr. Laura Park- Wyllie showed that
gatifloxacin Gatifloxacin (brand names Gatiflo, Tequin, and Zymar) is an antibiotic of the fourth-generation fluoroquinolone family, that like other members of that family, inhibits the bacterial enzymes DNA gyrase and topoisomerase IV. It was patented in 19 ...
, a commonly prescribed antibiotic marketed as Tequin, could cause potentially life-threatening blood sugar abnormalities. The investigation showed that patients treated for low blood sugar levels were more than four times as likely to have received gatifloxacin as other common antibiotics, while those hospitalized with high blood sugar levels were nearly 17 times as likely to have been treated with the medication.
Health Canada Health Canada (HC; french: Santé Canada, SC)Health Canada is the applied title under the Federal Identity Program; the legal title is Department of Health (). is the Structure of the Canadian federal government#Departments, with subsidiary unit ...
issued a warning shortly after the study appeared in the New England Journal of Medicine, and soon after, the drug's manufacturer announced it was halting production. # ICES research into the impact of mandatory reporting on reducing hospital-acquired
Clostridium difficile ''Clostridioides difficile'' (syn. ''Clostridium difficile'') is a bacterium that is well known for causing serious diarrheal infections, and may also cause colon cancer. Also known as ''C. difficile'', or ''C. diff'' (), is Gram-positive spec ...
infections led by Dr. Nick Daneman has influenced Ontario's MOHLTC policies on mandatory hospital reporting of quality improvement targets. # A 2013 ICES study led by
Thérèse Stukel Thérèse A. Stukel is a Canadian statistician who works as a senior core scientist at the Institute for Clinical Evaluative Sciences, as a professor in the Institute of Health Policy, Management and Evaluation of the University of Toronto, and as ...
identified nearly 80 informal multispecialty physician networks that formed the theoretical basis for the Ontario Community Health Links initiative currently underway for managing care for patients with complex conditions. The concept was cited as a model for using
big data Though used sometimes loosely partly because of a lack of formal definition, the interpretation that seems to best describe Big data is the one associated with large body of information that we could not comprehend when used only in smaller am ...
in the public interest in the 2015 Government of Canada "Report of the Advisory Panel on Healthcare Innovation" led by Dr. David Naylor. # Work led by ICES chief science officer Astrid Guttmann in 2015 showed that the number of children and youth being treated for
concussion A concussion, also known as a mild traumatic brain injury (mTBI), is a head injury that temporarily affects brain functioning. Symptoms may include loss of consciousness (LOC); memory loss; headaches; difficulty with thinking, concentration, ...
in Ontario had risen sharply during 2003–2011. Concern with these findings helped pave the way for the implementation of "Rowan's Law," requiring measures be taken to prevent and mitigate head injuries due to participation in youth sports. # The 2015 ICES research report "Brain Disorders in Ontario: Prevalence, Incidence and Costs from Health Administrative Data" produced in collaboration with the Ontario Brain Institute is being used in 2016 to plan Ontario's Dementia Strategy. # A 2015 ICES Western study led by Dr. Amit Garg and published in the New England Journal of Medicine showed the feasibility of a new technique to assess risk in living kidney donor candidates, which showed that some donors are unnecessarily excluded as donors for
kidney transplantation Kidney transplant or renal transplant is the organ transplant of a kidney into a patient with end-stage kidney disease (ESRD). Kidney transplant is typically classified as deceased-donor (formerly known as cadaveric) or living-donor transplantati ...
due to older age or comorbidities. The findings form a framework for the new international
clinical practice guidelines Clinical may refer to: Healthcare * Of or about a clinic, a healthcare facility * Of or about the practice of medicine Other uses * ''Clinical'' (film), a 2017 American horror thriller See also * * * Clinical chemistry, the analysis of bodily flu ...
in living kidney donation and a risk assessment tool that is being used with donor candidates in Ontario as part of the
informed consent Informed consent is a principle in medical ethics and medical law, that a patient must have sufficient information and understanding before making decisions about their medical care. Pertinent information may include risks and benefits of treatme ...
process. # Due to a rapid rise in the number of research studies conducted using routinely collected health data, ICES researchers were part of an international committee of researchers who published reporting guidelines called "RECORD" for all observational studies conducted using health data, which are applicable to research using health administrative data, electronic health records, registries, and other data sources. RECORD has been endorsed and implemented by over 15 journals since its publication in October 2015, including the PLoS group of journals, JAMA,
The BMJ ''The BMJ'' is a weekly peer-reviewed medical trade journal, published by the trade union the British Medical Association (BMA). ''The BMJ'' has editorial freedom from the BMA. It is one of the world's oldest general medical journals. Origi ...
, and CMAJ.


See also

* Canada Health Act * Canadian Institute for Health Information * Health care in Canada * Information and Privacy Commissioner of Ontario *
Ontario Health Insurance Plan The Ontario Health Insurance Plan ( French: ''Assurance-Santé de l'Ontario''), commonly known in both official languages by the acronym OHIP (pronounced ), is the government- run health insurance plan for the Canadian province of Ontario. OHI ...
*
Ontario Ministry of Health and Long-Term Care The Ministry of Health is the Government of Ontario ministry responsible for administering the health care system in the Canadian province of Ontario. The ministry is responsible to the Ontario Legislature through the minister of health, prese ...


References


External links


ICES official website

Information and Privacy Commissioner of Ontario

Ontario Ministry of Health and Long-Term Care

International Population Data Linkage Network
{{Authority control Medical and health organizations based in Ontario