The outcome of IHE initiatives is providing better information for developing health policy and best medical practices. IHE disseminates information in many ways. In addition to publications in peer-reviewed journals, IHE produces books and a variety of reports synthesizing information in a particular field.
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Since 2000, 5 studies have been published that each purported to estimate aggregate national mental health costs in Canada. Each of these studies used a different method. Our aim was to compare the studies, and we created a framework for the different elements used to assess mental health costs (direct costs, indirect costs, transfer payments, and “human” costs). In…
This report provides a summary of the IHE/CAPT Precision Health workshop that took place on October 22, 2017 in Toronto, Ontario. The intent of the workshop was to identify gaps and opportunities in implementing precision health technologies into the Canadian health system. The workshop was supported by unrestricted grants from Merck Canada and Hoffmann-La Roche Limited.The views…
2017 The Institute of Health Economics, in partnership with numerous other organizations, regularly hosts small invitational policy dialogues with visiting speakers and Alberta stakeholders to engage in policy dialogues on important topics relevant to Alberta health system priorities. Most of these events are conducted under Chatham House rules and deliberations are confidential,…
The Institute of Health Economics, in partnership with numerous other organizations, regularly hosts health policy series and single events to discuss current topics in health policy with a broad audience. One of the ongoing speaker series is the Alberta Innovates – IHE Health Policy Speaker Series, which showcases visiting thought-leaders in health. In development are a number…
Presenteeism (reduced productivity at work) is thought to be responsible for large economic costs. Nevertheless, much of the research supporting this is based on self-report questionnaires that have not been adequately evaluated.
Summary Report
Addressing gaps and challenges with the integration of precision health technologies into the Canadian health system – Summary report of an IHE/CAPT Precision Health Workshop Download Summary Report
Program
IHE/CAPT Precision Health Workshop – Final ProgramDownload Final Program
| Dat Tran, Ilke Akpinar, Richard Fedorak, Egon Jonsson, John Mackey, Lawrence Richer, Philip Jacobs
Purpose: In pharmaceutical clinical trials, industrial sponsors pay for study drugs and related healthcare services. We conducted a study to determine industry’s economic contribution of these trials to the Alberta healthcare system. Authors and Affiliations: Dat T. Tran1,2; Ilke Akpinar2 ; Richard N. Fedorak3 ; Egon Jonsson2 ; John R. Mackey4 ; Lawrence Richer5 ; Philip…
Summary Report Diabetes care and management in Indigenous populations in Canada – Summary report of a pan-Canadian policy roundtableDownload Summary Report Program Diabetes Care and Management in Indigenous Populations in Canada: A pan-Canadian Roundtable – Final ProgramDownload Final Program Background Document Diabetes Care and Management in Indigenous Populations…
Keynote Speaker Chief Dr. Robert Joseph O.B.C.Chief, Gwawaenuk First Nation; Ambassador, Reconciliation Canada Chief Dr. Robert Joseph, O.B.C., is a true peace-builder whose life and work are examples of his personal commitment. A Hereditary Chief of the Gwawa'enuxw First Nation, Chief Joseph has dedicated his life to bridging the differences brought about by intolerance, lack…
1 November 2017 Edmonton, Alberta On November 1st, 2017, the Institute of Health Economics (IHE) hosted a pan-Canadian roundtable discussion regarding diabetes care and management in indigenous populations in Canada. Participation included 49 delegates representing 34 unique organizations from Yukon, BC, Alberta, Manitoba, Ontario, and Quebec, as well as several national/Federal…
On November 1st, 2017, the Institute of Health Economics (IHE) hosted a pan-Canadian roundtable discussion regarding diabetes care and management in indigenous populations in Canada. This event was sponsored through an educational grant from Boehringer Ingelheim Canada, and was developed in consultation with an advisory committee including: Mr. Mehmood Alibhai (Boehringer Ingelheim…
On November 1st, 2017, the Institute of Health Economics (IHE) hosted a pan-Canadian roundtable discussion regarding diabetes care and management in indigenous populations in Canada. This event was sponsored through an educational grant from Boehringer Ingelheim Canada, and was developed in consultation with an advisory committee including: Mr. Mehmood Alibhai (Boehringer Ingelheim…
PDF of a PowerPoint presentation by John Sproule, Senior Policy Director, Institute of Health Economics.
