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PRIHS 2019/2020 - Stage 1

Personal Information

Legal Name of Applicant: Applicant Address: Applicant Phone Number: Applicant Representative Name: Phone: Email: Mailing Address:

Part 1 - Application Instructions:Alberta Innovates will only provide copies of the Application, including any attachments to the Applicant Representative. Accordingly, any change of the Applicant Representative should be to an individual who has the authority and permission to see the Application and any attachments.

All capitalized words or terms which are not defined within this Application have the respective meaning as set out in the Program Guide (the ‘Guide’) or Investment Agreement. In this Progress Report, the term “you” and “Applicant” are used interchangeably. You can view a copy of the Guide or the Investment Agreement.

It is essential that you have read, and that you understand, the Program Guide before completing this Application.

All Investment determinations made by Alberta Innovates (including declining an Investment) are final, non-appealable and binding. Notwithstanding the Applicant and the Project meeting the minimum requirements or eligibility criteria, or the results of any evaluation or recommendation or the involvement of an agent of Alberta Innovates, Alberta Innovates retains sole and absolute discretion regarding Investment determinations. Such determinations include whether to invest, the amount of the Investment (if any), and the terms and conditions of such Investment. Further, Alberta Innovates, in its sole and absolute discretion, has the right to decline any Application at any stage of the review process for any reason and does not owe a duty of reasonableness to the Applicant in making its Investment determination. By submitting this Application, the Applicant acknowledges that Alberta Innovates has no obligation to the Applicant during the course of receiving and reviewing the Application or in making its Investment determination.

Alberta Innovates will use its reasonable commercial efforts to inform the Applicant of the Investment determination made in respect of an Application in a timely fashion. Any failure to inform the Applicant of the Investment determination regarding an Application will not result in any obligation or liability of Alberta Innovates to the Applicant or any other interested party.

The Application may be reviewed by internal and external reviewers of Alberta Innovates. These experts will provide their recommendations to Alberta Innovates, and may also voluntarily provide constructive feedback meant for the Applicant. Alberta Innovates will make the final determination regarding approval of Applications and may at any time request an interview with the Applicant. Incomplete Applications will not be considered or reviewed.

Alberta Innovates may also, in its sole and absolute discretion, forward to the Applicant the constructive feedback, but will not provide any information regarding an expert’s personal information. Applicants are not entitled to access any information regarding the experts, including personal information, nor are they entitled to access or review the expert’s recommendation.

Alberta Innovates has the right, as determined in its sole and absolute discretion, to impose a life-time limit on the number of Applications an Applicant may submit.

If you require assistance in completing your Application, please contact.

Part 2 - Freedom of Information and Protection of Privacy Act (Alberta) (“FOIP”):Alberta Innovates is governed by FOIP. This means Alberta Innovates can be compelled to disclose the information received under this Application, or other information delivered to Alberta Innovates in relation to a Project, when an access request is

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made by anyone in the general public.

In the event an access request is received by Alberta Innovates, exceptions to disclosure within FOIP may apply. If an exceptionto disclosure applies, certain information may be withheld from disclosure. Applicants are encouraged to familiarize themselveswith FOIP. Information regarding FOIP can be found at http://www.servicealberta.ca/foip/. Should you have any questions aboutthe collection of this information, you may contact the .

Part 3 - Publication of Non-Confidential and Aggregate Information by Alberta Innovates:Alberta Innovates may (1) publish and/or disseminate in the public domain certain information contained within this Applicationas a way to promote success stories about innovation in the Province of Alberta and/or (2) use certain information containedwithin this Application as a way to verify information contained in this Application. On these bases, Alberta Innovates hasindicated which information provided in the Application has been deemed to be confidential and all other information is subject todisclosure by Alberta Innovates in its sole discretion at any time:

In addition, Alberta Innovates may aggregate information within this Application for the purposes of reporting or dissemination inthe public domain. For clarity, ‘aggregate’ means removal of personal identifiers such as names, locations and addresses of theApplicant and employees, and combining such information with that of other Applicants.

Disclaimer:

Project Overview

Project Title (non-confidential)

For sample purposes only. This application is subject to change.

Applicant

Indicate which Alberta institution/organization (the Applicant) will be administering the grant

Please confirm internal Institutional processes and deadlines for grant submissions.

Other

Other:

Address:

Phone Number:

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Non-Confidential Abstract (lay summary)

Provide a summary of the proposed activities in non-scientific, everyday language that would be accessible to a generalaudience and clearly communicates the significance and relevance of the proposed research activities. Use analogies,simplifications, and generalizations rather than scientific and technical terms.Please Note: This section may be provided to a diverse set of stakeholders, including the public.


