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Merrick Zwarenstein

Senior Core Scientist (Full Status) ICES Western Primary Care & Health Systems Research Program


Merrick Zwarenstein is a health services researcher who trained at the Karolinska Institute in Sweden, the London School of Hygiene in the UK and Witwatersrand University Medical School in South Africa. He worked briefly as a family doctor in Cape Town, South Africa, and still wishes he had not given up clinical work. He has helped to bring together partners from over a dozen countries, half of them low or middle income, in a number of European Union funded programmes to promote the conduct and use of health systems research, especially pragmatic randomized trials in healthcare decision-making. As well as supporting the development of more than 20 research projects, many of which have been published, this group also produced a number of tools for health services researchers, including web-based training tools for randomized trials (www.practihc.org). This network is helping to establish a tradition and capacity in health services research in Africa and Latin America.

Dr. Zwarenstein was the principal investigator for a network of Canadian health services and policy researchers focusing on overcoming limitations in the use of randomized trials in support of policy decision-making. This group has developed a new guideline for the design of pragmatic randomized trials. This guideline, which forms part of the internationally recognized Consolidated Standards on Reporting of Randomized Trials (CONSORT) statement, has influenced the way standards are described and published. Dr. Zwarenstein also developed new uses for health administrative databases in Ontario for the large-scale implementation and rigorous evaluation of quality of care interventions. He is the principal investigator of three randomized trials of knowledge translation interventions covering all Ontario primary care physicians. These trials will establish greater certainty around the use of printed educational messages — a widely used approach to changing physician behaviour — thereby providing guidance to ministries of health on how to achieve physician behaviour change to improve quality of care. He has studied nurse-physician collaboration and routinized patient care in South Africa and Canada as a threat to the safety and quality of hospital care and efficiency of resource use. He has helped to quantify this problem and led systematic reviews of effects of interventions for collaboration. He recently co-authored a book on teamwork in the health professions. He led the establishment at his hospital of an evidence-based hospital quality improvement program. Innovative projects include randomized trials of hand-held, computer-based physician order entry for prescriptions; knowledge translation interventions to deploy evidence-based intensive care unit clinical guidelines; and time countdown interventions as a strategy for promoting rapid thrombolysis for stroke patients.

Dr. Zwarenstein has acted as a consultant to the World Health Organization and a number of bilateral development organizations on research for programme development and evaluation, a process which he hopes will lead to redesign of implementation and evaluation strategies for complex healthcare intervention rollout, and not only in low and middle income countries. He has worked on the development of new approaches to primary care provider support and education for HIV/AIDS and ART care, which in expanded form are now being implemented as national policy in South Africa.

  • MSc, Medicine, University of the Witwatersrand
  • MSc, Community Health, London School of Hygiene and Tropical Medicine
  • PhD, Epidemiology and Public Health, Karolinska Institute
  • Health services research
  • Comparative effectiveness research
  • Knowledge translation
  • Decision support tools/systems
  • Statistics and research methods
  • Professor and Director, Centre for Studies in Family Medicine, Department of Family Medicine, Western University, Canada
  • Health Systems Researcher, Faculty of Health Sciences, Stellenbosch University, South Africa
  • Researcher, Centre for Global Health, Karolinska Institute, Sweden
  • Researcher, Knowledge Translation Unit, Department of Medicine, University of Cape Town, South Africa

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