Diabetes Care and Management in Indigenous Populations in Canada: A Pan-Canadian Roundtable
PDF of a PowerPoint presentation by Addie Pryce, Director of Health, Assembly of First Nations.
Diabetes Care and Management in Indigenous Populations in Canada: A Pan-Canadian Roundtable
PDF of a PowerPoint presentation by Hesham Nabih, President, HN Consultants Ltd.
Diabetes Care and Management in Indigenous Populations in Canada: A Pan-Canadian Roundtable
PDF of a PowerPoint presentation by Amelia Tekwatonti McGregor, Elder and Community Advisory Board Member, Kahnawake Schools Diabetes Prevention Project.
Diabetes Care and Management in Indigenous Populations in Canada: A Pan-Canadian Roundtable
PDF of a PowerPoint presentation by Dr. Dean Eurich, Professor, School of Public Health, University of Alberta, and Kari Meneen, Team Lead, RADAR; Diabetes Care Coordinator, OKAKI Health Intelligence Inc.
Diabetes Care and Management in Indigenous Populations in Canada: A Pan-Canadian Roundtable
PDF of a PowerPoint presentation by Ms. Jenney Samuelson, Vermont Blueprint for Health Expansion and Quality Improvement Program (EQuIP).
Health Policy Dialogues
Sunday, 22 October 2017 Toronto, Ontario 13:00 – 13:15 Introduction and Welcome – IHE Dan Palfrey, Senior Consultant, Institute of Health Economics 13:15 – 14:00 The Potential Contribution of Precision Health to Patient Care and the Canadian Experience Thus Far Katherine Bonter, Director Of Intellectual Property, Clementia Pharmaceuticals Inc.Download Presentation…
Speaker and Panelist Biographies Louise BinderHealth Policy Consultant, Save Your Skin Foundation Louise is a lawyer and health advocate who has been involved in informing the development of health policy and systemic treatment access practices from a patient perspective for more than 20 years. She started her work in this area in the HIV community in the early 1990s after her…
22 October 2017 Toronto, Ontario On October 22, 2017, in conjunction with the 2017 Annual CAPT Conference, the Institute of Health Economics (IHE) and the Canadian Association for Population Therapeutics (CAPT) co-hosted the IHE/CAPT Precision Health Workshop. Precision Health (PH) has potential to provide a wide range of solutions such as enhanced R&D efficiency, earlier diagnosis…
On October 22, 2017, in conjunction with the 2017 Annual CAPT Conference, the Institute of Health Economics (IHE) and the Canadian Association for Population Therapeutics (CAPT) co-hosted the IHE/CAPT Precision Health Workshop. Precision Health (PH) has potential to provide a wide range of solutions such as enhanced R&D efficiency, earlier diagnosis and time to treatment,…
PDF of a PowerPoint presentation by Jennifer Pillay, MSc Student, University of Alberta.
IHE/CAPT Precision Health (PH) Workshop – Integrating Precision Health into the Canadian Health System.
PDF of a PowerPoint presentation by Katherine Bonter, Director of Intellectual Property, Clementia Pharmaceuticals Inc.
IHE/CAPT Precision Health (PH) Workshop – Integrating Precision Health into the Canadian Health System.
PDF of a PowerPoint presentation by Kelly Robinson, Director, Health Products and Food Branch, Health Canada.
IHE/CAPT Precision Health (PH) Workshop – Integrating Precision Health into the Canadian Health System.
| Bing Guo, Paula Corabian, Charles Yan, Lisa Tjosvold
This evidence-based report examines expanding the role of paramedics in the community. It summarizes the various types of community paramedicine programs (characteristics, implementation, and funding sources in other jurisdictions) as well as the safety, effectiveness, and economic outcomes of these paramedic programs towards providing patients with alternate, non-emergency health…
PDF of a PowerPoint presentation by Dr. Des Gorman, Professor of Medicine and Associate Dean, Faculty of Medical and Health Sciences, University of Auckland; Executive Chairman of Health Workforce New Zealand.
Health Policy Dialogues
This lists all the documents/websites relevant to the guideline that are available on the IHE and TOP websites, both clinician and patient resources.