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Non-Confidential Scientific Abstract (for research projects only)

Please provide a scientific abstract of the proposal. Clearly state the topic and research question or hypothesis of your proposal.The key methods and expected results of your proposal should also be included.Please Note: This section may be provided to a diverse set of stakeholders, including the public.


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Problem

Specification of the problem

Identify a gap observed within existing health system (services, infrastructure, policy, etc.). This must include some quantitativemeasure(s) of the size of the gap in Alberta.Why is this problem a priority now (e.g., describe the clinical/human resource/infrastructure, the significance to Albertans, and/orthe cost implications of maintaining the status quo)?


Specification of the solution

Provide a brief description of the proposed solution(s) and how it will close the gap.Has this solution worked elsewhere? What evidence is there suggest that it will work in Alberta?What is the strength of evidence that suggest the proposed solution will provide an advantage over the status quo and/orpossible alternatives? (This argument should be based on the nature and strength of the current-state evidence base, and ideallyinformed by synthesis-level evidence )


Relevance

Articulate how the proposed solution meets the PRIHS objectives (e.g., improve the sustainability of Alberta’s health system,such as by reducing costs and/or improving quality relative to costs).


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Feasibility

Patient and Stakeholder Engagement

Using the chart below, describe how each operational area or stakeholder (ie. leadership, patients, policy other stakeholders)has been engaged and where each area is on the spectrum of participation (i. informed; ii. Consulted; iii. Involved; iv.Collaborated; v. Empowered).

Operational Area Level of Participation Engagement to date Phases of Engagement

For sample purposesonly. This application issubject to change.

For sample purposes only. Thisapplication is subject to change.(Please see Appendix A for categorydefinitions)

Engagement to date

For sample purposesonly. This application issubject to change.(Please see Guide forcategory definitions)

For sample purposesonly. This application issubject to change. Morerows can be added asneeded

Please see Appendix A for categorydefinitions. More rows can be addedas needed.

Engagement to date

Please see Guide forcategory definitions.More rows can be addedas needed

Strength of the Team

How have key stakeholders been engaged to date?If this is a PAN SCN approach outline how the approach to testing the solution will be integrated across the various SCN'sinvolved.


Team Leadership Role Last Name First Name Primary Organization Organizational Position

Operational Leadership

Collaborators

Last Name First Name Primary Organization Organizational Position Describe their role relative to the proposed solution

Last Name First Name Primary Organization Organizational Position Describe their role relative to the proposed solution

Implementation Study

How will the solution be put into practice?Have those who will be involved in/affected by the implementation been consulted and confirmed acceptability (e.g., operationalareas, practitioners)?

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If the solution was previously implemented somewhere else, identify any barriers and facilitators that were found during theimplementation of the solution.


For projects with an IT component: is third party software required for your project? If yes, what specific requirements areneeded?What IT resources will be required to implement?What IT hard components are required?What IT integration resources are required?Has IT been engaged to speak to need for/ability to integrate with Connect Care (if appropriate)?


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Impact

Expected Impacts

a) Describe your target population for the solution in terms of characteristics and size (e.g., This solution targets new dialysispatients in Alberta. There are approximately 1000 new dialysis patients in Alberta each year).


b) What sample do you intend to test your solution on? (e.g., Year 1: 50 patients/participants, Year 2: 75, Year 3: 100).


c) What is the total reach you anticipate if this proposed solution were spread to full deployment? (e.g., 800-1000patients/participants per year)?


d) What is the primary impact you expect the solution to have on a typical patient/participant (in terms of experience, outcomes,or service utilization)?


e) How will you measure/quantify this impact? Identify the most appropriate indicator(s).


f) Where will you obtain the necessary data for measuring impact? (Identify any existing data sources/systems you requireaccess to).


Instructions: this section of the application will be strengthened in collaboration with SCNs. For Stage 1, applicants are asked tostart to quantify the target population, test sample, types of impact expected, and strategies for measuring impact in a way thatwill facilitate comparison with the status quo. For Stage 2, applicants will have the opportunity to consult with operational,economic, and implementation science experts within AHS to build out this section in tabular form.

