Developing a rapid evidence response toCOVID‐19: The collaborative approach of Saskatchewan, Canada

Abstract

Introduction The COVID‐19 Evidence Support Team (CEST) was a provincial initiative that combined the support of policymakers, researchers, and clinical practitioners to initiate a new learning health cycle (LHS) in response to the pandemic. The primary aim of CEST was to produce and sustain the best available COVID‐19 evidence to facilitate decision‐making in Saskatchewan, Canada. To achieve this objective, four provincial organizations partnered to establish a single, data‐driven system. Methods The CEST partnership was driven by COVID‐19 questions from Emergency Operational Committee (EOC) of the Saskatchewan Health Authority. CEST included three processes: (a) clarifying the nature and priority of COVID‐19 policy and clinical questions; (b) providing Rapid Reviews (RRR) and Evidence Search Reports (ESR); and (c) seeking the requestors' evaluation of the product. A web‐based repository, including a dashboard and database, was designed to house ESRs and RRRs and offered a common platform for clinicians, academics, leaders, and policymakers to find COVID‐19 evidence. Results In CEST's first year, 114 clinical and policy questions have been posed resulting in 135 ESRs and 108 RRRs. While most questions (41.3%) originated with the EOC, several other teams were assembled to address a myriad of questions related to areas such as long‐term care, public health and prevention, infectious diseases, personal protective equipment, vulnerable populations, and Indigenous health. Initial challenges were mobilization of diverse partners and teams, remote work, lack of public access, and quality of emerging COVID‐19 literature. Current challenges indicate the need for institutional commitment for CEST sustainability. Despite these challenges, the CEST provided the Saskatchewan LHS with a template for successful collaboration. Conclusions The urgency of COVID‐19 pandemic and the implementation of the CEST served to catalyze collaboration between different levels of a Saskatchewan LHS.

Evaluating a learning health system initiative: Lessons learned during COVID‐19 in Saskatchewan, Canada

“… 6 , 17 Initiatives like CEST require institutional commitment, funding, and further integration within the healthcare structure. 19 This formative evaluation assessed user feedback on the challenges and benefits of CEST to improve the design of an LHS with the intent to enhance future healthcare outcomes.…”

“… 19 By coordinating weekly with the EOC chair, CEST's objectives were to (1) establish a rapid review process to support decision‐making, (2) create an online repository for knowledge sharing, and (3) initiate a learning health system in the province. 19 Clinical experts assessed the quality and confidence of the literature, and in the case of uncertainty about a topic, CEST conducted iterative “evergreen” reviews. Three distinct CEST processes evaluated the evidence and created outputs: (1) team question prioritization, (2) question refinement with the assistance of clinical experts, library staff, and master's or PhD‐level researchers to identify a search strategy, and (3) literature synthesis for clinical experts.…”

“…Of 108 COVID rapid reviews produced between March 2020 and March 2021, the typical turnaround time for the team was 21 days, with 20 completed in less than 1 day and 44 within 2 to 10 days. 19 Reviews were sent to local MHOs and condensed findings were sent to key decision‐makers. Reviews included EOC priority questions such as: “what is the evidence for the effectiveness of universal mask use by the public?” and “what public health interventions are effective in reducing the burden of COVID‐19 disease in comparable jurisdictions to Saskatchewan?” By April 27, 2022, the COVID‐19 online repository ( https://saskhealthauthority.libguides.com/covid-19/repository/home ) had completed a total of 171 reviews for 11 different research teams and produced 430 documents and tables, and updated 16 “evergreen” reviews since the Spring of 2020.…”

“…20 Additional background on the development of the initiative and its relationship to an LHS is described in a previous publication. 19 …”

“…Both researchers reflected on the conceptualization of codes and made revisions iteratively to develop a codebook. A program logic model (PLM) was developed to illustrate CEST's composition and its deliverables, 19 and the program's outputs and outcomes described by KIs (Figure 1 ). The PLM illustrates how CEST's outputs were influenced by the activities (ie, rapid reviews) and the outcomes were associated with the outputs of the program.…”