Link to Alberta Ambassador Guideline Adaptation Program
L’IHE dans votre poche 2017 – Guide de statistiques sur l’économie de la santé présente et divise les données les plus récentes en sections portant sur le fardeau économique de la maladie, les ressources en soins de santé, les comportements liés à la santé, l'état de santé, les…
This paper reviews implementation of enhanced recovery after surgery (ERAS) and its financial implications. Literature on clinical outcomes and financial implications were reviewed. Reports from many different surgery types shows that implementation of ERAS reduces complications and shortens hospital stay. These improvements have major impacts on reducing the cost of care even…
Alberta STE Report written under contract with the Alberta Health Technologies Decision Process (AHTDP). This STE report examines the social and system demographics, technological safety and therapeutic efficacy/effectiveness, cost-effectiveness, and budget impact of endovascular therapy for acute ischemic stroke, contextualized to the Alberta setting. Section Authors: Section…
This lists all the documents/websites relevant to the guideline that are available on the IHE and TOP websites, both clinician and patient resources.
Link to Alberta Ambassador Guideline Adaptation Program
This background document outlines the methods used to develop the Alberta Clinical Practice Guideline (CPG) for Management of Primary Headache in Adults, which was produced as part of the Alberta Ambassador Guideline Adaptation Program.
Link to Alberta Ambassador Guideline Adaptation Program
Ken Bond1, Alun Cameron2, Paula Corabian1, Bing Guo1*, Christa Harstall1, Iñaki Imaz Iglesia3, Carmen Moga1*, Maria Ospina1, Don Schopflocher4, and Ann Scott1 participated in the modified Delphi and or validation process; Patricia Chatterley1 and Liz Dennett1 searched the literature and provided information support; Wendy McIndoo1 provided assistance during the Delphi process.…
Roundtable Final Report
Real-world evidence: What role can it play in real-world decision making? Summary ReportDownload Summary Report
Roundtable Background Document
Real-world evidence: What role can it play in real-world decision making? BackgrounderDownload Backgrounder
This report provides a summary of the IHE Real-World Evidence Roundtable, which took place on December 12, 2016. The intent of the roundtable was to capture initial thinking regarding preferences and perceptions of the use of real-world evidence for pricing and reimbursement of new medicines in Canada and what more may be needed.
This report provides a summary of the IHE Biosimilars Forum engagement exercise that took place on April 23, 2017 in Ottawa, Ontario. The intent of the forum was to identify: options to categorize and consider biosimilars; a process to engage stakeholders to identify place in therapy and further evidence development that may be required; and an approach to knowledge exchange that…
IHE In Your Pocket 2017 – A Handbook of Health Economic Statistics includes the most currently available data, presented in separate sections on the economic burden of illness, health care resources, health behaviours, health status and demographics, and health system performance. IHE In Your Pocket was designed to provide a compact, comprehensive, and comparative overview…
| Thanh Nguyen, Ilke Akpinar, Jennifer Gratrix, Sabrina Plitt, Petra Smyczek, Ron Read, Philip Jacobs, Tom Wong, Ameeta E Singh
Adding universal rectal screening to urogenital screening should positively impact rectal Chlamydia trachomatis (CT) incidence in affected populations. A dynamic Markov model was used to evaluate costs and outcomes of three rectal CT screening strategies among women attending sexually transmitted infection clinics in Alberta, Canada: universal urogenital-only screening (UG-only),…
Speaker Biographies Keynote Speakers Mr. Nigel Edwards CEO, Nuffield Trust Nigel Edwards is Chief Executive at the Nuffield Trust. Prior to becoming Chief Executive in 2014, Nigel was an expert advisor with KPMG’s Global Centre of Excellence for Health and Life Sciences and a Senior Fellow at The King’s Fund. Nigel was Policy Director of the NHS Confederation for 11 years and has…
2 May 2017Edmonton, Alberta Building a Community-Based Health System: Lessons for a Path Forward is the 17th IHE Innovation Forum, a semi-annual event bringing together senior public- and private-sector experts and decision-makers to address health care policy issues. Our 17th IHE Innovation Forum Keynote Speakers are Nigel Edwards, CEO, Nuffield Trust, and Muhamad Elrashidi, Kern…
2 May 2017Edmonton, Alberta Welcome and Greetings GreetingsDr. Lorne TyrrellBoard Chair, IHEDr. Carl AmrheinDeputy Minister, Alberta Healthhttps://vimeo.com/album/4593585/video/216192193 Keynote Presentations Shifting the Balance of Care: Great ExpectationsMr. Nigel EdwardsCEO, Nuffield TrustDownload Presentationhttps://vimeo.com/album/4593585/video/216192696 Co-located, Integrated…
Building a Community-Based Health System: Lessons for a Path Forward is the 17th IHE Innovation Forum, a semi-annual event bringing together senior public- and private-sector experts and decision-makers to address health care policy issues.