PART 1: No. of people who will be exposed to your proposed intervention

Population impacted by theproposed intervention Clinical / Operational Data Source Prior to

theDuringYear 3

DuringYear 8

Example: This solution targets new Example: Total Dialysis intakes(excluding Home Hemodialysis

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PART 2: Hypothesized Improvement (Per-Patient)

PART 3: Estimated Clinical/Operational Impact

dialysis patients in Alberta. There areapproximately 1000 new dialysispatients in Alberta each year.

intakes) - Source: Alberta KidneyCare (AKC) operational data (AKC-South; AKC-North)

(A) 850 950 1100

EstimatedMaximum ReachPossible (B)

850 950 1100

EstimatedPercentage ofMaximum Reach(C= A/B)

1 1 1

Pre-Defined Impact Metrics Clinical / Operational Data Source DuringYear 0

DuringYear 3

DuringYear 8

Example: Proportion of new dialysisintakes (excluding HomeHemodialysis (HHD) patients) thatstart on less-costly PeritonealDialysis (PD) (rather than more-costlyFacility-Based Hemodialysis)

Example: Number of PeritonealDialysis (PD) Intakes and Number ofFacility-Based Hemodialysis (FBHD)Intakes - Source: Alberta KidneyCare (AKC) operational data (AKC-South; AKC-North)

Counterfactual - i.e.expectedperformancewithout intervention(D)

22% 22% 22%

Hypothesis / Plan -i.e. expectedperformance withintervention (E)

22% 27% 32%

Expected Improvement Clinical / Operational Data Source DuringYear 0

DuringYear 3

DuringYear 8

Example: Estimated Number of NewDialysis Patients Starting Dialysis ona less-costly modality (i.e. PeritonealDialysis (PD) as opposed to Facility-Based Hemodialysis (FBHD))

Example: Alberta Kidney Care (AKC)operational data (AKC-South; AKC-North)

F = (A) x AbsoluteValue(E - D) 0 48 108

Budget

What health services are currently being utilized as a result of the problem identified? How would they change as a result of thesolution (clinical effectiveness)?If the proposed project is associated with a larger program of research, what activities will be supported by the PRIHS grant andwhat activities will be supported by other funding?


Estimated Project Expenses Budget Line Project Year 1 Project Year 2 Project Year 3 TotalLabor/personnel (including fringe benefits) $0 $0 $0 $0

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Trainees $0 $0 $0 $0Minor medical equipment/devices (<$5000) $0 $0 $0 $0Administrative and Procedural expenses $0 $0 $0 $0Travel $0 $0 $0 $0Communication and Knowledge Transfer $0 $0 $0 $0Other $0 $0 $0 $0Total $0 $0 $0 $0

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Scientific Merit

Clinical Intervention

Describe the proposed methodology and measurement plan.How will local (Alberta) data/metrics support measurement and monitoring of the need/gap?


Implementation

Describe how you think change will happen.What is the plan for understanding knowledge about barriers, facilitators to and the contextual influences on implementation?What specific implementation outcomes will be measured?


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References

List of References

List the references (if any) related to this project.


As ONE PDF FILE, please attach any relevant figures/images or Letters of Support you wish to provide. Maximum 3 pages

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GUIDE: Key Stakeholder Collaborative Spectrum for AHS Solutions - Modified IAP2 Framework

Inform Consult Involve Collaborate Empower

Goal of patient, staff and/or key stakeholder participation

To provide balanced and objective information in a timely manner

To obtain feedback on analysis, issues, alternatives and discussions

To work with patients, staff and key stakeholders to make sure that concerns and aspirations are considered and understood

To partner with patients, staff, and other key stakeholders in each aspect of the decision making process

To place final decision-making in the hands of patients, staff, and/or key stakeholders

Promise to patients, staff and/or stakeholders

“we will keep you informed”

“we will listen to and acknowledge your concerns, and consider them in our process”

“we will work with you to ensure your concerns and aspirations are directly reflected in the decisions made”

“we will look to you for advice and innovation, and incorporate this into decisions as much as possible”

“we will implement what you decide”

Visual Representation of Interactions*

These levels of interaction can and are employed with different groups, during different stages of implementation, however, the default approach overarching the process should consider the collaborate-empower stages, unless there are important reasons why that should not be the default approach (e.g., stakeholders have asked

Participatory collaboration, linkage and exchange, integrated KT, among other approaches

Participatory collaboration, linkage and exchange, integrated KT, among other approaches

*http://axiomnews.com/sites/default/files/IAP2%20Spectrum%20of%20Public%20Participation%20712.jpg

Appendix A: The IAP2 spectrum is a tool frequently used within AHS to understand and describe patient engagement. Its use is encouraged.

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http://axiomnews.com/sites/default/files/IAP2%20Spectrum%20of%20Public%20Participation%20712.jpg

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