PDF of a PowerPoint presentation by Dr. Muhamad Elrashidi, Kern Center Population Health Scholar, Mayo Clinic.
IHE Innovation Forum XVII – Building a Community-Based Health System: Lessons for a Path Forward
PDF of a PowerPoint presentation by Mr. Nigel Edwards, CEO, Nuffield Trust.
IHE Innovation Forum XVII – Building a Community-Based Health System: Lessons for a Path Forward
23 April 2017 Ottawa, Ontario On April 23rd, the IHE held an invitational forum on the topic of biosimilars in conjunction with the annual CADTH meeting. Download Summary ReportTowards a framework for biosimilar evidence and knowledge exchange – Summary report of the IHE Biosimilars Forum The meeting objectives were to: leverage a previous IHE Biosimilars Forum and share summary…
Summary Report
Towards a framework for biosimilar evidence and knowledge exchange – Summary report of the IHE Biosimilars Forum Download Summary Report
Program
IHE Biosimilars Invitational Forum: Towards a Framework for Biosimilar Evidence & Knowledge Exchange – Final ProgramDownload Final Program
Biographies Ms. Julia Brown Julia Brown has been with Janssen Inc. for 14 years and is currently the Vice President of Government Affairs and Market Access. Previous roles at Janssen include National Director of Government and Community Relations, Director of Health Economics and Reimbursement, and Director of Government Relations, Ontario/Atlantic. Julia also serves as the Past-President…
12:30 – 13:00 Opening RemarksDr. Chris Henshall, Professor, Health Economics Research Group, Brunel Universityhttps://vimeo.com/album/4584047/video/215117100 13:00 – 13:15 Setting the Stage: Enabling Elements to Achieve Biosimilar ObjectivesMr. Dan Palfrey, Senior Consultant, Institute of Health Economicshttps://vimeo.com/album/4584047/video/215117153 13:15 –…
This IHE Biosimilars Invitational Forum provided the perspective of international, national, and Alberta speakers and panellists who described the biosimilar reimbursement approach taken and outcomes achieved by other jurisdictions, guiding principles and policy options for Alberta, and key performance indicators and targets for reimbursement policy going forward. Towards a Framework…
Alberta Health Services (AHS) has established a number of Strategic Clinical Networks (SCNs) in the province around specific health care topics (e.g., Cardiovascular Health & Stroke) and within areas where care is delivered (e.g., Surgery). The SCNs are the engines of innovation in the health system and have a mandate to find new and innovative ways of delivering care to provide…
This background document outlines the methods used to update the Alberta Clinical Practice Guideline (CPG) for the Evidence-Informed Primary Care Management of Low Back Pain, which was produced as part of the second phase of the Alberta Health Technology Assessment (HTA) Ambassador Program.
Link to Alberta Ambassador Guideline Adaptation Program
Symposium Agenda
e-Health Policy Symposium – Towards “Person-Centred” Integrated Health in Alberta – Morning AgendaDownload Agenda
Discussion Paper
Information Exchange: Engaging Providers in Health Care InnovationDownload Discussion Paper
14 February 2017 Edmonton, Alberta The Institute of Health Economics and the O’Brien Institute for Public Health, in collaboration with Alberta Health, are pleased to have co-hosted a public policy symposium – Towards “Person-Centred” Integrated Health – focused on moving Alberta towards a person-centric health system, and the need to improve continuity…
Biographies Moderators Dr. William Ghali, MD, MPH, FRCPCScientific Director, O’Brien Institute for Public HealthProfessor, Departments of Medicine and Community Health Sciences, University of Calgary Dr. Ghali is a General Internist (MD, University of Calgary; FRCPC, Queen’s University) with methodological training in health services research and epidemiology (MPH) from the Boston…
Tuesday, 14 February 2017 Edmonton, Alberta 09:00 – 09:15 Greetings and Opening Remarks Dr. Carl Amrhein, Deputy Minister of HealthDr. William Ghali, Scientific Director, O'Brien Institute for Public Health, University of CalgaryMr. John Sproule, Senior Policy Director, Institute of Health Economicshttps://vimeo.com/album/4434657/video/205238362 09:15 – 09:30 A Citizen's…
This symposium addressed the importance of integrated health information as a necessary foundation for improved patient and system outcomes. The focus of the symposium was to discuss the benefits and challenges of shared health information and to better understand the role that health care providers play individually and collectively in achieving more person-centred and integrated…
PDF of a PowerPoint presentation by Ms. Annamarie Fuchs, IMAGINE Citizens, Collaborating for Health.
e-Health Policy Symposium – Towards “Person-Centred” Integrated Health in Alberta
PDF of a PowerPoint presentation by Dr. Jennifer Zelmer, President, Azimuth Health Group; Editor-in-Chief, Healthcare Policy, Toronto, Ontario.
e-Health Policy Symposium – Towards “Person-Centred” Integrated Health in Alberta
PDF of a PowerPoint presentation by Ms. Kim Wieringa, Assistant Deputy Minister, Health Information Systems, Alberta Health.
e-Health Policy Symposium – Towards “Person-Centred” Integrated Health in Alberta
PDF of a PowerPoint presentation by Dr. Doreen Rabi, Clinical Endocrinologist, Associate Professor, University of Calgary.
e-Health Policy Symposium – Towards “Person-Centred” Integrated Health in Alberta
PDF of a PowerPoint presentation by Ms. Kathleen Ness, Assistant Deputy Minister, Health Service Delivery Division, Alberta Health.
e-Health Policy Symposium – Towards “Person-Centred” Integrated Health in Alberta
PDF of a PowerPoint presentation by Dr. Robert Reid, Chief Scientist, Trillium Health Partners, Institute for Better Health, Mississauga, Ontario.
e-Health Policy Symposium – Towards “Person-Centred” Integrated Health in Alberta
The Institute of Health Economics (IHE) Life Sciences Open Innovation Platform™ is an online “ideasourcing” platform to encourage a broad pan-Canadian community to comment on key issues and topics related to life science policy. Preliminary campaigns will focus on biosimilars policy. Ideas with the most support will be used to inform policy discourse at an IHE…
This report provides a summary of recently published information (January 2015 to present) regarding the glucose monitoring technologies that are commercially available in North America, as well as those that are emerging within the next five years (up to 2021).
Speaker Biographies Ms. Anne BabineauDirector, Prairies, Innovative Medicines Canada Anne is the Director, Prairies with Innovative Medicines Canada and works with key partners and stakeholders to advocate for an improved environment for the research-based pharmaceutical industry so that research and development activities in Canada can continue to develop new medicines and vaccines…
24 January 2017 Edmonton, Alberta This event was a first meeting of the SCNs and the Canadian innovative pharmaceutical industry (Innovative Medicines Canada and members). The event was held in Edmonton on January 24, 2017 and was hosted by Alberta Innovates, in partnership with Alberta Health Services/SCNs, Innovative Medicines Canada, and the Institute of Health Economics. The…
Summary Report
Partnering for a Healthier Alberta – Summary Report from SCN/Innovative Medicines Canada Engagement Held January 24th, 2017Download Summary Report
Thursday, 19 January 2017 Edmonton, Alberta Please click the following link to watch the recorded webcast: Event Webcast 08:15 – 08:30 Opening Greetings and Remarks Dr. Carl Amrhein, Deputy Minister of Healthhttps://vimeo.com/album/4374633/video/201377972 08:30 – 10:30 Session 1 Opening Addresses: High Performing Health Systems: Measuring and Managing Dr. Reinhard…
Speaker Biographies Dr. Carl Amrhein Deputy Minister of Health Dr. Carl Amrhein was appointed Deputy Minister, Alberta Health on August 4, 2015. Prior to this, he was the Official Administrator for Alberta Health Services and served as Provost for the University of Alberta from 2003 to 2014 Dr. Francois Belanger Vice President, Quality and Chief Medical Officer for Alberta Health…
19 January 2017 Edmonton, Alberta The Value in Health Invitational Forum: Standards, Quality, and Economics was intended to provide an overview from provincial, national, and international leaders around key issues to consider and address from a system perspective when developing an approach to extract value from a complex health system. The concept of system organization for a)…
The Value in Health Invitational Forum provided an overview from provincial, national, and international leaders around key issues to consider and address from a system perspective when developing an approach to extract value from a complex health system. The concept of system organization for a) development of standards, b) accountability arrangements and roles, and c) approaches…
PDF of a PowerPoint presentation by Dr. Francois Belanger, Vice President, Quality and Chief Medical Officer for Alberta Health Services, and Dr. Blair O'Neill, Associate Chief Medical Officer, Strategic Clinical Networks, Alberta Health Services.
Value in Health Forum: Standards, Quality, and Economics
PDF of a PowerPoint presentation by Dr. Reinhard Busse, Department of Health Care Management, Berlin University of Technology; Co-founder, European Observatory on Health Systems.
Value in Health Forum: Standards, Quality, and Economics
PDF of a PowerPoint presentation by Dr. Murray Ross, Vice President and Lead, Kaiser Health Policy Institute, Kaiser Permanente.
Value in Health Forum: Standards, Quality, and Economics
PDF of a PowerPoint presentation by Dr. Robert Nesse, Senior Medical Advisor, Healthcare Policy and Payment Reform for Mayo Clinic.
Value in Health Forum: Standards, Quality, and Economics
PDF of a PowerPoint presentation by Dr. Meredith Rosenthal, Professor of Economics and Associate Dean, School of Public Health, Harvard University.
Value in Health Forum: Standards, Quality, and Economics
PDF of a PowerPoint presentation by Dr. Richard Glazier, Senior Core Scientest and Chair of the Primary Care and Population Health Program at ICES.
Value in Health Forum: Standards, Quality, and Economics
| Alain Lesage, Roger Bland, Ian Musgrave, Egon Jonsson, Mike Kirby, Helen-Maria Vasiliadis
The Liberal government committed to making mental health services more accessible. Housing funding was increased in the last budget, but now commitment to comprehensive home care for the severely mentally ill and access to primary care treatments for common mental disorders are needed.
| Maureen Yunkap Kwankam, David Hailey, Philip Jacobs
Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #13. This assessment has been prepared in view of the interest at the University of Alberta Hospital in developing a cord blood banking facility in the province and to provide information to decision makers on the current status of cord blood transplantation (CBT). The principal purpose of the assessment was to…
Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #12. This report has been prepared following a request from the provincial Clinical Practice Guidelines Program for information on the accuracy of diagnostic tests for the detection of bacterial vaginosis (BV), vulvovaginal candidiasis (VVC) and trichomoniasis in females of reproductive age. The intention of this…
Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #11. This report has been prepared in view of the increasing interest in ultrasound technology for diagnosis of osteoporosis. Until recently, quantitative ultrasound (QUS) was mainly being used in research settings. This procedure is still not covered by provincial fee schedules. The recent FDA pre-marketing approvals…
Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #10. This report has been prepared as part of a project to assess the role of high cost functional diagnostic imaging (FDI) and related methods in routine health care. In the present paper, the potential application of four FDI methods to the management of epilepsy is considered. The assessment considered the current…
Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #8. This report has been prepared to provide information to health authorities and others on the available evidence on effectiveness of HBOT and the possible economic impact on health care should a second HBO facility be established in the province. Issues addressed in the report include: Whether HBOT has been…
Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #9. The present report has been prepared following a request by Alberta Health in relation to referral of patients outside the province for treatment with stereotactic radiosurgery (SRS). There was interest by the department in the comparative effectiveness of the two main approaches to SRS (GK and LINAC) and in…
Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #7. This assessment was undertaken at the request of a Regional Health Authority to provide input into a funding decision on a computerized dynamic posturography (CDP) system for use by a rehabilitation department. The focus of this study was restricted to the clinical use of CDP by the rehabilitation community.…